Pediatric Oncology Nursing: Support for an Uncertain Journey

Uncertainty—this is an every day occurrence for pediatric oncology patients and their families. The fear and anxiety experienced from the time a child is diagnosed throughout their long journey of treatments and tests needs to be eased by a familiar role: nurses. Jaime Giampapa

Since the very nature of cancer creates an atmosphere of unpredictability and unfamiliarity, pediatric oncology patients and their families need support from nurses who can provide care to meet not only their physical needs, but also their psychological and at times emotional needs. Nurses can make a difference to a family dealing with this illness by providing supportive care. This can be accomplished by nurses using creatively to care for these children, educating their parents, and developing therapeutic relationships along the way.
Cancer can tear a family apart. When a child is diagnosed with cancer, the family is “suddenly placed in the position of coping with a wide array of new situations, such as painful and frightening symptoms, uncertainty of prognoses, and changes in social relationships” (Suzuki& Kato, 2003, p 159). Not only does this foreboding situation put stress on the patient, but the whole family unit, which can be catastrophic. Parents describe the diagnosis and treatment of their child afflicted with cancer as one of the most stressful times of their lives (Kerr, et al., 2007), and this stress can cause a family to become ineffective. Through this tumultuous time, it is vital for the patient and his family to come together in support, and the nurse can aid in this effort.
Firstly, a nurse needs to creatively provide care to their pediatric oncology patients. By using creativity, the nurse may reduce the anxiety experienced by the patient during treatment and procedures, while also meeting physical needs. This is also a more efficient way of providing care. For example, many pediatric oncology patients have aichmophobia (fear of needles or pointed objects). A researched method of reducing this fear is utilizing simple stress reducing medical devices, defined as medical equipment, such as winged needles and syringes, with simple visual stimulation on its surface, such as stickers demonstrated by the picture(Kettwich, et al., 2007) . By using these stress reducing measures, it “has been demonstrated to markedly suppress anxiety, fear and aversion” (Kettwich, et al., 2007, p 21), which will allow the nurse to effectively and efficiently provide care to these patients.
Another creative method for treatment of pediatric oncology patients is beaded bracelets. The John Hunter Children’s Hospital introduced a Bravery Bead program in which patients receive beads spelling their name upon diagnosis and are awarded beads for completing treatments or procedures (Cotterell, 2005). This program provides children going through treatments to look forward to the fun reward of the beads after completion. Although research has not been conducted on how the beads have affected the children collecting them, one can conclude that the bracelets are symbolic of the journey they have traveled thus far. Nurses can play an integral role in implementing this program for their patients.
In addition to providing care to the patient, the nurse needs to be supportive of their parents. Parents are often overlooked when focusing on the patient’s needs, but the parents are dealing with feelings of anxiety and fear as well. Nurses need to recognize that parents “have to cope with the distress [of their child being diagnosed] along with their responsibilities as their child’s primary source of physical and psychosocial support” (Suzuki& Kato, 2003, p 160). If nurses help provide parents with the right tools to cope with their child’s illness, the child will most likely cope effectively as well. The most important tool, as identified by parents of pediatric oncology patients in a conducted study, was basic information about their child’s illness (Kerr, et al. 2007), which the nurse can address by answering questions parents may have about their child’s cancer. By locating some reliable resources (such as pamphlets, booklets and internet sites) for parents, as well as referring them to various support groups or information sessions, the nurse can attempt to fulfill the parent’s needs. In addition, 84% of the same “parent need” study revealed that emotional needs were also important for the nurse to address (Kerr, et al., 2007).
Finally, nurses need to develop a therapeutic relationship with the pediatric oncology patients and their families. The ideal therapeutic relationship is described as “the nurse combin[ing] the basics of everyday care with the human touch” (Hawes, 2005, p16), which allows the parents to feel their child is in the right hands. Trust is of utmost importance among the patient, his parents and his nurse. The relationship should be connected, but not to the point of over-involvement. This may be characterized as the nurse “tak[ing] on the role of ‘omnipotent rescuer’” (Hawes, 2005, p 15) in which the nurse has become controlling within the relationship overstepping necessary boundaries. Care should be shared between families, and the nursing staff in complete balance.
In conclusion, nurses can make the difference in pediatric oncology by providing complete supportive care for the patients and their parents. For years, nurses have been known as the “caring role” in our society, and nurses fill that role with pediatric oncology patients by establishing a care plan that involves a holistic approach to nursing. This can be accomplished by nurses creatively providing care to these children, educating their parents, and developing therapeutic relationships during their journey to recovery. The nurse develops a professional, but compassionate, relationship with the patient and the family to give complete care that will meet all their needs, physiological and psychological.


Disadvantages

A. Nurses develop therapeutic relationships with pediatric oncology patients and their families.
I. Nurses can become too involved with the patients and their families.
A nurse can become the “omnipotent rescuer” for a particular family, which can develop into an unhealthy relationship for the nurse and the family involved. This relationship usually occurs when the nurse is inexperienced and does not know how to set boundaries between themselves, the patients and their families, indicating over-involvement. Common behaviors for blurred boundaries include the nurse-patient relationship transforms into social context, also the nurse can become controlling in the patient’s care at the expense of the patient. Nurses who fall into this type of therapeutic relationship need to develop boundaries to care for the patient, but not escalate the situation to the point that it is unhealthy for the pediatric oncology patient and the nurse providing the care. By learning from mistakes and listening to experiences of mentor nurses, pediatric oncology nurses can learn to develop positive therapeutic relationships

Hawes, R. (2005). Therapeutic relationships with children and families. Paediatric Nursing, 17(6), p15-18. Retrieved October 12, 2007, from Expanded Academic at http://web.ebscohost.com.

II. Culture, ethnicity and race can reduce the effectiveness of a therapeutic relationship between the nurse and pediatric oncology patients and their family.
Some families of patients with cancer have different beliefs and practices due to their culture, ethnicity and race. This can prove to be a barrier in developing a positive therapeutic relationship with the nurses providing care. If the nurse is not thoroughly informed of the family’s individual culture, communication may be very difficult to achieve. This is especially true when the patient and their family speak a different language. In this situation, an interpreter may not always be available for the nurse to keep the family involved in their child’s care. It is often difficult to use children, family members and friends of the family to translate because this form of communication may not allow the patient’s family to speak openly about the care of their child. The barrier of communication continues if the nurse fails to incorporate traditional cultural beliefs of a family into treatment plans which can cause the family to not trust the nurse and staff to effectively care for their child. A nurse in this situation must learn to effectively communicate with the family in order to provide the optimum care for the pediatric oncology patient and develop the vital therapeutic relationship.

Wong, D.L., Perry, S.E, Hockenberry, M.J., Lowdermilk, D.L., Wilson, D. (2006) Maternal child nursing care: 3rd ed. St. Louis, Missouri: Mosby Elsevier. p 1219-1220

B. Nurses educate parents of pediatric oncology patients
I. Parents are stressed due to their child’s status and may not retain the information taught.
Parents of pediatric oncology patients are not retaining the essential information taught because of their stress at the time of education and minimal opportunity to have proper education. Due to the increase in ambulatory care and short hospital stays, the available time to properly educate parents has decreased, and therefore, so has the absorption of information. Important aspects to the patient’s care, such as “the signs that should cause alarm and long-term implications of a disease” can contribute to ignorance of how to adequately care for their child (Fox, Smith, 2003). Not only is short hospital time reason for poor digestion of information, but also their stress levels are not conducive to learning. According to Fox and Smith, most parents need additional information after their child has been discharged and cannot recall the information provided at the hospital. Therefore, because of the parent’s heightened stress level, they forget the instructions about their child’s care. Nurses must use different forms of providing information, such as pamphlets and resourceful internet sites, to enforce information learned in the hospital and prevent parent confusion.

Fox, A., Smith, P. (2003) Parents and the internet. Internet journal of pediatrics & neonatology. 3(1), p 110-116.

II. Parents that have lower socioeconomic status and education may not be able to comprehend the education regarding their child’s illness.
When parents of pediatric oncology patients have a lower socioeconomic status and have lower levels of education, the understanding of their child’s treatment may not be fully comprehended. These parents are not able to process and make sense of the information given by nurses, and may lead to misunderstandings and confusion. This is not conducive to an acceptable ability to provide knowledgeable care to their child. Parents in this group also cannot understand distressing aspects of their child’s illness because they do not understand the process behind the cancer. Although there is not sufficient data to fully support the correlation between lower education and uncertainty, one can conclude that these two topics are related. In order to combat confusion and uncertainty in these situations, the nurse must use understandable information for these parents to comprehend, and then check their knowledge after education.

Santacroce, S. (2002) Uncertainty, anxiety and symptoms of posttraumatic stress in parents of children recently diagnosed with cancer. Journal of pediatric oncology nursing. 19, p 104-111

Resources

Cotterell, D. (2005). Beads for a brave journey. Australian Nursing Journal, 13(3), p31-32. Retrieved October 12, 2007, from Expanded Academic at http://web.ebscohost.com.

Fox, A., Smith, P. (2003) Parents and the internet. Internet journal of pediatrics & neonatology. 3(1), p 110-116.

Hawes, R. (2005). Therapeutic relationships with children and families. Paediatric Nursing, 17(6), p15-18. Retrieved October 12, 2007, from Expanded Academic at http://web.ebscohost.com.

Kerr, L., Harrison, M., Medves, J., Tranmer, J., & Fitch, M. (2007) Understanding the supportive care needs of parents of children with cancer: An approach to local needs assessment. Journal of Pediatric Oncology Nursing, 24, 279-293.

Kettwich, S., Sibbitt, Jr., W., Brandt, J., Johnson, C., Wong, C., & Bankhurst, A. (2007) Needle phobia and stress-reducing medical devises in pediatric and adult chemotherapy patients. Journal of Pediatric Oncology Nursing, 24, p 20-28.

Santacroce, S. (2002) Uncertainty, anxiety and symptoms of posttraumatic stress in parents of children recently diagnosed with cancer. Journal of pediatric oncology nursing. 19, p 104-111

Suzuki, L. & Kato, P. (2003) Psychosocial support for patients in pediatric oncology: The influences of parents, schools, peers and technology. Journal of Pediatric Oncology Nursing, 20, p 159-174.

Wong, D.L., Perry, S.E, Hockenberry, M.J., Lowdermilk, D.L., Wilson, D. (2006) Maternal child nursing care: 3rd ed. St. Louis, Missouri: Mosby Elsevier. p 1219-1220