Katrina Fetter, BSN, RN, OCN
Attendees at the 2014 ONS Annual Congress were encouraged to “Get Up, Get Moving” by recommending physical activity to improve patient outcomes, and if the standing-room-only crowd which gathered to hear more about the campaign is any indication, it’s a goal nurses are more than ready to run with.
Starting with a preview of the initiative in Anaheim, ONS hopes to build awareness of the program among oncology nurses before it is rolled out with educational materials and other resources later this year, explained Katrina Fetter, RN, BSN, OCN, nurse manager at Lancaster General Hospital in Pennsylvania, during a clinical chat on the topic.
The goal of the campaign, she explained, is to increase the number of patients who receive safe and effective recommendations from their nurses to participate in physical activity.
“Part of the reason that we chose physical activity for this initiative,” said Fetter, is that it “provides a big bang for your buck. It is a single intervention that reaps a lot of benefits.”
The thinking on physical activity has changed significantly since the time when nurses were likely taught to encourage their cancer patients to rest, Fetter noted.
“Many of our patients and many of our nurse colleagues still believe that.”
Yet the evidence shows that exercise is beneficial in alleviating many side effects of cancer treatment, including fatigue, anxiety, depression, and lymphedema.
ONS has included physical activity in its recommendations for practice in these four areas as part of its Putting Evidence into Practice (PEP) series, explained Fetter. “There is also emerging evidence in the literature that physical activity can be beneficial for patients experiencing sleep–wake disturbances, cognitive impairment, and maybe chronic pain as well."
“We’re not trying to turn our cancer patients into marathon runners or into hardcore exercise folks,” Fetter stressed. “It’s about what they can do and increasing the level of what they are currently doing.”
Fetter added that the benefits of physical activity far outweigh any risks or adverse outcomes patients might experience.
The US Department of Health and Human Services recommends 2.5 hours of physical activity per week, employing both aerobic and strength-building components, and the American College of Sports Medicine (ACSM) have adapted these guidelines for patients with cancer. This information will be part of the educational materials ONS will make available for oncology nurses when the “Get Up, Get Moving” campaign is launched later this year.
Fetter said that an important aspect of the ACSM guidelines is that “patients don’t really need a lot of testing or referrals prior to recommending exercise to them.” For example, activities such as walking and flexibility and resistance training are very simple for patients to do without prior testing.
“Obviously, some of our patients have special considerations,” Fetter stressed. “You want to think about your patients who might have neuropathy, and what’s going to be safe for them. Also, anyone with bone metastases or bone mineral density issues which increase fracture risk, as well as any range-of-motion concerns. They may also have an ostomy or lymphedema we must consider.” These patients aren’t exempt from physical activity, said Fetter. “It’s about working physical activity into what works for them.”
Nevertheless, few clinicians actually recommend physical activity for patients with cancer. “When I was learning the ropes of oncology nursing, I don’t think that I was really taught to sit down with my patient and recommend physical activity,” Fetter acknowledged.
What are the barriers to recommending physical activity? First, clinicians need to overcome earlier advice to promote rest, said Fetter. “We’re all about caring, and when a patient says, ‘No, I’m tired; I don’t want to do that,’ it can be hard for us to push through and say here’s why you should do it.” One way to begin this conversation is to explain to patients that research and clinical practice experience have demonstrated that if they exercise, they will feel better.
Another barrier is that many nurses feel that it is up to the physician to make those recommendations, but it’s in the nurses’ scope of practice to make them, reminded Fetter.
“Every patient can move a little bit more,” Fetter concluded, and “all of us are able to talk to our patients about that.”
“This is a very powerful project that we’re all very excited about—the positive impact that a group of oncology nurses our size can make.”
<<< View more from the 2014 ONS Annual Congress