Critical thinking and continuity
As cancer care becomes increasingly complex, critical thinking — the ability to make careful evaluations based on evidence, education, and experience — has become a vital skill for oncology nurses. At the Genitourinary (GU) Program, which treats patients with prostate cancer, Brian Paul, R.N., M.S., demonstrates critical thinking every day. He organizes care for patients returning to the clinic, fields phone inquiries, helps educate patients about their treatment, and connects patients and family members with psychosocial services or social workers.
"Once a physician determines a course of treatment, it becomes the nursing staff 's responsibility to see that treatment is carried out in an organized way," says Paul. "I also work as a patient advocate to make sure care and services best meet their needs."
"The goal is to come up with a plan the patient is peaceful with. If not, we find a way to change it."
— Cinda Gaumer, R.N., URP
Nurse practitioners like Eileen O'Holleran, R.N., M.S.N., CPNP, have advanced training that allows them to evaluate patients independently and provide care in consultation with supervising physicians. O'Holleran works with pediatric stem-cell transplant patients, spending most of her time in the Jimmy Fund Clinic, DFCI's outpatient pediatric clinic.
O'Holleran may first meet patients and family members before admission to the stem-cell transplant unit at Children's Hospital Boston, Dana-Farber's partner in inpatient pediatric care. After transplant, she may then see them for weeks, months, or even years. "The continuity and long-term relationship are wonderful, not only for the patients and families, but also for me as their practitioner," reflects O'Holleran, who was a history major in college, but went on to earn a masters degree in nursing from Yale University.
"Once the patient goes home from the hospital, the focus usually shifts from the cancer itself to the potential side effects of treatment, such as graft-versus-host disease and increased susceptibility to infections," she adds. "It is a long road for many of these families, and I am able to get to know them as people and patients. Together we determine what is best for them based on that knowledge."
"Once the physicians determine a course of treatment, it becomes the nursing staff's responsibility to see that treatment is carried out in an organized way."
— Brian Paul, R.N., M.S., Genitourinary Program
Like other nurse practitioners, O'Holleran is the primary contact for her own group of patients — ordering medications, tests, and other services for them. When questions or significant changes in a patient's health arise, O'Holleran consults with senior physicians and collaborates with fellows — physicians completing advanced specialty training.
Patient-focused care planning
Critical thinking and good connections are key elements for Cinda Gaumer, R.N., URP. As a care coordination nurse, Gaumer is responsible for the "big picture" of a patient's experience with cancer, including almost daily exchanges with insurance companies about patients' progress, prognosis, and care needs. She also meets with patients, families, and health-care team members.
One of Gaumer's primary tasks is to assist in devising plans for patients as they leave inpatient care. Her strength is making a quick assessment and developing a plan that minimizes patients' concerns about the next step in their care. "The goal is to come up with a plan the patient is peaceful with," says Gaumer. "If not, we find a way to change it."
A current challenge for Gaumer and other oncology nurses is remaining centered on patients while striving to contain costs under managed care and other business pressures. "In some ways the focus on costeffectiveness is good because it has meant less waste," reflects Zano. "On the other hand, DFCI and the nurses have to work harder to remain patient-focused."
Libby Tracey, R.N., Ph.D., AOCN, director of Adult Ambulatory Clinics and Patient Services, agrees. "Nurses are healers. They want to stay close to the bedside to reassure and educate their patients, and determine if outcomes of care are satisfactory," says Tracey. "Some trends in health care today threaten to depersonalize the nurse-patient relationship. It's something we have to work around."
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