Simple Intervention Decreases Oral Mucositis from Head and Neck Cancer Treatment

A painful effect of cancer treatment.

Nurse Cindy Dawson provides patient education on oral care kit used in a nurse-led intervention to reduce oral mucositis severity in adults treated for head and neck cancer. Photo courtesy of Kay Klein.

Years ago, when I worked with patients being treated for head and neck cancer who had been admitted for one reason or another, I felt helpless in the face of their extremely uncomfortable oral mucositis. None of our topical concoctions seemed to bring much relief to these patients, who had often endured disfiguring surgery as well.

While there is as yet no perfect solution to this uncomfortable side effect from the radiation or chemotherapy used to treat head and neck cancers, a group of oncology staff nurses and their colleagues have demonstrated that a consistent, standardized approach to oral care for these patients may significantly alleviate the pain of this almost universal treatment effect.

Consistent, standardized oral care.

After reviewing the literature on oral care, Cullen and colleagues enhanced their usual patient teaching with oncology radiation center outpatients, worked with staff in all disciplines to ensure that their oral care messages were consistent, and assembled a specific oral care kit (containing such items as non-irritating toothpaste, lip salve, […]

Comforting Our Patients: The Importance of Well-Chosen Words

‘What I Said,’ ink and crayon on paper, Julianna Paradisi 2018

Nurses and writers understand the importance of well-chosen words. Precision of language is important for both. But nurses learn the emotional impact of words, wisely or poorly chosen, on the job, directly from our patients. There’s seldom an opportunity to edit or revise on the floor of a nursing unit. Words cannot be unsaid.

As an oncology nurse navigator, my nursing practice is almost entirely based on words. My stethoscope, which rarely left my body when I was a PICU nurse, now rests coiled like a snake in a basket, nestled among the art supplies I used to illustrate this post.

Since patients rate my nursing skills by my words, the ability to pass the ‘bs test’ is more important than ever before in my career. As a navigator, I have impressed a patient or two (and helped them get proper care) by recognizing over the phone that the symptoms they described were cardiac related and not the side effects of cancer treatment. But for the most part, words are the tool I rely on to prove my value.

It’s the nature of nurses to want to comfort our patients. We understand their emotions run high when they are faced with a […]

A Closer Look at the Joint Commission’s New Guidelines for Pain Assessment and Management

Photo © Burger / Phanie / Science Photo Library.

Starting on January 1, 2018, the Joint Commission’s new and revised pain assessment and management standards for accredited hospitals will go into effect. Notably, the guidelines—as we report in a November news article—address safe opioid prescribing practices.

Among new requirements, the Joint Commission says hospitals should:

  • Designate a leader or team responsible for pain management and safe opioid prescribing.
  • Include patients in developing a pain management treatment plan—including realistic expectations and measurable goals—and educate them on discharge plans related to opioid adverse effects and safe use, storage, and disposal of opioids.
  • Use prescription drug monitoring program (PDMP) databases to identify patients at risk for opioid addiction.
  • Identify opioid addiction treatment programs for patient referrals.
  • Inform staff about consultation and referral services available for patients with complex pain management needs.
  • Collect and analyze data on pain assessment and management to identify areas in which safety and quality could be improved.

The full list of new and revised guidelines is available here. How might these changes affect life for nurses and patients? Comments are welcome below.

Are We Hearing the Questions that Patients and Their Families Don’t Ask?

“The spoken and unspoken messages we give patients and families are powerful.”

Viewpoint author Juanita Reigle

As a ‘frequent flyer’ of late, accompanying a family member on the long trek through cancer treatment, I’m acutely aware of the ways in which doctors and nurses communicate with us. Some have never mastered the art of interacting with people in stressful conditions. Others have remarkable radar and a special ability to “read between the lines,” identifying concerns that he and I haven’t yet voiced.

In ‘She’s Fine,’ the Viewpoint essay in AJN’s October issue, Juanita Reigle reflects upon how we respond to the questions patients and family members don’t raise. Some are left unasked because people are too overwhelmed to formulate a question. Some people aren’t ready to hear the answers. And sometimes, sadly, families sense that this doctor or nurse really doesn’t want to engage with them.

[…]

The Words We Use to Talk About the Act of Suicide

    marie + alistair knock/flickr creative commons

Suicide. A dear friend of mine died this way almost 40 years ago, leaving behind a beautiful six-month-old boy and a beloved and loving husband. I have never given any thought to the way we friends and family refer to her death. Then last week, I came across a 2015 blog post by the sister of a man who died in the same way.

In the post on a website that shares experiences of disability and mental illness, former hospice social worker Kyle Freeman argues that this term suggests criminality. She points to laws in the U.S. that, until a little more than 50 years ago, defined suicide as a criminal act. Kyle feels this history has perpetuated a sense of shame and embarrassment in survivors.

“…the residue of shame associated with the committal of a genuine crime remains attached to suicide. My brother did not commit a crime. He resorted to suicide, which he perceived, in his unwell mind, to be the only possible solution to his tremendous suffering.”

Kyle believes that the common use of the phrase “committed suicide” is not only inaccurate but can add to the suffering of those who have lost friends or family in this way. She prefers the term dying by suicide. […]