Constituent member of ANA The mission of the Delaware Nurses Association is to advocate for the interest of professional nurses in the state of Delaware. The Delaware Nurses

Association is dedicated to serving its membership by defining, developing, promoting and advancing the profession of nursing as an art and science.Quarterly circulation approximately 12,000 to all RNs, LPNs, and Student Nurses in Delaware.

Volume 39 • Issue 3 August, September, October 2014

Inside DNA REPORTER

Reporter The Official Publication of the Delaware Nurses Association

Childhood Cancer: Caring, Coping and Clinical Trials are Key to Success

Page 5

After Ringing the Bell: A Wellcoaching Survivorship Program

Page 8Clare Wilson, RN, MS,

LMHC, NBCCBarbara Plummer BSN, RN, MBA/HCA, CPON

current resident or

Presort StandardUS Postage

PAIDPermit #14

Princeton, MN55371

Executive Director’s Column. . . . . . . . . . . . 1

Wilmington Blue Rocks Game . . . . . . . . . . 3

President’s Message . . . . . . . . . . . . . . . . . . 3

Childhood Cancer Survivorship . . . . . . . . . 4

Childhood Cancer: Caring, Coping, and

Clinical Trials are Key to Success . . . . . . 5

Oncology Clinical Trials Nursing . . . . . . . . 6

Nurse Navigator Impact on Cancer

Screening Compliance . . . . . . . . . . . . . . . 7

After Ringing the Bell: A Wellcoaching

Survivorship Program . . . . . . . . . . . . . . . 8

Medical Support: A Novel Multidisciplinary

Approach in Oncology . . . . . . . . . . . . . . . 9

Delaware Today Magazine Top Nurses Gala . . 11

Guest Editor Executive Director’s Column

Darcy Burbage, RN, MSN, AOCN®, CBCN®

Darcy began her nursing career as an LPN and went on to receive her BSN from Wilmington University and her MSN in Oncology Nursing from the University of Delaware. She has thirty years oncology nursing experience in a variety of roles ranging from bedside nursing, clinical trials, community outreach, radiation oncology, private practice, performance improvement, and as the care coordinator in the Christiana Care Breast Center. She implemented the role of the Survivorship Nurse Navigator at the Helen F Graham Cancer Center and Research Institute where she works with individuals who have completed cancer treatment using evidence based management strategies. Darcy holds dual certification as an advanced oncology and certified breast care nurse. In addition to her clinical experience, she has held multiple leadership positions in the local and national chapters of the Oncology Nursing Society. She was the founding coordinator of the Breast Care Special Interest Group and was instrumental in helping to develop the first subspecialty certification examination offered by the Oncology Nursing Society. She is currently Chair of the Special Interest Groups of the Oncology Nursing Society. Darcy has served on the Board of Directors of the Delaware Breast Cancer Coalition, the Delaware Chapter of the American Cancer Society and is currently on the Professional Advisory Board of the Cancer Support Community Delaware. She has authored articles, books chapters, online courses and has presented locally and nationally on multiple oncology topics and is a past recipient of the Pearl Moore Making a Difference Award. Darcy can be reached by e-mail at dburbage@christianacare.org or at her office at (302) 623-4407.

Darcy Burbage

Insights into Oncology Nursing

Guest Editor continued on page 10 Executive Director’s Column continued on page 2

I hope this edition of the Reporter finds you well. Thank you to all of our members for your continued support. If you are not a member, please consider joining. Together we can continue to move nursing forward in our state.

Thank you to Delaware Today! Once again Delaware Today magazine did a fantastic job recognizing nurses in their May edition. The celebration and recognition continued with a lovely Delaware Today magazine gala held at the Christiana Hilton. Almost 200 people attended to commemorate the excellent work nurses do for the community. (See page 11 for photos.)

To participate in the Delaware Today Top nurse, you must be a member of the Delaware Nurses Association. To open this opportunity up for nurses who are members of their specialty nurse organization, DNA has redesigned its organization affiliate program, Nurses Better Together, that will now include participation in Delaware Today’s Top Nurse. Information on the organization affiliate program can be found on the DNA website: www.denurses.org. Please share this information! Together, we can support, strengthen and offer greater recognition of the nursing profession in our state.

A special shout out to the Wilmington Blue Rocks for celebrating nurses at the May 20th game. Thank you! DNA President Leslie Verucci and DNA President-Elect Karen Panunto demonstrated their awesome pitching skills during the ‘first pitch’ at the start of the game. DNA also had a table on the breeze way with information on the nursing profession. It was a great time! (See page 3 for photos.)

Lastly in May, DNA visited our national legislators at the Capitol in Washington DC. This annual event is a great opportunity to express your voice and concerns at the national level. This year’s participants voiced their concerns about the ACA implementation and discussed end of life issues with our legislators and their staff members. In addition, there was discussion with issues such as the evolution of the nursing role with Janet Haebler, ANA Associate Director for State Government Affairs. Thank you to the American Nurses Association (ANA) for arranging the meetings and securing the room. Please be on the lookout for next year’s bus trip to the Capitol and join us.

Sarah Carmody

Page 2 • DNA Reporter August, September, October 2014

OFFICIAL PUBLICATION of the

Delaware Nurses Association4765 Ogletown-Stanton Road, Suite L10

Newark, DE 19713Phone: 302-733-5880

Web: http://www.denurses.org

The DNA Reporter, (ISSN-0418-5412) is published quarterly every February, May, August and November by the Arthur L. Davis Publishing Agency, Inc., for the Delaware Nurses Association, a constituent member association of the American Nurses Association.

ExECUTIvE COmmITTEEPresident TreasurerLeslie Verucci, RN, MSN, Victoria Varga, RN CNS, CRNP-A, APRN-BC

Past President SecretaryKaren Panunto Alana King, MSN, RN Ed.D, RN, APN,President Elect

COmmITTEE CHAIRSContinuing Education Advanced PracticeTerry Towne, MSN, RN-BC-NE-BC Allen Prettyman, Kathy Davidson, MSN, RN-BC, SDS PhD, FNP-BCCo-Chairs

Committee on Nomination Professional Development Jane Kurz, PhD, RN May Oboryshko, MSN, RNChair

Vacant Legislative Melanie Marshall, RN

Vacant

Environmental Ad-Hoc CommunicationsAnn Darwicki, RN Karen Panunto EdD, RNNursing Healing Our Planet Ann Darwicki, RN(NHOP)

Executive DirectorSarah J. Carmody, MBA

CE CoordiatorKaren Andrea, MS, RN, BC

Subscription to the DNA Reporter may be purchased for $20 per year, $30 per year for foreign addresses.

For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, sales@aldpub.com. DNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.

Acceptance of advertising does not imply endorsement or approval by the Delaware Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. DNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of DNA or those of the national or local associations.

managing EditorsKaren L. Panunto, Ed.D, RN, APN

Ann Darwicki, RN

The DNA Reporter welcomes unsolicited manuscripts by DNA members. Articles are submitted for the exclusive use of The DNA Reporter. All submitted articles must be original, not having been published before, and not under consideration for publication elsewhere. Submissions will be acknowledged by e-mail or a self-addressed stamped envelope provided by the author. All articles require a cover letter requesting consideration for publication. Articles can be submitted electronically by e-mail to Karen L. Panunto, EdD, RN, APN @ Karen.Panunto@wesley.edu.

Each article should be prefaced with the title, author(s) names, educational degrees, certification or other licenses, current position, and how the position or personal experiences relate to the topic of the article. Include affiliations. Manuscripts should not exceed five (5) typewritten pages and include APA format. Also include the author’s mailing address, telephone number where messages may be left, and fax number. Authors are responsible for obtaining permission to use any copyrighted material; in the case of an institution, permission must be obtained from the administrator in writing before publication. All articles will be peer-reviewed and edited as necessary for content, style, clarity, grammar and spelling. While student submissions are greatly sought and appreciated, no articles will be accepted for the sole purpose of fulfilling any course requirements. It is the policy of DNA Reporter not to provide monetary compensation for articles.

Reportervision: The Delaware Nurses Association is dedicated to serving its membership by defining, developing, promoting and advancing the profession of nursing as an art and science.

mission: The Delaware Nurses Association advocates for the interest of professional nurses in the state of Delaware.

Goals: The Delaware Nurses Association will work to:1. Promote high standards of nursing practice, nursing education, and nursing research.2. Strengthen the voice of nursing through membership and affiliate organizations.3. Promote educational opportunities for nurses.4. Establish collaborative relationships with consumers, health professionals and other advocacy

organizations.5. Safeguard the interests of health care consumers and nurses in the legislative, regulatory, and

political arena.6. Increase consumer understanding of the nursing profession.7. Serves as an ambassador for the nursing profession.8. Represent the voice of Delaware nurses in the national arena.

Published by:Arthur L. Davis

Publishing Agency, Inc.

http://www.denurses.org

Executive Director’s Column continued from page 1

This is an election year for DNA treasurer. If you are interested and a DNA member, please contact the office at (302) 733-5880. Election results and the passing of the gavel from Leslie Verucci, DNA President to Karen Panunto, DNA President Elect will occur at the General Membership meeting during the lunch hour at the DNA Fall Conference November 7, 2014 at Delaware State University. Mark your calendar!

Enjoy the rest of your summer and thank you for all you do!

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Did you know the DNA Reporter goes to all registered nurses in

Delaware for free?

Arthur L. Davis Publishing does a great job of contacting advertisers, who support the publication of our newsletter. Without Arthur L. Davis Publishing and advertising support, DNA would not be able to provide the newsletter to all the nurses in Delaware.

Now that you know that, did you know receiving the DNA Reporter does not automatically provide membership to the Delaware

Nurses Association?

DNA needs you! The Delaware Nurses Association works for the nursing profession as a whole in Delaware. Without the financial and volunteer support of our members, our work would not be possible. Even if you cannot give your time, your membership dollars work for you and your profession both at the state and national levels. The DNA works hard to bring the voice of nursing to Legislative Hall, advocate for the profession on regulatory committees, protect the nurse practice act, and provide educational programs that support your required continuing nursing education.

At the national level, the American Nurses Association lobbies, advocates and educates about the nursing profession to national legislators/regulators, supports continuing education and provides a unified nationwide network for the voice of nurses.

Now is the time! Now is the time to join your

state nurses association! Visit www.denurses.org to join or

call (302) 733-5880.

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August, September, October 2014 DNA Reporter • Page 3

We have had a busy time this spring/summer first with Delaware Today Excellence in Nursing Program which included an article in the May Issue of Delaware Today and a wonderful fun gala for the winners and their families. The turnout was great and everyone had a great time. Again we are looking forward to this yearly.

Also the Delaware Nurses Association and the Delaware Organization of Nurse Leaders have been working on our own Nursing Excellence which will be held now in September. See the website for forms and please nominate those you work with who so deserve recognition for all they do. This is always a great event honoring our own who consistently promote, excel, and bring a positive approach to their area of practice.

The Delaware Board of Nursing and the Delaware Nurses Association continue to work on the language and changes in the rules and regulations to add the Consensus Model. We are actively working to provide knowledge and education regarding the role of Advanced Practice Nurses to our legislators.

Most recently Sarah, Karen and I were in Washington for the American Nurses Association Membership Assembly. A new President, Pamela Cipriano of the Virginia Nurses Association and the new Vice President, Cindy Balkstras of Georgia Nurses Association, where elected. Also elected were Patricia Travis, Maryland Nurses Association, in the Secretary position. Gingy Hershey–Meade of the Ohio and Indiana Nurses Association, as Treasurer and Jesse Kennedy from Oregon Nurses Association for Director at Large were also elected. Congratulations to all.

New initiatives that the ANA will be working on in the upcoming year include:

• Full Practice Authority for all RN’s. ANA’spillar documents note that in order for the healthcare system to be completely optimized, RN’s knowledge, skills, and abilities must be fully utilized. This initiative is also consistent with the IOM Future of Nursing: Leading Change and Advancing Health through a mode of professional regulation. RN’s and APRN’s need to have the ability to practice to the full extent of their education, knowledge and professional and specialty nursing scope and standards of practice.

Wilmington Blue Rocks Game

President’s Message

Leslie Verucci

• Integration of Palliative Care into theHealthcare Delivery Systems: Removing barriers and improving access. It was noted that Medicare coverage for hospice services and payment models have not been changed in over 30 years and does not reflect current recommendation for exemplary palliative and hospice care delivery models. The goal is to work in partnership with Hospice and Palliative Care Associations to reform reimbursement mechanisms.

• Increased development of High PerformingInterprofessional Teams and develop outcome measures that avoid adverse events and readmissions related to inadequate communication and handoffs. These teams deliver high quality care more effectively and efficiently.

Last but not least, this will be my last note as President. I have so enjoyed my time in this role and will continue to work closely with the Delaware Nurses Association to keep the nurses in the State of Delaware safe and recognized for the hard work they do every day. I will continue my work on the APN committee working on the Consensus Model and the Prescription Drug Monitoring Committee. Karen will step into this role in the fall and will be a great addition to the board of directors as president. She presently has worked hard in keeping the Reporter up and running. Please welcome her and offer as much support to her as you have done for me. Thank you to all the great nurses we have in this state.

President Leslie Verucci and President Elect Karen Panunto throwing the first pitch.

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Page 4 • DNA Reporter August, September, October 2014

Joanne Quillen, MSN, PNP-BC

Joanne Quillen earned her BSN from Wilmington College and her MSN from the University of Pennsylvania with a special emphasis in Pediatric Oncology. Joanne worked for 3 years at the Children’s Hospital of Philadelphia in Neuro Oncology before coming to the Nemours A.I. DuPont Hospital for Children nineteen years ago to develop a Pediatric Oncology Survivorship Program. She is Board Certified as an Advanced Practice Pediatric Nurse Practitioner and currently coordinates the Pediatric Oncology Survivorship Program at Nemours. In addition, she follows Neuro Oncology patients who are receiving active therapy. Joanne is actively involved in research pertaining to childhood cancer survivors and has received the Daisy Research Grant evaluating childhood cancer survivors transitioning to adult healthcare. Joanne can be reached by email at joquille@nemours.org or at her office at (302) 651-6765.

The overall 5-year survival rate for children diagnosed with cancer has reached approximately 80% (Altekruse et al., 2010). Estimates indicate that one in every 640 young adults in the USA will be a survivor of childhood cancer (Hewitt, et al., 2003). The success rate is due to most children (90%) treated on a research protocol, sponsored through the Children’s Oncology Group with treatment consisting of a multimodal approach which may include surgery, multiagent chemotherapy, and or radiation therapy. The Children’s Oncology Group (COG) is the world’s largest organization focusing on children and adolescent cancer research whose members include medical experts from North America, New Zealand, Australia, and Europe.

Unfortunately, many adult childhood cancer survivors are at risk of developing adverse health outcomes as a result of their previous diagnosis and/or treatments. Oeffinger et al. (2006) found that thirty years after diagnosis of a pediatric cancer, 75% of survivors had a chronic health condition, more than 40% had a serious health problem and one third had multiple health problems. While some conditions are subtle, others can be life-threatening. The Childhood Cancer Survivor Study (CCSS) revealed almost half of survivors had at least one adverse health outcome (Hudson et al., 2003). In 2002 the Childrens Oncology Group developed evidenced based guidelines (www.survivorshipguidelines.org) which help providers screen and manage childhood cancer survivors (Kopp, Gupta, Pelayo-Katsanis, Wittman, and Katsanis, 2012).

Kadan-Lottick et al. (2002) examined the knowledge of survivors of childhood cancer who were all young adults. Only 35% of the survivors thought their past treatments could cause a serious health problem in the future. More alarming was that when survivors were asked to recall their chemotherapeutic agents, only 52% of the survivors received doxorubicin, and 30% who had received daunorubicin could recall they had received these drugs even after being prompted with the name of the anthracyclines. This is alarming since many survivors exposed to anthracyclines are at risk of developing cardiac sequelae decades after their therapy. The Children’s Oncology Group (COG) has developed long-term screening guidelines based on total anthracycline exposure and chest radiation. Many medical providers are unaware of this association making it more important that patients are aware of their own risks and suggested follow-up (Diller, 2011).

Childhood Cancer Survivorship

Joanne Quillen

Bhatia et al. (2003) described the risks to female survivors of childhood cancer who received chest radiation as part of their treatment and the associated risk of developing breast cancer. The COG late-effects guidelines suggest mammogram screening to start as young as 25 years of age or 10 years post exposure to radiation therapy, whichever comes last. A study by Smith et al. (2010) evaluated female survivors who were part of the CCSS to describe the breast cancer surveillance practices of this cohort. The largest group represented in the study consisted of Hodgkin lymphoma survivors (58.1%). The study reported approximately 45% of the women had not had a screening mammogram over the preceding 2 years. As survivors age, their risk of developing second tumors increases.

With an improvement in cure rates, survivors are now entering their reproductive years. Not surprisingly, maintenance of fertility is an extremely important issue in regards to the long-term quality of life for these survivors of pediatric cancer (Jeruss, 2009). Unfortunately, gonadal damage is a relatively common consequence of treatments used to cure pediatric cancer (Meistrich, 2009; Meirow & Nugent, 2001). Alkylating agents and radiation can impact both male and female gonadal function. A recent report by the CCSS revealed that when 6000 male survivors of pediatric cancer were compared with a sibling cohort, the male survivors were half as likely to sire a pregnancy (Green et al., 2010).

Finally, the lack of adult care providers who are informed about the unique follow up needs of pediatric cancer survivors is limited. In a recent article by Diller (2011) it was revealed that many survivors and adult health care providers are unfamiliar with the potential late effects of childhood cancer treatment and the suggested routine follow-up. For example, most adult primary care providers are not aware that many survivors of Acute Lymphocytic Leukemia (ALL) are at increased risk for obesity and metabolic syndrome (Rogers, Meachem, Oeffinger, Henry and Lange, 2005). Nathan et al. (2013) examined the knowledge level of 1124 family physicians regarding the appropriate follow up care for survivors of childhood cancer. Eighty one percent had cared for 2 or less childhood cancer survivors in the past 5 years. Only 16% could describe the appropriate follow up care based on recommended surveillance for secondary breast cancer, and 10% could identify appropriate cardiac recommendations. These studies further underscore the importance of survivors and their families knowing about their diagnosis, treatment, risk for late effects, and recommended follow up care.

In 2006, the Institute of Medicine (IOM) recognized oncology survivorship as a specialty and listed recommendations. Most importantly, survivors should have a detailed summary of their oncology treatment, potential late effects, and appropriate surveillance guidelines. Survivorship is part of the cancer journey which includes promoting healthy lifestyle choices and education which may reduce potential late effects in the future.

ReferencesAltekruse, S. F., Kosary, C. L., Krapcho, M., Neyman, N., Aminou, R., Waldron, W., &

Edwards, B. K. (2010). SEER cancer statistics review, 1975-2007. Bethesda, MD: National Cancer Institute. Retrieved from http://seer.cancer.gov/csr/1975_2007

Bhatia, S., Yasui, Y., Robison, L.L., Birch, J.M., Bogue, M.K., Diller, L… Meadows, A.T. (2003). High risk of subsequent neoplasms continues with extended follow-up of childhood Hodgkin’s disease: report from the late effects study group. Journal of Clinical Oncology 21(23), 4386–4394.

Diller, L. (2011). Adult primary care after childhood Acute Lymphoblastic Leukemia. The New England Journal of Medicine, 365, 1417-1424.

Green, D.M., Kawashima, T., Stovall, M., Leisenring, W., Sklar, C.A., Mertens, A.C., Donaldson, S.S., Byrne, J., & Robison, L.L. (2010). Fertility of male survivors of childhood cancer: A report from the childhood cancer survivor study. Journal of Clinical Oncology 28(2), 332-339.

Hewitt, M., Weiner S., & Simone J. (Ed.). (2003). Childhood Cancer Survivorship: Improving Care and Quality of Life. National Academies Press.

Hudson, M. M., Mertens, A.C., Yasui, Y., Hobbie, W., Chen, H., Gurney, J.G.,…Oeffinger, K. (2003). Health Status of Adult Long-Term Survivors of Childhood Cancer, A Report from the Childhood Cancer Survivors Study. Journal of the American Medical Association, 290 (12), 1583-1592.

Jeruss, J.S., Woodruff, T.K. (2009). Preservation of fertility in patients with cancer. New England Journal of Medicine, 360 (9), 902-911.

Kadan-Lottick, N.S., Robison, L. L., Gurney, J.G., Neglia, J.P., Yasui, Y., Hayashi, R.…Mertens, A.C. (2002). Childhood Cancer Survivors’ Knowledge about Their Past Diagnosis and Treatment Childhood Cancer Survivor Study. Journal of the American Medical Association, 287, 1832-1839

Kopp, L.M., Gupta, P., Pelayo-Katsanis, L., Wittman, B., & Katsanis, E. (2012). Late Effects in Adult Survivors of Pediatric Cancer: A Guide for the Primary Care Physician. The American Journal of Medicine, 1-6.

Meirow, D. & Nugent, D. (2001). The effects of radiotherapy and chemotherapy on female reproduction. Human Reproduction Update, 7 (6), 535-543.

Meistrich, M.L. (2009). Male gonadal toxicity. Pediatric Blood Cancer, 53 (2), 261-266.Oeffinger, K.C., Mertens, A.C., Sklar, C.A., Kawashima, T., Hudson, M.M., Meadows,

A.T.,…Robison, L.L. (2006). Chronic health conditions in adult survivors of childhood cancer. The New England Journal of Medicine, 355, 1572-1582.Nathan, P.C., Daugherty, C.K., Wroblewski, K.E., Kagin, M.L., Stewart T.V., Hlubocky F.J,

…Henderson, T.O. (2013). Family physician preferences and knowledge gaps regarding the care of adolescent and young adult survivors of childhood cancer. Journal of Cancer Survivorship,7(3), 275-282.

Rogers, P.C., Meacham, L.R., Oeffinger, K.C., Henry, D.W. & Lange, B.L. (2005). Obesity in Pediatric Oncology. Pediatric Blood and Cancer, 45(7), 881-891.

Smith, S.M., Ford, J.S., Rakowski, W., Diller, L., Hudson, M.M., Mertens, A.C., Stanton, A.L., Henderson, T.O., Leisenring, W., M., Robinson, L.L., & Oeffinger, K.C. (2010). Inconsistent mammography perceptions and practices among women at risk of breast cancer following a pediatric malignancy: A report from the Childhood Cancer Survivor Study. Cancer Causes Control, 21(10), 1585–1595.

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August, September, October 2014 DNA Reporter • Page 5

Barbara Plummer BSN, RN, MBA/HCA, CPON

Barbara earned her Diploma in Nursing from the Nursing School of Wilmington. She received her BSN and a Masters in Business Administration and Health Care Administration from Wilmington University. She is certified in Pediatric Oncology Nursing and has worked in various roles caring for adults and children with cancer and their families for over 30 years. The last 20 years she has worked at Nemours/AI duPont Hospital for Children where she currently works in the role of the Cancer Care Coordinator. Barbara can be reached by email at bplummer@nemours.org or her office at (302) 651-5754.

Children are not just little adults. This especially holds true when a child has cancer. Childhood cancer is considered a rare disease in the United States. According to Childcancer.org (2014), “Currently, one in every 330 children in the United States develops cancer before the age of nineteen (p.1). Despite its rare occurrence “cancer is the second most common cause of death among children ages 1 to 14 years in the United States, surpassed only by accidents” (Siegel, Naishadham, & Jemel, 2012, p. 25)

When cancer occurs in children, it typically originates from different germ cell layers as compared to adult cancers. Because of this difference, childhood cancers have unique patterns of distribution and occurrence. There are few identified environmental and genetic risk factors that contribute to the occurrence of childhood cancers. Most children are otherwise well prior to their cancer diagnosis. Parents often ask “How long has my child had cancer?” or “Could I have done something to find this sooner?” Symptoms of childhood cancer at presentation are similar to those of common childhood illnesses. Treatment is aimed at reducing cells that proliferate quickly while keeping side effects at a minimum. As treatment is initiated the child, family, and community is embraced by the health care team to ensure the best outcomes possible for all who are touched by the disease.

Distribution and Occurrence RatesAccording to the National Cancer Institute (2008)

many different cancers come under the umbrella term of childhood cancer, each with a specific behavior and treatment:

There are twelve major types of childhood cancers, leukemias and cancers of the brain and central nervous system account for more than half of the new cases. About one-third of childhood cancers are leukemias. The most common type of leukemia in children is acute lymphoblastic leukemia. The most common solid tumors are brain tumors with other solid tumors (e.g., neuroblastomas, Wilms tumors, and sarcomas such as rhabdomyosarcoma and osteosarcoma) being less common. (p. 1)

TreatmentChildren with cancer are treated with surgery,

chemotherapy, biotherapy, radiation therapy, stem cell transplant, or a combination of these modalities. Children with cancer are less likely to have comorbidities than those that accompany the aging adult body such as obesity, hypertension, diabetes, and peripheral vascular disease. Treatment consists of the use of many chemotherapy agents that have been used as the backbone of treatment for over 30 years. New agents and treatment combinations target proteins or chromosome translocations characteristics to particular cancers. Specific cancers are assigned risk group classifications with specific treatment regimens intending to deliver the necessary agents for cure with consideration for reduction of treatment toxicity. Long term sequelae related to cancer and its treatment can impair overall health and quality of life for years to come for these patients as their bodies

Childhood Cancer: Caring, Coping and Clinical Trials are Key to Success

Barbara Plummer

are still growing and developing. Long term sequelae may include infertility, neurocognitive changes, endocrine and growth deficiencies, pulmonary, cardiac toxicities, and impairment in psychosocial functioning.

Clinical Trials and Success RatesClinical trials are an integral part of the treatment

approach for children with cancer. The pediatric oncology treatment model focuses on considering open clinical trials as an option for each newly diagnosed patient. Families are involved in in-depth ongoing discussions about available treatment options and rights of research participants. Making important decisions and signing consent for research at a time when families have just received a devastating cancer diagnosis is difficult. Many pediatric oncology treatment studies are designed so that initial consenting offers the choice for identical treatment on or off study. Second consents, that require informed decision making, are signed about a month into treatment when families are more knowledgeable and better able to emotionally make treatment decisions. In addition to treatment studies that are offered to the families, there are many other research studies aimed at investigating tumor biology and improving supportive care and quality of life for patients and families. It is not unusual for a single patient to be on three or more research studies throughout the disease trajectory. The Children’s Oncology Group (COG) is an international group of investigators that conducts research for children and young adults with cancer. Through clinical trials new treatment modalities are developed and accepted as the standard of care, improving survival and quality of life. According to Siegel et al. (2012), “the 5-year relative survival rate for all cancers combined improved from 58% for children diagnosed between 1975 and 1977 to 83% for those diagnosed between 2001 and 2007” (p. 25). It is estimated that overall survival rates for childhood cancers are now close to 90%. According to the National Cancer Institute (2013), “Although outcomes have improved for many childhood cancers, progress in others has been limited. Brain tumors remain the leading cause of cancer-related death in children” (p.1).

Multi Disciplinary ApproachDelivering quality healthcare to children with

cancer and their families comes with many

challenges. With cure as the ultimate goal, many other factors are considered when planning care. Caring for families touched by cancer requires an interdisciplinary team approach that extends to the entire community. Culturally diverse care is provided to address the individual physical and emotional needs of the patient and their family; the center of the team. Good communication is essential between the many providers which can include: pediatric oncologists, physician specialists, nursing, social work, psychology, occupational and physical therapists, child life specialists, school teachers and palliative care, all of whom enhances care delivery. Therapeutic play for the child with cancer and his/her siblings improves coping and illness acceptance. School visits enhance reintegration into normalcy for the child. It also promotes illness understanding and acceptance for teachers and classmates. Overall, this approach improves adaptation, outcomes and quality of life for everyone involved.

SummaryOur hope is that through intensive research we can

find better ways to cure cancer while preventing long term sequelae. While striving for this cure, we attempt to offer cancer treatment with the smallest loss of childhood as possible as well as to avoid as many physical and psychological effects possible with the overall goal of eliminating childhood cancer.

ReferencesChildhood Cancers facts.org. retrieved from http://

childcancer.org/healing/resources/childhood-cancer-facts/

National Cancer Institute (NCI) (2008). Care for Children and Adolescents with Cancer, A Snapshot of Pediatric Cancers. Retrieved from http://www.cancer.gov/cancertopics/factsheet/NCI/children-adolescents#r1,

National Cancer Institute (NCI) (2013). Care for Children and Adolescents with Cancer. Retrieved from http://www.cancer.gov/researchandfunding/snapshots/pediatric.

National Cancer Institute (NCI)(2008). Fact Sheet: Childhood Cancers. retrieved April 29, 2104 from http://www.cancer.gov/cancertopics/factsheet/Sites-Types/childhood

Siegel, R., Naishadham, D. & Jemal, A., Cancer statistics, 2012. CA: A Cancer Journal for Clinicians, 62. Retrieved from http://onlinelibrary.wiley.com/doi/10.3322/caac.20138/full.

“ALDDE”

Page 6 • DNA Reporter August, September, October 2014

Kandie Dempsey, MS, RN, OCN, DBA (abd)

Kandie Dempsey earned her BSN and MS in Health Care Administration from Wilmington University and is currently completing her dissertation towards a Doctorate in Business Administration. She is a certified in Oncology Nursing and has worked at Christiana Care Health Services for 27 years. Currently, she is the Director of Cancer Research at the Helen F. Graham Cancer Center and Research Institute. She has served on a variety of national committees specific to oncology research including but not limited to: The National Cancer Institute, Cancer & Leukemia Group B; The Alliance for Clinical Trials in Oncology; National Surgical Adjuvant Breast & Bowel Project; the Cancer Trials Support Unit and the Oncology Nursing Society. Locally, she is past president of the Delaware Diamond Chapter of the Oncology Nursing Society. She has served in a leadership capacity with the NCI National Community Cancer Centers Program and assisted with mentoring other sites nationally. She has published in Proceedings of the Society of Surgical Oncology, Clinical Cancer Research, Delaware Medical Journal, Journal of Clinical Oncology, and Oncology Issues. Currently, she is the national Chair of the Clinical Research Professionals Committee for the Alliance for Clinical Trials in Oncology. Kandie may be reached at KDempsey@Christianacare.org or via phone at (302)623-4450.

Oncology Clinical Trials Nursing

Kandie Dempsey

In the United States, one person dies from cancer approximately every minute. The American Cancer Society estimated that 590,350 people were expected to die from cancer in 2013 in the USA – more than 1,600 per day (ACS, 2013, p. 1). Cancer is the second leading cause of death, exceeded only by heart disease. One in four deaths is from cancer. Some 1,660,290 new cancer cases in the USA are estimated to be diagnosed in 2013, and this rate is expected to rise significantly as the population ages.

The National Institutes of Health (NIH) estimates that the overall costs of cancer in the US in 2008 were $201.5 billion: $77.4 billion for direct medical costs (total of all health expenditures) and $124.0 billion for

indirect mortality costs (cost of lost productivity due to premature death) (ACS, 2013, p. 3). These costs are projected to increase as the population grows and ages. Researchers must collaborate to develop new strategies to prevent, control, and treat cancer in order to decrease incidence of the disease and mortality and to improve quality of life. Cancer clinical trials will help to accelerate progress.

Cancer clinical trials as defined by the National Cancer Institute (NCI) are research studies conducted with people to find better ways to prevent, diagnose, and treat cancer (NCI, 2013). Clinical trials test many types of treatment, such as new drugs, approaches to surgery or radiation therapy, combinations of treatments, or methods such as gene therapy to help future patients diagnosed with cancer. These studies are the final step in the process of developing new drugs and other means to fight the disease, and they are the means by which basic scientific research is moved from the laboratory into treatments for people with cancer. Clinical trials are required in response to the pressing need to develop successful cancer therapies to improve morbidity and reduce mortality. The NCI estimates that approximately 20% of adult cancer patients in the US are eligible to participate in an oncology clinical trial, although only 3% of adult cancer patients actually take part (NCI, 2002, p. 76).

Well-trained and educated Clinical Research Professionals (CRPs) are the key to successful completion of the research process. CRPs are referred to by a variety of job titles including (but not limited to) Clinical Research Associate, Research Coordinator, Data Manager, Data Coordinator, and Research Nurse. The Society of Clinical Research Associates (SoCRA, 2013) provides the following definition of a research professional:

A Clinical Research Professional functions as a clinical investigator, sub-investigator, clinical researcher, research nurse, administrator, coordinator, consultant, or educator in clinical trial management. A Clinical Research Professional is involved in one or more aspects of clinical trials research, including data collection, analysis, or monitoring; case management of protocol participants; recruitment and enrollment of human subjects; protection of subjects and subjects’ rights through Institutional Review Board relations; development of informed consents; preparation of adverse event experience reports; construction or monitoring of case report forms; maintenance of drug accountability records; grant and budget development; report preparation; education of other health-care professionals, patients or families regarding clinical trials, protocol development, program administration; and research program audit. (http://www.socra.org/html/certific.htm)

CRPs typically hold degrees in areas such as nursing, biology, statistics, and health care administration. The CRP is primarily responsible for collecting, organizing, and submitting data for clinical trials (Price, Barrett, & Roark, 2006). The deployment of CRPs who are knowledgeable and trained in all aspects of clinical research enhances the conduct of clinical trials, and their monitoring promotes adherence to protocol requirements. The Oncology Nursing Society (ONS) states the following:

Coordination of clinical trials (e.g., coordination of clinical sites, development of standardized treatment orders, symptom management, patient education and advocacy, facilitation of informed consent, assistance with participant accrual and retention) is accomplished best by RNs who have been educated and certified in oncology nursing. (ONS, 2009, p. 5)

In response, ONS published Oncology Clinical Trials Nurse Competencies in 2010 providing a summary of the fundamental competencies CRPs require in order to participate in oncology clinical trial processes.

Cancer affects us all-whether we have it, care about someone who does, or worry about getting it in the future. The more people that participate in clinical trials, the faster we can answer the critical research questions that will lead us to better treatment and prevention options for all cancers. We will never know the true effectiveness of a cancer treatment, or a way to prevent cancer, unless we are able to involve more people in clinical trials. Although significant progress has been made in preventing, diagnosing and treating cancer, no standard effective treatments currently exist for many types of the disease and further improvement of effective therapies is required. For this reason, individuals diagnosed with the disease are encouraged to participate in clinical trials.

Delawarean’s have access to a robust number of clinical trials right here in their own communities. The NCI has sponsored research across the state since 1987 and is in the process of combining its two community-based research networks to create a single network, the NCI Community Oncology Research Program (NCORP). NCORP will support a wide range of clinical research, including treatment-focused as well as cancer prevention and control–based clinical trials; population-based studies; and behavioral, health services, and outcomes research. Additionally, several hospitals and private physician practices across the state participate in industry sponsored oncology clinical trials providing options not available through the NCI.

ClinicalTrials.gov is a Web-based resource that provides patients, their family members, health care professionals, researchers, and the public with easy access to information on publicly and privately supported clinical studies on a wide range of diseases and conditions. Individuals may find and view clinical trials by conducting basic and advanced searches of clinical study records; browse studies; and search for clinical trials by disease site, topic, country, or region. Study results by disease site are also available. Learn more about clinical research and find out how clinical studies are conducted and who can participate by visiting https://clinicaltrials.gov/ct2/home.

ReferencesAmerican Cancer Society (ACS). Cancer facts & figures

2013. Retrieved from the American Cancer Society website: http://www.cancer.org/acs/groups/content/@epidemiologysur ve i lance/documents/document/acspc-036845.pdf.

National Cancer Institute (NCI) (2002). Cancer clinical trials: A resource for outreach, education, and advocacy. NIH Publication 02-50-53. Retrieved from https://accrualnet.cancer.gov/sites/accrualnet.cancer.gov/files/ResourceGuide_Book_m.pdf.

National Cancer Institute (NCI) (2013). Learn about clinical trials. Retrieved from http://www.cancer.gov/clinicaltrials/learningabout/what-are-clinical-trials.

Oncology Nursing Society (ONS) (2010). Oncology Clinical Trials Nurse Competencies. Retrieved April 15, 2013. http://www2.ons.org/media/ons/docs/publications/ctncompetencies.pdf.

Price, K. C., Barrett, B. K., & Roark, J. M. (2006). Cancer and Leukemia Group B clinical research associates committee. American Association for Cancer Research, Clinical Cancer Research, 12(11), 3642s-3642s. doi: 10.1158/1078-0432.CCR-06-9014.

Society of Clinical Research Associates (2013). SoCRA certification. Retrieved from http://www.socra.org/html/certific.htm.

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August, September, October 2014 DNA Reporter • Page 7

Paula Hess, MSN, RN, OCN®

Paula Hess earned her ADN and MSN from Wesley College. She also has a degree in Music Education from Mansfield State College (now Mansfield University). She is an Oncology Certified Nurse and has been employed by Bayhealth Medical Center since 1996. Her oncology experience includes Cancer Educator, Cancer Screening Nurse Navigator, and currently Cancer Nurse Navigator. She has been an active member of the Delaware Cancer Consortium since its inception and Secretary of the Delaware Prostate Cancer Coalition. Paula is also a longtime volunteer for the American Cancer Society and Cancer Support Community. She can be reached by email at paula_hess@bayhealth.org or at her office (302) 430-5064.

Nurse Navigator Impact on Cancer Screening Compliance

Paula Hess

Turn back the clock to the last century. According to the Centers for Disease Control and Prevention United States Cancer Statistics (CDC, USCS, 2013) in 1999, Delaware ranked number six in the nation for cancer mortality. Since that time, our ranking has dropped to number thirteen (CDC/USCS, 2013). That accomplishment was a team effort in which nurses played a vital role.

The process began in 2000 with a Concept Mapping Project comprised of nearly two hundred participants including cancer survivors, family members, professionals, and scientists. Concept mapping is a method of representing relationships between ideas, images, or words. This process was used to compile, evaluate, and categorize information received from the participants in order to gain a better understanding of the complexity of issues related to Delaware’s high cancer mortality. Questions were posed related to access to care, financial/insurance issues regarding diagnosis and treatment coverage, how to best reach the underserved and high-risk populations, and what impact the environment has on our cancer rates.

In March 2001 the Delaware Advisory Council on Cancer Incidence and Mortality was created and evaluated the information from the Concept Mapping Project to identify possible causes for our high rate of cancer deaths. Multiple focus areas emerged, including environment, education, tobacco, prevention, quality of care, insurance and disparities. After the results were analyzed and prioritized, the Delaware Cancer Consortium (DCC) was established.

The DCC was tasked with developing goals and objectives from the information gathered by the Advisory Council. Seven formal committees emerged, with nursing representation on almost every one. The chairperson of each committee was appointed to the Board in order to keep the DCC appraised of their committee’s progress. The focus of this article is to highlight nurses’ involvement in the accomplishments of the Colorectal Cancer Committee.

The goals of the Colorectal Cancer Committee were as follows: to increase colorectal cancer screening - specifically colonoscopies, eliminate the screening disparity that existed between African Americans and Caucasians, and allocate funding through the state Screening for Life program to provide coverage for uninsured and underinsured individuals who met the income guidelines (Delaware Advisory Council on Cancer Incidence and Mortality, April 2002). Screening for Life (SFL) is a statewide program that provides certain cancer screening coverage for uninsured and underinsured individuals who meet income guidelines. Breast and cervical cancer screenings are paid through federal funds. However, the State of Delaware had to allocate additional money to cover colorectal cancer screenings.

During the time it took to approve additional funds, the Colorectal Cancer Committee addressed the screening rate issue and how to best educate, break down barriers, and motivate people to screening. Because of nurses’ education, knowledge, and respect in the community, it was determined that they would fulfill this important role. In 2005, a detailed job description was created for Colorectal Cancer Screening Coordinators and grant funded positions were implemented at all major hospitals throughout the state of Delaware.

These nurses were responsible for identifying underserved, uninsured, and high risk populations within their communities. Census tract data and community mapping, which identified characteristics of community subsets, enabled them to focus outreach and education to those most in need. The nurses attended a weeklong cultural sensitivity training that gave them insight and skills to acknowledge and respect the cultural norms of various groups. This provided a means to approach myths and misinformation regarding cancer screenings in a meaningful manner while maintaining trust.

The Colorectal Cancer Screening Coordinators were successful in reaching out to high risk populations such as African Americans, the uninsured, and underinsured. Large and small group events were held to provide education and break down barriers to screening.

Some of these barriers included knowledge deficits about screening recommendations, lack of insurance coverage, language, transportation, and having a “buddy” to accompany them to the procedure. The Colorectal Cancer Screening Coordinators participated in statewide health fairs. Presentations were also made to churches, schools, businesses, and civic organizations of various sizes. A “Champions of Change” program was developed to address the lower screening rates in the African American community. This program provided training and materials to interested individuals who were willing to take the message of the importance of colorectal cancer screening to groups of their peers.

This pilot program proved very successful in increasing colorectal cancer screening rates, especially in the high risk African American community. In recent years, colorectal cancer screening prevalence has increased dramatically among African American Delawareans such that currently there is no difference in colorectal cancer screening rates between African Americans and Caucasians. Grubbs et al. (2013) noted the following screening rates for Delawareans:

Colorectal cancer screening rates for all Delawareans > (greater than or equal to) 50 years increased from 57% in 2002 to 74% in 2009. Screening rates for

African Americans rose from 48% to equal the rate among whites of 74% during the same time period. (p. 1929)

Delaware is the first state in the nation to achieve this goal. The recently released Cancer Incidence and Mortality in Delaware 2006-2010

(Delaware Division of Public Health, 2014, p. 5) reports the following achievements: • From 1996–2000 through 2006–2010, Delaware’s colorectal cancer

incidence rate decreased 26.4 percent while the national rate decreased 18.9 percent.

• From 1996–2000 through 2006–2010, Delaware’s colorectal cancermortality rate decreased 28.3 percent compared with 22.6 percent nationally. The decline in colorectal cancer mortality was most notable among African American females (51.8 percent).

• Increases in early detectionwere responsible for some of the improvementseen in overall colorectal cancer mortality. Data from the 2012 Behavioral Risk Factor Surveillance (BRFS) survey showed that in 2012, Delaware ranked fourth highest in the U.S. in colorectal cancer screening; 75.1 percent of Delawareans age 50 and older reported ever having had a sigmoidoscopy or colonoscopy, compared to 67.3 percent nationally.

Because preliminary data was showing the positive impact of nurse navigation on colorectal cancer screening rates, outreach was broadened in 2007 to include all of the cancer screenings covered by the Screening for Life Program: breast, cervical, colorectal, and prostate. The Colorectal Cancer Screening Coordinator position was expanded and renamed to Cancer Screening Nurse Navigators and the DCC Colorectal Cancer Committee was renamed the Early Detection and Prevention Committee.

What started as a pilot study has become a model program for other states as they also tackle the issues of disparities in their communities. As more data become available, it will surely show the continued value of nurses in closing the gap. Now supported by independent hospital systems, the Cancer Screening Nurse Navigator program continues. Although significant improvements have been made there is still much more to be done to eliminate the disparities that remain in our local communities and move Delaware further down the ranking for overall cancer mortality.

In summary, due to the success of the colorectal cancer screening program, the first state is working toward being the first in the nation to implement a statewide screening initiative for lung cancer following the recently released National Comprehensive Cancer Network Guidelines for lung cancer screening (NCCN, 2014). The Cancer Screening Nurse Navigators will no doubt once again lead the way in making a positive impact on the health of Delawareans.

ReferencesDelaware Advisory Council on Cancer Incidence and Mortality (April, 2002). Turning

commitment into action: Recommendations of the Delaware Advisory Council on Cancer Incidence and Mortality. Delaware Division of Public Health: Behavioral Risk Factor Surveillance. Retrieved from http://www.dhss.delaware.gov/dph/dpc/aboutbrfss.html.

Delaware Division of Public Health (2014). Cancer Incidence and Mortality Report 2006-2010. Retrieved from http://dhss.delaware.gov/dph/dpc/ca-stats.html.

Grubbs, S.S., Polite, B.N., Carney, J., Bowser, W., Rogers, J., Katurakes, N., Hess, P., & Pasket, E.D., (2013). Eliminating racial disparities in colorectal cancer in the real world: It took a village. Journal of Clinical Oncology, 31(16), p. 1929.

NCCN Clinical Practice Guidelines in Oncology, Lung Cancer Screening version 2.2014. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/lung_screening.pdf.

U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999-2000 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute (2003). Retrieved from http://www.cdc.gov/uscs.

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Page 8 • DNA Reporter August, September, October 2014

Clare Wilson, RN, MS, LMHC, NBCC Cancer Care Coordinator

Tunnell Cancer Center, Beebe Healthcare

Clare Wilson graduated with her Nursing Diploma from Nursing School of Wilmington in 1974 and went on to earn her BSN and MSCC (Master of Science in Community Counseling) f r o m W i l m i n g t o n University. She is certified in Counseling through the National Board of Certified Counselors and is a certified Health Coach by the Wellcoaches ® Corporation and is also a Licensed Mental Health Counselor in the state of Delaware. She has worked in Oncology for over thirty years and is currently the Cancer Care Coordinator at Beebe Healthcare’s Tunnell Cancer Center where one of her roles is to provide wellcoaching and supportive counseling to patients and their families. In addition, she has been a facilitator at The Cancer Support Community of Delaware since 1997. Clare can be reached by email at cwilson@beebehealthcare.org or at her office at (302) 645-3087.

A bell rings. The sound is heard throughout the infusion center and echoes down the halls. The bell ringing signifies a patient’s end of active treatment. Its significance is very personal to each patient and caregiver. For other patients in the treatment area, it is seen as a sign of hope. Patients and caregivers anxiously await their turn to ring the bell. The ringing is followed by cheers and clapping and, as expected, the room is filled with celebration. As patients walk the hallway exiting the treatment area, there is fear as well as joy in their eyes, and often unexpected tears. The end of active treatment is a very stressful time. Although this time is a primary goal for patients at the start of treatment, reaching this goal often brings unexpected anxiety. Fear of recurrence sets in, as well as other future uncertainties. All too often, caregivers, families, and friends believe this is an appropriate time to withdraw support. The patient may feel alone, uncertain, fearful, and anxious. A cancer diagnosis, treatment, and fears about the future often promote lifestyle changes. “Why does it take a challenge to our survival for us to give ourselves permission to really live?” (Carr, 2007, p.72)

Tunnell Cancer Center’s Psychosocial Services Program provides education, supportive counseling,

After Ringing the Bell: A Wellcoaching Survivorship Program

Clare Wilson

and wellcoaching to patients and caregivers throughout their treatment trajectory. Although available at any time, most patients enter wellcoaching to assist them in the transfer from active treatment to long-term survivorship. All of the services are provided free of charge. For patients thinking about making a change – and for those who have made that decision – the wellcoaching program offers the next step in their survivorship plan. The primary goals of wellcoaching are: to encourage personal responsibility, deep thinking, self-discovery, and self-efficacy. Clients ask their own questions, find their own answers, and create their own possibilities. The heart of coaching is the relationship between the coach and the client, which enables the client to reach goals, fulfill dreams, and thus live a meaningful life. The coach’s role is to help clients discover their strengths, clarify their values, increase their awareness, set priorities, meet challenges, brainstorm possibilities, and design positive action.

Moore & Tschannen-Moran (2010) points out that Prochaska’s Five Stages of Change model provides coaches with an understanding of how and when behaviors can be altered, and why clients sometimes struggle, fail, or quit:

1. Pre-contemplation: “I won’t or I can’t” change. This is often the initial response to the loss of control experienced after diagnosis and treatment. For some patients, the only goal is to get their life back; no change needed or desired.

2. Contemplation: “I may” change. Clients are thinking about adopting healthy behaviors and lifestyles, and perhaps changing unhealthy ones. Identifying motivators for change, understanding personal challenges, and identifying clients’ strengths are key factors for moving clients forward. Clients are encouraged to think of problem solving through strength building. Focusing on strengths (instead of the problem) empowers clients, and this client-focused approach has been shown effectively to change behaviors.

3. Preparation: “I will” change. Clients have strong motivators; they acknowledge barriers and identify possible solutions. Clients are continually supported through positive thoughts that result in positive beliefs and actions. The coach encourages “change talk,” which helps clients explore change. The client makes the case for change, not the coach. This leads clients to formulate a vision. A vision statement is very powerful and very personal. The client defines a three-month vision. The statement is active. Clients may choose something as simple as, “I am at peace,” or may compose 1-2 pages of vision–again, personal and powerful. The vision statement leads to goals. Defining goals is a key factor in assisting clients to change

behavior. In coaching, goals are identified as SMART (specific, measurable, action-based (behaviors), realistic and time-lined). An example of a SMART goal for someone whose vision statement is, “I am at peace,” may look like this: I meditate for twenty minutes in my sitting room three times a week,” or for a client working on healthy lifestyle changes, “I work out at the gym five times a week for one hour.”

4. Action: “I am” changing. Clients who have identified their vision and goals are consistently practicing new behaviors and refining new and healthy lifestyle changes. They experience what is known as flow, which allows them to fully engage challenges as they arise. The coach’s challenge is to allow the client to fluctuate, (flow) between not too bored and not too anxious, so as to maintain positive changes and outcomes. The bulk of coaching takes place in this stage.

5. Maintenance: “I still am.” The changed behavior has become a habit and occurs automatically. Clients are confident they can maintain the new behavior. They are also aware that dedication and work are still needed to prevent lapses (pp. 33-37).

In recent years, the role of “coach” in the field of nursing has added another dimension to our changing and challenging health care delivery system. As healthcare transitions to a health promotion model, the roles of nurse coach will expand. In oncology nursing, the growing number of survivors needing new and innovative approaches to survivorship care will also fuel the change. For nurses interested in coaching, there is a plethora of Nurse Coach Certification programs. In 2012, the American Journal of Nursing Book of the Year in the category “Professional Development” was awarded to, “The Wisdom of the Whole: Coaching for Joy, Health, and Success,” (Bark, 2012). Over the past years nursing research has advanced in this area, but much more is necessary. Lewis and Zahlis (1997) reference the analysis of coaching dating back to 1959. Bernardo (2010) cites a wellness coaching research study for cancer survivors. Both authors and researchers acknowledge the benefits of coaching and stress the importance of the need for continued research.

As I approach my fortieth year of nursing, I find myself reflecting on my many nursing roles. In recent years, nurse coaching has allowed me to blend my clinical and psychosocial experience. The opportunity to coach oncology patients in particular has confirmed the strength of the human spirit. Empowering clients to develop a positive mindset, to identify strengths and values that help motivate change and develop healthy lifestyles, motivates me to do the same. As a health care professional, nurse coaching has given me the opportunity to become a positive role model capable of mentoring my colleagues. As an entrepreneur, nurse coaching offers the autonomy of private practice. Also, many nurse coaches are hired by organizations providing health and wellness coaching as an employee benefit.

Nurse coaching is effective because nurses bring a unique perspective to the practice of coaching. Our educational and clinical backgrounds are positive assets. Our “being skills” – authenticity, empathy, positive regard, and mindfulness – are vital to the role. As nurses, we are often placed in the role of “expert” by the patient. Coaches, however, believe that clients are whole, creative, resilient, and resourceful, and therefore value the client as the expert. The nurse who can make this switch and acknowledge the client as the true expert will be at the forefront of this growing trend in nursing, and will benefit from this rewarding role.

ReferencesBark, L. (2012). The wisdom of the whole: Coaching for

joy, health, and success. San Francisco, CA: Create Space Press.

Bernardo, L. (2010). Wellness coaching: Benefits for cancer survivors. Journal of Oncology Nursing. Retrieved from http://www.hcplive.com/publications/oncngOncologyNursing/2010/February2010/

Carr, K. (2007). Crazy sexy cancer tips. Guilford, CT: Skirt.Lewis, F. M. & Zahlis, E. H. (1997). The nurse as coach:

A conceptual framework for clinical practice. Oncology Nursing, 24(10), 1695-1702.

Moore, M. & Tschannen-Moran, B. (2010). Coaching psychology manual. Philadelphia, PA: WoltersKluwer.

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August, September, October 2014 DNA Reporter • Page 9

LaTonya E. Mann FNP-BC, MSN, OCN, CRNIOncology Nurse Navigator

LaTonya earned her Licensed Practical Nurse degree in 1985 from Salem Community College, Associate Degree in Nursing in 1992 from Gloucester County College, Bachelors in Nursing in 2009 from Immaculata University, and Masters Degree from University of Delaware in 2013. She is board certified as a Family Nurse Practitioner. LaTonya is dual certified in oncology and infusion nursing and she serves as Director-at-Large for the Delaware Diamond Chapter of Oncology Nursing Society and is also a member of the Delaware Coalition of Nurse Practitioners and Delaware Nurses Association. LaTonya brings over 25 years of experience in various settings including intensive care and home infusion therapy. She has held her role as an Oncology Nurse Navigator at Helen F. Graham Cancer Center and Research Institute of Christiana Care Health System since 2005 where she specializes in the care of patients with head and neck cancer. Her role is to follow patients with a cancer diagnosis through the continuum of care using a care management model. LaTonya can be reached by email at lamann@christianacare.org or at her office (302) 623-4706.

LaTonya E. Mann

The need exists to revamp the current health care system in order to provide access to health care and better manage chronic care conditions (AANP, 2012). The most discussed model is that of the “medical home.” The medical home is best described as a model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety (PCPCC, 2012). It has become a widely accepted model for how primary care should be organized and delivered that encourages providers and care teams to meet patients where they are, from the simplest to the most complex conditions (PCPCC, 2012).

Because of the evidence supporting the use of nurse practitioner’s (NP’s) in primary care, widespread support has been generated for the use of NP’s to enhance the quality of patient care, reduce health care costs, and increase patient satisfaction. Legislation, regulation, and demonstration projects that address patient centered primary care: (1) must be based on the Institute of Medicine’s (IOM) definition of primary care. The provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community, (2) should be designed to allow all licensed primary care providers to serve in this role, 3) should give special attention to the support of safety net providers who provide care for patients who would not otherwise have access to care, (4) should include nurse practitioners in the design and development of such programs and finally, (5) should recognize nurse practitioner led practices as medical homes (IOM, 1996, p.29). The Medical Payment Advisory Commission (Med PAC) has also focused attention on the promotion of primary care as a means to improve quality and control costs in the Medicare system. While Med PAC has noted that data on the number of non-physician practitioners treating Medicare Patient is compromised, a recent report has recommended that policy makers consider ways to make changes in subsidies that would promote primary care: “…allocating shares toward NPs and physician assistants-key professionals in managing patients’ chronic conditions-could be useful for promoting primary care service use” (ANA, 2010, p.2).

The Veterans Health Administration (VA), the largest integrated health care system in the country, is often cited for its comprehensive electronic medical record and coordinated care. The American Nurses Associations (2010) points out the role of NPs in the VA health system:

Act as individual primary care physician (PCP) in both the home and hospital setting and are responsible for delivering essential and preventive care, providing patient and family education, and coordinating all care services. Each of the 4.5 million primary care patients in the VA is assigned an individual PCP, and of the 5000 providers, 20% are NPs. (p.3)

According to Principles for Patient and Family Centered Care (2013), consumer advocacy groups have studied the medical home model and have put forth a set of principles that should guide the development and implementation of the medical home from the consumer perspective. These principles refer repeatedly to the care team and specify that the team “is led by a qualified provider of the patient’s choice, and different types of health professionals can serve as team leader” (Principles for Patient and Family Centered Care, 2013).

In a report released in 2010, The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine noted the following as barriers to practice for advanced practice registered nurses:

Restrictions on scope of practice, policy and reimbursement related limitations, and professional tensions have undermined the nursing profession’s ability to provide and improve both general and advanced care. The Committee’s first recommendation was to remove scope of practice barriers to allow advanced practice registered nurses (APRNs) to practice to the full extent of their education and training. (p.2)

NPs are also PCPs. Their advanced education prepares them to provide initial, ongoing and comprehensive care, including taking comprehensive health histories, performing physical examinations, ordering and interpreting laboratory tests and other studies, and prescribing medication and other therapies. They provide a host of services that emphasize health promotion and disease prevention, but also diagnose and treat acute and chronic illness and disease, working collaboratively

medical Support: A Novel multidisciplinary Approach in Oncologywithin the health care team and referring patients who need specialized care (AANP, 2013).

Based on this medical home model, in August 2013 the Helen F. Graham Cancer Center and Research Institute (HFGCCRI) implemented the Medical Support Multidisciplinary Center (MDC). The purpose of the Medical Support MDC is to provide generalist medical care for acute and sub-acute medical issues arising in cancer patients undergoing treatment related to other non-cancer chronic medical conditions such as diabetes, hypertension, chronic obstructive pulmonary disease, as well as side-effects of therapies prescribed such as nausea, vomiting and diarrhea, or other distressing symptoms. Care is provided in a consultative model with physician support and oversight as well as with the support of a nurse navigator who identifies potential barriers and facilitates appropriate referrals as needed to additional supportive services such as dietary, social work, pharmacy, psychology, physical and occupational therapy.

Multidisciplinary Centers are the best way for patients to see a multiple group of physicians from different specialties who will most likely play a major part in their treatment plan. Complex tasks are accomplished more easily when professionals within health care teams have clear goals, are cooperative and mutually supportive of one another, and are aware of each other’s role. In order to achieve this team effectiveness, team members need to be able to communicate clearly within and across the different professional disciplines and with the patients. The MDC eases access to outpatient generalist medical services during a patient’s cancer treatment while working to reduce hospital admissions and ED visits for issues that can be taken care of in the ambulatory setting.

Through this MDC, the NP consults with the patient’s primary care physicians and oncologist to provide high quality, timely access of multidisciplinary care for cancer and other complex medical problems to patients. The MDC makes scheduled follow up appointments with patients, but also has capacity for same day and emergency visits. The intention of this MDC is not to replace a patient’s primary care doctor, but to provide extra support while undergoing cancer care.

In conclusion, a multidisciplinary team approach provides care for the challenging population of patients with cancer. Optimal care is provided best by a multidisciplinary team approach with diverse capabilities. The multidisciplinary team strives to exceed the expectations of the patients and their families. The patients and families express satisfaction with their care. Increased communication and collaboration by the nurse practitioner and nurse navigator increase the quality of care provided to the patient population and each member of the team is respected for their talents and expertise. This is a perfect example of how nurses are leading the change in healthcare.

ReferencesAmerican Academy of Nurse Practitioners (AANP 2013). Fact Sheet. The Medical Home:

What Is It? How do Nurse Practitioners Fit In? Retrieved from http://www.aanp.org/legislation-regulation/federal-legislation/medicare/68-articles/349-the-medical-home.

American Nurses Association (ANA, 2010). Issue brief: Solving the crisis in primary care. Retrieved from http://nursingworld.org/AmbCareSurvey.

Institute of Medicine. (2010). The Future of nursing: Advancing health, leading change. Washington, DC: National Academies Press.

Institute of Medicine of the National Academies. (1996) Primary Care: American’s Health in a New Era. Washington, DC: National Academy Press, 29.

Patient Centered Primary Care Collaborative (PCPCC, 2012). Defining the Medical Home: A patient-centered philosophy that drives primary care excellence. Retrieved from http://pcpcc.net/content/joint-principles-patient-centered-medical-home.

Principles for Patient-and Family-Centered Care. (2013). The Medical Home from the Consumer Perspective. Retrieved from http://www.nationalpartnership.org/site/DocServer/Advocate_Toolkit-Consumer_Principles_3-30-09.pdf?docID=4821.

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Page 10 • DNA Reporter August, September, October 2014

Oncology care has evolved over the years due to advances in early detection, treatment modalities, and symptom management. The American Cancer Society (2014) estimates that one in three adults will be diagnosed with an invasive cancer in their lifetime while pediatric cancers represent one percent of all new cancers diagnosed in the United States. In addition to these advancements, we are also seeing an increase in the aging population which present unique challenges as some individuals have co-morbid conditions which need to be managed along with their cancer, or may occur as a result of their cancer treatment. With these improvements, oncology nurses have been taking the lead to enhance the care provided to patients and families throughout the cancer continuum.

Oncology nurses practice in a variety of settings and roles ranging from the bedside to clinical trials, navigation, community outreach, genetics, survivorship, home care and hospice, as well as in various outpatient settings such as radiation oncology and in private practices. They can also be found in the pharmaceutical industry, academia, quality improvement and in consultative roles.

The articles in this issue of the DNA Reporter provide a brief overview of just a few highlights of the progress that has been made in oncology care in Delaware and the important contributions that oncology nurses have made and continue to make to improve the patient care experience. From the impact of clinical trials in reducing the mortality from childhood and adult cancers to the improvements made in eliminating the health care disparities in colorectal cancer, oncology nurses have been at the forefront by putting evidence into practice. Oncology nurses have also paved the way to enhancing the care provided to cancer survivors and in multidisciplinary centers by utilizing Advanced Practice Nurses in program development and in providing a medical home to address the complex needs of patients with cancer. Regardless of your practice setting, it is very likely that you will care for a cancer survivor as individuals are surviving and thriving and will be transiting back to providers in their community for ongoing surveillance and continuing health care. It is important that we work together to continue to provide the best possible outcomes for this unique patient population.

I admit I’m biased. I love being an oncology nurse and can’t imagine doing anything else. I have been privileged to work with amazing colleagues who are not only compassionate, but are also the smartest and most dedicated professionals that I know. I have also had the honor to meet and care for, laugh and cry with, a remarkable group of individuals-those living with cancer. This year, the Delaware Diamond Chapter of the Oncology Nursing Society (DDCONS) celebrated its 25th anniversary. Although our theme was celebrating change, and yes, thankfully, things have changed and improved for our patients, I’m glad to know that the heart of oncology nursing has stayed the same.

ReferenceAmerican Cancer Society (2014). Cancer facts and figures. Retrieved from http://www.

cancer.org/acs/groups/content/@research/documents/webcontent/acspc-042151.pdf.

Guest Editor continued from page 1

Mayumi Lea Anthony MiddletownMichele Belson LewesGifty Boateng DoverLisa Bowdle Delaware CityAnnamarie Breeden New CastleDarcy Burbage NewarkJne Campbell BearSylvia Christmas DoverJennifer Cormier NewarkJanet Cunningham NewarkLauren Deaver BearChanai Delbridge SmyrnaDebra Finney MilfordBolanle Folarin Chester, PACharlene Friday LewesLori Gagnon MiddletownSharon Garrick NewarkGregory Grevera Rehoboth BeachNancy Hankin MiltonJessica Heesh Butler FredericaKali Hermann NewarkChristine Hoch NewarkAndrea Holecek LewesJane James NewarkCatherine Jarman SmyrnaCourtney Johnson Newark

Kevin Kempista NewarkTaffi Lang DoverAmanda Lewicki NewarkRobin Maracle CamdenJennifer McCloskey WilmingtonSharon Mills-Wisneski DoverNancy Mwangi TownsendMelissa Mykut SeafordMary Ann O’Neil NewarkAmber Palo HarringtonValeria Pelly SmyrnaJessisca Phippin NewarkMaria Randall DoverVera Robinson Winder BearMargaret Roth HockessinLudmila Santiago-Rotchford CamdenKim Scott DoverDavid Skillman WilmingtonAlicia Smalls WilmingtonMichelle Stokes BearKara Streets MiddletownStephani Sullivan CamdenShari Thomassen BearPaula Tomanovich NewarkCynthia Watson Chadds Ford, PA

ICU Director (Full Time - Hospital): Manages patient care in 9-bed Intensive Care Unit in collaboration with physicians and other care providers; Plans for short and long range strategic and operational goals, service design, and resource allocation; Leads staff with clear vision and direct line of communication; Coordinates care for assigned areas to maximize patient services and outcomes; Works to improve service by encouraging/supporting innovation, creativity and self-management. Bachelor’s Degree in Nursing preferred with minimum 5 years clinical experience required. Minimum 3 to 5 years management experience preferred.

RN Obstetrics (Full Time - Hospital): Works as team member under direction of Charge Nurse and Director; Performs variety of nursing procedures using patient centered approach; Applies critical thinking assuring appropriate care based on patient needs using age specific assessment, communications and knowledge of patients capabilities. Fetal monitoring competency to be completed within first year; Neonatal Resuscitation Program completed within three months of hire. Licensed RN, Delaware license. Experience in acute care facility preferred. Other experience and education may be considered.

RN Wound Care (Standby- Hospital): Works under direction of Director of Wound Care; Assists in developing care plans, pathways and treatment delivery to facilitate optimal care and outcomes; Applies critical thinking assuring appropriate care based on patient needs using age specific assessment, communications and knowledge of patient capabilities; Participates in community education; Substitutes as Hyperbaric Tech as needed; Assists with registration, scheduling and marketing. Graduate of 2, 3 or 4 year RN program. BSN preferred. Completion of approved hyperbaric course with experience in outpatient wound and hyperbaric care preferred. Other experience and education may be considered.

HISTOLIGIST (Standby - Hospital): Prepares tissue and body fluid specimens for microscopic examination by pathologist; Performs special staining or immune-histochemical techniques requested by pathologist; Performs appropriate clerical/computer applications necessary to process and charge for specimens; Participates in education and training activities; May participate in routine administrative and non-routine technical functions within scope of services. Must be flexible and willing to work non-primary areas as needed. Minimum 2 years experience in histology or cytology lab. Must be registered Histology Technician with nationally recognized organization or be registry eligible. May consider a minimum 2 years experience and working knowledge of tissue processing, embedding and microtomy.

Nanticoke Health ServicesNow Hiring Apply Online: www.Nanticoke.org

Nanticoke Health Services is located in Sussex County, Delaware and includes Nanticoke Memorial Hospital, an independent community hospital, and the Nanticoke Physician Network. Nanticoke has been named to Becker’s Top 150 Places to Work in Healthcare for the fourth year.

Sussex County, Delaware is located just 30 minutes from the Atlantic Ocean or from the Chesapeake Bay and provides access to many outdoor activities, parks and waterways.

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August, September, October 2014 DNA Reporter • Page 11

Delaware Today magazine Top Nurses Galamay 21, 2014

Page 12 • DNA Reporter August, September, October 2014

After receiving treatment in an emergency department (ED), a 36-year-old woman died of undiagnosed sepsis. The physician and nurse who treated her were sued by the family.

The lawsuit claimed that the nurse — who had worked a busy, 14-hour shift in the ED — failed to document an elevated heart rate on discharge and failed to tell the physician that the patient had had her spleen removed. The jury awarded the plaintiffs $1.2 million. The nurse was responsible for 40% of that award: $480,000.1

AFTER A BUSY DAY, A FATAL ERROR OCCURRED.

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65007 (8/14) Copyright 2014 Mercer LLC. All rights reserved.Underwritten by Liberty Insurance Underwriters Inc., a member company of Liberty Mutual Insurance, 55 Water Street, New York, New York 10041Administered by: Mercer Consumer, a service of Mercer Health & Benefits Administration LLCIn CA d/b/a Mercer Health & Benefits Insurance Services LLC AR Ins. Lic. #303439 | CA Ins. Lic. #0G39709