Congress Abstracts 2003

35

EVIDENCE-BASED PRACTICE: A METHOD OF IMPROVING NURSING PRACTICE. Mary Boyle, RN, OCN^®, Deirdre McGee, RN, BSN, Deborah Semple, RN, MSN, OCN^®, Susan Derby, RN, MS, CGNP, Joanne Frankel Kelvin, RN, MSN, AOCN^®, and Diane Loseth, RN, MSN, Memorial Sloan-Kettering Cancer Center, New York, NY.

Evidence-based practice (EBP) is increasingly advocated as a way of improving nursing practice. At this NCI-designated comprehensive cancer center, ambulatory oncology nurses used an EBP approach to improve nursing communication when breaking bad news to patients. The project was initiated in our research council. Through brainstorming techniques, we identified that healthcare providers often have difficulty communicating to patients that their cancer is no longer treatable and that they are close to dying. Avoiding open communication at this time results in lost opportunities to help patients and families address end-of-life issues and to optimize quality of life before a crisis develops. A team of interested staff was formed and bi-weekly meetings were scheduled. The first two meetings were spent clarifying thoughts and focusing the project. Two clinical questions were identified: “What are the barriers to effectively communicating bad news?” and “What strategies can effectively help to improve communication?” These questions guided the review of literature and search for evidence that the group critiqued and summarized. A lack of nursing resources lead to the use of the SPIKES model developed by Dr. Robert Buckman. This model is a sequential approach to dealing with bad news, initially developed to help physicians deal with difficult patient interactions, yet the group felt it was appropriate and useful for nurses in oncology practice. A two-part educational program was developed for nursing staff. A didactic session, presented as nursing grand rounds, outlined the steps of EBP and described the SPIKES model in detail. This was followed by interactive sessions on each nursing unit with an opportunity for discussion and role-playing.
This presentation will describe the SPIKES model and detail the steps of EBP used by oncology nurses at this center to improve nursing communication related to breaking bad news, thus improving nursing practice.