Research Paper on Oncology Patients in the ED

Introduction

Currently, cancer is a major cause of morbidity and mortality worldwide. In 2012, 14.1 million adults globally were diagnosed with cancer, and there were 8.2 million deaths as a result of the endemic. 60% of the deaths were occurring in less developed nations (Young et al., 2016). In the United States, cancer is the second leading cause of death. More than 1.6 million new cases are reported with approximately 600, 000 deaths occurring in 2015 (Lash et al., 2017). As a result of these high cancer cases, it is estimated that annual costs dedicated to the treatment of patients will escalate to $173 billion by 2020 (Lash et al., 2017).. Part of the reason for increasing costs of cancer treatments is the highly fragmented healthcare services where a patient is referred to multiple providers including primary care providers and specialists (Lash et al., 2017).. Oncologists generally manage cancer treatments; however, patients may often need services from providers in the emergency department (ED) especially where unexpected health concerns arise (Lash et al., 2017). It is even estimated that oncology patient visits to the ED range from 1% to 83%, and exceed those of the general population (Lash et al., 2017). While the use of ED by oncology patients is suitable for acute health concerns, some nurses (who play a key role in attending to such patients) do not have experience working with a cancer patient. The intent of this paper is to provide research and advice on how nurses can be better equipped to handle oncology patients and get ahead of their medical help which can, in turn, reduce medical costs arising from referral to multiple care providers. Creating awareness of an ED nurse on the first signs or symptoms to look for when assessing an oncology patient alongside documentation of treatment plans for each patient helps them get ahead on their medical help.

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Role of a Nurse to Oncology Patients in the ED

The nurse, especially the specialist acute oncology nurse (AON), play evolving roles during cancer treatment. These roles can be categorized into various groups as discussed below.

Communication

A nurse acts as a mediator between the patient and other physicians involved in the provision of healthcare services. Similarly, a nurse plays a crucial role in enhancing communication between the oncology patients and the physicians in the ED. Excellent communication in this setting is vital between the acute medical and emergency care teams and the oncology team improvement of patient safety and care as it facilitates the efficiency of service delivery (Putt & Jones, 2014). Specialists AON acts as a link between the teams involved in patient care in the ED to ensure that each party is aware of the patient's circumstances (Putt & Jones, 2014). AON specialist serves information and advice to both the patient and the carers with varied aims. One is to encourage self-monitoring and monitoring patients remotely as may be suitable. Another aim is to advise oncology patients on the significance of their cancer to their current issue. They also target to assume the key worker role as may be appropriate (Putt & Jones, 2014). Patients feel safe and secure when they are in contact with AON as they are assured that their problems are being monitored, and this is realized through effective two-way communication.

Education

Oncology nurses play a critical role in educating cancer patients presenting in the ED. AON facilitates and educates fellow nurses to help in developing oncology skills appropriate for assessment and management of patients at all the time (Putt & Jones, 2014). When oncology nurses are educated and facilitated to offer high standard care to patients in the ED, AON specialists can be assured that patients receive the same level of assessment and management even when they are not physically around to manage care delivery. The nurses, in turn, provide education to the patients and family members before and during therapy. The main aim of patient and family education is to assist with coping with the diagnosis, make long-term adjustments, gain information on prevention, and develop knowledge and skills as well as attitudes that will help in maintaining or regaining health status.

Advocacy

Nurses are the patients' advocates. They are better positioned to serve this function because they are the most trusted members of the healthcare team, thus can advocate for the patient's right to informed decision making and autonomy (Tariman & Szubski, 2015). In cancer treatments, there are several instances where ethical discussions ensue. Nurses, as patient advocates, intervene in such instances to "broach a patient's autonomy to the ethical discourse" (Tariman & Szubski, 2015). Thus, the nurses can help in ensuring that the rights of oncology patients are protected in such instances when ethical choices have to be considered.

Symptom Assessment, Monitoring, and Management

When oncology patients in the ED require administration of chemotherapy, the nurses are actively involved in the assessment of the symptoms, monitoring, and management using standardized checklists among adults and children. Also, nurses in this setting can employ the caring, optimism, planning, and expert information (COPE) intervention to accomplish symptoms assessment, monitoring and management and ensure that specific patients needs are achieved (Tariman & Szubski, 2015). Thus, oncology nurses are at the center stage of discerning cancer symptoms among the patients that visit the ED and should be equipped to identify those signs and symptoms efficiently.

Treatment Outcome Evaluation

Due to the popularity of the evidence-based practice, nurses are mostly involved in outcome evaluation initiatives. Nurses possess a unique ability to develop, implement, and evaluate efficiency and effectiveness of nurse-led risk assessment tool appropriate for the decrease in febrile neutropenia among cancer hospitalized patients (O'Brien, Dempsey, & Kennedy, 2014). Likewise, oncology nurses play a role in evaluating outcomes to scrutinize the cost-benefit analysis and efficacy of undertreating chemotherapy side effects such as nausea and vomiting (O'Brien et al., 2014). Therefore, oncology nurses can help cancer patients evaluate their treatment outcomes and ensure application evidence-based initiatives in their treatment.

Psychological Support

Some oncology patients visit the ED several times during their acute stages of the disease and often present with psychological problems such as depression. Nurses offer psychological support to such patients and their families throughout the cancer care continuum (O'Brien et al., 2014). For instance, during the phase I trials, oncology nurses provide psychological support to patients by allowing them to express what is important in their lives and helping them to search a way they can live their remaining part of life satisfactorily (O'Brien et al., 2014). In end-of-life care, nurses offer guidance, information, and support to the family and patients especially when they need to make difficult decisions such as those regarding artificial feeding (O'Brien et al., 2014). Moreover, oncology nurses play a critical role in providing emotional support to women receiving treatment for breast cancer to ensure that they are satisfied with the decisions they make and avert psychological distress. The simple act of nurses to listen to patients and being present for them especially during periods of decision uncertainties are the nursing roles that offer much needed psychological support to the cancer patients.

Key Indicators that a Patient is Suffering from Cancer

For a nurse to effectively provide medical help to an oncology patient, he or she should be able to quickly identify key signs and symptoms of the disease. This can only be achieved if the nurse is aware of the key indicators of the disease. Cancer is a disease that attacks different parts of the body, and as such different categories of the disease have been described including prostate, lung, and colorectal for men, breast, lung, and colorectal for women, and leukemia, brain tumors, and lymphoma for children. According to Rivera et al. (2017), most common types of cancer associated with ED visits in the United States are breast, prostate, and lung cancer, and the patients commonly present with pneumonia, nonspecific chest pain and urinary tract infection. Signs and symptoms of cancer, therefore, depend on the type or category of the disease, where it is located and where the cancerous cells have spread to.

More generally, some signs and symptoms may suggest the presence of cancer in a patient. Where a patient complaint of change in bowel or bladder habits, it may prompt cancer suspicion. Also, cancer can be signaled by a sore throat that does not heal for a long time. Unusual discharge or bleeding, for instance, nipple secretions, may also show that the patient is likely suffering from cancer. Some other generalized signs and symptoms of cancer include unexplained loss of appetite or weight loss, a steadily worsening pain in the bones or other body parts, persistent nausea, vomiting and fatigue, unexplained low-grade fevers that come and go or sometimes persist, and recurring infections that do not go away despite administration of usual treatment (Hui, dos Santos, Chisholm & Bruera, 2015).

Nonetheless, different types of cancer present peculiar signs and symptoms that can easily be spotted if a nurse has the knowledge of each of the cancer types. For breast cancer, there are common changes that suggest a possible cancer presence. A thickening or lump in the underarm or in or out of the breast is a common sign. The breast may also change in shape or size. For instance, the shape or size of one breast is not comparable to the other. There are also signs of puckering or dimpling in the skin of the breast. This is characterized by wrinkling of the skin around the breast or formation of small folds. New nipple retraction may also be noticeable as a signal that an individual is developing breast cancer. Furthermore, the breast may be discharging unusual fluid from the nipple. The fluid may be bloody. Breast may also appear swollen, red or scaly. This is noticed by observing the areola or breast nipple. These signs and symptoms apply to most types of breast cancers. However, inflammatory breast cancer (IBC) which is an aggressive form of breast cancer that can make an individual visit ED is profound and its signs are easy to spot. It manifests in breast swelling, reddening, distinct lump, bruised skin, burning, arching, and a higher breast temperature or increased breast warmth.

Colorectal cancer affects the large intestine. This type of cancer mostly manifests in changes in bowel habits. Common changes include constipation, diarrhea, and change in consistency of the stool (Hui et al., 2015). For example, an individual may experience an alternation between diarrhea and constipation from time to time. Similarly, the patient may begin experiencing changes in bowel movement patterns which are unusual. The stool may also contain blood which is an indication of rectal bleeding that could be as a result of cancerous developments. The patient complains of abdominal discomforts such as pain, gas or cramps. Moreover, colorectal cancer may manifest in a feeling whereby the bowel does not empty completely. This type of cancer is usually accompanied by fatigue and an unexplained weight loss.

Another type of cancer that a patient referred to the emergency department can be suffering from is the lung cancer. Lung cancer usually does not show signs and symptoms until advanced stages. The patient may present with a cough that does not go away. Lung cancer can also be indicated by coughing up of blo...