Big Sky ONS Newsletter Features Message from the President Election update No Dose

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Henry Barrett
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1 Winter 2007 Big Sky ONS Newsletter Features Message from the President Election update No Dose Message from the President: It is always hard to believe how quickly time marches forward whether we are ready for it or not! I can t believe the holidays are over and we are well into the new year! There are just a couple of announcements and recognitions I would like to share with membership this month. First, I would like to extend a warm thank you to the chapter and all members for the various charitable donations over the holiday season. As you may recall, we held a food drive during November to contribute to the Billings Food Bank, along with a $100 donation. Thanks Christina Schye for suggesting and organizing this! Second, the chapter decided to sponsor two families over the holiday season with gifts. Thanks Elaine Wurscher for doing the shopping for the family identified by St. Vincent s and thanks Sunny Park for helping with the shopping and collecting additional funds for the family identified by Billings Clinic! Each of the families was very appreciative and I believe our chapter truly made a difference in making the holiday season a little brighter for these families! The 2007 ONS Congress is coming up quickly April 24 th through the 27 th. This year it is being held in exciting Las Vegas! Hopefully some of you will be able to attend be sure to check out some of the reduced airfares for 3 night stays through Allegiance Airlines! 1

2 In addition to the national conference, we have a local committee working diligently on plans for the Fall 2007 Big Sky ONS conference! Thank you to Cindy Frank, Amy Walton, Kathy Wilkinson, Elaine Wurscher, and Patti Yeska for joining me in the planning of this conference! We are excited with some of the possible topics and speakers so stay tuned for upcoming announcements related to date, location, and program agenda! Lastly, I would like to mention that I spent some time in December updating the Big Sky ONS virtual community, which is accessible at We have posted information related to chapter programming, as well as copies of the business meeting minutes and newsletters there, so check it out and sign up for automatic notification when information on the site has been updated! Submitted by Karyl Blaseg, Big Sky ONS President Congratulations to Karyl for being on the ONS Institute of Learning Planning Committee in 2007 and for taking on being the Chair Person in 2008 when it is in Seattle. We need to start planning how we can support Karyl in this role. A GREAT BIG THANK YOU TO OUR OUTGOING BIG SKY CHAPTER OFFICERS: Elaine Wurscher, Secretary Christina Schye, Membership & Nominations Chair Thanks for all that you have contributed to a very successful chapter! 2

3 No Doze? How to Help Patients with Cancer Sleep By Cindy Frank RN BSN OCN How much sleep does one need? Well that depends on the amount that permits you to be alert, wide awake and energetic during the day. The average amount that a person needs is approximately 8 hours and varies from person to person. Sleep needs vary considerably and can be genetically determined. Normal sleep regulation is controlled by two factors. First is homeostasis, which means that a persons sleep need is dependent on the amount and timing of sleep and waking during the day. Environmental influences fall into this category and they are needed to reset the 24 hour clock and cycle. Examples of environmental influence include the seasons, tides, moon phases and the light/dark cycle, which has the greatest influence. Light acts to reset or synchronize the body s clock so that it is in phase with the sun s cycle. Other environmental influences include meal times, noise, social factors, cultural factors, exercise, clocks and music. Second is circadian rhythm, which is your internal sinusoidal rhythm of approximately 24 hours that is dependent of sleeping and waking. Circadian rhythm is a self-sustaining process that is regularly occurring and can be biologically inherited. Some things that disturb the sleep/wake cycle in adults with cancer include but are not limited to insomnia and hypersomnia, medications, obstructive sleep apnea, restless leg syndrome, and the influence of co-morbidities. At-risk populations for sleep disturbances, include being female, a psychological history including anxiety and depression, history of abuse, pain and advanced cancer. A thorough screening assessment should be done on all cancer patients. This assessment should include what time they go to bed, excessive daytime sleepiness, awakenings during the night, regularity and duration of sleep, snoring and medications. An example of a recommended measure for calculating the amount of sleep at night may include but is not limited to: sleep efficiency number of minutes of sleep divided by the total number of minutes in bed multiplied by 100. You want this number to be greater than 80% of sleep a night. An example of a recommended measure for the daytime could include: 3

4 napping during the day the number of minutes of sleep during the daytime, which can be either intentional or unintentional. An environmental assessment should include: temperature, mattress, linens, bed clothing, noise, lights and location. So what can we do for patients? First, use the assessment tools available to figure out what is causing the sleep disturbance. Second, treat any medical, mental or other contributing factors and thirdly, evaluate for the need for referral to a sleep center. Some pharmacological agents that may help include: hypnotics (valium, restoril, ativan, ambien, lunesta), antidepressants (amytriptiline, SSRI s), antihistamines (benadryl), neuroleptics (thorazine) and various herbs (St. Johns wort, valerian root, melatonin). The pharmacologic listed above can help decrease the time it takes to fall asleep and the number of awakenings during the night. Patients that are receiving pharmacologic agents need to be reassessed every 10 to 14 days for efficiency of the drug and to determine if another means should be considered. Cognitive behavioral therapies (CBT) are also a good option to try and can be used alone or in combination with other therapies. Some types of CBT include sleep restriction (ie: limiting amount of time in bed, increasing activity during the day and avoiding daytime napping), sleep hygiene (ie: go to bed and wake at same time every time, eat know sooner than 3 hours before bedtime), relaxation therapies (ie: self reflection, decreasing stress), complementary therapies (ie: expressive therapy and writing, healing touch, massage and muscle relaxation, yoga and meditation), stimulus control (ie: decrease noise and lighting level in room), and exercise. In conclusion, everyone needs sleep to function and when determining how to help someone you need to assess for the characteristics of the sleep disturbance, consider the patients values, beliefs and goals, and consider the safety, cost, and effectiveness of the method used. Educate your patients on the different methods that are available and work as a team to achieve the goal of good sleep. Congratulations New Big Sky Chapter Officers!! Patti Yeska, President-Elect Dani Wright, Secretary Amy Walton, Membership & 4

5 In November of 2006 I had the opportunity to attend ONS Institutes of Learning in Pittsburgh. IOL offers a variety of half-day sessions as well as several all-day sessions covering many oncology nursing topics. Choosing which to attend can be difficult, as there were many I was quite interested in. The most interesting to me, though, was one on intraperitoneal chemotherapy for women with ovarian cancer. I knew that my employer, Billings Clinic, would be welcoming the addition of Dr. Randy Gibb, who is Montana s first GYN-Oncologist, so I wanted to learn what IP chemo was all about. The class was very good, taught by 3 different nurses from 3 different large cancer centers. I learned that IP chemo is ideal for ovarian cancer because a higher concentration of chemo can be instilled and it is slow to be cleared from the IP space, which gives the tumor much more direct exposure to the chemo. Some of the chemo is absorbed systemically but it is cleared quickly. The tumor size must be smaller than 1 cm, and the tumor must be debulked prior to starting treatment. The thing that most amazed me about IP chemo is how much fluid is instilled into a patient s IP space. Two liters was used in the clinical trials discussed, which ensures that the chemo is adequately distributed throughout the IP space. The patient then must turn every 15 minutes for 1-2 hours to make sure the chemo reaches up, under, above, and around all areas. All this fluid is gradually absorbed, not removed, as I had originally assumed. There are many other principles of IP chemo, as well as potential complications and adverse effects. It also remains quite controversial in the oncology community. But the clinical trail data is clear in its findings of survival benefits to patients when including IP chemo with IV chemotherapy treatments. Attending IOL and learning about IP chemo reinforced for me my commitment to Oncology Nursing and increased my desire to learn more, not just about IP chemo, but also about other new treatments in difficult to treat cancers. If you ever have the opportunity to attend any of Oncology Nurses Society conferences, I highly recommend that you do. The wealth of information is unbelievable and the camraderie is amazing. You will meet people from all over the U.S. and beyond, and learn things from them you never thought possible. Plus it s a great chance to explore a city you may never ordinarily go to! Christina Schye, RN, OCN 5

Remember Daffodils Days a American Cancer Society Event. Place your order for 10 Daffodils for $8.00, 10 Daffodils with a vase $12.00, or the Gift of Hope which is 10 Daffodils with a vase for$12.

6 Remember Daffodils Days a American Cancer Society Event. Place your order for 10 Daffodils for $8.00, 10 Daffodils with a vase $12.00, or the Gift of Hope which is 10 Daffodils with a vase for$12.00 which are given to a cancer patient Big Sky Oncology Nursing Society Sponsors Ronald McDonald Family for Christmas Late last fall, Big Sky voted to sponsor two needy families for Christmas and authorized $200 to be spent on gifts for each family. At our January 9, 2007 meeting, a thank you letter was read from Connie Grammens, Executive Director of Ronald McDonald House of Billings. The family staying at Ronald McDonald house consisted of parents and two children, one of whom was an 8 month old undergoing medical treatment. Big Sky purchased clothing and a gift card for each family member, delivering the gifts on December 14 th. A portion of the thank you note reads, On behalf of the children and their families of Ronald McDonald House of Billings, we thank Big Sky Oncology Nursing for their donation of Christmas gifts.your gifts were delivered today and the family was so excited. You truly made their Christmas. The baby is going home today. Submitted by Elaine Wurscher Thank you for all the submission of articles by Cindy Frank and Christina Schye. Please remember to Thank these authors for their time and sharing of information. 6

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HEALTH 3--DEPRESSION, SLEEP, AND HEALTH GOALS FOR LEADERS. To educate participants regarding the sleep wake cycle.

HEALTH 3--DEPRESSION, SLEEP, AND HEALTH GOALS FOR LEADERS Talk about the relationship between depression, sleep, and health problems. To educate participants regarding the sleep wake cycle. To provide