Oncology nurses are special beings, for the job requires a heart of gold to care for patients with cancer. The field of cancer is tough: Nurses assist patients and their families through the stress of diagnosis and treatment, as well as the uncertainties of cancer, death, or survival.

Nurses are entrusted with the treatment and prevention of infections, too, since most oncologic treatments cause immunosuppression.

 However, coronavirus disease 2019 (COVID19) has brought new challenges to our care, because we must increase our vigilance to prevent infection. This increased surveillance occurs prior to and during patient treatment and again at follow-up visits, not only for patients, but also for family members and staff.

In addition to addressing their patients’ physical needs, oncology nurses often are also more emotionally vested in their patients than nurses in other fields, partly because treatment protocols are intensive and prolonged. They listen to patients’ concerns and, based on their specific needs, refer them to available resources in the community.

Oncology nurses are viewed as educators, counselors, and acquired friends. As teachers, they develop a special bond when caring for patients. Knowledge of the patients and their treatment regimens helps provide better individualized care.2 As acquired friends, they develop a loving bond with patients and their families, helping to celebrate joyous occasions and surmounted obstacles, as well as being there for demises. This special attachment sometimes extends beyond the walls of treatment facilities.

We interviewed 8 oncology nurses in the hematology oncology clinic and treatment unit to gauge their emotional responses to caring for this population during the pandemic. Their worries and perspectives include:

Nurses feel they are taking a risk, because asymptomatic people can carry COVID-19 without even knowing it. They dread the possibility of infecting themselves and their family members, which may include sick parents or asthmatic children.

 Nurses admit that the exhaustion often is more mental than physical, because they are more aware of their surroundings and precautions than ever. They ensure they are wearing the recommended personal protective equipment recommended by the Centers for Disease Control and Prevention. This can come at the price of physical ailments such as headache, shortness of breath, and skin allergies. Constant use of strong disinfectants can aggravate their ailments.

. As patients’ apprehension increases about their safety during treatments, nurses are subjected to questions regarding hand hygiene, glove wearing, and cleanliness of equipment. This has taken a toll on their psyche, and they may feel patients view them as a “Typhoid Mary.”

 The nurses empathize with patients overwhelmed with anxiety and fear of going to the hospital even if they become sick or develop neutropenic fever. Nurses may have to treat cases more aggressively when treatment is delayed, which, in turn, increases patients’ fear of disease progression. If patients’ support systems are fragmented because family or friends are not allowed to accompany them to visits, nurses step up to provide more emotional support.

A paradigm shift occurred from physical to telehealth visits. Although some patients embrace the technology, others feel a sense of disconnect and report being distracted by dog barking, a child’s scream, or a telephone ring. In addition, many yearn for the reassurance of a physical exam.

On a positive note, nurses report that, even during these troubled times, they’ve been able to discover new passions, such as reading, gardening, petting, baking, dancing, and sewing.

COVID-19 is unprecedented and defies the best scientists. It affects businesses, organizations, health care institutions, and individuals of all social status. In these unparalleled times, oncology nurses have a duty to provide the best quality and compassionate care to patients. As Brenda Nevidjon, MSN, RN, FAAN, said, “We can’t touch each other, but we can still touch lives.”

Cancer prevention: Oncology nurses save lives by raising awareness. ONS Voice

Accessed August 21, 2020. http://www.voice.ons.org/news-and-views/cancer-prevention-oncology-nurses-save-lives-by-raising-awareness

The 3 “other” roles of an oncology nurse. Catawba Valley Medical Center. April 2018. Accessed August 21, 2020. 

https://www.catawbavalleyhealth.org/Medical-Center/About-Us/News/2018/April/The-3-Other-Roles-of-an-Oncology-Nurse.aspx

Nevidjon, B. We can’t touch each other, but we can still touch lives. ONSVoice

August 3, 2020. Accessed August 21, 2020. https://voice.ons.org/news-and-views/we-cant-touch-each-other-but-we-can-still-touch-lives

Articles

Partner Perspectives

The pandemic may elicit fear, but nurses’ dedication to their patients remains steadfast.

Cancer Care During COVID-19:  Nurses Share Their Perspectives

Oncology nurses are a rare breed. They not only stay abreast of the constantly changing world of oncology to ensure the best treatment for their patients, but also provide another level of care, showing love and support to patients with cancer and their families. Nurses change people’s lives, but for them, it’s just another day’s work.

Every year, CURE Media Group, which is operated by MJH Life Sciences, the parent company of 

, honors these heroes through the Extraordinary Healer® Award for Oncology Nursing. And although this year’s event was not in a ballroom filled with nurses and live music, the passion of the winners shone through just the same during the virtual event. 

Christine Santure, BSN, RN, received the Extraordinary Healer Award

 for launching her Caring for the Caregiver program at University of Pittsburgh Medical Center Hillman Cancer Center in Pittsburgh, Pennsylvania.

Elizabeth Farrat, BSN, RN, CCRN-K, also was honored. She was the recipient of 

’s first Finest Hour Award, which recognized her dedication in the midst of the coronavirus disease 2019 pandemic.

Both women were nominated by their colleagues, who saw their commitment to patients. Also in this issue are highlights from the 

School of Nursing Oncology™ annual meeting. Read the 5 articles in this issue, and then head to gotoper.com for a continuing education quiz worth 1 credit hour.

Although the Extraordinary Healer® and Finest Hour awards are exciting accolades, oncology nurses should be honored every day. We at 

 thank you for all you do. As always, thanks for reading!

From the Chairman

We Honor Oncology Nurses for Their Dedication

Zoom and other videoconferencing methods have become the technological platform used by many organizations in health care to maintain clinical operations. Despite videoconferencing’s many benefits, users are complaining of headaches, ocular pain, fatigue, and more. Those in leadership positions struggle to find balance between connecting with others and transitioning meetings to Zoom in an effort to reduce the spread of coronavirus disease 2019. This phenomenon has become known as “Zoom fatigue” and has led to increasing amounts of stress during the pandemic.1

Practitioners also may feel increased stress because of the minimal time and training they had before making the switch to videoconferencing. Being on camera and maintaining “Zoom etiquette” can be challenging and impersonal, especially among people who have not previously communicated with each other. The fear of failing technology or operating the equipment incorrectly can produce anxiety, another aspect of Zoom fatigue that can be mentally exhausting. Steps to take to decrease fatigue from being on a computer all day include the following:

• Avoid multitasking and be fully present during meetings.

• Put a “Do not disturb” note on your door. This will prevent sensory overload and maximize your ability to focus.

• Make small adjustments to how you are seated or standing to keep your blood circulating. Sitting in the same location for extended periods may lead to increased fatigue.

• Schedule meetings at least 30 minutes apart. This small gesture can not only minimize headaches and ocular pain, but also will increase your attention span during each meeting.

Taking care of yourself is as important as your productivity during the pandemic. It is your responsibility to put you first and maximize your coping in order to endure this new normal.

1. Maheu, M. Zoom fatigue: What you can do about it. Telebehavioral Health Institute. August 29, 2020. Accessed September, 2020. 

https://telehealth.org/blog/zoom-fatigue-what-it-is-what-you-can-do/

Nurse's Notes

Whether staring at a screen for hours or worrying about learning technologies, nurses face new challenges with videoconferencing.

Handling "Zoom  Fatigue"  Amid Constant Videoconferencing

Christie Santure, BSN, RN, started her career as a candy striper — red-andwhite-striped jumper, white tights and all. “I have always known, from the beginning, that I wanted to be a nurse,” she says. “I started out in high school, volunteering at the local hospital. Since the age of 15, that’s all I have ever wanted to do.”

This year, Santure celebrates 40 years as a nurse. After earning her Bachelor of Science in nursing at Oakland University in Rochester, Michigan, she spent 5 years involved with medical and surgical nursing and then 25 years on the American Red Cross blood collection staff. It wasn’t until she had a personal brush with oncology that she decided to make the move to the University of Pittsburgh Medical Center Hillman Cancer Center, where she currently works.

“I had a family member get cancer,” she says. “At the time, not knowing much about oncology made me want to learn more to be able to support my family. Everyone appreciated so much what the oncology nurses did to help them through that difficult time, and I just wanted to be able to help families who were going through a similar situation, the way those nurses helped us.”

Santure was relocating to Pittsburgh because of her husband’s job, so she used the impending move to switch to oncology nursing and never looked back. Three years in, she became oncology certified; today, she spends her days administering chemotherapy. Although the position can be “emotionally and physically exhausting,” she says, it also gives her strength.

“I’ve become such a better person because I appreciate things so much more now than I did before I went into oncology,” she says. “I appreciate the preciousness of life and the importance of being there to support your family.” That includes all her patients, whom she says “become like family.”

Her goal is to walk in the shoes of the nurses who inspired her along the way. “Watching those nurses, I was so in awe of what they were doing, both the nursing practice and the clinical expertise, as well as the fact that they were just so compassionate,” she says.

Three years ago, Santure carried that compassion forward by launching a Caring for the Caregiver program at her institution, which previously did not offer a support group for that population.

“It all began with an interaction with a caregiver of a patient who said she needed support but didn’t want to burden her family, and she felt guilty telling her family she was feeling very stressed, anxious, and overwhelmed,” Santure recalls. “Caregiver research has shown they are ‘silent patients,’ as they many times forgo their own doctors’ appointments and health care because they are so consumed with caring for their loved one, and, in turn, their own health suffers. Being together in a group gives them a safe environment to talk about their feelings and not feel guilty for having those feelings.”

Outside of work, Santure has been involved in the Greater Pittsburgh Chapter of the Oncology Nursing Society for the past 10 years; this is her third year serving on its board and her second as treasurer. She takes the lead in planning the chapter’s annual nursing conference and other community service projects.

Although she is living her lifelong dream through nursing, Santure is quick to point out that her career isn’t her only wish come true: She has been married almost as long as she has been working. “I’m married to my college sweetheart,” she says, “married 38 years, and we have 3 wonderful children.”

Feature Story

Santure said working in oncology made her a better person. The nurse recently received CURE®’s 2020 Extraordinary Healer® Award.

Living Her Dream: An Interview With Christie M. Santure, BSN, RN

When considering the importance of medication adherence, former US Surgeon General C. Everett Koop said it best: “Drugs don’t work in patients who don’t take them.” That was 35 years ago, and the issue remains a major area of concern for clinicians today.

Many prescriptions are never filled—and even when filled, they often are not taken as prescribed. Stay-at-home orders from the coronavirus disease 2019 (COVID-19) pandemic may be making things worse.

As the pandemic continues to spread, medication adherence has never been more critical, especially for elderly patients and those with chronic conditions who are the most susceptible to complications, including death, from COVID-19, according to the Centers for Disease Control and Prevention. To protect the most vulnerable patients, physicians and pharmacists must work together to identify the reasons patients aren’t taking their medications as prescribed and provide solutions that improve adherence.

There are 3 primary reasons patients don’t fill prescriptions or take their medications as directed: high cost, lack of symptoms, and forgetfulness.

A major contributor to medication nonadherence is high out-of-pocket costs for prescription drugs. Results of a study published in Annals of Internal Medicine also found a direct correlation between the amount of a patient’s copay and the likelihood of prescription abandonment. Patients with $50 copays were nearly 4 times more likely to abandon a prescription at a pharmacy than patients paying $10.

Today, millions of Americans have lost their jobs, their health insurance, and the incomes they used to pay for out-of-pocket health care costs. One in 7 report they would avoid seeking care for potential COVID-19 symptoms because of cost concerns, according to a recent Gallup-West Health poll. Unless patients find some financial relief, medication nonadherence rates surely will rise.

Lack of symptoms and misunderstanding of disease

Patients often do not understand why they need certain medications. It’s not uncommon for a person to say they don’t feel their blood pressure is high or that they don’t have any symptoms from high cholesterol. If they don’t feel sick, people may stop taking their medications, which can have serious consequences over time. This situation often leads to unnecessary visits to the emergency department and, occasionally, hospital admissions that could have been avoided. During the current health crisis, we have all been encouraged to stay at home, limit trips to the grocery store and pharmacy, and postpone nonessential medical care. This means patients may have less interaction with physicians and pharmacists who can educate them about prescribed therapies. Now is the time for care team members to adopt proactive measures to make sure patients understand what their medications are for, how to take them, and why doing so as prescribed is important.

Delaying or forgetting to pick up prescriptions

Even in life before the pandemic, it was easy to put off a trip to the pharmacy for a prescription. Now, as many of us remain sheltered at home, it’s a challenge to recall what day it is, much less remember to pick up a prescription.

Using reminder tools that notify patients when medications are prescribed and when they are ready to be picked up, pharmacists and physicians can help reduce prescription abandonment. Many independent pharmacies and national chains are offering free delivery services for prescriptions, which is particularly beneficial for patients who feel leaving home could compromise their health. Additionally, health plans have eased restrictions on filling prescriptions in larger quantities, reducing trips to the pharmacy.

Improving medication adherence with technology

Care team members can improve medication adherence and health outcomes by leveraging technologies that provide price transparency, offer access to educational materials, and send reminders directly to patients’ mobile devices. Technology also can facilitate secure communication between prescribers and pharmacists.

For example, when prescribers see patient-specific drug pricing details at the point of encounter within prescribing workflows, it empowers them to discuss formulary options and out-of-pocket costs with patients and potentially review financial assistance options if cost is a barrier. Real-time price transparency tools let patients know exactly how much their medication will cost before going to the pharmacy. These tools eliminate the “sticker shock” experienced when the pharmacist accesses the patient’s health plan benefits to discover the medication is unaffordable for the patient.

Care providers also can reduce financial barriers with new technology that gives patients direct access to copay assistance options. Emerging solutions may link patients to educational content about prescribed medications, giving them a better understanding of the prescribed therapy.

Thomas E. Sullivan, MD, is chief strategy officer and chief privacy officer for DrFirst. He is a board-certified cardiologist and internal medicine specialist with more than 40 years of clinical practice, and he is a past president of the Massachusetts Medical Society.

Web Exclusive

Improve Medication Adherence With Technology

As frontline providers of cancer care, oncology nurses often have to have important, though difficult, conversations with patients and their families—including end-of-life (EOL) discussions. It is crucial that nurses go into the situation prepared, while not assuming that they know how the patient feels or how they will react, explained Brianna Kirkland, RN, CHPN, of Sangre de Cristo Hospice and Palliative Care in Pueblo, Colorado.

“Never assume that you know, or you understand, the same thing as the person in front of you. Never assume that you’re smarter, and never assume that you are in a situation where you know exactly what they’re feeling, what they’re thinking,” Kirkland says.

 recently polled our audience about EOL conversations.

 What questions or suggestions do you have regarding EOL discussions?

“How do you judge a patient’s readiness, and how do you, as a nurse, feel ready and prepared?”

“Is the patient ready to hear what you have to say? [Don’t forget] spiritual concerns, pain control, and family needs.”

“Is the doctor on board? Have the doctors talked about stopping treatment, and am I overstepping my boundaries?”

What advice do you have for other nurses regarding EOL discussions?

“Focus on palliation, not ‘giving up.’”

"Talking about end of life doesn’t make it come any sooner. It is rarely a ‘one-and-done’ conversation."

The Social Nurse

We polled our audience about their comfort levels   with end-of-life conversations.

October

Cancer Care During COVID-19: Nurses Share Their Perspectives

We Honor Oncology Nurses for Their Dedication

Handling "Zoom Fatigue" Amid Constant Videoconferencing

Living Her Dream: An Interview With Christie M. Santure, BSN, RN

Improve Medication Adherence With Technology

End-of-Life Conversations: What Nurses Are Saying