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Service Learning Project
Kristen Sismilich, B.A.University of South Florida
Clinical AgencyBaypines VA: Hematology/Oncology Clinic
Services provided: chemotherapy, transfusions, lab work, biotherapy, broad spectrum antibiotics
Partnerships: American Cancer Society, Oncology Nursing Society
Preceptor: Cindy Bowman, RN, MSN/Nursing Education, OCNnational oncology educator
Client PopulationVeterans with cancer receiving outpatient
chemotherapy
DemographicsWWII, Korean Conflict, Vietman Era, Gulf War Era,
Operation Enduring Freedom (Iraq, Afghanistan)Race: majority are white; 11% black, 6% hispanic,
4% other (American Indian/Alaska Native, Asian, Pacific Islander)
Gender: 10% female (Veteran Population Projections: FY2010 to FY2040)
Health Needs of Population
Major health problems: cancer, co-morbidities
Appropriate education tools regarding chemotherapy side effects and when to seek medical attention
Goal of SLP: Veterans undergoing chemotherapy will be aware of the signs and symptoms that require immediate medical attention
RationaleLife threatening side effects
New patientsReceive ample amounts of information all at one
timeOverwhelming
Create a tool that is easy to access, read, understand and rememberPictures, description of side effects, numbers to
call
Healthy People 2020 Objective: Improve the health literacy of the
population
Increase the proportion of persons who report their health care provider always gave them easy-to-understand instructions about what to do to take care of their illness or health condition (Healthy People 2020)
Relationship to SLP: development of tool
Description of SLPGoal: nurses to understand the rationale for tool
Objectives: By the end of the lesson chemo nurses will be able toDemonstrate patient teaching at the beginning of
chemotherapy (application)Classify signs and symptoms in order of their
severity (analysis) Justify the necessity of monitoring for specific
signs and symptoms during chemotherapy (evaluation)
Presentation Poster
Healthy People 2020 Objectives Chemotherapy related side effects
Damage to rapidly dividing stem cells Drug toxicity
Symptoms Fever (neutropenia) Nausea/Vomiting (dehydration, noncompliance) Dyspnea/SOB (anemia, cardiovascular, pulmonary toxicity) Burning (UTI, dehydration, cellulitis) Bleeding (thrombocytopenia) Pain (IV infiltration or infection) Oral mucositis (Gates & Fink, 2008, & Polovich, Whitford, & Olsen,
2009) Tool
When To Contact Your Doctor
Blood Mouth Sores
FEVER
Burning Pain
Shortness of Nausea and
Breath Vomiting
Call the Hematology/Oncology Clinic#727-398-6661 OR #888-820-0230 ext. 5125
Monday - Friday 7:30 to 4:30(if clinic is not open, go to the emergency room)
FEVER: If you have shaking, chills, or a fever greater than 100.4, go to the emergency room.
Vomiting: If you have you have vomiting for more than 24 hours or if you are unable to eat or drink.
Blood: If you have black stools, blood in the stools, or any other unusual bleeding or bruising.
Shortness of Breath: If you have an unusual cough, sore throat, lung congestion, or shortness of breath.
Pain: If you have intense pain in a new place, or pain that does not get better after taking pain medicine.
Burning: If you have burning when you urinate or blood in the urine, or if you have burning at your IV site.
Mouth Sores: If you cannot eat because of mouth sores or if you have white patches or red areas.
Any new or unusual symptom that lasts more than 1 day.
Modifications During Planning
Patient feedbackAre they aware of side effectsDo they know when to contact providersAre their caregivers awareMore beneficial for new patients vs “veteran”
patients
Added days and hours of clinic
Participant ResponseNurses
appreciated and valued development of tool
PatientsResponded positivelyThought tool would be useful and beneficial
To achieve goal in future: implementation of tool
ImplementationTool has to be submitted and approved by the
VA Include in welcome packet
EvaluateNumber of calls to chemo clinicNumber of patients reporting to emergency room
Impact of Health PolicyPatient Protection and Affordable Care Act
Health literacy: degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions
Research: health information is presented in ways that are not usable by most adults
CDC: every organization involved in health information and services needs its own health literacy plan to improve its organizational practices
Create health information and services that truly make a positive difference in people’s lives
Low Health Literacy and Health Outcomes: An Updated Systematic
Review 80 million Americans have limited health literacy
Greater risk for poorer access to care and poorer health outcomes
Update 2004 systematic review Determine if low health literacy related to poorer use of health
care, outcomes, costs, disparities in health outcomes
Low health literacy associated with poorer health outcomes and poorer use of health care services
Finding ways to reduce effects of low health literacy on health outcomes justifies the attention of policymakers, clinicians, and other stakeholders (Berkman, Sheridan, Donahue, Halpern, & Crotty, 2011)
ReferencesBerkman, N., Sheridan, S., Donahue, K., Halpern, D., & Crotty, K. (2011). Low Health Literacy and Health Outcomes: An Updated Systematic Review. Annals of Internal Medicine. Vol 155(2), 97-107.
Centers for Disease Control and Prevention. (2011). Health Literacy. Retrieved from http://www.cdc.gov/healthliteracy/learn/index.html
Gates, R. & Fink, R. (2008). Oncology Nursing Secrets. St. Louis, MI: Mosby Inc.
Healthy People 2020. (2013). Retrieved from www.healthypeople.gov/2020
Polovich, M., Whitford, J., & Olsen, M. (2009). Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Pittsburgh, PA: Oncology Nursing Society.
Veteran Population Projections: FY2010 to FY2040 (n.d). Retrieved from http://www.va.gov/vetdata/docs/QuickFacts/Population_quickfacts.pdf