Service Learning Project

Kristen Sismilich, B.A.University of South Florida

Clinical AgencyBaypines VA: Hematology/Oncology Clinic

Services provided: chemotherapy, transfusions, lab work, biotherapy, broad spectrum antibiotics

Partnerships: American Cancer Society, Oncology Nursing Society

Preceptor: Cindy Bowman, RN, MSN/Nursing Education, OCNnational oncology educator

Client PopulationVeterans with cancer receiving outpatient

chemotherapy

DemographicsWWII, Korean Conflict, Vietman Era, Gulf War Era,

Operation Enduring Freedom (Iraq, Afghanistan)Race: majority are white; 11% black, 6% hispanic,

4% other (American Indian/Alaska Native, Asian, Pacific Islander)

Gender: 10% female (Veteran Population Projections: FY2010 to FY2040)

Health Needs of Population

Major health problems: cancer, co-morbidities

Appropriate education tools regarding chemotherapy side effects and when to seek medical attention

Goal of SLP: Veterans undergoing chemotherapy will be aware of the signs and symptoms that require immediate medical attention

RationaleLife threatening side effects

New patientsReceive ample amounts of information all at one

timeOverwhelming

Create a tool that is easy to access, read, understand and rememberPictures, description of side effects, numbers to

call

Healthy People 2020 Objective: Improve the health literacy of the

population

Increase the proportion of persons who report their health care provider always gave them easy-to-understand instructions about what to do to take care of their illness or health condition (Healthy People 2020)

Relationship to SLP: development of tool

Description of SLPGoal: nurses to understand the rationale for tool

Objectives: By the end of the lesson chemo nurses will be able toDemonstrate patient teaching at the beginning of

chemotherapy (application)Classify signs and symptoms in order of their

severity (analysis) Justify the necessity of monitoring for specific

signs and symptoms during chemotherapy (evaluation)

Presentation Poster

Healthy People 2020 Objectives Chemotherapy related side effects

Damage to rapidly dividing stem cells Drug toxicity

Symptoms Fever (neutropenia) Nausea/Vomiting (dehydration, noncompliance) Dyspnea/SOB (anemia, cardiovascular, pulmonary toxicity) Burning (UTI, dehydration, cellulitis) Bleeding (thrombocytopenia) Pain (IV infiltration or infection) Oral mucositis (Gates & Fink, 2008, & Polovich, Whitford, & Olsen,

2009) Tool

When To Contact Your Doctor

Blood Mouth Sores

FEVER

Burning Pain

Shortness of Nausea and

Breath Vomiting

Call the Hematology/Oncology Clinic#727-398-6661 OR #888-820-0230 ext. 5125

Monday - Friday 7:30 to 4:30(if clinic is not open, go to the emergency room)

FEVER: If you have shaking, chills, or a fever greater than 100.4, go to the emergency room.

Vomiting: If you have you have vomiting for more than 24 hours or if you are unable to eat or drink.

Blood: If you have black stools, blood in the stools, or any other unusual bleeding or bruising.

Shortness of Breath: If you have an unusual cough, sore throat, lung congestion, or shortness of breath.

Pain: If you have intense pain in a new place, or pain that does not get better after taking pain medicine.

Burning: If you have burning when you urinate or blood in the urine, or if you have burning at your IV site.

Mouth Sores: If you cannot eat because of mouth sores or if you have white patches or red areas.

Any new or unusual symptom that lasts more than 1 day.

Modifications During Planning

Patient feedbackAre they aware of side effectsDo they know when to contact providersAre their caregivers awareMore beneficial for new patients vs “veteran”

patients

Added days and hours of clinic

Participant ResponseNurses

appreciated and valued development of tool

PatientsResponded positivelyThought tool would be useful and beneficial

To achieve goal in future: implementation of tool

ImplementationTool has to be submitted and approved by the

VA Include in welcome packet

EvaluateNumber of calls to chemo clinicNumber of patients reporting to emergency room

Impact of Health PolicyPatient Protection and Affordable Care Act

Health literacy: degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions

Research: health information is presented in ways that are not usable by most adults

CDC: every organization involved in health information and services needs its own health literacy plan to improve its organizational practices

Create health information and services that truly make a positive difference in people’s lives

Low Health Literacy and Health Outcomes: An Updated Systematic

Review 80 million Americans have limited health literacy

Greater risk for poorer access to care and poorer health outcomes

Update 2004 systematic review Determine if low health literacy related to poorer use of health

care, outcomes, costs, disparities in health outcomes

Low health literacy associated with poorer health outcomes and poorer use of health care services

Finding ways to reduce effects of low health literacy on health outcomes justifies the attention of policymakers, clinicians, and other stakeholders (Berkman, Sheridan, Donahue, Halpern, & Crotty, 2011)

ReferencesBerkman, N., Sheridan, S., Donahue, K., Halpern, D., & Crotty, K. (2011). Low Health Literacy and Health Outcomes: An Updated Systematic Review. Annals of Internal Medicine. Vol 155(2), 97-107.

Centers for Disease Control and Prevention. (2011). Health Literacy. Retrieved from http://www.cdc.gov/healthliteracy/learn/index.html

Gates, R. & Fink, R. (2008). Oncology Nursing Secrets. St. Louis, MI: Mosby Inc.

Healthy People 2020. (2013). Retrieved from www.healthypeople.gov/2020

Polovich, M., Whitford, J., & Olsen, M. (2009). Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Pittsburgh, PA: Oncology Nursing Society.

Veteran Population Projections: FY2010 to FY2040 (n.d). Retrieved from http://www.va.gov/vetdata/docs/QuickFacts/Population_quickfacts.pdf