I love to read and am always reading something. As an oncology nurse for 30 years, more than half of which were spent as a clinical trials nurse, I needed to read to keep up with the fast-paced healthcare environment. However, sometime during those years, I rarely had a chance to appreciate everything that I was reading. Now, as a PhD student at Duquesne University School of Nursing, I am reading more than ever. My doctoral education has been a turning point that led me to start appreciating what I was reading instead of reading because I had to learn something new to keep pace. These readings led me to 

The Emperor of All Maladies: A Biography of Cancer

I would encourage anyone who works in the oncology world to read it. In my opinion, it is an amazing book and certainly worthy of the Pulitzer Prize that it won in 2011.

Mukherjee wrote the book during his medical oncology fellowship at Dana-Farber Cancer Institute in Boston. He takes you on a journey that consolidates piecemeal learning about cancer into a unified perspective about the disease. The book is written as a biography and replays the history of cancer from the first known sources of documentation of the disease. This history allows us to understand events in the context of our society and, more specifically, medical evolution.

As an oncology nurse, I had basic knowledge of cancer. I began working as a registered nurse in 1988, a time when most chemotherapy was administered on an in-patient basis. After completing a chemotherapy course, I understood what chemotherapy was and how it worked, as well as how the treatments affected my patients and how I could manage their adverse events. What I did not know was how oncology care evolved to the place where chemotherapy was no longer considered a one-size-fits-all therapy.

For example, Sidney Farber, MD, made significant advancements in the field. He knew it would take community involvement and advocacy to move the science forward. The Jimmy Fund, established in 1948 to raise money to help fund research, is an example of such advocacy. We raise money for all sorts of cancer projects in today’s environment, but have you ever stopped to appreciate who helped spur these early philanthropic efforts? Another early “influencer,” Mary Lasker, is also included in Mukherjee’s book. It is amazing to me that in the mid 20th century, when women were still primarily working in the home, she united those around her to help her advance medical research. She was instrumental in moving the research efforts of the American Cancer Society forward, as well as influencing Congress to fund research. Through their pioneering efforts, both Farber and Lasker laid a solid foundation upon which oncology care has continued to advance. It is difficult to appreciate the synergistic contributions of these 2 leaders without knowing their full history.

As a clinical trials nurse, I had the unique opportunity to be involved in groundbreaking trials, from the first tests with paclitaxel (Abraxane), cetuximab (Erbitux), and trastuzumab (Herceptin) to the cancer prevention trials whose results demonstrated the value of tamoxifen against breast cancer in certain high-risk populations. In hindsight, I understood the science behind why the trials were being conducted, but probably did not appreciate their history. Mukherjee takes you through the early studies that linked cancer with environmental exposures such as smoking. He also discusses the development of diagnostic tests, such as the Pap smear.

Pharmaceutical development is also addressed in this book. How scientists discovered linkages to genetic and genomic information and disease responses is unbelievable at times. Mukherjee describes how Genentech almost dropped development of trastuzumab. If it were not for the persistence of Dennis Slamon, MD, PhD, and his discovery linking HER2 activity in breast cancer, we might not have trastuzumab. Mukherjee describes how Slamon personally called a woman with highly amplified HER2 and asked her to participate in the early trials of the drug. She initially refused, but after a second phone call from Slamon, she agreed to participate. Although in 1993 the woman thought she had only months to live, she was alive and well as of the publication of the book.

For me, reading this book was an amazing journey that enabled me to link everything that I already knew into a clearer image of cancer. However, history is yet to be written, as the global community, advocacy groups, and the scientific world continue to battle this everchanging disease. The incredible part is that targeted cancer therapy is the last “type” of therapy described in the book. Just imagine the advances that are yet to be discovered.

 KELLY FILCHNER, MSN, RN, OCN, CCRC is a PHD STUDENT AT DUQUESNE UNIVERSITY SCHOOL OF NURSING

Articles

Partner Perspectives

“In hindsight, I understood the science behind why the trials were being conducted, but probably did not appreciate their history.”

Oncology Nurses: Have You Read a Good Book Lately?

Caring for a patient with advanced cancer can have a significant impact on the caregiver’s physical and mental health.

 We also know from previous research that patient and caregiver mood states are interdependent.

 Thus, it is impossible to address adverse psychological outcomes in patients without also examining the caregivers’ needs. The demographics of these caregivers are changing: Men now account for 40% of the caregiver population.

Even with the rise in male caregivers for patients with cancer, little research has been done to ensure there is effective support for both male and female caregivers. Several researchers have reported that men experience fewer negative aspects of caregiving (such as depression) compared with female caregivers.

 However, this does not hold up when researching other psychological domains. A study by Kim and colleagues

 found higher distress in male spousal caregivers compared with their female counterparts when patients had worse psychosocial functioning. Additionally, male caregivers of patients with breast and gynecologic cancers reported difficulty expressing emotions to others, particularly their male friends.

 The purpose of this study was to examine the gender differences in mood states in caregivers of patients with advanced cancer.

Data were collected from a sub-sample of an Institutional Review Board—approved, nonrandomized palliative care clinical trial. The parent study recruited patients with advanced lung, gastrointestinal, or gynecologic cancer and their caregivers. Caregivers were interviewed by a research assistant who administered the Profile of Mood States (POMS)-short form. The POMS, a psychological rating scale used to assess transient, distinct mood states,11 measures 6 dimensions of mood and uses a 5-point Likert scale.

Scores are summed for each subscale. Higher scores for these subscales are representative of greater mood disturbance.

Of the 222 caregivers enrolled in the study, 152 (68.5%) were female and 70 (31.5%) were male. The majority were Caucasian, with the most common relationship to the patient being spouse/partner. We found that the male caregivers were slightly older (mean age, 60 years), more likely to be a spouse of the patient (90%), and more likely to be employed than their female counterparts. Female caregivers had a mean age of 55 years, were a spouse of the patient in 58% of the cases, and were employed in 55% of the cases.

In addition to describing the demographic similarities and differences between male and female caregivers, we examined psychological outcomes of caregiving by gender. In previous similar studies, most of the male caregivers were spouses of female patients with breast or gynecologic cancer.10 In our sample, however, 42.9% of the male caregivers were caregivers of female patients with gynecologic cancer. Our sample of male caregivers comprised caregivers of patients with lung (21.4%) or gastrointestinal (35.7%) cancer.

We found that male caregivers of patients with cancer had lower tension/anxiety scores (P = .04), lower depression scores (P = .009), and less fatigue (P = .04) than female caregivers of patients with cancer (Figure).

Female caregivers reported higher levels of tension/anxiety, depression, and fatigue. The findings regarding depression differences are similar to those reported in the general caregiver population as well as the general population. However, few studies have looked at other psychological or physical outcomes such as tension, anxiety, and fatigue.

This information is essential for clinical nurses in the oncology setting. It is important to assess all caregivers for distress, anxiety, depression, and fatigue early in the cancer care process. Although male caregivers had lower scores on these dimensions compared with female caregivers, they still reported scores higher than the general population in these domains—particularly in the area of fatigue. Clinical nurses often have the best understanding of how caregivers are faring and are often the member of the healthcare team who spends the most time with both the patient and the caregiver. As cancer care continues to rely on the efforts of caregivers, it is important for oncology nurses to assess both patients and their caregivers for indicators of stress, anxiety, and fatigue.

Our data support the work of others in showing that female caregivers are more likely to be depressed and anxious; however, it is important to note that both genders experience these negative psychological outcomes. Oncology nurses are in the best position to assess, support, and refer caregivers of patients with cancer—both male and female&mdash;to sources of support. Whether caregivers receive informal support from family, friends, or support groups or receive more formal support from a primary care provider, oncology nurses are best equipped to see that these caregivers receive the support that they need.

1. Corà A, Partinico M, Munafò M, Palomba D, Health risk factors in caregivers of terminal cancer patients: a pilot study. 

. 2012;35(1):38-47. doi: 10.1097/NCC.0b013e31820d0c23.

2. Frambes D, Given B, Lehto R, Sikorskii A, Wyatt G. Informal Caregivers of cancer patients: review of interventions, care activities, and outcomes. 

. 2017;40(7):1069-1097. doi: 10.1177/0193945917699364.

3. Jacobs J, Shaffer K, Nipp R et al. Distress is Interdependent in Patients and Caregivers with Newly Diagnosed Incurable Cancers. 

. 2017;51(4):519-531. doi: 10.1007/s12160-017-9875-3.

4. Bambauer KZ, Zhang B, Maciejewski PK, et al. Mutuality and specificity of mental disorders in advanced cancer patients and caregivers. 

5. Sharma N, Chakrabarti S, Grover S. Gender differences in caregiving among family - caregivers of people with mental illnesses. 

. 2016;6(1):7-17. doi: 10.5498/wjp.v6.i1.7.

6. Nijboer C, Triemstra M, Tempelaar R, Mulder M, Sanderman R, van den Bos G. Patterns of Caregiver experiences among partners of cancer patients. 

7. 5. Li Q, Mak Y, Loke A. Spouses' experience of caregiving for cancer patients: a literature review

. 2012;60(2):178-187. doi: 10.1111/inr.12000.

8. Pinquart M, Sorensen S. Gender Differences in caregiver stressors, social resources, and health: an updated meta-analysis. 

. 2006;61(1):P33-P45. doi: 10.1093/geronb/61.1.P33.

9. 7. Kim Y, Loscalzo M, Wellisch D, Spillers R. Gender differences in caregiving stress among caregivers of cancer survivors. 

. 2006;15(12):1086-1092. doi: 10.1002/pon.1049.

10. Lopez V, Copp G, Molassiotis A. Male Caregivers of patients with breast and gynecologic cancer. 

. 2012;35(6):402-410. doi: 10.1097/ncc.0b013e318231daf0.

11. McNair D, Lorr M, Droppleman L. Profile of Mood States. 1971. 

Educational and Industrial Testing Service

Caregivers' Mental Health Varies by Gender

Each day, oncology nurses show up to care for patients facing some of their most difficult times. Compassion and empathy are required skills that allow nurses to connect with their patients. Over time, personal relationships develop that include sadness, fear, and celebration. The ability to connect and be present both professionally and emotionally requires skills built upon experience and deeply rooted personal values. Maintaining professional and emotional boundaries is not always easy, however, and all nurses are at risk for boundary crossing and violations.

A therapeutic relationship is the gold standard of all nurse—patient relationships. It is professional, patient centered, and built on trust. According to the National Council of State Boards of Nursing, there are no definite lines of separation between underinvolvement and overinvolvement.

 It is the nurse’s responsibility to understand an imbalance of power can lead to boundary violations. Nurses can protect themselves by doing the following steps:

• Ensuring the relationship is always therapeutic

• Setting up measures to safeguard against boundary crossing, especially if there is an isolated example

• Understanding that boundaries can be compromised by patient needs, the nature of therapy, influences from the community, and the care setting

However, as nurses often find, real life does not always fit neatly into a handbook for maintaining professional boundaries. There is an emotional cost that comes with caring for our patients. At times, it can be difficult to separate a patient’s suffering from our own vulnerability. Sometimes when our emotions cloud our better judgment, we find ourselves letting our guard down and inadvertently crossing a professional or emotional boundary.

One example may be providing your personal cell phone number to a patient, for after-hours support, even though hospital policies state this is not appropriate. During moments like these, nurses need to step back and spend time understanding what is driving them to cross a boundary that could affect their career. Offering your cell phone number might seem to be in the best interest of the patient at the time, but the consequences can reverberate. Among these is confusion for the patient and caregiver. Consider these questions:

• In the event of a medical emergency, who does the patient call?

• Does your liability insurance cover you for providing patient care after hours?

• How do you document after-hours conversations with patients?

• How do you respond to calls that you may not receive due to limited cell phone coverage?

There is also the risk of your patient developing an emotional dependence that will be difficult to manage as your relationship escalates to a level that far exceeds what is considered a normal and professional relationship.

Maintaining healthy boundaries help nurses guard their hearts from being consumed with pain and suffering. It also helps ensure you will have room for the next patient who will need your care. The following are healthy tips to help protect yourself from becoming consumed by those who are suffering.

• Protect your time away from work. Be careful about picking up overtime.

• Spend time with people who build you up and who you truly care about.

• Make your passion a priority. Spend time doing what makes you feel alive and connected outside of the work environment.

• Let go of things that you can’t control.

Most importantly, always take time to remember why you chose oncology nursing for your career. This is what will ground you during your most vulnerable and difficult days.

National Council of State Boards of Nursing. A Nurses Guide to Professional Boundaries. Chicago, IL: NCSBN; 2018.

Professionally Speaking

How to balance providing compassionate cancer care and maintaining professional boundaries.

Just a Call Away? The Dilemma of Providing Patients With Personal Contact Information

In the setting of cancer-related pain, opioids are a common treatment that can elicit nausea and vomiting that worsen quality of life and directly impact patient outcomes.

Pathophysiological effects of opioids, including increased vestibular sensitivity, decreased gut motility, and stimulation of the chemoreceptor trigger zone can predispose patients to nausea. Up to 40% of patients with cancer who receive opioids for pain may experience these adverse eventss.

 In turn, opioid-induced nausea and vomiting (OINV) may lead to fatigue, anxiety, and increased pain.

Determining whether the nausea or vomiting is related to the opioids, rather than the chemotherapy, may be challenging. Possible secondary effects of the patient’s disease process include obstruction, gastrointestinal stasis, increased intracranial pressure, or other cerebral secondary causes.

 These should not be overlooked. Therefore, clinicians should not only treat the symptoms of nausea and vomiting, but also investigate the root cause. Diagnostics to rule out tumor-related bowel obstruction or constipation should be considered. Likewise, other biochemical and pharmaceutical agents, such as chemotherapy or antibiotics, may be to blame. Testing should be performed as appropriate to the patient’s condition and disease trajectory rather than reaching a premature assumption that the opioid administration is the culprit.

Treatment of OINV lacks strong literature support for effective medication regimens. The strongest recommendations include changes to the opioid regimen, such as rotating the opioid of choice, adjusting the dosage parameters, and changing the route of administration, typically from oral to subcutaneous or intravenous (IV).

The addition of adjuvant agents to reduce opioid usage has not been shown to reduce nausea and vomiting symptoms.

 Of pharmacologic therapies, both prophylactic and symptomatic use of prokinetic agents, such as metoclopramide, are cited in some studies as demonstrating effectiveness by improving gut motility.

 But caution must be maintained in evaluating for potential obstruction prior to aggressive use of prokinetic anti-emetics. Prophylactic use of anticholinergics, such as scopolamine patches, may also be considered.

Ondansetron is commonly used and cited in some literature for breakthrough nausea and vomiting, although no sources cite strong support for any single agent.

In instances of bowel obstruction and neurological complications, management and treatment of nausea/vomiting may be different and prokinetic and anticholinergic therapies may not be first-line treatment under those circumstances. Also, current research on combined opioid/antiemetic agents in the prevention of OINV is showing promise.6 Additionally, cannabinoids are listed in some literature as having a positive effect on nausea and vomiting, although less so than metoclopramide.

Nonpharmacological interventions should also be considered for treatment. Much of the literature supporting their use has not specifically studied OINV, however, although they have demonstrated benefit in general nausea and vomiting and chemotherapy-induced nausea and vomiting. Included among these modalities:

• Aromatherapy, ginger and peppermint in particular

• Acupuncture and acupressure, when used in conjunction with pharmacological therapy

In the end-of-life (EOL) setting, agents that are not typically used in the management of nausea and vomiting may play a potential beneficial role. Benzodiazepines and antihistamines often have limited utility in routine care due to their sedative properties, yet in EOL care, they represent a potential source of relief from intractable nausea and vomiting.2,4 Diagnostic workup may be deprioritized in the EOL setting in favor of aggressive multimodal nausea regimens to reduce overall suffering.

Regardless of the cancer stage, nausea and vomiting are debilitating symptoms that greatly decrease a patient’s ability to tolerate diseasemodifying treatments. Therapies that help to control nausea and vomiting while still allowing management of symptoms, such as dyspnea and pain, with opioids can contribute greatly to an improved quality of life.

Giusti R, Mazzotta M, Filetti M, et al. Prophylactic use of antiemetics for prevention of opioid-induced nausea and vomiting: a survey about Italian physicians’ practice [published online January 26, 2019]. 

Corli O, Santucci C, Corsi N, Radrezza S, Galli F, Bosetti C. The Burden of Opioid adverse events and the influence on cancer patients’ symptomatology [published online February 16, 2019]. 

 4th ed. New York, NY: Oxford University Press; 2016:175-190.

Zuniga J, et al. Prevention of opioid-induced nausea and vomiting during treatment of moderate to severe acute pain: a randomized placebo-controlled trial comparing CL-108 (hydrocodone 7.5 mg/acetaminophen 325 mg/rapid-release, low-dose promethazine 12.5 mg) with conventional hydrocodone 7.5 mg/acetaminophen 325 mg [published online January 17, 2019]. 

Laugsand E, Kaasa S, Klepstad P. Management of opioid induced nausea and vomiting in cancer patients: systematic review and evidence-based recommendations. 

. 2011;25(5):442-453. doi: 10.1177/0269216311404273.

Walsh D, Davis M, Ripamonti C, Bruera E, Davies A, Molassiotis A. Updated MASCC/ESMO consensus recommendations: management of nausea and vomiting in advanced cancer. 

Fast Facts for the Frontline

Up to 40% of patients with cancer who take opioids experience nausea and vomiting.

Opioid-Induced Nausea and Vomiting: What the Oncology Nurse Should Know

From left to right: Michael J. Hennessy, Jr., James LaBelle, MD, PhD, David Cohen, Caitlin Cohen, MSN, RN, CPNP-AC, CPHON, Giuliana Rancic, and Kristie Kahl.

Generosity is the thread that tied together the 3 oncology nurses honored in 

®’s 2019 Extraordinary Healer® contest. Two finalists and a winner were recognized in April for giving more time and effort than their jobs demanded to support their patients, colleagues, and institutions.

In essays by patients, colleagues, and family members, these nurses and 51 others were cited for going above and beyond the call of duty by offering life-changing compassion, expertise, and helpfulness.

Caitlin Cohen, MSN, RN, CPNP-AC, CPHON, a nurse practitioner at the University of Chicago Medicine Comer Children’s Hospital, in Illinois, was declared the winner and received a trip and spa package to Miami Beach, Florida. The ceremony was held in conjunction with the Oncology Nursing Society’s 44th Annual Congress in Anaheim, California, and featured a keynote address by Giuliana Rancic, an entertainment journalist, author, entrepreneur, fashion designer, and beauty expert—and a survivor of breast cancer.

As a nurse practitioner for children facing bone marrow transplants, Cohen supports and advocates for patients and their families. At the Extraordinary Healer® event, her fellow oncology nurses were moved by stories of how she goes above and beyond for those patients. In one case, she provided high-calorie protein and vitamin drinks for a malnourished young man whose mother was having trouble affording food—all the while letting the family think the hospital was providing the supplements. In another example, Cohen spent a lot of extra time over 6 months lending a supportive ear to a patient whose depression and anxiety made it difficult for her to cope with a bone marrow transplant. Cohen also became an integral support for one family that suffered a lot of loss in a short period of time, taking time outside of her work hours to be there for them.

Barbara Bittner, RN, OCN, of AdventHealth in New Smyrna Beach, Florida, and Charlene’s Dream in Daytona Beach, Florida, a finalist, was recognized for her efforts as a volunteer while continuing to put her patients first in her job as a nurse navigator. Bittner cofounded Charlene’s Dream in 2015. The nonprofit organization, which provides education and support to local women with cancer, was founded in honor of fellow nurse navigator Charlene Brady, who died of cancer but had envisioned such a facility. Bittner was praised for running an arts therapy group there for a year and then a satellite support group. For a while, her nominator pointed out, she was regularly driving 25 miles out of her way to pick up a support group member who needed transportation to meetings.

Angela Hammack, BSN, RN, OCN, a charge nurse and clinical educator with Jackson Oncology Associates in Mississippi, was cited for turning her passion for running into a way to honor those she takes care of and for raising over $100,000 for cancer research and patient support. In one instance, in 2017, she trained for 5 months to run a 100-mile course, which she completed in 29 hours, 36 minutes, and 2 seconds. Hammack works to support Hope House of Hospitality, which provides a place for those who travel for treatment; the Cancer League of Jackson, which raises money for the American Cancer Society; Susan G. Komen; and the American Lung Association. She has worked on oncology legislation at the national and state levels, including helping with the passage of an oral parity law.

Michael J. Hennessy, Jr., president of CURE Media Group, said the event is one of his favorites because it recognizes “so many passionate people who truly care about what they do and the patients they affect daily.” Having accompanied his mother to chemotherapy treatments, he added, he’s witnessed the fact that oncology nurses listen, care, and are nurturing and patient.

Rancic, perhaps best known as a solo anchor and managing editor for TV’s E! News, discussed her cancer journey, which started as she faced infertility.

While embarking on a third round of in vitro fertilization in 2011, a nurse named Kelly told Rancic she needed to have a mammogram— even though she was 36, had no family history of breast cancer, and was healthy. The reason was that, in case she had estrogen-driven breast cancer, pregnancy could fuel the disease.

Soon thereafter, Rancic was shocked to learn she had exactly that disease. A lumpectomy failed to remove all the cancerous tissue, so she opted for a bilateral mastectomy—after which she and her husband had a son with the help of a surrogate. Without Kelly, Rancic said, she doesn’t know if she’d be alive today.

Rancic recalled another oncology nurse, Jessica, who caught her trying to flee the hospital as she waited to hear if she had cancer. Jessica calmed her down and stayed with her until she received the diagnosis. She also gave Rancic useful advice by encouraging her to think of questions she wanted to ask the oncologist and bring them in writing to her next appointment, so that fear and emotions wouldn’t cause her to forget them. Since then, Rancic has shared that same advice with thousands of women.

Rancic went public with her breast cancer journey on the reality show Giuliana and Bill “because you never know what sort of impact you can have; you could save or change a life,” she said. “The best I could do was to be honest and share and let others know that if it could happen to me, it could happen to anyone.”

She told the audience, “With what you do each and every day as oncology nurses, you have that exact same power, and so much more. The impact you have on the people you meet is lifechanging. We don’t ever forget you. You stay in our hearts forever, and I am proof of that.”

Rancic, who is now 7 years cancer free, created Fab-U-Wish in 2013. It’s a program to grant fashion, beauty, and celebrity-themed wishes to women battling breast cancer. Her other charitable initiatives include helping to support The Pink Agenda and the Breast Cancer Research Foundation.

Cohen and Bittner were nominated by colleagues, while Hammack was nominated by a caregiver— the daughter of one of her patients. The 3 have joined more than 1000 nurses nominated since the inception of the Extraordinary Healer® Award for Oncology Nursing in 2007. Finalists and their nominators have included men and women, adults and children, representing a variety of cancer centers and hospitals.

Each nominee took the stage with her nominator, who then read her essay aloud. Cohen was nominated by James LaBelle, MD, PhD, also from Comer Children’s Hospital. “Caitlin had been a floor nurse for another stem cell transplant program, so I knew that she had the skills to be a transplant nurse, taking care of some of the most ill patients with some of the most complex conditions in the hospital,” he wrote. “What I didn’t know about at the time was her exquisite talent in not only taking care of the medical needs of patients but also advocating for them and their families, as well as her ability to heal spiritually. She embodies the reason that every clinical provider goes into medicine in the first place.”

Bittner was nominated by Dianne Rohald, a colleague at both AdventHealth and Charlene’s Dream. “If you Google ‘team player,’ you will find descriptions such as the following: someone who adapts quickly to new situations, avoids office politics, focuses on team goals, appreciates others’ work styles, and celebrates peers’ successes,” Rohald wrote. “These all perfectly describe Barb.” Hammack was nominated by Cora Beth Hartfield. “Let me just speak freely from the heart about my friend, who has given more to me and my family than I could imagine,” Hartfield wrote. “She ultimately took the journey with us, as most oncology nurses do, sometimes without even knowing it. She stood by us during the 5½ years that Mother battled through 16 different chemotherapy regimens, and Angela was there toward the end of life when Mother was no longer able to continue fighting. She went the distance with Mother, like she has done with so many of her patients. Today, she, along with others at Jackson Oncology Associates, continue their brave and worthy nursing responsibilities, as they are caring for my mother’s brother, my uncle Robert K. Pierce, who is battling colon cancer.”

The event was sponsored by the pharmaceutical companies Bristol-Myers Squibb, Amgen, and Janssen. Part of the evening included a tribute to the late Kathryn West, MSN, RN, OCN, an oncology nurse who served as advocacy director at Amgen and died last year of colorectal cancer at age 55. She played a pivotal role in the launch and success of Amgen’s Breakaway from Cancer program, which shares resources with patients, from prevention through survivorship, and was instrumental in attracting actor Patrick Dempsey as one of its ambassadors.

The audience saw short tribute videos recorded by Dempsey, a former star of Grey’s Anatomy, and Joan Lunden, former host of ABC television’s Good Morning America.

The actor said that his Dempsey Center in Maine, which provides supplementary cancer services for free, would not have existed without West’s support.

Lunden recalled a twinkle in West’s eye, “which was her passion for the fight against cancer and to try to improve the lives of people with the disease.” She urged the audience, “Go out there, and carry on her legacy.”

Cover Story

In essays by patients, colleagues, and family members, three nurses were honored for their life-changing compassion.

Caitlin Cohen, MSN, RN, CPNP-AC, CPHON, Wins CURE's 2019 Extraordinary Healer Award

Resilience is a phenomenon we often think of relative to patients and families who persevere despite overwhelming odds. I remember such a family from decades ago whose memory remains with me to this day.

The patient was a high school senior hospitalized for treatment of acute leukemia that was diagnosed after successful treatment for pediatric osteosarcoma. Despite hope, prayers, and a fierce fighting spirit, this charismatic teenager died. Her mother, a breast cancer survivor at the time, soon developed a recurrence, ultimately succumbing to brain metastases. Within a year, the patient’s father was treated for lung cancer and died. The middle child, a daughter who was extremely impacted by her sister’s cancer experience, became an oncology nurse. She got married, worked for a year on an in-patient oncology unit, and then, we later learned, died of the same sarcoma that had been diagnosed in her sister. This family scenario sounds made up and impossible to be true. But it indeed happened. Left to integrate these horrendous losses into their young lives were the 2 youngest children, in elementary school at the time this spiral of loss and grief began. Now they are in their late 30s, and I continue to wonder, how were they able to persevere?

The ability to live beyond exposure to considerable emotional trauma and overwhelming sorrow is also germane to health professionals, particularly nurses. Yet research on resilience in this cohort is a contemporary focus, which currently lacks a universally accepted definition.

 Components of resilience include characteristics of persistence and survivorship, growing from adversity, and being dynamic in nature.

 What remains questionable is if resilience can be learned or if it is an innate coping construct.

Hart and colleagues reviewed the research on the phenomenon of resilience in nursing. Their findings outline contributing factors that negatively impact resilience in professional nursing practice. They include the concept of “psychological emptiness” emanating from workplace frustrations, such as not having their opinions valued or personal perspectives honored. “Diminished inner balance” was demonstrated when nurses struggled with navigating the competing demands of their work and personal lives. “Workplace dissonance” was especially prevalent in new graduates who experienced anxiety and ambiguity related to gaps evident between academic preparation and the real world of nursing practice. On the contrary, intrapersonal characteristics were delineated that enhance resilience in nursing. These include the nurses’ use of hope, self-efficacy, cognitive re-framing, toughening up, and making grounded connections.2 Research is still evolving regarding the corollaries of nurses’ resilience and interventions to enhance its effectiveness. However, early findings are instructive in considering future investigations.

A Chinese study of over 1000 nurses attempted to discern the relationship between burnout and resilience.

 There were 2 keys: the perception of work setting change and turmoil as a normal part of life versus a threat to life. Nurses who viewed adversity as a normal component of their profession appeared better able to cope with emotional strain when it appeared. This supports the positive nature of reframing as an intervention option, as well as the potential of teaching strategies that enhance resilience.

A program to build resilience in palliative care clinicians was also reported.

 In creating a paradigm, conceptual model, and curriculum to move clinicians toward resilience, the researchers posited that a multipronged intervention was required. This included teaching clinician resilience skills using cognitive behavioral therapy, positive psychology, and mindfulness and including the integration of workplace engagement strategies that paralleled clinician resilience skill building. These addressed enabling control, structuring rewards, building community, promoting fairness, recognizing values, and calibrating workload.

The benefits of fostering resilience in nurses are many. These include the retention of seasoned and highly credible nurses, enhancement of their professional career satisfaction, and ultimately, optimum care of patients and their families. Our work is highly complex and emotionally laden. Thus, it is inherent that we will be wounded by it. We must invest time and resources into the prevention of the negative emotional sequelae of nursing in order to maximize our science. Building resilience is key.

Aburn G, Gott M & Hoare K (2016). What is resilience? An integrative review of the empirical literature. 

Hart PL, Brannan JD, De Chesnay M (2014). Resilience in nurses: An integrative review

Guo Y, Luo Y, Lam L, Cross W, Plummer V, Zhang J (2018). Burnout and its association with resilience in nurses: A cross-sectional study. 

Back AL, Steinhauser KE, Kamal AH, Jackson VA (2016). Building resilience for palliative care clinicians: An approach to burnout prevention based on individual skills and workplace factors. 

May 2019

Oncology Nurses: Have You Read a Good Book Lately?

Caregivers' Mental Health Varies by Gender

Just a Call Away? The Dilemma of Providing Patients With Personal Contact Information

Opioid-Induced Nausea and Vomiting: What the Oncology Nurse Should Know

Caitlin Cohen, MSN, RN, CPNP-AC, CPHON, Wins CURE's 2019 Extraordinary Healer Award

Resilience Is the Antidote to Nursing Trauma