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Patient care gets revamped
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Patient care gets revamped
Staff learns from studies on care practices and bedside reporting
Jonathan Bilyk
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Jonathan Bilyk is a freelance writer.
As a nurse manager at Cancer Treatment Centers of America Eastern Regional Medical Center in Philadelphia, Marie Decker sometimes feels the last thing her patients want to hear is “nursespeak.”
But based on surveys she’s seen, patients actually often times enjoy when nurses speak about their care, particularly when that discussion takes place at their bedside. In 2015, Decker, MSN, RN, AOCN, NE-BC, HN-BC, presented to the annual Oncology Nursing Society Congress the results of a recent pilot study she helped coordinate at CTCA. The study examined what might happen if nurses took the shift change reporting from the unit nurses’ station to the patients’ rooms. Decker’s pilot study bolstered new evidence-based literature about the potential benefits of bedside reporting. “We realized the noise level (at the nurse’s station) at change of shift was high,” Decker said. “There were 10 nurses giving reports at one time, so we asked our nurses the questions: ‘Did you have difficulty hearing?’ ‘Did you have difficulty completing your report?’ The answer was, ‘Yes, we need to change.’” From there, the pilot expanded and grew, “one nurse, one patient at a time,” Decker said.
Beginning first with practice rounds, Decker said the nurses eventually took the program into the rooms of consenting patients, introducing the oncoming nurses and discussing that particular patient’s status, care and condition, and the plan for the coming hours. “We try to avoid getting extremely clinical, and save any required technical ‘nursespeak’ for outside the room,” Decker said. “We don’t want to overwhelm the patients.”

The painstaking efforts bore positive results, she said, as surveys following the month-long pilot demonstrated strong patient support for the change. Decker said 99% of the patients surveyed said they liked the new bedside reporting method. “They said it was very comforting for them,” she said. Decker said most liked “being included in the conversation — unless they wanted to sleep. They enjoyed being able to say goodbye to the nurse whose shift was ending, and meeting the oncoming nurse before they begin actually providing care.” Nurses surveyed about the program also said they wished the program to continue, with 44% of them adding they believed the bedside reporting program increased the “professionalism of their practice.” A year later, the program was standard practice in one unit of the hospital and was expanding to other units. “The handoff has become pivotal to ensuring the continuity of care,” Decker said.
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We try to avoid getting extremely clinical, and save any required technical ‘nursespeak’ for outside the room. We don’t want to overwhelm the patients.”
— Marie Decker, RN
Survey care plans study
Mary Ellen Galiczynski, BSN, RN, OCN, transplant coordinator at CTCA Philadelphia, shared the promising results of her survey of primary care physicians continuing the care of stem cell transplant recipients who had been discharged following successful transplant at CTCA. Those physicians, she said, were enthusiastic about the “survivor care plans” sent home with transplant recipients. She said the care plans discuss possible long-term side effects from the transplant and intensive chemotherapy for oncology patients, including potential cardiac, pulmonary, dermatological and ophthalmological issues. The plan, she said, helps the patient’s hometown physician know what a newly developed odd rash may mean, or when and what dose of a vaccine to give to a transplant recipient whose immune system has been rebooted. “This way, they’re more apt to get the patient treated there than to send them back to us unnecessarily,” Galiczynski said. About 63% of the physicians surveyed said the care plans were “vital” elements of the transition, and all surveyed found the plans helpful, she said.
Patient empowered care study
In another study, nurse practitioner Deborah Selm-Orr, MSN, RN, CRNP, AOCN, examined the effects of the CTCA patient-empowered care model on symptoms of chemotherapy-induced nausea and vomiting, comparing that to the more standard chronic care model. “As an oncology nurse, I’m looking at ways to help patients deal with the nausea and vomiting,” Selm-Orr said. “That is one of the most feared side-effects of chemo.” While the CTCA model showed some promise for further study, she said the results were largely inconclusive, as both groups of patients — those who had experienced both care models — reported little difference in symptoms. Further, the comparison was complicated by differences in the strength of chemotherapy drugs used and differences in cancer types.