The not-so-clinical skills

Placement allocation. A daunting prospect for all! There are, as always, disappointments. Many of these are for valid reasons, such as very similar/the same as another placement, too far away or you’ve experienced it as a service user/you worked there.

But I’ve noticed that many people (including myself previously!!!) get disappointed with placements if they aren’t “hands on” enough. But why?

We all enter into nursing for different reasons, and many of us will prefer “more clinical environments” than others. But does this mean that we should expect these placements throughout our studies? No! Because that wouldn’t reflect what nursing is!

Even with the nursing role changing, the non-clinical skills such as communication, leadership, delegation and teamwork will always be at the forefront of nursing. These skills may seem “soft”, but they are the bread and butter of our practice and are transferable across all jobs!

I’ll use an example of my own.  My first ever placement was on outpatients, and I was gutted! Most of my nursing friends were off living the dream on wards, whilst I was falling asleep in doctor’s consultations. The staff were lovely, but I wanted more! I was convinced that my time in outpatients was a write off, completely pointless to my nursing education. Surprise surprise, I was wrong! My listening skills improved greatly, and, since I spent so much time noting down words I did not understand, I learnt a lot about pathology. Whilst at the same trust later on in my degree, I was able to reassure patients and relatives about the outpatient clinic process. When I held someone’s hand during a painful procedure, I learnt how even the smallest of actions can make a difference. And I still fondly remember when I was present whilst someone was being told they were cancer free, and I cried with the patient and their mother. These experiences and lessons have stayed with me throughout my training, and I am so grateful for that!

Clinical skills can be taught at any time in your career, whether you are in your first year of training or you have been practising for 30 years. But the non-clinical skills, those are harder to teach. They require time, experience and reflection. And remember; your degree is the start of your learning, not the end!! 

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Spoke with Learning Disability nurses, in the community!

As the end approaches for me, I been thinking more and more about what experiences I want to have before I become a qualified nurse. The beauty of being a student is the range of places you can go, especially when its an area you might not otherwise experience!

When I signed up to do my spoke with the community learning disability nurses, I was excited. I’ve had quite a few personal experiences with caring for people with learning disabilities, but very little exposure during my training. My aim of the spoke was to understand the role of an LD nurse better, as well as gain a better understanding in how I can support patients I will have in the future.

I’ll start by saying that the team who looked after me for the day were fantastic. They were super welcoming, made me laugh a LOT and were all happy to teach me. The day started (after cups of tea, obviously) with a meeting, which included looking at one patient in detail and discussing the best plan.

In the afternoon, myself and one of the nurses visited a patient who had been discharged but was up for review. We met with the patient, the manager of the home he lived in and went through the original nursing assessment, ensuring that any changes were updated. As the waiting list is very long for this team, these reviews aim to keep the patient in their own care and give advice to those caring for them.

My spoke allowed me to understand that learning disability nurses have a very holistic role, and are often at the centre of someone’s care. Referrals for the service can range from talking to young people about sex, relationships and consent to helping a home co-ordinate different services. I had never considered the breadth of their role, but I will now!

Many students can be worried about caring for a patient with learning disabilities, as it is often “unknown territory” and often requires different methods of communication. Everyone who had a learning disability should have a hospital passport, which should include the necessary information to help care for your patient. The link nurse for learning disabilities and of course (if the patient has one) the community learning disability nurse can also help with any questions.

I can 100% recommend getting a spoke with a Learning Disability nurse, whether its in community or in the hospital!

 

If you’ve had an interesting spoke/exposure and want to blog about it, please contact us via email/Facebook/Twitter/Instagram!

 

“The Student”

Being addressed as “the student” is not my favourite thing in the world. I’ve never spoken up about it, but I feel it makes you into a commodity as opposed to a human being who is there to learn. My usual response is to introduce myself, and keep introducing myself until people understand that I have a name. It sounds daft I know, but it tends to work.

But sometimes introductions are not enough.. I was working a Saturday shift, in order to see my mentor, and it was my 3rd day of placement that week. During handover, I noticed that my mentor wasn’t there and none of the nurses were regular members of staff; but agency staff who I had seen once or twice. I was really disheartened that my mentor didn’t turn up. And then, after handover, they allocated the Trainee Nursing Associate with a nurse, and left me standing there like a proper lemon.

I was hurt. I’d spent the past 2 days working really hard on placement, during the snow and short-staffing. I thought I was finally somewhat integrated in the team.  The tiredness, shock and hurt built up, and I had to retreat to the staff room to try and calm myself down. I just kept thinking, I’m third year! I shouldn’t be doing this! Why am I upset!

I knew why. I’m a confident person, happy to talk to anyone and everyone. But when you’re in a room of people and nobody acknowledges your existence, confidence can be hard to come by.  After some kind and supportive words from my boyfriend (an endlessly calming presence even via text), I knew it was my responsibility to make something of this situation. So I spoke to the nurse in charge and (after being passed between 3 different nurses), one finally agreed to take me.

I ended up having an okay day, and the nurse I was working with let me be mostly autonomous, and still made time to teach me about NG tubes and giving medication down them. At the end of the shift, she apologised for not wanting to take me on initially. She felt that, with the time pressures and being an agency nurse, it wouldn’t be fair to me. I explained that as a third year, and having been on the ward for a few weeks now, I was quite happy being somewhat autonomous and would ask if I needed anything/wanted to learn about something.

This experience threw me, and I need to raise it with someone so it doesn’t happen again. But it did teach me how important it is to communicate your needs to whoever you’re working with, and make yourself known. It’s not easy, and it can be daunting, but it needs to be done!

If you’ve had a similar experience, feel free to comment and share your story.

If you’re interested in writing a blog for us, about anything student nursing related, please find us on Facebook, Twitter or email us.

What to take on your first ever day of placement

Planning for placement can be tricky when going for the first time. Having had no healthcare experience prior to my first placement on an elderly medical ward, I had no idea what to expect or what I might need to bring with me for my first shift. Two years on, there are now staple items I never leave for placement without. Aside from the essential lip-balm and hand cream, here are my top tips on what to bring for your first shift:

Directions to placement google maps

Your first challenge of the day is to get to placement safely and on time, which could involve an early morning trek across Manchester. If you’re familiar with Manchester, or have had a test run, this should be a doddle, but if not, it’s a good idea to make sure you know the address of your placement as well as making a note of the bus times or directions – just to avoid a panicked Google search at 6am on your first day. I’d also make a note of the phone number of your placement, just in case you are delayed for any reason and need to let them know. Our Student Nurse Survival Pack has some helpful advice on planning your journey.

Pens, LOADS of pens! 

pexels-photo-261591.jpegAs you soon discover, pens are like precious gold-dust in the NHS. Everyone from nurses to patients will ask to borrow your pens and it’ll be a miracle if you ever see them again. Definitely don’t take your favourite fountain pen or any expensive stationary because it won’t hang around for long. My suggestion is to buy a big stash of cheap pens with the clicky tops that you can keep in your bag, so even if all yours go walkies, you’ll have a back-up. Alternatively, as every student or registered nurse knows, if you ever see free pens on offer TAKE AS MANY AS YOU CAN! They should always be black ink though, as it’s the only colour we can use to document in patient notes. I also chuck a highlighter or two into my pocket as I find this handy for highlighting key details on the handover sheet.

A pocket-sized notebook

A lovely friend who is already a registered nurse gave me this tip before my first placement: “make sure you take a notebook”. It is one of the best practical tips I’ve had as a student and I follow it to this day. So many things will crop up during a shift that you might want to look-up when you get home or remember, so it’s really handy having a notebook there to quickly jot down your thoughts to remind you later. I’ve also used mine to write reflections on the bus home or simply note down a set of observations or phone message if my handover sheet is covered in writing. I bought pack of small notepads and take a fresh one for each placement and they have been a godsend.

Fob watchfob watch

I’m sure you’re all sorted with this one already – the fob watch is one of the iconic pieces of nursing uniform – you’ll feel like a proper nurse when you pin it on for the first time! As well as making you look like a nurse, it is also an invaluable piece of nursing equipment that helps you measure vital signs like pulse and respiration rate as well as keep track of the time, a very important skill to master as you progress through your training. Whether you have an expensive fob watch given to you by friends and family or a freebie from the nursing fair, it doesn’t matter too much – you will use this every single shift and feel lost without it on days you might forget it. You’ll know you’ve starting to assimilate to the nursing life when you go to check your fob watch instead of wrist to tell the time outside of placement!

A diary

pexels-photo-733857.jpegA piece of advice from a chronically disorganised person approaching her thirtieth year on this planet: invest in a diary. Preferably in January.  As you may have already learnt, there is so much to juggle on a nursing degree – uni, assignment deadlines, exams, placement, family commitments, paid work, a social life (god forbid!) – meaning that things can come unstuck pretty fast without a bit of organisation. In first year it soon became clear that my usual ‘keep-things-in-my-head-and-pray-nothing-clashes’ approach was not going to work. A simple diary saved my sanity and probably a few friends who were sick of me double booking. The more tech-savvy among you will have this covered with phone calendars etc but I find a good old-fashioned hardback diary works best – I always take this with me to placement so I can plan my ‘off-duty‘ (nursing word for rota) with my mentor and spokes in advance, making sure this fits around uni and other commitments.

FOODpacked lunch

As someone who thinks about food almost all day, I can not emphasise this enough – take a packed lunch with you to placement! Breaks are often short (typically 30 minutes) and the last thing you want to do is run across a large hospital or find a nearby shop to buy an overpriced lunch which you have to wolf down on the way back. You’ll want to spend as much as your break as possible relaxing (ideally sitting down) and recharging for the next part of your shift, so it’s a good idea to bring something with you like a sandwich, last night’s leftovers or even a can of soup so that it’s one less thing to worry about. Most placement areas will have access to a microwave so you’ll be able to heat up something up, though this may be trickier for anyone on district/community placements where you might be out and about. It took me a good few months to get into the habit of packing my lunch, but it has saved me loads of money and hassle meaning I can now fully enjoy my breaks. Invest in a sturdy lunch box and large re-usable water bottle – it’s so easy to get dehydrated when you’re running around on a hot ward, but having a bottle there reminds you to drink. Our blog on healthy eating also has some good tips.

Identification and clinical skills training certificates

Some placements require you to bring along some kind of identification, like your student card, for your first shift. I had a placement in sexual health, for example, that needed to see my student ID on my first day as part of their confidentiality policy – while you might need it for other placements in order to be given a Trust ID badge. Your university name badge is also essential and will help staff and patients get to know you and remember your name – they’ll have no excuse for calling you ‘the student’! Our induction checks on PARE also require our mentor to see evidence of mandatory training like basic life support that you will have done in clinical skills, so it is a good idea to either bring these along or take pictures of them to show your mentor so that they can sign this off.

What NOT to take

As well as thinking about what to take on your first day, it’s also helpful to know what not to bring. The main thing here is any valuables like a purse or laptop. Some placement areas might be able to offer you a spare locker but many won’t and I’ve sadly heard of student nurses whose valuables have been stolen from communal changing/break rooms which can sometimes be left unlocked. While this is really rare, I wouldn’t take the risk – I leave my purse or any other valuables at home and just bring my bank card and a small amount of cash, which I keep with me in the top pocket of my uniform – just remember to take it out when you get home, so it doesn’t go in the wash! If you need to bring a tablet with you for completing your OnlinePARE for example, just let your mentor know and I’m sure they’ll be able to find a secure place to lock it away.

So there’s a run down of my top items to take on your first day of placement. Of course, as you progress through your training you’ll find that other items become handy in different placement areas – like alcohol gel in the community, a pen torch in A&E, a pair of blunt-ended scissors on wards or a stethoscope for wards that measure manual blood pressure – but these key items will help you start off on the right foot. With a little bit of pre-planning you can arrive at placement feeling totally prepared and ready to nurse – good luck!

‘Survival Pack’ for first year student nurses goes LIVE!

As our fabulous first year student nurses at UoM prepare to head out on placement for the first time next week, we are delighted to announce that the Student Nurse Survival Pack for 2017/18 is now LIVE!Picture1

Created by student nurses, this year’s Student Nurse Survival Pack is crammed with all kinds of information you might find useful for practice including travel tips to get you to your first shift safely, advice on the roles of you and your mentor on placement and where to access help and support.

Whether you have a quick skim through before your first shift or it becomes a trusty source of information as you find your nursing feet, we hope that the Survival Pack will answer key questions or calm any pre-placement nerves – don’t worry, we all had them!

While you are here, don’t forget to explore our blog! We have more than 170 blogs written by student nurses and midwives, past and present, covering a vast range of topics in the adult, child, mental health and midwifery fields. From first introductions to ‘tools of the trade‘; the ward to community; night shifts to exciting electives – we hope that you find something useful or interesting as you get to grips with the art and science of nursing (…and guess what, we have a blog on that too!)

This week we’ll be posting a series of blogs, sharing everything we can from our own experiences to help you prepare for your first few shifts.  If there is anything in particular you want to know about then please do get in touch – find us on facebook (‘Student Nurse Placement Project‘) or Twitter (@placementproj).

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As ever, we would also love to hear from you in the coming months if you have an experience in practice that you would like to share. To join our team of student bloggers or simply post a guest blog about an aspect of nursing then email Catherine or Kate to get started.

All that is left to say for now is GOOD LUCK!! We are all right behind you and hope you have a fantastic first week on placement! x

 

 

A brief Introduction to Oncology: Part I

Since graduating in September last year I’ve been working in Oncology, it’s been a steep learning curve and there’s still so much more to learn but I thought I’d share a few bits and pieces that might be useful background reading for anyone with an oncology placement coming up! Skip to the bottom of the page for a list of useful resources and a glossary of oncology terms.


Cell Biology Basics

Cancer can be defined as malignant uncontrolled growth from abnormal cell division. Before any new placement I found it useful to recap the relevant anatomy and physiology beforehand, therefore I thought it might be useful to include a mini recap of the basics of the cell cycle. If your oncology placement has a particular sub-speciality, for example haematology or gynaecology, you may also find it useful to revise the relevant body system.

cell cycle

Mitosis can be subdivided into 4 stages, prophase, metaphase, anaphase and telophase. G1 is when cellular contents (excluding chromosomes) are duplicated, S phase is where DNA is synthesised and duplicated and the G2 phase is when checking for errors in chromosome repair occurs, then the cells divide to produce two daughter cells. From G1, some cells may enter G0, a resting phase when cell division ceases.

Different cytotoxic drugs act on different parts of the cell cycle. As such you may find that different types of chemotherapy are given in combination to have a synergistic effect.

hallmarkswheel

The Hallmarks of Cancer, as described by Hanahan and Weinberg, illustrates the different types of mutations within carcinogenesis that enable survival and uncontrolled growth of cancer cells in tumours. Researchers can use these hallmarks as a focus for mechanisms of cytotoxic drugs. For example; Bevacizumab (Avastin), prevents angiogenesis so it slows the growth of new blood vessels, preventing the growth of this new vasculature supplying the tumour.

Cancer Staging

TNM staging is the most widely used clinical staging tool for solid tumours (does not apply to CNS tumours or haematological malignancies). It categorises the stage of the cancer with three simple alphanumeric codes corresponding to the categories of the primary tumour, involvement of lymph nodes and whether the cancer has metastasised. Prefixes and codes for additional modifiers can be added to give additional clinical information including details such as resection margins or specific histology of samples.

TNM staging

A number of disease group specific staging classifications are also used, a few you may come across are: Dukes (colorectal), Clarke & Breslow (melanoma), Lugano classification (lymphoma), Gleason score (prostate), and Robson staging system (renal cell carcinoma).

Communication

As with any placement area, communication is key! The following tools may be useful to recap  before starting your next placement.

SBAR

For acute situations the SBAR handover tool is great to clearly handover key clinical information. It provides structure to help you provide clear and concise information.

When exploring broader concerns with patients and relatives the Sage & Thyme communication tool can be really useful to help gather information and respond with empathy. Developed at UHSM in 2006 it can provide structure to responses in emotive situations, actively listening with the patient guiding the solution. (I’d also strongly recommend going on this course if you ever get the opportunity to go while on placement or in your future career.)

If you’re dealing with patients or relatives who wish to make a complaint the LASTED mnemonic can be useful to help structure a response but in your role as a student it’s best to escalate the situation to a member of staff; Listen, Acknowledge, Solve, Thank, Explain, Document.

IMG_5761

Source: Learning aid from Critical Care Department at Manchester Royal Infirmary

Body language, although non-verbal is an important communication tool. SOLER, SURETY and other similar models help illustrate the key components in effective non-verbal communication.

Last but not least, always remember to introduce yourself to patients and ask their permission before performing or observing any procedure! #hellomynameishello-my-name-is-logo-web

Palliative Care

From the latin Palliare, meaning ‘to cloak’, palliative care is essentially the relief of pain and associated symptoms without treating the underlying cause of the condition. You may come across this as ‘Best Supportive Care’ in a move away from negative connotations of palliative care in the media.

Dame Cecily Saunders was the founder of the hospice movement and a pioneer in palliative medicine. As increasing numbers of people began to die in a hospital environment rather than at home, she recognised the inadequacy of care and the fears of patients. Particularly regarding a terminal cancer diagnosis, where pain relief was insufficient due to the prevailing medical beliefs surrounding opiates. She led an evidence based medical and social change to provide holistic care encompassing physical, spiritual and psychological well-being in the last days of life.

Within palliative care you’ll gain exposure to pain management, controlling nausea and secretions, as well as learning how to manage other issues such as, constipation, terminal restlessness and spiritual distress. This will be in cases where a patient’s primary cancer has spread to other organs and is no longer considered curable, some patients may have a longer prognosis and better quality of life and others will have a much more limiting diagnosis so there can be a wide spectrum within palliative care, therefore care should accordingly be holistic and individual. It’s also imperative to discuss a patient’s preferred place of care and preferred place of death as part of the holistic assessment and Advance Care Planning, you may find the 5 Stages of Grief (Denial, Anger, Bargaining, Depression and Acceptance) by Elisabeth Kubler-Ross a useful resource as a framework to understand the grieving process.

Despite a life limiting metastatic cancer diagnosis there can still be treatment options sometimes this will include palliative intervention such as chemotherapy, radiotherapy and also surgeries. Sometimes hormone therapies or receptor specific SACT (for example, Trastuzumab (Herceptin) in HER2 positive breast cancer). In these cases the aim will be to prolong life and improve remaining quality of life. In these cases it’s important for the medical team proposing the treatment to have sensitive but frank discussions with the patient to ensure there are no misconceptions around the purpose of any proposed treatments.

On that note, remember that oncology isn’t all doom and gloom!! You may find that some people may comment that they think it must be a depressing job but it can be a really rewarding  and holistic environment. Cancer is a very emotive topic and most people will have a friend or family member who has been affected by cancer.

Although the prevalence of cancer may have increased in recent years, the overall incidence of cancer has remained fairly stable . This is due to an increase in overall life expectancy leading to an older demographic of patients with cancer who, some decades ago would likely have died of other comorbidities. Recent developments in anti-cancer therapies has led to an increase in patients living with cancer, including conditions which would have historically been untreatable.

However, as with any areas of nursing there you will experience end of life care and care of the deceased person. It’s important to remember that most people have had very limited experience with death and it can sometimes be hard to process difficult situations that your peers can’t relate to.

Remember if you’re struggling or feeling upset it’s absolutely okay to take yourself off to a quiet corner to collect yourself if you need to, you are supernumerary! Don’t underestimate the benefits of a debrief with your preceptor and remember that your AA and the PEF are always available. If you want to talk to somebody out of office hours the Greater Manchester Nightline listening and information service is open from 8pm-8am during term time.

ECOG Performance Score

This grading tool is commonly used in all areas of oncology to assess disease progression and how this impact’s on a patient’s activities of daily living. Created by the Eastern Cooperative Oncology Group, this 0-5 scale is something you will come across on any oncology placements, familiarising yourself with the descriptions of these categories will help you understand the impact of performance status on patient’s day to day experiences.

Grade 0 : Fully active, able to carry on all pre-disease performance without restriction
Grade 1 : Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work
Grade 2 : Ambulatory and capable of all self care but unable to carry out any work activities, up and about more than 50% of waking hours
Grade 3 : Capable of only limited self care, confined to bed or chair more than 50% of waking hours
Grade 4 : Completely disabled, cannot carry on any self care, totally confined to bed or chair
Grade 5 : Dead

Specific side effects are graded primarily using the CTCAE (Common Terminology Criteria for Adverse Events) database. You can view this online here.

Neutropenic Sepsis

Neutropaenia is defined as having a Neutrophil count of less than 1. Chemotherapy can cause a drop in Neutrophil count, some patients on cytotoxic treatment will often be given a Granulocyte Stimulating Factor (GCSF) prophylactically to prevent neutropaenia.

Sepsis

The nadir (lowest point) of a patient’s white cell count usually occurs 7-10 days after chemotherapy. It’s important to consider this if you suspect sepsis.

Sepsis is a life threatening immune response to infection. Make sure that you escalate your concerns quickly to your mentor or another nurse if you think a patient may have sepsis, then they can begin treatment within the hour to improve outcomes. You can find out more information about the Sepsis Six campaign here: www.sepsistrust.org 

Metastatic Spinal Cord Compression

MSCC is an oncological emergency, it occurs when the pressure from a tumour site begins to compress the spinal cord and pain and neurological symptoms occur. This can happen from either a tumour within the CNS system growing within the spinal cord itself, from a tumour pressing on the vertebrae or from vertebrae collapsing and pressing upon the cord as they are weakened by metastases within the bone (bony metastases are more common in progressive Prostate, Lung and Breast cancers).

A ‘red flags’ early warning system has been developed to help quickly identify symptoms that can indicate cord compression. If you suspect a patient may have MSCC it’s important to act quickly and escalate this. The longer the symptoms occur the worse the prognosis can become for the patient and paralysis can become permanent.

MSCC

Its also important to consider these red flags in other clinical settings, such as A&E because ~25% of patients who present with MSCC do not have a diagnosed primary cancer. MSCC is a palliative condition as the cancer has already spread and mestastasized to other sites but it’s still really important to diagnose and treat to prevent paralysis. Even if patients aren’t having active treatment and are being managed with best supportive care, communication is really important as early treatment can mean improved quality of life, but patients may be reluctant to have a hospital admission if their preferred place of care at the end of life is at home.

Chemotherapy Induced Nausea & Vomiting

CINV is one of the main worries of patients undergoing chemotherapy. Since the first chemotherapy treatments were used in the 1940s, antiemetics have come along a long way. Although some drugs, such as Cisplatin, are still highly emetogenic, CINV is able to be better managed through use of anti-sickness medications since it was first licensed for use in 1979. However, due to the portrayal of chemotherapy in films and television, CINV is often a source of great worry for patients. Therefore it’s important to communicate well with your patients to provide information and reassurance and assess the effectiveness of their anti-emetics.

The main causes of CINV are sensitivity of the GI mucosal lining, stimulation of the 5HT3 receptors and direct stimulation of the chemoreceptor trigger zone, although some pathways are unknown. Some common categories of antiemetics are listed below: Most can be given by a variety of routes of administration, you can check these in the BNF, on Medusa (an online injectable medicines guide) or the electronic medicines compendium. 💉💊

Antihistamines- Cyclizine: H1 receptor antagonist. Main side effect: drowsiness but also has anti-muscarinic properties causing xerostomia (dry mouth), blurred vision and urinary retention. Most commonly used for drug induced N&V but also useful in pregnancy as cyclizine is non teratogenic. Hepatic metabolism, half life approximately 20 hours. Note that cyclizine and metoclopramide can’t be given together.

Antimuscarinic- Hyoscine: main mechanism of action is competitive inhibition at M1 receptor. Classic side effects of antimuscarinic drugs may be present- dry mouth, blurred vision and urinary retention.

Dopamine receptor antagonists- Domperidone:  A pure dopamine receptor antagonist, domperidone is often used for drug induced N&V and postoperatively. Metoclopramide: At higher doses metoclopramide also acts as a 5-HT receptor antagonist, this dual action makes it especially effective in CINV. It also has prokinetic effects- this means the rate of gastric emptying is increased alongside an increase in muscle tone of the gastroesophageal sphincter. They are both metabolised in the liver and have significant first pass metabolism.

5-HT receptor antagonsists- Ondansetron, Palonosetron, Granisetron: These drugs all act on 5HT3 receptors within the gut but also in the chemoreceptor trigger zone within the brain. Ondansetron is very commonly given with emetogenic chemotherapies, it’s important to note that for patients  over 65 years old, it should be administered in a bag infused over 15 mins to reduce risk of long Q-T syndrome but if given as a bolus should be given slowly to avoid vein irritation- “Zofran Flare”. Constipation is a common side effect. Palonosetron has similar properties but is longer lasting.

Neurokinin receptor antagonists- Aprepitant: Also known as Emend, it acts in the CNS on NK1 receptors. Aprepitant also has a secondary effect of increasing the effects of 5-HT receptor antagonists and corticosteroids. It is absorbed in the GI tract and metabolised by the liver. Aprepitant can interact with Warfarin, decreasing its effect.

Corticosteroids- Dexamethasone is an example of a corticosteroid given for CINV, in itself it only has weak antiemetic effects but has an additive effect when given with 5-HT receptor antagonists.

Other antiemetic compounds- There have also been recent studies into the use of herbal compounds such as ginger which was previously used in traditional Chinese medicine and mint to investigate their antiemetic properties.

You can browse other side effects from chemotherapy on the Common Terminology Criteria for Adverse Events (CTCAE) database.

 

Alternative Therapies

As with all nursing specialities, it’s important to ensure that we provide evidence based practice. Some patients may have queries about alternative therapies they have heard about. This can include things like dietary advice such as eating peach stone extract and can be quite dangerous (http://scienceblog.cancerresearchuk.org/2017/11/01/alternative-cancer-therapies-the-potential-impact-on-survival/). Even some over the counter remedies from health food shops, such as St. John’s wort, can have adverse interactions with medication so it’s always best for patient’s to consult their medical team before taking any additional supplements. Patients may also decline treatment in favour of unregulated and unproven therapies if they are worried about side effects, which reiterates the importance of effective and empathetic communication to address patients concerns and allow them to make informed decisions about their care.

The benefits of complementary therapy alongside conventional treatment should not be understated. Relaxation techniques can be beneficial for needlephobic patients during cannulation or for claustrophobic patients requiring scans or radiotherapy using molded masks. Research has also been done into acupuncture to help prevent peripheral neuropathy.


More topics to follow in An Introduction to Oncology: Part II, including an overview of Central Venous access devices, Scalp cooling, Immunotherapy treatments, Radiotherapy and other palliative care emergencies such as hypercalcaemia and arterial bleeds, watch this space! If there’s any other topics you’d like to be included or to give feedback, please use the form below!

Many thanks to my fantastic preceptor Laura for all your advice and support in helping me survive my first year being qualified and also for proofreading this article!


Useful Resources:

I’d also really recommend The Emperor of all Maladies: A biography of Cancer, by Siddhartha Mukherjee if you’re interested in oncology and a bookworm like me!

Glossary:

Adjuvant Therapy- Treatment (usually hormone therapy, chemotherapy or radiotherapy) given after surgery to ‘mop-up’ any remaining cancerous cells.

Brachytherapy- Radioactive seeds planted within a patients tumour, often used in prostate, cervical and endometrial cancers.

Cancer of Unknown Primary- See also Malignancy of Undefined Origin. True CUP is a very small percentage of MUO patients and has implications for treatment options if the primary cell line is unknown. Provisional CUP is the terminology used until a primary diagnosis has been made or confirmed as a true CUP.

Carcinogen- Substances known to cause cancer.

Carcinoma- Cancers which originate from tissues that line internal organs or the skin.

Clinical Oncology- Medical specialty focussing on the treatment of cancer with radiotherapy.

Concurrent- Different modalities of treatment given at the same time, for example chemotherapy alongside radiotherapy.

Cytotoxic- A substance toxic to living cells.

Emetogenic- A substance with the capacity to introduce vomiting (emesis) and nausea.

Dysplasia- The presence of an abnormal cell type, whose growth may be a precursor to cancerous tissue.

In Situ- A Carcinoma In Situ means the tumour has not spread from its original location.

Local Therapy- Treatment specific to the affected area such as surgery or radiotherapy.

Malignancy of Undefined Origin- The term used until a CUP is diagnosed or a primary site is discovered either through scans or histology from biopsies.

Medical Oncology- Medical specialty focussing on the treatment of cancer with drugs.

Metastasis- The spread of cancer from a primary site to other organs of the body either via the bloodstream or lymphatic system or through direct infiltration of adjacent organs by the tumour.

Neo-Adjuvant- Anti-Cancer therapies given to shrink the tumour initially before second stage treatment, usually surgery so the tumour is easier to resect.

SACT- Systemic Anti Cancer Therapy. This encompasses both chemotherapy and immunotherapy.

Finding your feet in third year: a lesson from A&E

*Disclaimer: this post includes description of a traumatic situation which some may find distressing* 

When I started 3rd year, I was excited! I had a fantastic end to second year, and I truly felt ready to enter my final year of my degree. But with that excitement came the endless worrying about jobs, dissertation, and work for other modules. When placement began, I realised I felt like a complete novice again! Despite only having two months off over summer, I felt like I couldn’t remember how to do anything on placement (clinically speaking). I was even putting on blood pressure cuffs the wrong way. Everyone asked me what year I was in, and saying “I’m in third year, but I don’t know what I’m doing” every time was ruining my confidence.

It wasn’t until my 5th shift when I finally started to feel less on edge. I was working in resus (for the most critically ill patients in a&e), and we had an man with chest pain and fluctuating consciousness. Since he was in a bad way, a few anaesthesiologists from ICU came to set up mechanical ventilation for the patient. It was really fantastic to see everyone working together almost seamlessly, and including me in their decision making. I was given little jobs such as getting supplies or checking the observations but it was all I could really help with at the time. After a very long trip to CT, it was clear our patient was deteriorating. As soon as he was back in resus, our patient went into cardiac arrest. The nurse I was working with asked if I had done CPR before, and if I wanted to get involved. To my own surprise, I agreed. I have been learning CPR for well over 5 years now, so I knew that I could help in some way. Each person did 2 minutes of CPR, whilst keeping an eye on the defib heart monitor. Due to the patient being on a hospital bed, we all had to stand on a stool in order to reach, which I found really bizarre!

I wish I could accurately describe the feeling of trying to save someone’s life, but I can’t. There was so much adrenaline rushing around me, but all I kept thinking about was how I was currently involved in the worst day of someone’s life.

During CPR, the doctors confirmed (through an echo-cardiogram) that there was nothing left we could do. Myself and the nurse went to work on ensuring our patient was at peace, and ready to be seen by his family. They were in shock and declined, which I understand. And our day went on. I had a debrief with the nurse, and a HCA who had also performed CPR for the first time, which was lovely. We spoke about how CPR is so different from how it is often portrayed. I had never thought about the fact that you won’t be able to reach a patient without standing on a stool, or how someone must time each session of CPR.

Despite being a high-pressure and sad situation, it helped me a lot. I did something I had never done, but had extensively prepared for. If you feel like you are back at square one, despite being a third year, I challenge you to think about what you do on placement. I think there is a tendency to see progression as acquiring new skills, but sometimes its about putting our current skills to use in a new situation.