Staff retention and development through education

Proceedings 172 of 18th Annual Conference Education Poster Abstract Session A SystematicApproachto the Assessmentand Treatmentof Oral Mucositis Joy Diamond, RN, MS, CPNP, Laura Kennedy, RN, MSN, CPNP, Pediatric Nurse Practitioner-Leukemia/Lymphoma Service, Texas Children’s Cancer Center, Texas Children’s Hospital, Houston, TX Oral mucositis is one of the most common side effects of cancer treatment. The oral mucosa is comprised of membranes of a high mitotic index with rapid epithelial turnover and maturation rate. This causes the oral mucosa to be susceptible to the adverse effects of chemotherapy as well as radiation therapy. Chemotherapy and radiation therapy alter the integrity of the mucosa, the microbial flora which normally inhabit the oral cavity, salivary quantity and composition, as well as the epithelial maturation. As a result, these treatments and altered physiologic states cause significant pain, dysphagia, alteration in nutritional status, and the propensity for localized infections which may disseminate systematically. A protocol was developed to provide pediatric oncology nurse practitioners with a framework for managing oral mucositis. This presentation detailed the strategies adopted for the assessment, clinical diagnosis and grading, and treatment and prevention of oral mucositis in the pediatric population. Assessment includes a history of current risk factors (chemotherapy, radiotherapy, neutropenia), a narrative description of the oral cavity and any associated problems such as pain or decreased oral intake. lndications for further laboratory tests or cultures are addressed. Symptomatic and therapeutic treatment recommendations are guided by the combination of a grading system which indicates severity and a clinical diagnosis of infection. Prophylactic regimens for the neutropenic and non-neutropenic patient are used to prevent or minimize complications. The importance of accurate assessment and appropriate treatment of oral mucositis cannot be underestimated. This protocol provides specific guidelines for the management of oral mucositis and may be used by all members of the health care team. Staff Retentionand Development ThroughEducation Sherri Belton, RN, BSN, Clinical Nurse Leader-PediatricOncology, British Columbia Children’s Hospital, Vancouver, BC, Canada; and Dori Van Stolk, RN, BSN Staff retention is a serious reality at many institutions throughout North America. There are many techniques to lure nurses to a hospital, but how do we make them stay? The purpose of staff development here at British Columbia Children’s Hospital (BCCH) has been to lengthen the stay of staff nurses as well as encourage personal development. Through a variety of educational opportunities in the Oncology/ Hematology/Bone Marrow Transplant (BMT) unit and hospital wide, nurses in our program are advancing to an expert level in oncology nursing. A new staff member to the Oncology/Hematology/BMT nursing program is enrolled in a 5-day orientation which covers such topics as basic cell kinetics, hematopoiesis, types of childhood cancer, combination therapy, peripheral blood stem cell collection, and oncological emergencies. After this program and a sevenshift preceptorship, the nurse embarks on her career as an oncology nurse. Soon after beginning employment, a nurse becomes certified in central line care. This 4-hour workshop involves learning skills such as drawing blood, heparin locking, dressing changes, vascular access device accessing, and emergency care of a central line. Four to 6 months after orientation, or when the nurse is feeling confident in this area of nursing, he/she then attends the Chemotherapy Level 1 workshop. This is a 2-day workshop in Proceedings of 18th Annual which the activities range from case studies, completing chemotherapy checklists and calendars, becoming familiar with the Children’s Cancer Group protocols to administering chemotherapeutic agents. Upon completing this workshop, each nurse becomes certified in giving chemotherapeutic agents through central and peripheral intravenous (N) lines. One year after employment, the nurse is ready to move to the next level: BMT. This orientation involves 4 days of classroom activity and a 1 -day practicum with a nurse working in BMT. The content includes: the types of BMT, preparative regime, graft-versus-host disease, ethical issues, psychosocial support and graft failure, and all aspects of caring for a BMT patient. Once a nurse has worked in our program for an extended period, opportunities are plentiful. A nurse may request to become IV certified and then completes a 6-month rotation through our outpatient clinic. Before starting in the clinic, the nurse completes a self-learning module on administering vesicant drugs through a peripheral N and managing extravasation. When the didactic portion is completed, the nurse is then observed giving 10 N push vesicants, and on completion of this task, becomes Chemotherapy Level I1 certified. Another milestone in moving closer to the expert level in oncology nursing. There are also many different educational sessions and opportunities to become involved in other developmental activities. Every month we have mini-inservices and careplanning sessions that deal with topics, current issues or problems. Examples of topics include seizures, chest tubes, new medications and a review of different diseases. There are also opportunities to participate in any one of the oncology committees: education, research, and management. Another level of expertise is achieved as staff nurses are encouraged to teach classes to new staff in orientation programs. This is a great learning opportunity for all parties involved. Evaluation of this comprehensive education program is achieved by several means: self report from each nurse after each program, performance appraisals based on competencybased education outlined by the Registered Nurses Association of British Columbia and particularized for pediatric oncology nursing, and continuous quality monitoring. Conference 173 Setting and achieving goals are vital in the success of any individual. Creating an environment that allows one to set and reach professional and personal goals is essential in keeping an individual interested and excited about the career they have chosen. In this time of shrinking resources, the benefits of long-term planning and development outweigh the cost of continually training new staff members. Here at BCCH, the Oncology/Hematology/BMT program is constantly evaluating, changing, and creating an environment in which individuals can learn and achieve any level to which they aspire. In the past 4 years staff turnover in our program has decreased substantially. With these kinds of opportunities, staff retention is just a natural progression. An Action Plan for Teaching Tammy Arnerson, RN, BSN, 6211 W. Northwest Highway, G210, Dallas, TX 75225; and Gretchen Hirschey, RN, BSN The child with chronic health problems has complex physical and psychosocial needs which require ongoing patient-family education. Throughout the teaching process, nurses should provide instruction, demonstration and reinforcement to increase families’ knowledge and ability to care for their child at home. Continuous patient education can help to decrease length of hospital stay and complications at home with a potential for decreasing or controlling health care costs. The purpose of this retrospective, descriptive study was to assess the level of patient education being provided, as evidenced by documentation, on a 30-bed inpatient hematology/ oncology unit. Members of the unit-based practice committee conducted 30 random medical record audits and concluded that less than 10% of the medical records had documentation of teaching. The practice committee developed an action plan based on the needs identified through the audits and through verbal communication with staff. Patient/family education materials, including medication cards, procedure cards, and home teaching packets were developed to ensure consistent teaching among staff nurses.