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We are a large SIG by membership, but we tend to have the same core group of members attend the SIG meetings each year. Ideally, professional ethical behavior and accountability are synonymous and will mirror the organization’s mission statement and code of ethics. Conflict may arise when individuals within a healthcare system do not perform in a manner that is perceived as fulfilling the defined institutional ethical standards.
This author proposes an assessment of ethical standards at the time of hire and open discussion of jobs within that organization that are a good fit for the individual’s values.
Private and governmental agencies evaluate and determine acceptable clinical activities and institutional performance for healthcare accreditation. This article was written with the intent of assessing the potential need for the organizational ethics evaluation of employees upon hire, matching of employees with appropriate positions, and organizational ethics grading. The spinal cord is a long, hollow bundle of nervous tissue running parallel along the upper two-thirds of the spinal column and ending at the L2 vertebrae. Compression of the spinal cord can occur from collapsed vertebrae or the presence of a tumor and causes neurologic dysfunction.
SCC occurs from tumor invasion of the vertebrae, causing its collapse into the spinal cord as well as from direct tumor invasion of the spinal cord and neural tissue, resulting in obstructed blood flow and neurologic damage. Eighty-five percent of oncologic SCCs occur as a result of metastatic tumor invasion, whereas only 3% are caused by primary malignancies of the spinal cord. Compression of the spinal cord inhibits neural function, resulting in disabilities ranging from sensory and motor dysfunction to complete paralysis.
Late symptoms consist of bowel and bladder incontinence, sexual impotence, muscle atrophy, and paralysis.
Magnetic resonance imaging is the diagnostic procedure of choice to detect spinal cord compression.
Pain relief is treated through the use of corticosteroids and opioids; anticonvulsants and antidepressants should be the first goal of treatment.
Therapy should be aimed at treating the underlying malignancy through the use of radiation, surgery, and chemotherapy. The superior vena cava is a thin-walled vessel located in the right anterior superior mediastinum and is surrounded by the sternum, trachea, aorta, right bronchus, lymph nodes, and pulmonary artery. It collects venous drainage from the head, neck, upper extremities, and upper thorax and transports it to the right atrium. Because of its location in the thorax, the superior vena cava is vulnerable to compression. Mechanical obstruction of the superior vena cava can occur from the presence of a tumor, enlarged lymph nodes, or a thrombus and causes a decrease of venous drainage from the head, neck, arms, and thorax.
The development of SVCS is dependent upon the growth rate of the tumor, the extent and location of the blockage, and presence of collateral circulation. SVCS results in impaired venous drainage, consequently causing increased venous pressure, decreased cardiac output, and venous stasis. SVCS is most common in patients with advanced lung cancers and non-Hodgkin lymphoma but also occurs in patients with tumors of the mediastinum, metastatic breast cancer, and germ cell tumors. Later symptoms include headache, visual disturbances, change in mental status, hypotension, tachycardia, respiratory distress, dysphagia, and hemoptysis. Treatment is based on the origin of the primary cancer and may include radiation, chemotherapy, or surgery.
The brain is a closed system with three components: the brain, cerebrospinal fluid (CSF), and the vasculature and blood supply. ICP is defined as an increase of pressure within the skull that can result from or cause brain injury. This increased pressure can cause damage to the central nervous system (CNS) but also can cause a restriction in blood flow to the blood vessels that supply the brain. Early symptoms include headache, change in mental acuity, change in level of consciousness, restlessness or agitation, blurred vision, dizziness, neck stiffness, anorexia, and nausea and vomiting. Late symptoms include weakness, decreased level of consciousness, seizures, ataxia, papilledema, hemiparesis, and aphasia. For a sudden increase in ICP, treatment may include breathing support, draining of cerebrospinal fluid to lower pressure in the brain, medications to decrease swelling, and in rare cases, removal of part of the skull. Prognosis is dependent upon rapidity of fluid accumulation, amount of pressure, prompt diagnosis, and treatment. The pericardium consists of a thin, fibrous sac with two layers: viseral layer and parietal layer. Increased venous blood return can cause increased venous pressure, which can lead to decreased stroke volumes, decreased cardiac output, and poor tissue perfusion. Early symptoms include chest pain, dyspnea, cough, muffled heart sounds, anxiety or agitation, weak or absent pulses, hiccoughs, hoarseness, and fatigue.
Late symptoms include tachycardia, tachypnea, peripheral edema, narrow pulse pressure, increased central venous pressure, change in mental status, pulsus paradoxus greater than 10 mm Hg, fever, oliguria, and cyanosis.
The author wishes to express that she has been a paid clinical consultant by Merck, Inc., in the past 12 months. In August 2010, ONS:Edge distributed a summary of a survey of nursing knowledge related to invasive fungal infections (IFI) in patients with cancer. This Merck sponsored survey of ONS members commenced in 2007 by reaching out to nurses having contact with patients at high risk for fungal infection. Approximately three quarters of the oncology nurses display a good understanding of the risk of IFIs in their patients with myelodysplastic syndrome, prolonged neutropenia, and acute leukemia and undergoing hematopoietic stem cell transplant.
Other populations at risk for IFIs include those receiving high-dose corticosteroids, TNF-alfa antagonists, and IL-2 receptor antibody. Nurses responding to the survey recognize that they have an important role in direct management and education of these patients. The most compelling finding of this survey is that nurses are concerned about a rising incidence of these clinical complications among their patients. Patients with a hematological malignancy (HM) may become critically ill as a result of their disease process and its treatment. Several factors have improved ICU survival such as non-invasive mechanical ventilation, prophylactic antibiotics, administration of growth factors, and earlier admission.

Studies found that the type of HM did not predict outcome, and remission status did not influence short-term survival.
Patients receiving SCT (autologous or allogenic) often require support of ICU after transplant. After admission to the ICU, respiratory failure and the need for mechanical ventilation was consistently a predictor of poor outcome. When deciding to admit patients with HM to the ICU for resuscitation and intensification of care, all variables surrounding the patients’ underlying disease process need to be examined. RE:Connect is a blog written by oncology nurses on a variety of topics of interest to other nurses in the specialty, including facing day-to-day challenges at work, juggling busy lives at home, and keeping up to date with the magnitude of information available for practicing nurses.
In the latest issue of ONS Connect, the Five-Minute In-Service takes a look at How Much Time Nurses Need to Give Chemotherapy, which appeared in the December 2010 issue of the Clinical Journal of Oncology Nursing. In the first-ever installment of CJONPlus, Cindy Tofthagen, PhD, ARNP, AOCNP®, addressed questions based on a descriptive study she conducted with adults experiencing chemotherapy-induced peripheral neuropathy.
If you do not provide an e-mail address, you will not be notified when a new SIG newsletter or communiqué is posted. Receive information about the latest advancements in treatments, clinical trials, etc. Participate in ONS leadership by running for SIG coordinator-elect or join SIG work groups.
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If you created log-in credentials for the ONS Web site and wish to have different log-in information, you will not be able to use the same e-mail address to generate your new credentials. Once you have your log-in credentials, you are ready to subscribe to your SIG’s Virtual Community discussion forum. As an added feature, members also are able to register to receive their SIG’s announcements by e-mail. To print a copy of this newsletter from your home or office computer, click here or on the printer icon located on the SIG Newsletter front page. The Oncology Nursing Society (ONS) does not assume responsibility for the opinions expressed and information provided by authors or by Special Interest Groups (SIGs). Our SIG was able to sponsor one of the educational offerings at IOL this year, and the planning for Congress in 2011 is already underway!
I hope that with the addition of more CNE credits, more members will attend, and those who are interested in membership can see what we have to offer. It is a distinct aspect of professional excellence, yet it may have variable features depending on the professional role or context of practice (Johnson & Ridley, 2008).
Standards for codes of ethics were developed in the 1990s and encompass business and staff employment standards. Several measures indirectly address these issues in the form of mandates to assess patient and staff satisfaction and evidence of healthy work environment standards.
Some questions that need to be addressed include: Do you think an ethics questionnaire is practical, and can it achieve the stated goal? Responses that are sincere and truthful will contribute to evidence-based research of this topic. With greater numbers of these patients surviving with their disease and living in their homes and communities rather than the hospital, the importance for all oncology nurses and many home health and primary care practices to be knowledgeable about IFIs has escalated.
With proper preventive strategies, we believe that this serious clinical problem can be minimized. Early intervention and management may increase survival, but when considering life-saving measures, decisions need to be based on what is best for the patient. However, a poorer prognosis exists for patients needing mechanical ventilation and cardiopulmonary resuscitation (CPR).
However, patients need to be reassessed continually about choosing to continue treatment or withdraw support. However, worse outcome was predicted in patients with myeloma with a lack of complete remission and patients with acute leukemia in relapse or refractory status. Studies show that the rate of survival among patients who have received SCT has increased since 1998.
Organ failure has a poor prognostic outcome, but it is the same for patients with or without cancer. The author stated that cancer patients are often overoptimistic about their survival prognosis. The decision to treat or not treat should rely on the clinical picture and the terminal state of the disease. Erickson discusses her article and describes patterns of fatigue through the eyes of the adolescent. Do you want to easily stay up to date with all of the evidence in particular PEP topic areas or learn more about summarizing and critically appraising evidence? You still will receive your SIG information as part of your membership as long as we have a valid e-mail address on file for you. Print copies of each online SIG newsletter also are available through the ONS National Office. Acceptance of advertising or corporate support does not indicate or imply endorsement of the company or its products by ONS or the SIG.
We hope to have a program of specific content that will earn continuing nursing education (CNE) credits for members who attend the SIG meeting. In the past decade, healthcare professionals have experienced an increased emphasis on professional accountability.
They serve to merge the interdependent features of the patient and staff systems with the external business and community system. In some institutions, interpreting actions and determining or enforcing a disciplinary action can be an individual managerial decision. The introduction of ethics grading through the normal accreditation process permits organizations to learn of their weaknesses and concentrate on strengthening the healthy work environment. All responses are appreciated and will be used to increase awareness and improve and provide ethical patient care.

On a whole, nurses recognize the clinical problem that is present in the risk for IFIs and strategies for prevention and management, but gaps in the knowledge are apparent. Intensify, resuscitate, or palliate: Decision making in critically ill patient with hematological malignancy. The fact that hospitals vary in patient selection criteria and level of ICU support places limits on the comparison studies. Several studies showed that poor performance status one week prior to the patient being admitted to the hospital was an independent factor for poor prognosis. Patients who have received SCT with allogenic cells have more frequent admissions to ICU secondary to the increased rate of pulmonary complications. A discussion with the patient, family, and the multidisciplinary team needs to take place, and the patients’ values and preferences always should be honored.
As a reader, join in on the conversation and connect with other oncology nurse readers by posting your own stories, tips, ideas, and suggestions in the comments section at the end of each blog post. Please feel free to e-mail me and let me know what topics would interest you so that we can incorporate them into our SIG meeting. Institutions view this as a responsibility to maintain patient safety and wellness but also to include the conscientious use of healthcare resources and money within an allotted timeframe. This may result in biased interpretations that do not account for appropriate human resource issues such as limitations placed upon the individual who performed an action deemed inappropriate. Assessment should address the institution’s practices related to hiring, terminating, error management, training, communication, and civility. Have you noticed an increase in patient and staff dissatisfaction that the patient or staff may be reluctant to report? In some cases, such as advanced directives and terminal irreversible illness, escalation of care would be inappropriate. A six-month and one-year survival study in patients with HM demonstrated a long-term survival rate if discharged from the hospital. Conflicting studies exist on whether neutropenia was a significant predictor of outcome, although the majority of the studies showed that it was not.
Interestingly though, degree of donor and recipient match, remission status, underlying disease, and source of stem cells were not predictors of survival.
This could be because of the media’s portrayal of high survival rates for patients after cardiac arrest.
Those who participate in PEP activities are eligible for ONC-Pro points on an annual basis. The system should provide a clear, unbiased, and democratic evaluation of reported errors in judgment or action with consideration of possible training or education deficiencies, time constraints, workload demands, and personal incapacities such as addiction or mental illness.
Standard assessment tools for this purpose have not been developed at this time but are becoming a valued addition to the clinical work of an organization. However, with the increasing survival rate of patients with HM, decisions need to be made on whether to intensify, resuscitate, or palliate.
Studies done by Gruson and Benoit showed that patients with bacterial infections had a better survival prognosis than those with fungal infections; it was presumed that this was because of the reversible nature of bacterial infections. Some studies show early admission after transplant had worse outcomes while others showed later admissions had worse outcomes.
It is important to talk to the patient about quality of life after an arrest, including functional and neurological disability.
The system should clearly state and inform all employees of actions they consider to be work-related and those that will incur involvement of licensure boards.
The healthy work environment that embodies accountability by individuals and the system ultimately will result in best practices and a safe work environment.
This article recognizes that treatment decisions are complex and difficult and must be individualized to the patient. Graft versus host disease requiring steroids was shown to be an independent poor prognostic predictor.
The scoring systems may have a useful role in providing information to families and patients about prognostic outcomes to help them make end-of-life decisions. These ethics experts could, but may not, be the same as the clinical ethics committees focusing on patient and family conflicts. Patients should not be denied intensive care unit (ICU) admission or escalation of treatment based solely on their underlying malignancy. Patients who have received SCT with hepatic and renal failure have a predicted mortality rate of 98%–100%.
As with any ICU illness, survival depends on response to treatment, the number of organs failed, days on a ventilator, and duration of ICU stay. These ethics experts could be consulted on issues such as patient and staff interactions, use of hospital resources, or staffing standards.
This article discusses several variables that impact survival of patients admitted to the ICU. Factors such as cancer prognosis, co-morbidities, preadmission status of the patient, and clinical circumstances surrounding the arrest need to be taken into consideration. There should be clear established criteria for the nature of conflicts that will be resolved within the institution and those which will be referred to licensing organizations.
If it is not believed that the patient will survive the CPR attempt, then it should not be offered.
Staff concerns that are referred to licensing agencies should be transparent and clear to all individuals involved.
However, if there is a chance of survival, but the outcome complications outweigh the benefits, the physician should speak with the patient and family.

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