Association Of Pediatric Oncology Nurses Research Articles

PROVIDING PEDIATRIC PALLIATIVE CARE

High-quality pediatric palliative care should be an expected standard in the United States, especially since the publication of the numerous position statements such as "Precepts of Palliative Care for Children and Adolescents and Their Families," a joint statement created by the Association of Pediatric Oncology Nurses, the National Association of Neonatal Nurses, and the Society of Pediatric Nurses. Although many barriers still exist, dedicated individuals and teams strive to promote models of excellence and improve care for children with life-threatening conditions and their families. The Pediatric Advanced Care Team, a joint project of Dana-Farber Cancer Institute and Children's Hospital, Boston, is one such interdisciplinary pediatric palliative care consultation service. Founded in 1997, we have grown and learned from formal study and our extensive clinical work with families, children, and our colleagues. This article describes our journey as an interdisciplinary team forging a new service within two renowned medical institutions in which historically the primary emphasis of care has been on cure and innovation. Although these values remain, our work has resulted in an increased acceptance of balancing treatment of the underlying disease or condition along with treatment of the physical, psychosocial, and spiritual needs of the child and family through life or death. One of our goals is to help promote a balance of hope for cure with hope for comfort, dignity, and integrity for every child and family.

A Preview of the Association of Pediatric Oncology Nurses 28th Annual Conference

A Preview of the Association of Pediatric Oncology Nurses 28th Annual Conference

Pain Management for the Child with Cancer in End-of-Life Care: APON Position Paper

Although there have been major advances in the treatment of childhood cancer with an overall survival rate of more than 70%, cancer continues to be the leading cause of death in children resulting from disease. In 1998, 2,500 children in the United States died of cancer-related causes. Each year cancer kills more children than asthma, diabetes, cystic fibrosis, congenital anomalies, and acquired immunodeficiency syndrome combined. The Association of Pediatric Oncology Nurses (APON) is the leading professional organization for nurses caring for children and adolescents with cancer and their families. The highest standards of nursing practice are achieved through education, research, certification, advocacy, and affiliation. It is the position of APON that pain in the child dying of cancer can be effectively managed. This can be accomplished by making the prevention and alleviation of pain a primary goal, partnering with the patient and parents, and aggressively using appropriate pharmacologic and non-pharmacologic interventions. The pediatric oncology nurse has an essential role in the child's pain management at the end of life through nursing assessment, identifying expected outcomes, and performing and evaluating interventions.

The Practice Net: An Opportunity to Share Ideas and Compare Practice With the Association of Pediatric Oncology Nurses (APON

The Practice Net: An Opportunity to Share Ideas and Compare Practice With the Association of Pediatric Oncology Nurses (APON

Development of two instruments measuring social support for siblings of children with cancer.

The literature on childhood cancer provides a very limited understanding of healthy siblings' perceptions of supportive interventions during the childhood cancer experience. The purpose of this article is to discuss the development of the Nurse-Sibling Social Support Questionnaire (NSSSQ). Instrument methodology for the study involved item development, face and content validation, and internal consistency reliability as described by Hockenberry-Eaton, Manteuffel, and Bottomley (1997). Item development for the research instrument evolved from an extensive review of the literature and clinical experience of the principal investigator. Content validity of the instrument was accomplished by five experienced pediatric oncology nurses according to the methodology described by Lynn (1986). Using the content validity index, each nurse rated each item as either 4 or 5, indicating 100% agreement among experts that these items measured the concept of social support. Readability for the instrument was determined by using a computerized program. Results showed that readability was concordant with the grade school level for all items. Twenty-five school-age siblings of children with cancer and their mothers were asked to complete the questionnaire. Instrument completion was accomplished in less than 1 hour. The NSSSQ showed high internal consistencies (alpha coefficients >.90). Results indicated that siblings' perceptions of social support differed from those of their mothers. Siblings perceive emotional and instrumental support as greater in importance, whereas mothers perceive emotional and informational support as more beneficial to siblings. Support issues for siblings of children with cancer have been difficult to assess because of the lack of appropriate instruments. This study finding provides exploratory evidence to suggest that the new instrument can help measure siblings' perceptions of social support during the childhood cancer experience.

Crisis intervention strategies when caring for families of children with cancer.

A diagnosis of childhood cancer is an unexpected life event that often precipitates a situational crisis for all family members. Required cancer treatments and other ongoing stressors for both child and family will significantly disrupt the family's equilibrium and well-being. An increasingly important role of the pediatric oncology nurse is to facilitate crisis intervention strategies that help families adjust to the psychosocial stresses associated with childhood cancer, yet many nurses have little or no training in crisis theory and/or crisis intervention strategies. This article reviews family crisis theories and outlines crisis intervention strategies that are appropriate for the family of a child with cancer.

Association of Pediatric Oncology Nurses Publishes Core Curriculum

Association of Pediatric Oncology Nurses Publishes Core Curriculum

Social support for siblings of children with cancer.

This descriptive study investigated nursing interventions used by pediatric oncology nurses to provide social support to siblings of children with cancer. The study was guided by House's conceptualization of social support which includes components of emotional, instrumental, informational, and appraisal support. A sample of 250 randomly selected pediatric oncology nurses were mailed the Sibling Social Support Questionnaire (SSSQ), developed by the researcher, to determine what interventions they use in clinical practice to provide social support to siblings of children with cancer. With 134 nurse respondents, the SSSQ demonstrated high internal consistency (Cronbach's alpha of .95). Results indicated that the two most frequently used nursing interventions to provide social support to siblings are: (1) encouraging parents to spend time with their other children and (2) providing honest responses to questions asked by siblings.

The 1992 APON Delphi Study to Establish Research Priorities for Pediatric Oncology Nursing

The Association of Pediatric Oncology Nurses (APON) recently sponsored a two-wave Delphi study to identify the most important research priorities for pediatric oncology nursing. Seventy-five research priorities were rated for importance by 227 APON members. The majority of these members were inpatient or ambulatory care nurses who had been in pediatric oncology more than 25 months. The top 10 research priorities were primarily about nursing procedures and psychosocial care needs of patients and families. The top priority was to "measure the quality of life and late effects of treatment in long-term survivors of childhood cancer." Study findings will be used to encourage researchers to conduct research on these priorities and to encourage funding organizations to support research related to these priorities.

Issues affecting nursing's support for children with cancer.

During the past 17 years, pediatric oncology nursing has evolved from an unknown specialty into an organization exemplary of advanced nursing practice. Pediatric oncology nursing is now recognized as a distinct subspecialty within pediatric nursing. The Association of Pediatric Oncology Nurses (APON), organized in 1976, has grown from an initial 10 members to 1200 members in 1990. The growth of pediatric oncology nursing as a specialty is due largely to a group of nurses responsible for the organization of APON. These individual's vision in the early 1970s shaped the future of pediatric oncology nursing by promoting the development of nursing standards that increased nursing's accountability for the care of children with cancer. Today, nurses play a major role in the complex management of childhood cancer. Issues facing the nursing profession during the next decade will have a direct impact on the specialty of pediatric oncology nursing. The nursing shortage, nursing's changing image, and emerging nursing roles will influence pediatric oncology nursing's ability to care for children with cancer and their families in the future. As pediatric oncology continues to advance, innovative nursing roles must evolve to meet the health care needs of children with cancer.

Perceived sources of stress among pediatric oncology nurses.

This study examined the stressors most commonly experienced by pediatric oncology nurses. A descriptive, correlational design was used, and Selye's stress theory served as the theoretical framework. The final sample consisted of 155 members of the Association of Pediatric Oncology Nurses who completed and returned the Spielberger State-Trait Anxiety Inventory, and the Pediatric Oncology Nurse Stressor Questionnaire (PONSQ). The participants reported that relapse or sudden death of a favorite patient was their greatest source of stress. The second most common stressor was a workload perceived as too great to give quality patient care. The participants reported no more state or trait anxiety than the reference group. Statistics for white-collar working women were used as the reference group by Spielberger. The PONSQ shows that pediatric oncology nursing is a stressful profession. Additional research is needed to identify positive strategies for reducing this stress.

Using the Revised APON Standards of Practice

In 1988, the Association of Pediatric Oncology Nurses published its first Scope of Practice Statement. At that time the Standards of Practice were revised in the process outcome format. Six standards refer to direct care of the child and family and a final standard refers to the nurse's professional responsibility to maintain expertise as a specialist or competency as a generalist. The development of these two documents and how they are used by the practitioner and the educator is discussed.

The Role of the Nurse Practitioner in the Evaluation of Long Term Survivors of Childhood Cancer

More children survive cancer today than ever before. Accordingly, there is an ever growing need for nurse specialists to care for these long term sur vivors (LTS) of childhood cancer. In 1983, a Follow-up Clinic for LTS was estab lished at the Children's Hospital of Philadelphia Cancer Research Center. A nurse practitioner (NP) was hired to identify the eligible patients, inform them of the available service, and provide them with the specialized care that was necessary. Recently, the role of the NP has been greatly expanded and currently consists of three major components: clinician-caregiver, educator, and researcher. As the clinician-caregiver, the NP must be knowledgeable about late effects of therapy, demonstrate clinical expertise, and have a broad background in human growth and development. As an educator he or she must provide information to the public (teachers and the general community), to the medical community, to parents, and to patients. As a researcher, the NP must collect and analyze data, plan future studies, and write grant proposals. The multi-faceted role of the NP working with long term survivors of childhood cancer will continue to expand in the future. It is important that nurse practitioners be attuned to the importance of follow-up care and realize that they play a critical role as coordinators of care for these children and their families. The entire text of this presentation can be found in the article by Wendy L. Hobbie entitled "The Role of the Pediatric Oncology Nurse Specialist in a Follow-up Clinic for Long-Term Survivors of Childhood Cancer", Journal of the Association of Pediatric Oncology Nurses, Vol. 3, No. 4, 1986.

Work related stresses of pediatric bone marrow transplant nurses.

The annual conference of the Association of Pediatric Oncology Nurses, entitled Caring: The Foundation of Pediatric Oncology Nursing, was held October 12-14, 1988, in Denver, Colorado. Our thanks to Jory Goldmann, the National Program Chairperson, and Mary Jo Cleaveland, the Local Program Chairperson, and her committee for their hospitality and a very informative meeting. The following are abstracts of some of the clinical, education, and research presentations from this meeting.

Cancer chemotherapy in children: nursing issues and approaches.

Abstract Competent administration of chemotherapy to children demands mastery of a large and growing body of knowledge. Many institutions now require formal preparation with both didactic and clinical components. New technology for drug delivery, new drugs, new applications for older drugs, and new drug combinations are continually evolving. This is a particular challenge for the adult oncology nurse who works with a small pediatric population. Pediatric oncology nurse colleagues are invaluable resources and may be consulted through the Association of Pediatric Oncology Nurses, co-operative group study protocol committees, and pediatric cancer treatment centers.

1984 Proposed By-Laws Changes Association of Pediatric Oncology Nurses

1984 Proposed By-Laws Changes Association of Pediatric Oncology Nurses

Nursing Care of the Child with Cancer Association of Pediatric Oncology Nurses

Lecturer in the Department of Parent and Child Nursing and Transition Services University of Washington Graduate School of Nursing Seattle, Washington

BRAIN TUMOR

MARY JO CLEAVELAND, RN, BSN, is head nurse, oncology services, Denver Children's Hospital, Colo, Ms. Cleaveland is president of the Association of Pediatric Oncology Nurses.