DiversityNursing Blog

By JANE E. BRODY

The teenage years can be tough enough under the best of circumstances. But when cancer invades an adolescent’s life, the challenges grow exponentially.

When the prospects for treatment are uncertain, there’s the fear of dying at so young an age. Even with an excellent chance of being cured, teenagers with cancer face myriad emotional, educational and social concerns, especially missing out on activities and losing friends who can’t cope with cancer in a contemporary.

Added to that are the challenges of trying to keep up with schoolwork even as cancer treatment steals time and energy, and may cause long-lasting physical, cognitive or psychological side effects.

Sophie, who asked that her last name be withheld, was told at 15 that she had osteosarcoma, bone cancer. After a bout of how-can-this-be-happening-to-me, she forged ahead, determined to stay at her prestigious New York high school and graduate with her class.

Although most of her sophomore year was spent in the hospital having surgery and exhausting chemotherapy, she went to school on crutches whenever possible. She managed to stay on track, get good grades — and SAT scores high enough to get into Cornell University.

Now 20, Sophie is about to start her junior year and is majoring in biology and genetics with a minor in computer science. She plans to go to medical school, so this summer she has been studying for the MCATs and volunteering at a hospital.

Her main concern now is that people meet and get to know her as a whole, normal person, not someone who has had cancer, which is why she asked that I not identify her further.

“I’m pretty healthy, and I don’t want people to think I’m weak and need special care,” she said in an interview.

“Having cancer puts other issues into perspective,” she added. “I feel like I have to do as much as I can. I’ve gotten involved in so much. I try to enjoy myself more. And I don’t regret for a minute how I’ve been spending my time.”

Sophie’s determination to do the most she can and her desire for normalcy are hardly unusual, said Aura Kuperberg, who directs an extraordinary program for teenagers with cancer and their families at Children’s Hospital Los Angeles. Dr. Kuperberg, who has a doctorate in social work, started the program, called Teen Impact, in 1988. It operates with the support of donations and grants and deserves to be replicated at hospitals elsewhere.

“The greatest challenge teens with cancer face is social isolation,” she said in an interview. “Many of their peers are uncomfortable with illness, and many teens with cancer may withdraw from their friends because they feel they are so different and don’t fit in.”

In the popular young adult novel “The Fault in Our Stars,” a teenager with advanced cancer says, “That was the worst part of having cancer, sometimes: The physical evidence of disease separates you from other people.”

Within the family, too, teenagers can feel isolated, Dr. Kuperberg said. “Patients and parents want to protect one another. They keep up a facade that everything will be O.K., and feelings of depression and anxiety go unexpressed.”

Teen Impact holds group therapy sessions for young patients, parents and siblings so they “don’t feel alone and realize that their feelings are normal,” Dr. Kuperberg said. The goal of the program, which also sponsors social activities, is to help young cancer patients — some still in treatment, others finished — live as normally as possible.

“For many, cancer is a chronic illness, with echoes that last long after treatment ends,” Dr. Kuperberg said. “There are emotional side effects — a sense of vulnerability, a fear of relapse and death, and an uncertainty about the future that can get in the way of pursuing their hopes and dreams. And there can be physical and cognitive side effects when treatment leaves behind physical limitations and learning difficulties.”

But, she added, there is often “post-traumatic growth that motivates teens in a very positive way.”

“There’s a lot of altruism,” she said, “a desire to give back, and empathy, a sensitivity to what others are going through and a desire to help them.”

Sophie, for example, took notes for a classmate with hearing loss caused by chemotherapy. She recalled her gratitude for the friend “who was there for me the whole time I was in treatment, who would come over after school and sit on the couch and do puzzles while I slept.”

One frequent side effect of cancer treatment now receiving more attention is the threat to a young patient’s future reproductive potential.

In an opinion issued this month, The American College of Obstetricians and Gynecologists urged doctors to address the effects of cancer treatment on puberty, ovarian function, menstrual bleeding, sexuality, contraceptive choice, breast and cervical cancer screening, and fertility.

“With survival rates pretty high now for childhood cancers, we should do what we can to preserve future fertility,” said Dr. Julie Strickland, the chairwoman of the college’s committee on adolescent health care. “We’re seeing more and more cooperation between oncologists and gynecologists to preplan for fertility preservation before starting cancer treatment.”

The committee suggested that, when appropriate, young cancer patients be referred to a reproductive endocrinologist, who can explore the “full range of reproductive options,” including the freezing of eggs and embryos.

For boys who have been through puberty, it has long been possible to freeze sperm before cancer treatment.

Although some female patients may be unwilling to delay treatment, even for a month, to facilitate fertility preservation, at the very least they should be offered the option, Dr. Strickland said in an interview.

She described experimental but promising possibilities, like freezing part or all of an ovary and then implanting it after cancer treatment ends. It is already possible to move ovaries out of harm’s way for girls who need pelvic radiation.

Source: http://well.blogs.nytimes.com

By Sarah Cutrufello, RN, MSN, OCN

As an oncology nurse, I witness how ordinary people living with cancer cope with their extraordinary disease; how common people summon the uncommon strength to receive the toxic cocktail of chemicals that medical professionals call “treatment.” Each case is different, each patient unique.

About two years ago, I was fortunate to develop a relationship with a woman who had a special way — quiet, gentle, dignified — of handling her disease. At 66, she had been diagnosed with acute myelogenous leukemia. 

When we first met, she looked up at me from her hospital bed and solemnly said, “I should be in Switzerland today … .” Her husband finished the thought — they had booked a week-long trip to Germany and Switzerland. Recently retired, the couple had reserved a place in their minds for that special spot to drink tall glasses of wine in a cabin overlooking the Alps. 

Yet here they were, in a hospital room in Philadelphia. Their updated itinerary consisted of eating tasteless scrambled eggs and lying on an uncomfortable mattress overlooking the brick buildings of the hospital’s sprawling city complex. It was not fair. 

In that moment of our first meeting, I felt a profound sadness. This woman had an exciting life that she shared with her husband, who one could instantly tell was head over heels for his wife. Cancer was robbing her of this life.

She never said she was scared or upset or angry. She was appreciative of everything I did. When the physician’s team came in, she fooled them with her sweet smile and upbeat attitude. It almost was worthy of some kind of perverse Oscar award for “Best Performance in a Terminally Ill Role.” 

But I could see through the act to the deep pain and hurt of the “actress” lying in bed; someone who was struggling to come to terms with the fact that as recently as a month prior she was enjoying a vibrant life with her husband and friends back home.

A few weeks later, on St. Patrick’s Day, she could barely wait to tell me as I walked in, “I should be at a great party today.”

“A great party? Tell me about this party,” I said.

Her face lit up as she told me how her neighborhood opened its homes on St. Patrick’s Day to hold a sort of bar crawl. Again, though, there was the hint of disappointment. 

I listened with a smile on my face and said — as I always said when we talked about events she could no longer attend — “When you get out of here, you will do these things. I promise.” These words felt like equal parts truth, lies and hope mixed together in some kind of phrase that needs to be said on such occasions.

Later, as I was unhooking her blood transfusion, I noticed she had found a few moments to sleep. I stood there for a moment, silently, my eyes filling with tears. It occurred to me just how disappointed she must have been every time she woke up and was confronted with the reality that is cancer. 

She was not in Switzerland or Germany or enjoying a great St. Patrick’s Day party with friends. The life she had known before cancer stopped her in her tracks was happening someplace far removed from where she was. She would die about a year and a half after I met her. 

Above all else, this experience taught me the importance of approaching patients with open ears and an open heart. Dealing with anxiety, anticipation, fear, loneliness, uncertainty or any number of other emotions, our patients often need a kind of nursing care that goes beyond administering their prescribed treatment.

At the close of that day’s shift, I said to another clinician, “I feel her sadness. She breaks my heart.” To which the other person gave a quick chuckle and said, “She’s not sad.” 

I thought to myself: another Oscar-worthy performance. 

Source: Nurse.com

One of our fellow nurses needs some help dealing with racism in the workplace. Do you have any advice or experiences that will help her out?:

"How do you deal with racist comments directed toward yourself from patients? I've experienced racist attitudes before, but never verbalized comments in a derogatory manner from a patient until this week. Naturally I felt very down for a few hours afterward and I continue to think about it. It wasn't the negativity toward me per se, it was the thought that there could be more people out there thinking/feeling the same animosity toward me over something I cannot control, my phenotype. I take pride in my cultural heritage and wonder how anyone cannot see the beauty in diversity. I also thought that because they are sick they let their true thoughts out. Could any healthy person walking around be feeling the same thing but be inhibited from making it known? Then I thought of the people who could be dealing with this on a regular basis. How do you deal?"

By Alexandra Wilson Pecci

Source: Health Leaders Media 

For many nurses, leaving high school doesn't mean leaving the bullies behind. Bullying has been called nursing's "dirty little secret," but judging by the numbers, it's hard to believe it could be kept secret at all.

Most women can relate in some way to the 2004 Lindsay Lohan movie Mean Girls, in which her character encounters a group of bullying high school girls who say things like this: "Half the people in this room are mad at me, and the other half only like me because they think I pushed somebody in front a bus."

But while most women can leave memories like this behind when they graduate from high school, for those who enter nursing and become victims of nurse-on-nurse bullying, leaving high school hasn't made the mean girls disappear; they're just wearing scrubs now.

Bullying has been called nursing's "dirty little secret," but judging by the numbers, it's hard to believe it could be kept secret at all.

Twice as many nurses as other Americans have experienced bullying in the workplace. According to study of 612 staff nurses in theJournal of Nursing Management, 67.5% had experienced bullying from their supervisors, while 77.6% had been bullied by their co-workers. Compare that to the 35% of Americans outside healthcare who've reported workplace incivility, says the Workplace Bullying Institute.

Not only is bullying among nurses an issue, it's one that most nurse managers aren't equipped to handle properly, according to Cheryl Dellasega, PhD, RN, CRNP, co-author with Rebecca Volpe of the new book Toxic Nursing: Managing Bullying, Bad Attitudes, and Total Turmoil.

Bullying "is a huge problem now in the workplace," Dellasega tells me. "I think a lot of nurse managers don't get a lot of training in conflict resolution."That's especially true when they have little more management experience than any of their co-workers but were promoted to the role because they have a bachelor's degree and a few extra years of seniority, Dellasega says.

Dellasega's new book is a follow-up her to When Nurses Hurt Nurses: Recognizing and Overcoming the Cycle of Nurse Bullying, and aims to help managers and administrators understand and deal with bullying among their nurses.

In order to write the new book, the authors not only conducted a literature review, but also reviewed hundreds of blogs written by nurses about situations of conflict. By doing so, Dellasega and Volpe were able to identify key themes and scenarios that are common to bullying, as well as which groups of people were commonly involved in bullying.

Finally, the authors interviewed nurse management experts to give insight into dealing with such situations. "There were different pockets of nurses who seemed to be really engaged in the situation, as either a victim of the aggressor," Dellasega says. For example, new nurses are often victims.

"I think that brand new, young nurses [are] sort of the classic targets," Dellasega says. Often, these nurses are idealistic about their work and excited about how they're going to make a difference, but the older, established, more jaded nurses engage in bullying to knock them down a little. In fact, Dellasega says, sometimes the young nurses' preceptors are the ones who are doing the bullying because they feel like the role is a thankless one.

"I know that even…the literature…supports that preceptors often don't feel well prepared to do the job and often don't want to do the job," she says.

Another group of nurses who are often bullied are part-time, agency, or floater nurses who are picked on because they're not part of the regular nurses' clique.

Yes, clique. Dellasega says the regular nurses who are in the clique often make rude or sarcastic comments to or about the new person, or even go so far as not sharing supplies. Even nurses who come in from other floors can be left of out, even though they're just there to help.

Dellasega says that the cliques and bullying in a hospital comes with the same kind of baggage that most of us thought we left behind in high school. But for nurses, there's the added stake of patient safety. Although studies haven't explicitly linked increased bullying to decreased patient safety, research does say that happier nurses do their jobs more effectively. (Conversely, nurse burnout is linked to higher healthcare-associated infection rates).

"It's not a big leap to figure that when you go into work… if there's a toxic environment… you won't be able to give your full attention to patient care," Dellasega says.

Bullying also leads nurses to call in sick more often in order to take mental health days. Abusive behaviors can even cause nurses to develop post-traumatic stress disorder, anxiety, depression, or insomnia, a Joint Commission survey has found. Hospitals can also lose valuable employees to bullying and many nurses have left their jobs because of it.

"Things get to a point where they just can't take it," Dellasega says. Sometimes nurses feel like they're "going into the battle zone every day."

Nurse managers shouldn't let things get to that point. Managing relationships should be day-to-day work, not something that only happens during moments of high tension.

"Don't wait for it to get to the point that there's explosive conflict," Dellasega says.

Just as Dellasega discovered which nurses and situations tend to breed bullying, she and her co-author also discovered which environments are healthy. Bullying is rarer when there is a sense of teamwork, collaboration, and authentic communication with coworkers.

Dellasega says the ideal nurse manager is transparent, letting the staff ask questions and answering honestly, even if the answer is "I don't know, but I'll find out."

Feelings of empowerment are also important to reduce bullying and satisfaction. And upper hospital management should provide appropriate training for new nurse manager about how to effectively and positively deal with bullying.

Finally, Dellasega says nurses managers should monitor their own behavior to ensure that they're not engaged in bullying themselves, even if inadvertently. For example, sighing heavily after someone speaks could be interpreted as negative. Other behaviors to watch out for are favoritism, certain body language, gossiping, and speaking in a raised voice.

"I think nurse manager have to really monitor their own behavior and be cognizant of anything they might do," Dellasega says. "The nurse manager sort of sets the standards.