Constance Ziegfeld, Acting Director of Oncology Nursing, details a change in the approach of oncology nursing. The editorial was originally published in 1989. It is reproduced below and is also available for download.
Oncology nursing at The Johns Hopkins Hospital changed in 1977, when the Oncology Center opened. Before that time, nurses took care of patients throughout the hospital without the benefit of specific oncology education and support services. There was inconsistency in the approach to patients’ problems and in the use of the hospital’s resources. The opening of the Oncology Center changed all that, allowing us to develop a new approach to oncology nursing. Bright, new graduates, with a core of experienced oncology nurses, were eager to learn and to apply their intelligence and skill to provide the best possible care for cancer patients at a time when tremendous strides were being made in the field of oncology.
Our initial efforts concentrated on education of our nurses, patients and their families, and health care providers from other disciplines. Oncology nursing is different from other types of nursing. The problems encountered are multivaried and somewhat unique. The success of these efforts would not have been possible without the inspiring leadership of Linda Arenth, who is now a vice president of the hospital. Part of what makes nursing so special at the Oncology Center is its integration with other disciplines and the rich resources that the hospital provides. Although most of our nurses maintain bedside responsibilities, clinical specialists, educators, and researchers provide additional resources to improve patient care. The consistent theme around which all of our activities are oriented is improving the quality of life for our patients and their families.
Some of the programs that have been developed by our nurses have attracted wide attention because of their value and efficiency. Vivian Scheidler has developed special expertise in pain management and has, in collaboration with physicians, developed an effective program of educating nurses and physicians about managing pain in cancer patients. She is a resource for physicians and other health care providers on pain management, as well as an accumulator and analyst of information obtained from various research efforts relevant to this subject. Her expertise is projected into the community. Providing information and materials to physicians outside the Center and to other health care providers makes her work special.
Another nursing program here, developed by Patti Wilcox, is that of breast evaluation. The program was developed in response to the observation that, despite all the progress being made in diagnosing breast malignancies, many women in the community did not avail themselves of the resources here, either through fear or ignorance. Under Ms. Wilcox’s guidance, a group of nurses here started a breast evaluation program for women in the community who had breast problems. The program includes screening and education and also makes referrals to physicians. Working with Dr. Mike Stefanek, a psychologist, Patti Wilcox has also developed a program for high-risk family members of breast cancer patients.
Nurses are involved in several research projects at the Oncology Center. One of these explores the various techniques of breast examination used by professionals and patients. Periodically, we must take a hard look at so-called “tried and true” procedures to make sure that we really need them. We also have two ongoing research projects geared to what we considered to be major nursing problems.
One of these projects involves identification of the best techniques for indwelling catheter dressings. We have been applying such dressings routinely for many years, but is our method the best way of preventing infection? Is it the most cost efficient and best for the nurse? The other research problem involves the routine administration of medication prior to infusion of blood products. Does such predication cause side effects? How does it affect the administration of blood products? We are looking into these important questions, trying to find out if procedures that we have long taken for granted may need to be drastically changed to improve patient care.