"How are you doing, Carrie?" I asked one of our new nursing graduates. Her reply was one I've often heard from nurses with limited experience in oncology.
"I love what I'm doing. I've always wanted to care for people with cancer, but there is so much to learn that I sometimes
feel overwhelmed by it all."
As Carrie is learning, cancer care is a challenging and rewarding area of nursing. It requires excellent critical thinking
skills, clinical expertise, compassion, and specialized knowledge. In our hospital, we've found a way to help nurses like
Carrie to better acclimate to our unit. We developed easy-to-use cue cards grounded in practical experience.
Identifying a need, gathering information
It all started at a staff meeting. We were talking about the "pearls of wisdom" each of us had accumulated over the years
and wondered if there were some way to distill that accumulated experience for nurses who were new to our specialty. Our director,
Rebecca Fellows, RN, suggested that we collect those "pearls," extract their essence, and create a set of cue cards for the
nursing staff. She asked me, a veteran with 30 years of nursing experience, to coordinate the project.
I began by making a colorful poster to let folks know what we planned. I also developed forms to collect the information we'd
need. A form for symptom management, for example, asked nurses to supply the basic considerations for a particular symptom,
such as nausea or constipation, including the etiology, the appropriate nursing assessment, and the medical and nursing management
involved. The form for postop care had spaces for information on a particular surgery—modified radical mastectomy or prostatectomy,
for instance—the reason for the surgery, the post-operative care required, and the complications to watch for.
Our experienced nurses responded with great enthusiasm. Completed forms came pouring in, and we soon had all the data we'd
need.
Organizing our notes into handy, at-a-glance cards
Designing the cue cards was the next step. We decided to color-code them according to topic:
Blue cards
would identify a type of cancer, with signs and symptoms, treatments, sites of metastases, common emergencies, nursing assessments,
and nursing interventions.
Red cards
would deal with oncological emergencies.
Yellow cards
would address symptom management.
Purple cards
would cover postop care of patients undergoing oncological surgeries.
Orange cards
would highlight miscellaneous topics such as central line care for the oncology patient.
The information on each card would be presented in bulleted form and be precise, easy to read, and understandable. (You'll
find samples, adapted for RN.) The templates are all similar, but each card has unique properties based on both the subject and the nurses who helped
develop it.
Cancer Care Cues Breast cancer
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For me, developing the cue cards became a family affair. My husband, Robert, had recently retired. He loves computer projects,
so I enlisted his help, both to fine-tune the templates and type in all the information. As the finished products emerged,
the nurses involved in their creation were so proud and excited that the project kept getting bigger and bigger.
Cancer Care Cues Constipation
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So far, we've completed 42 very useful cards. Among them are:
- descriptive cards highlighting particular types of cancer, such as breast, bladder, colon, and testicular cancer;
- tips on coping with cancer-related emergencies, including disseminated intravascular coagulation (DIC), cardiac tamponade,
malignant pleural effusion, and septic shock;
- information on managing symptoms common to cancer patients, like constipation, nausea and vomiting, dyspnea, malignant ascites,
and neutropenic fever;
- cards detailing postop care for such oncologic surgeries as modified mastectomy with axillary lymph node dissection, breast
reconstructive surgery, sentinel lymph node biopsy, and radical prostatectomy; and
- guidance for managing miscellaneous problems and procedures, such as extravasation and anaphylaxis, as well as how to access
implanted ports and care for a variety of central lines.
Stepping back to evaluate our work
Do the cards accomplish what we set out to do? Yes, indeed. Take the nursing student who couldn't understand why her breast
cancer patient needed an MRI of the brain—until she read the breast cancer card and learned that 30% of metastases go to the
brain, according to our sources.1,2
"Wow, this really helps," she said.
Or the seasoned nurse who'd recently begun working on our unit and wondered how best to care for a patient with stomatitis
and diarrhea. She consulted the cue cards for each symptom and found out which mouth rinses and analgesics would make her
patient more comfortable, then followed up by collecting a stool sample, as directed, and sending it to be tested for C. difficile toxin. When the test came back positive, the RN requested an order for the appropriate antibiotic and her patient benefited
from the early intervention.
Still another RN was confused about DIC. After reading the card, she knew how to interpret the lab values.
When ED nurses wanted to know how to care for neutropenic patients presenting with fever, we made a cue card for them, too.
Now they understand the importance of taking cultures and initiating antibiotic therapy quickly to avoid sepsis.
And the project keeps expanding. After reading some of our cards, the neurology clinical nurse specialist jumped on the bandwagon
and developed cards for the neurology/orthopedic unit. Our LPNs and patient care associates made cards for their own area
of practice, too, and one of our nurse educators recently used them in a teaching project.
Then, to the delight of our most experienced nurses, the National Oncology Nursing Society accepted the cards for a poster
presentation at its annual conference. Our presentation got accolades from attendees, some of whom thought the cue cards would
be just the thing to boost retention.
Our cancer care unit is blessed with caring, skillful nurses. With some of us nearing retirement, we've found a way to train
new nurses to fill our shoes—and to help them love what they do. We can't imagine a more fitting legacy.
REFERENCES
1. Otto, S. (2001). Oncology nursing (4th ed.). St. Louis: Mosby.
2. Yarbro, C., Frogge, M., et al. (Eds.). (2000). Cancer nursing: Principles and practice (5th ed.). Sudbury, MA: Jones & Bartlett Publishers.
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