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  1. 1. Service Learning Project Kristen Sismilich, B.A. University of South Florida
  2. 2. Clinical Agency  Baypines 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, OCN  national oncology educator
  3. 3. Client Population  Veterans with cancer receiving outpatient chemotherapy  Demographics  WWII, 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)
  4. 4. 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
  5. 5. Rationale  Life threatening side effects  New patients  Receive ample amounts of information all at one time  Overwhelming  Create a tool that is easy to access, read, understand and remember  Pictures, description of side effects, numbers to call
  6. 6. 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
  7. 7. Description of SLP  Goal: nurses to understand the rationale for tool  Objectives: By the end of the lesson chemo nurses will be able to  Demonstrate 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)
  8. 8. 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
  9. 9. When To Contact Your Doctor Blood Mouth Sores FEVER Burning Pain Shortness of Nausea and Breath Vomiting
  10. 10. 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.
  11. 11. Modifications During Planning  Patient feedback  Are they aware of side effects  Do they know when to contact providers  Are their caregivers aware  More beneficial for new patients vs “veteran” patients  Added days and hours of clinic
  12. 12. Participant Response  Nurses  appreciated and valued development of tool  Patients  Responded positively  Thought tool would be useful and beneficial  To achieve goal in future: implementation of tool
  13. 13. Implementation  Tool has to be submitted and approved by the VA  Include in welcome packet  Evaluate  Number of calls to chemo clinic  Number of patients reporting to emergency room
  14. 14. Impact of Health Policy  Patient 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
  15. 15. 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)
  16. 16. References Berkman, 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 Gates, R. & Fink, R. (2008). Oncology Nursing Secrets. St. Louis, MI: Mosby Inc. Healthy People 2020. (2013). Retrieved from 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