Art and Nursing: Exhibiting Art Within a Power Point Presentation About Oncology Nurse Navigators

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The above paintings are original works by Julianna Paradisi, and may not be used or reproduced without permission.

This year, I’ve had a few opportunities to try on the art of public speaking, a newish skill for me. The topics revolved around breast cancer, and oncology nurse navigation.

Recently, I was asked to speak to a group of inpatient oncology nurses about the role of nurse navigators for breast cancer patients, and the application to the hospital setting. Integrating the patient experience throughout the continuum of cancer treatment is a prominent part of what nurse navigators do, and inpatient nurses wanting to learn more (and earned CE) about oncology nurse navigation is exciting.  It demonstrates ONNs have an impact on patient care.

For the occasion, I decided to learn a new skill: creating a Power Point presentation. I know, I know, some of you were making Power Point presentations since your first elementary school book report, but you probably can’t write in cursive as well as an older nurse, or use a real typewriter.

Here’s the stipulation: because I am also an artist, I have a thing against using clip art or stock images from the Internet to illustrate my words. If you are familiar with my blog posts for Off the Charts you already know this.

So, not only did I learn to create, and present a Power Point slide show, I used jpegs from a series of paintings I made of mountains, illustrating the presentation from the perspective of my personal practice. For many, the word navigator connotes images of the ocean or GPS, but as a breast cancer survivor turned ONN, I see myself as a sherpa, someone who has climbed the mountain, familiar with its terrain and potential for treachery. I lead patients  up the mountain, summit, and then come back down. The paintings of mountains also suggest the barriers to care ONNs are tasked with removing for patients. The theme was woven into the closing remarks of the presentation.

Most of the paintings depict Mount Hood, the dominating peak and iconic symbol of Portland, Oregon, my home.

I gave the presentation with a sense of creative satisfaction in finding another way to merge art into my nursing practice.

 

 

 

 

Modern Nurses: Audio/Video Girl

Digital Microscope ink on paper 2016 by Julianna Paradisi

Digital Microscope ink on paper 2016 by Julianna Paradisi

Preparing materials for tumor conferences is part of my role as an oncology nurse navigator. It involves, among other responsibilities, reviewing the cases, printing copies of the agenda for the attendees, managing the sign-in rosters, and providing updated lists of available clinical trials. It also requires powering on the projector, the screen, and setting up the digital microscope necessary for the pathologist and radiologist to project slides of the tumor cells, and the MRI or Cat can images on the large screen for discussion.

Suddenly, and unexpectedly, I’ve become Audio/Video Girl. Other nurses of my generation will appreciate the humor in this.

Does any one remember watching film strips and movies in grade school classrooms? Did your hand shoot up when the teacher asked for volunteers to set up and run the projector? Mine did, but it was always a boy who was chosen. Eventually, I stopped raising my hand.

Years later when I became a pediatric intensive care nurse, I discovered an aptitude for tubes and wires, or rather I learned to get one fast. The ability to troubleshoot a ventilator until a respiratory therapist could fix it became handy too. I realized the level of skill I’d developed when as a single mom I set up my stereo system (you who grew up with bluetooth streaming have no idea how easy you have it), and a desk top computer with printer/fax using a dial-up modem. In case you are to young to know, we could not use our computers and phones at the time in those days.

I digress.

Learning to set up the electronic equipment for tumor conference was a lot like how I learned almost everything as a nurse: someone showed me how to do it once, and then I was on my own. However, as mentioned, I have developed an aptitude for technology: during the demonstration I snapped pictures of the wire connections with my phone, creating a visual reference guide to use later.

I was anxious the first time I set up by myself. While lifting the digital microscope which I imagine costs a hefty portion of my annual salary from its cart to the conference table, I distracted myself from my fear of dropping it by imagining twenty doctors staring at me because it didn’t work. Tumor conference would be a disaster if I failed..

The microscope and projector worked. Relieved, I glanced at the doctors, men and women, seated around the table. Some of the male faces resembled grown up versions of the boys in grade school my teachers chose to run the projectors. Some of them probably drive cars electronically more complex than the audio video equipment I had just set up.

To be clear, I am treated respectfully as part of the multidisciplinary team at tumor conference. I’m proud to be part of this valuable service offered to our patients. I am happy with my life choices. However, I wonder what might be different if girls were chosen equally with boys to run the projectors when I was young?

 

 

 

 

Switching to Oncology From Another Nursing Specialty

illustration by julianna paradisi

illustration by julianna paradisi

One of the most enjoyable aspects of my recent job transition is meeting new colleagues. Not only are they a great group of nurses, but for the opportunity to exchange information.

During one such discussion, the topic was how we learned oncology. Unlike myself, a former PICU nurse, some had started out in oncology as new grads. We all agreed that nursing school does not provide much preparation for oncology nursing. The conversation then turned to “how I became an oncology nurse.” 

It occurred to me that other nurses might be seeking information about how to break into oncology nursing.

I offer this advice:

  • If you want to transition from another nursing specialty into oncology, do some research about the skills the two have in common. For instance, skills carrying over from the ICU to an oncology unit are the use and maintenance of central lines (although you’ll probably need to learn accessing implanted ports), and whole body assessments. The interpretation of lab values, and acting on them is as important in oncology as the ICU. Conditions such as SIAH, SVC syndrome, and more are common to both specialties, as is pain management. Highlight these similar skills during a job interview.
  • Consider outpatient oncology. Much of cancer treatment is now done on an outpatient basis. While outpatient nursing is very different than inpatient, it is as rewarding and challenging.
  • In the beginning, focus on one or two common cancers (breast cancer and colon cancer for instance). Develop a familiarity with their treatments, particularly the chemo regimens. From there, expand your knowledge base while gaining experience.
  • Earn oncology CE. This provides two benefits: First, it guides your focus on one or two cancers. Second, it provides certificates you can add to a resume for an oncology job interview. You can find oncology related CE at the Oncology Nursing Society (ONS.org) and The Oncology Nurse Community (TheONC.org) website offers a library tab, which is a great resource for nurses seeking oncology CE.
  • Immerse yourself in oncology culture. Become a national member of the ONS. Sign up for electronic newsletters.
  • Cultivated local networking. Join the local ONS chapter, and participate. I meet nurses seeking oncology positions all the time at these meetings, which are often attended by oncology unit managers too. Sign up as a member of a cancer department’s team for fundraising events, another way to meet and network with oncology nurses and managers while helping others.

What advice do you have for nurses, new or experienced, desiring to break into oncology nursing?

Using Perspective As a Tool Against Nursing Burnout

The death rate for humans on the planet Earth is currently 100 percent. I know this is not a pleasant thing to read while enjoying your first cup of coffee this morning, or perhaps you’re enjoying a calming glass of wine later this evening. It’s unpleasant enough that perhaps you will not finish reading this post, but it’s true nonetheless.

Ravens by jparadisi

Ravens by jparadisi

Running parallel to our fear of dying is our pursuit of eternal youth. Cosmetic surgery and procedures are a billion dollar industry. Many men and women consider regular treatments for balding, teeth whitening, the prevention and removal of wrinkles, and coloring gray hair part of normal maintenance. Some choose to have  the evidence of time wiped from their faces by a surgeon’s scalpel.

The struggle nurses face in striking the right balance between hope and realistic outcomes for our patients is in part due to society’s mythical belief that death is preventable, when in fact, it’s inevitable. As humans, nurses buy into the myth to some extent also.

Discussing this, a nurse friend and I joked about gray hairs and wrinkles. She remarked, “Getting old is terrible.”

“No,” I said, “It’s not. It’s what nurses do for a living. We help people stay alive so they can grow old.”

See? It’s a matter of perspective.

Whenever someone asks, “Is it hard being a cancer nurse working with dying patients?” the above thoughts come to mind. The answer is, “I don’t see oncology nursing from that perspective.”

Yes, oncology nurses work with the dying, but I perceive our practice as helping people live to their fullest capacity.

Nurses cannot guarantee patients a cure or how long they’ll live, but by promoting prevention, treatment, and providing tools for managing chronic disease, we encourage them to pursue their best life possible as things stand. If nurses lose this perspective, how can we hope to share it with our patients?

There is balance in the realization that death is part of life. Death and loss cause grief, a normal response. Grief and loss are painful. We fear death and loss, but they are a natural occurrence of living. Maintaining a realistic perspective is a tool for burn out prevention among nurses.

All people die. Nurses are here to help patients live until that day.

I grieve their loss, and mine, because I glimpse my mortality too in the faces of the dying.

Thank you for reading this entire post.

Lessons About Medication Errors From Baseball

In the commercial, three guys are standing around a grill, talking about baseball. One of

painting by jparadisi

Baseball Card by jparadisi

them quotes a stat.

Another one says, “Really? Are you sure?”

The first guy says, “I’m 99.9 percent sure.”

The third guy says, “Then you don’t know.”

I don’t remember what product was advertised. I remember the commercial because the question of certainty came up regarding a medication order.

I was reviewing the chemotherapy orders:

  • Patient name and identifiers: √
  •  Orders are dated with today’s date: √
  •  The chemotherapy ordered is appropriate for the patient’s diagnosis: √
  •  The dosage is correct: Uh oh. Wait a minute.

The total dose (in milligrams) did not equal the product of milligrams times meter squared (m2). The reason was easy to spot, however.
The chemotherapy infusion was to be administered as a continuous infusion over two days. The order read:

xxxx mg of chemo drug X m2 = xxxx mg X 48 hours = total dose of chemo drug

The doctor meant to write:

xxxx mg of chemo drug X m2/every 24 hours = xxxx mg X 48 hours = total dose of chemo drug

I was 99.9 percent sure, which means I wasn’t certain. Unlike quoting baseball stats, there is no room for uncertainty in chemotherapy administration. Interestingly, a pharmacist felt 99.9 percent certainty was good enough and mixed the cassette sitting in front of me.

To be fair, this was not the patient’s first infusion. The pharmacist mixed the chemo based on past orders. Using a previous record to predict a result in the future is the definition of betting, which works in baseball, but not so much when administering chemo.

I called the office where the order originated. The nurse on the other end of the phone pulled up a copy of the order. “Oh, he meant to write every 24 hours. If I write that and fax it back to you, will that work?”

“Yes it would,” I said. “Are you certain?”

“I’m 99.9 percent sure.”

“Certain enough to sign your name to an order?” I asked.

There was a pause, and she said, “I’ll have the doctor take a look, sign it, and fax it back to you.”

I thanked her.

The corrected order, signed by the doctor, arrived on the fax machine. The checklist was successfully completed, and the infusion started.

I was 100 percent certain the infusion was correct.

Do you ever feel like the nurse holding everything up? What’s your opinion? Would you trust your familiarity with a patient’s past orders and go ahead with the infusion? Does your work environment support nurses delaying treatment while verifying orders?

JParadisiRN Guests (Live) on RNFM Radio: Nursing Unleashed March 18 9pmEST/6pm PST

Sometimes a Surgical Mask feels like a Gag by jparadisi

Sometimes a Surgical Mask feels like a Gag by jparadisi

I’m honored to have received an invitation from fellow nurses and radio talk show hosts Keith Carlson and Kevin Ross to interview live on their internet radio program, RNFM Radio: Nursing Unleashed!
We’ll discuss incorporating art into nursing practice.
If you aren’t able to listen during the live show, each episode is archived on the site for listening at your convenience. We’ll discuss ways to incorporate art into nursing practice.
Here’s the details:
  • JParadisiRN guests (live) on “RN.FM Radio: Nursing Unleashed!”, the newest internet radio station for nurses.
  • The LIVE interview is on Monday, 3/18/13 at 9pm EST / 6pm PST. You can listen in here: http://www.blogtalkradio.com/rnfmradio
  •  Even better – CALL IN with your questions, comments, thoughts, or just to say “hi!”
  • If you can’t listen in, bear in mind that the show will be immediately archived and available for listening on Blog Talk Radio (http://blogtalkradio.com/rnfmradio), and will also be quickly available as a free downloadable podcast on iTunes.
  • Call-in # is: (347) 308-8064.
  • The link to listen in on Monday, 3/18/13 at 9pm EST / 6pm PST again is: http://www.blogtalkradio.com/rnfmradio

I look forward to connecting with you then!

Diet As Tolerated: This Week’s Post for TheONC

Diet As Tolerated watercolor by jparadisi 2012

In yesterday’s post A Social License III: Nursing Synchronicity I write about an impromptu discussion with a young woman in a department store while shopping for work pants. It’s  common phenomenon for strangers to reach out to nurses even when we are off duty. I pair this post like a fine wine with my post this week for TheONC.org,  titled, Diet As Tolerated, which describes another off duty encounter, this time at a cocktail party in a trendy restaurant.

Started in February 2012, with almost 7,000 Likes on Facebook, TheONC.org is an online social forum where oncology nurses and cancer care teams can leverage their collective knowledge, nurture professional growth and emotionally support each other in a secure environment, as registration is required.

Moderated by oncology nurses and key opinion leaders, TheONC (The Oncology Nursing Community) features discussions and commentary covering key issues ranging from symptom management and palliative care to managing ethnic and cultural diversity.

Other resources in the community include:

  • A Library of resources including patient education materials and presentations by community members
  • Clinic Close-Up, where members can view video-based interviews with experts from large group practices, private practices, and academia covering a variety of topics
  • News items relevant to clinical practice
  • An interactive Quiz feature where nurses can test their diagnostic knowledge on a regular basis
  • A Calendar of national and regional events and meetings specific for oncology nurses and cancer support team members

TheONC is like having a weekly national oncology conference conveniently online. A wide range of topics have already been discussed, including Stem Cell Transplant, pediatric oncology, survivorship, nursing while going through cancer treatment, and much more. Once you’ve registered, posts can be saved for future reference.

Follow TheONC on Twitter @The-ONC, and Like us on Facebook.

You Can Find Me Here: New Posts for TheONC

Resurrection Chair by jparadisi

It’s been a busy lately, and when it’s not, I’m  out enjoying the sunshine. Nevertheless, I’m keeping up with new blog posts both here, and for The Oncology Nursing Community (TheONC).

In case you missed it, last week for TheONC, I wrote When a Partner Doesn’t Do in Sickness and In Health, about the painful reality of partners leaving cancer patients at diagnosis or during treatment.

This week, I discuss helping patients cope with cancer in Helping Patients Build a Cancer Toolbox.

TheONC.org is a new online social forum for oncology nurses and cancer care teams where they can leverage their collective knowledge, nurture professional growth and emotionally support each other in a secure environment, as registration is required.

Moderated by oncology nurses and key opinion leaders, TheONC features discussions and commentary covering key issues ranging from symptom management and palliative care to managing ethnic and cultural diversity.

Other resources in the community include:

  • A Library of resources including patient education materials and presentations by community members
  • Clinic Close-Up, where members can view video-based interviews with experts from large group practices, private practices, and academia covering a variety of topics
  • News items relevant to clinical practice
  • An interactive Quiz feature where nurses can test their diagnostic knowledge on a regular basis
  • A Calendar of national and regional events and meetings specific for oncology nurses and cancer support team members

TheONC is like having a weekly national oncology conference conveniently online. A wide range of topics have already been discussed, including Stem Cell Transplant, pediatric oncology, survivorship, nursing while going through cancer treatment, and much more. Once you’ve registered, posts can be saved for future reference.

Follow TheONC on Twitter @The-ONC, and Like us on Facebook.

New This Week at TheONC & at Scrubs Magazine

This week for TheONC I blog about nurses helping patients stuck at anger in their grief process. These nonviolent patients are difficult to bond with because the anger is often expressed as dissatisfaction with their caregivers, sometimes disruptive of work flow.  Staying engaged in their care is challenging, but not impossible.

TheONC is an online community for oncology nurses and care teams. Join the conversation. Like us on Facebook, and follow us on Twitter @The_ONC.

Yes, that’s me talking about my fear of “big, hairy adult patients” while transitioning from pediatric intensive care nurse to adult oncology nurse in Theresa Brown RN’s article, Field of Dreams published in the summer 2012 issue of Scrubs Magazine. (By the way, I found I enjoy adult patients more than I ever expected!) Theresa interviewed several nurses about how they arrived in their specialties. She explains her own journey too. Scrubs is available at uniform stores, and by subscription.

TheONC: A New Blogging Community for Oncology Nurses and Teams

Last week CancerNetwork launched TheONC; an online community for oncology nurses and staff. TheONC is a gated site for professionals so login is required to participate. The video link below explains more fully:

video.asp?section_id=1687&doc_id=238579

TheONC features bloggers with a wide spectrum of expertise writing on various aspects of cancer care. As a contributing blogger, I write from the perspective of an artist working in oncology. Through weekly posts, readers and I will discuss creativity, and its pursuit, in nursing. Images of my artwork accompany the posts. My first went live yesterday.