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Pediatric oncology focuses on caring for pediatric patients, ages zero to eighteen, who are diagnosed with cancer. Research has shown certain interventions which benefit with treatment of these patients. Not only does the nurse working with pediatric patients care for the patient, they also care for the patient’s support system, including parents, siblings and other family members. A nurse working in a pediatric oncology unit should exhibit strong communication skills and a professional behavior and provide education to the patients and their family or support system manners. A pediatric oncology nurse must also work with members of the healthcare team, such as the oncologist, pediatrician, social worker and case managers. A nurse caring for a pediatric patient can provide care that has the potential to improve the quality of life, including preventing the spread of infection, supporting the family and siblings as well as the patient, and providing alternative therapies to help decrease feelings of anxiety and fear in pediatric patients and families, and promote a better environment during treatment.
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Preventing Infection in Pediatric Oncology
Healthcare providers follow a standard set of guidelines to prevent the spread of infection to patients. It is especially important for healthcare providers to follow these guidelines when working with patients who are immunocompromised, as in patients receiving cancer treatment. While there has been improvement in the rate of pediatric patients that survive cancer, there are still ways nurses can improve their care practices to help decrease the risk of infection.
A research study performed by Elizabeth A. Duffy and Margaret Rabatin in 2018 focused on prevention of central line associated bloodstream infections (CLABSI) in pediatric oncology patients. A Central Venous Catheter access site is the main treatment option for pediatric patients receiving chemotherapy. Central venous sites can become infected if not properly cared for and if the correct steps are not properly followed from the time of insertion until removal of the access site. Depending on how long chemotherapy treatment is, the central venous access could be used for months to years. (Duffy & Ravatin, 2018).
Pediatric patients are at risk for infection due to their immunosuppressed immune system, compromised mucous membranes and neutropenic periods. Duffy and Rabatin state that “nurses have a direct, ongoing goal in patient care and the interventions or procedures that put patients at risk for infection” (Duffy & Rabatin, 2018, 112). Due to this, nurses are a major component in preventing and finding evidence of infection. They can also help increase infection prevention by educating the families of the patients, so they are aware of the signs, symptoms and risks of a central line infection. The nurse’s role in teaching families and patients involves showing them proper care of the access site, demonstrating the proper handwashing technique, and explaining how to properly care for the site on a day to day basis.
Another study performed by Leslie S. Kersun, Anne F. Reilly, Susan E. Coffin, and Kathleen E. Sullivan in 2013 focused on how to protect pediatric oncology patients from the flu. “All patients with hematologic or solid cancers undergoing chemotherapy are considered to be at high risk of influenza related complications; children with malignancies are particularly vulnerable.” (Kersun, Reilly, Coffin & Sullivan, 2013, 204).
Visitors and healthcare workers who are infected with the flu and healthcare workers infected with the flu are the most common reasons a pediatric oncology patient would become infected with the flu. Due to this, nurses should encourage all visitors to wash their hands before visiting, and if they have flu like symptoms to abstain from visiting the patient until symptoms have resolved for a certain amount of time. Nurses must also be aware of their own health and should not come in to work when they have symptoms of the flu to protect the patient.
The research conductors also stated that
children with cancer are at risk of being hospitalized longer, more susceptible for becoming neutropenic and developing pneumonia, and that the flu can last up to twice as long in a pediatric cancer patient compared to a healthier pediatric patient; and if a pediatric patient is sick with an illness, they are not able to have chemotherapy treatment, which will delay their recovery process. (Kersun et al., 2013).
To prevent transmission of influenza, the nurse should implement and follow precautions based on the patient’s symptoms. (For example, a patient who is not showing any signs or symptoms of the flu would be on standard precautions, but a patient showing signs or symptoms of the flu would be on contact or droplet, depending on the specific symptoms). The nurse should also reiterate to visitors to avoid visiting if they have had a cough, fever or runny nose until symptoms subside.
Psychosocial Issues Patients and Families May Face
A study by Dr. Pat F. Bass in 2018 researched the psychosocial issues in pediatric oncology. Dr. Bass states that several factors must be looked at when handling a diagnosis of cancer. Cognitive, emotional, familial and physical factors must all be looked at prior to view their impact on the patient and cancer diagnosis. Dr. Bass also explains that different ages will react differently due to their developmental level. Dr. Bass states that
“in the emotional/ behavioral spectrum, the infant or toddler may experience dysfunction related to self- soothing while a preschool-aged child may experience significant aversion to medicine, diets or another domain compared with siblings as a result of unfairness or disruption of normalcy. Adolescents may display risk taking behaviors” (Bass, 2018, 12-13).
He also discusses the cognitive delays that may occur among the varying ages and states that adolescents can develop thoughts on death both abstractly and theoretically, while infants and toddlers’ cognitive thought may have delayed development due to illness. (Bass, 2018).
Psychosocial delays seen in the preschool child are focused on the loss of control they may feel and the fear that they won’t be able to do their own tasks independently, such as toileting and eating. These delays may cause the preschooler to act with anger, frustration or anxiety, while adolescents may feel frustration if they are not accepted by their friends and run the risk of becoming isolated and feeling lonely. (Bass, 2018).
Another aspect that should be addressed is the support system of the patient. Due to the stress of the situation, “married couples may begin to have some issues along with any anxiety or stress that they are feeling individually” (Bass, 2018, 14). Patients who have poor psychosocial support and those who also have a preexisting condition are also at risk for psychosocial dysfunction. Siblings of the patient are also at risk for psychosocial dysfunction because siblings can experience feelings such as being forgotten, becoming depressed, developing anxiety, and loss, fear, jealousy due to the diagnosis of the patient and the effect it takes on the support system. (Bass, 2018).
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Nurses can also have psychosocial barriers when caring for pediatric oncology patients and their families. Dr. Bass states that a couple of barriers for healthcare workers are time constraints or restrictions, difficulty in finding providers to work in the field, and difficulty keeping the providers in the field. A way to help these families and patients is to allow an environment that is supportive, but still allows them some time to live their daily lives. Dr. Bass states that “parents often rely upon food/parking vouchers, dependable childcare for healthy siblings, and flexible work arrangements in order to survive a lengthy hospitalization” (Bass, 2018, 15).
One of the first actions a nurse or healthcare worker should do when demonstrating patient- centered care for a pediatric patient is assessing the potential for psychosocial distress on the patient and the family. Dr. Bass states that “although potentially time consuming, screening is essential to identify potential issues” (Bass, 2018, 16). From there, the healthcare team can focus on what factors will help decrease distress on the patient and family and look for ways to provide help when needed.
Nurses can help with the environment by allowing access for parents to work from the inpatient setting if the parent can work from a computer. The nurse should also discuss with the parents or caregivers what caregiving or economic demands they feel they are going to face while the patient is in treatment. By the nurse talking to the parents and the patient about the demands they feel they are going to face, the nurse is facilitating open communication between the healthcare team and patient. Another solution would be to allow for siblings to visit and work on schoolwork or do activities together to try to keep a sense of connection while the patient is in the hospital. The nurse can also suggest other coping mechanisms for the family and patient, such as writing and coloring.
Animal Assisted Therapy and Pediatric Oncology Patients.
Complementary and alternative therapies can be used for patients to help them better cope with their diagnoses, illnesses and recovery as a different approach to therapy management in the healthcare setting. Complementary and alternative therapies can vary depending on the patient and patient preferences, past experiences and access to these other options. Studies have been done that focus on the effect of pet assisted therapy with pediatric oncology patients and the perceptions of family and nurses. Therapy dogs have been suggested for alternative therapy for their calming factor that they have on a patient. Specifically, dogs are believed to decrease anxiety.
A study done by Rebeca Lima Moreira and Fabiane do Amaral Gubert (2016) performed a study that looked at nurses’ perception of Animal Assisted Therapy (AAT). Animal assisted therapy has been thought to decrease pain and anxiety and increase quality of life in patients. This study focused on using dogs in the pediatric oncology setting. Using a dog with therapy in cancer patients has previously shown to promote self- care, improve socialization with the patient, and improve communication among the healthcare team and family.
Moreira and Gubert’s study results showed that using animal therapy had a direct effect on hospitalized patients, their relatives and the healthcare team. These results also showed that animal therapy decreased anxiety while the patient was hospitalized and showed that adaptation to the hospital was easier.
Moreira and Guebert (2016) pointed out that before starting animal assisted therapy, “the nurse must be aware of the risk factors around the child or the adolescent with cancer, since they are more susceptible to develop infection” (Moreira & Guebert, 2016, 1127). A nurse working in a pediatric oncology unit would be demonstrating quality improvement because they would be improving the overall care and safety of the patient’s health.
Another study performed by Nathiana B. Silva and Flavia L. Osorio (2018) looked at ways to find a safety protocol for animal assisted therapy and to evaluate the effect it had on children in outpatient pediatric oncology units. Their study found that there was an improvement in pain levels of the patients and a decrease in irritation, stress and depressive symptoms. Silva and Osorio (2018) also interviewed family members of the patients and they too reported decreased levels of stress and anxiety.
With these findings, animal assisted therapy could be an intervention used with pediatric oncology patients. By following safety procedures, a nurse could suggest to families and patients, or to unit managers, of the positive effects’ studies have shown about using animal assisted therapy. For a nurse to implement animal assisted therapy, she would use her evidence- based practice that she has learned about to safely promote therapy and could identify the positive outcomes of using animals to decrease symptoms of stress felt during a cancer treatment.
Pediatric oncology nurses can better help the environment, safety and infection prevention by performing tasks such as proper hand hygiene, following proper protocols when performing dressing changes and educating families and patients about the risks of infection and how to prevent infection. Pediatric oncology nurses help families by offering support and providing education on the diagnosis, treatment plans and offering complimentary or alternative strategies to help combat some side effects that occur during treatment. By the nurse performing these actions and combining the suggested interventions together, they can improve the quality of care for the patient by decreasing their anxiety, stress and pain and better helping them with the transition to inpatient care and decrease the risk of further infection in pediatric oncology patients. The nurse acts as an educator to the patient and family and has the potential to advocate for alternative therapy strategies that will promote positive effects on the patient and family.
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