Nursing Role in Pediatric Cancer Care

1. Nursing Role in Pediatric Cancer Care Julia Challinor, RN, PhD University of California, San Francisco First International Symposium in Pediatric and Adolescent Cancer INCTR and Georgetown University in Addis Ababa January 18-21, 2011

2. Nursing Role • Patient Safety • Patient and Family Assessment • Physical • Emotional • Communication • Teaching • Assess and Manage Treatment Side-effects • Error Prevention • Team Work • Nursing Children

3. Nursing Role - Safety • Ensuring patient safety • Right medication at right time • Vigilance for patient’s physical and psychological status and changes • Communication of nursing assessment to appropriate multidisciplinary team members

4. Nursing Role - Assessment • Assessing patient’s and family’s concerns • May go beyond physical complaints • Nutrition, transportation, language, misunderstandings • Must be actively elicited • May require notifying appropriate multidisciplinary team members • Assessing patient’s physical and emotional well-being • Regular and complete physical assessment on all nursing shifts • Temperature, BP, pulse, pain, discomfort, skin, I/O, IV site • Alert, oriented, verbally responsive with age-appropriate language, depressed, sad, angry, non-verbal cues of emotional status

5. Nursing Role - Communication • Consistent and comprehensive communication about patient and family status • Within the nursing team • Among the multidisciplinary team members • Physicans • Residents • Medical students • Others as applicable

6. Nursing Role - Communication • Assure and explain to patient and family about nursing support during the treatment period • When speaking with the patient, use developmentally appropriate language • When speaking with a parent elicit their understanding of what will happen to their child • Address misconceptions and myths about childhood cancer

7. Nursing Role - Teaching • Disease and treatment • Solicit and address patient’s and family’s understanding of the child’s diagnosis and planned treatment • Clarify any misunderstandings • Parents and children in stress find it difficult to comprehend in one session what is happening to their child – repeat and repeat and repeat as necessary • Examples • Tell me what you believe is wrong with your child? • Tell me what you think is going to be your child’s treatment? • What worries you about your child being in the hospital? • Who can help you during the time your child is in the hospital?

8. Nursing Role - Teaching • Teaching and explaining to patients and families • Reinforcing information delivered by physicians and multidisciplinary team members • Diagnosis • Treatment • Expected side-effects of treatment • Family’s role in care giving and support • How to manage excretions, nourishment, nausea/vomiting, comforting, pain, fear, fever, and infection

9. Nursing Role – Side Effects • Pain • Cancer is painful • Procedures are painful • Nurses need to constantly assess and address children’s pain • Pharmacologically and non-pharmacologically • Observe and document non-verbal expressions of pain • Take action for pain even if child is not crying • Pain medication that is ordered should be given around the clock whether the child is complaining or not • Children play even in severe pain so behavior is not a reasonable sign of pain • Pain retards healing • Explain to family why you are administering pain medication

10. Nursing Role – Side Effects • Infection • Children on treatment for cancer are neutropenic and at high risk for infection • Infection can kill a child • Infection control starts with hygiene • Hygiene = hand washing • Personal – nurses and ALL staff touching patients • Setting – floor, bed, instruments, bathrooms, etc. • Family and visitors – feeding child, caring for child

11. Nursing Role – Error Prevention • Nursing practice is complex • Errors are made by all members of health care teams around the world, including physicians • Nurses are a vital component of the structure of checking and re-checking all medications and interventions planned for a child • It is this system that eliminates potentially harmful errors • Nursing guidelines and standards of care are essential to providing safe care • Written specific steps for nursing interventions prevent errors and ensure safety • chemotherapy preparation and administration, insertion of IVs, transfusion procedures, etc.

12. Nursing Role – Team Work • Nurses do not work in isolation • Nurses need to support other nurses • Help prevent burn-out • Acknowledge when you need help • Be aware of colleagues who may need help • Care for your own emotional needs • Nursing children with cancer is VERY difficult, demanding, and complex • Providing support to families is time-consuming but essential

13. Nursing Role - Children • Children are not just mini adults • their bodies (and minds) work in different ways • the onset of symptoms can be sudden and extreme • Because children are still growing, the impact of the illness or injury on their development has to be taken into account • because they are young, they may be more scared or confused by what is happening to them.

14. Developmental Stages • Infants, children, pre-adolescents, and adolescents do not react or manage illness in the same way. • Some children may show regressive behavior when under the stress of hospitalization • A teenager may behave like a young child • A young child may adopt infantile behavior

15. Families • Children have parents and brothers and sisters who are all involved in different ways. • Children's nurses work closely with patient's families as part of the caring process. • the child's parents or whoever would normally look after them at home. • Give the child's carers the confidence and ability to carry on with their caring role, knowing when to stand back and when to take-over if necessary. • It requires a special set of attitudes and open mindedness to people's different ways of relating to their children.

16. Distress • Paediatric nursing can sometimes involve managing distress • A rich mix of emotions often surrounds child illness such as panic, anxiety, anger, powerlessness, and guilt • You'll play a key part in helping families come through their crisis • http://www.medical-colleges.net/pediatric.htm

17. Children in Africa