nurses
To the Editor: The recent paper by Ferrell and colleagues’ illustrates the need for ongoing s in cancer pain maneducational progr cted toward muses at agement that are all levels of practice, educators as well as clinicans. Many surveys have concluded that nurses have a disproportionate concern about logic dependence (addiction) p of tolerance, and respiratory develo depression.2-s The article by Ferrell and colleagues traces part of the educational problem to its source, and illustrates, ong other things, the need for accessible continuing educational programs for nurses. programs must be provided by ex can correct misinformation and update current knowledge beyond that which occurs in nursing texts. ‘The Pain Service at Memorial SloanKettering Cancer Center has attempted to address this problem through the develop ment of a variety of ongoing educational programs and resources for nurses in pain assessment and management. The goal of these programs is to bring the expertise of a cancer center to the community by offering nurses the resources necessary to become local experts. These programs range from a 2day observership to a l-year pain fellowship. In addition, educational materials have been developed as teaching guides that can be used when these nurses become their community’s educators. A telephone “hotline” is also in place and is used by these 0 U.S. Cancer Pain Relief Committee, 1992 Published by Elsevier, New York, New York
and
otbers,
including
physicians,
ese educational een mcorporated
The most succe as follows:
Ob~owtxsiia’pProgram A 5day observership deve
ogram
is offered
to one or
worlc in his or her institution. e nurse spends time with different members of the multidisciplinary team and ob serves the process of individual and collaborative treatment of patients and families in both inpatient and ambulatory settings. The pain observes multidisciplinary visitor rounds, inpatient and outpatient assessment, the use of opioid drugs by conventional and novel routes, methods of analgesic studies, cognitive behavioral approaches to pain o:, and a model of supportive care. re is no charge to the nurse participants. Approximately 200 nurses from 40 states and four countries have participated in the program since 1985. 08853924/92/$5.00
W. 7 No. 8 Ahmbei- I992
LJ?h?rs
440
@m-Year Pain Fellowship A l-year clinical practicum, initiated in 1989, is offered to Master’s prepared nurses with a minimum of 2 years experience in oncoIogy nursing. One nurse fellow can be accomodated each year. This program attempts to prepare qualified nurses to function as clinical specialists in their own institutional and community settings. The long-term goal is to have an identified nurse expert or cadre of such experts in each hospital or health-care delivery system, who can act as information resources and as educators in pain management, analgesic studies, and supportive care. The nurse fellow is given the opportunity for “hands on” experience with the pain consultation team, supportive care program, and pain research program. Funding for the first 3 years of this program (which provides the nurse with a stipend for living expenses) has come from the generous support of the Society of Memorial Sloan-Kettering Cancer Center. There is no charge to the nurse fellow. The source of future funding for this program is still under review. Our most recent nurse fellow has been funded by her parent institution, and it is hoped that at least partial funding for future nurse fellows will come from similar sources. These programs are not expensive. They are incorporated into the day-today activity of the interdisciplinary pain team and require no extra staE or space. However, a commitment is required from the institution of the participating nurse to provide both time and travel expenses. Some pharmaceuti-
her&y&amine
ViitingRelated
for Nausea and
to Cancer
Chemothemlbywith Ciqdatin To the Editor: In a previous study’ we found that diphenhydramine (DHM) is not a useful adjuvant antiemetic drug when it is added to high doses of metoclopramide (MCP).Also it does not prevent completely the extrapyramidal side effects of MCP.’ DHM,2n3 an
cal companies have been heipful in providing travel expenses to some participants and in the development of educational material. The success of these programs suggests that there are a variety of practical solutions to the need for continuing education of nurses in pain management and supportive care. Nonetheless, hospitals and nursing schools have been slow to recognize that pain assessment and management require a specific lcnowledge base and level of expertise. Unless this recognition develops, funding will not be provided for nurses to participate in such and professionals who are not programs, qualified will continue to teach in this area. Nessa Coyle, RN and Jean Adelhardt, RN Department of Neurology, Pain Service Memorial Sloan-Kettering Cancer Center New York, New York
1. Ferrell BR, McCaffery M, Rhiner W. Pain and addiction: an urgent need for change in nursing education. J Pain Symptom Manage 1992;7:117-124. 2. McCaffery M, Ferrell BR, Page EO, Lester M, Ferrell BA. Nurses’ knowledge of opioid analgesics and addiction. Cancer Nurs 1990;13:21-27. 3. Spross J, McGuire D, Schmitt R. Oncology Nursing Society position paper on cancer pain. Oncol Nurs Forum 1990;17:595-614. 4. Hamiton J, Edgar L. A survey of nurses’ knowledge of pain control. J Pain Symptom Manage 1992;7:1819. 5. Watt-Watson J. Nurses’ knowledge of pain issues: a survey. J Pain Symptom Manage 1987;2:207-211.
antihistaminic agent, was intended to potentiate the antiemetic efficacy through blocking of histamine receptors in the brainstem and to counteract any extrapyramidal reaction induced by MCP.5 In other trials,**sMCP and DHM were used in combination with dexamethasone (DXM), so we continued our study using three drugs (MCP, DXM, and DHM). A group of 47 hospitalized patients who received previous cisplatin-based chemotherapy at a dose of 100 mg/m2 of body
To the Editor: The recent paper by Ferrell and colleagues’ illustrates the need for ongoing s in cancer pain maneducational progr cted toward muses at agement that are all levels of practice, educators as well as clinicans. Many surveys have concluded that nurses have a disproportionate concern about logic dependence (addiction) p of tolerance, and respiratory develo depression.2-s The article by Ferrell and colleagues traces part of the educational problem to its source, and illustrates, ong other things, the need for accessible continuing educational programs for nurses. programs must be provided by ex can correct misinformation and update current knowledge beyond that which occurs in nursing texts. ‘The Pain Service at Memorial SloanKettering Cancer Center has attempted to address this problem through the develop ment of a variety of ongoing educational programs and resources for nurses in pain assessment and management. The goal of these programs is to bring the expertise of a cancer center to the community by offering nurses the resources necessary to become local experts. These programs range from a 2day observership to a l-year pain fellowship. In addition, educational materials have been developed as teaching guides that can be used when these nurses become their community’s educators. A telephone “hotline” is also in place and is used by these 0 U.S. Cancer Pain Relief Committee, 1992 Published by Elsevier, New York, New York
and
otbers,
including
physicians,
ese educational een mcorporated
The most succe as follows:
Ob~owtxsiia’pProgram A 5day observership deve
ogram
is offered
to one or
worlc in his or her institution. e nurse spends time with different members of the multidisciplinary team and ob serves the process of individual and collaborative treatment of patients and families in both inpatient and ambulatory settings. The pain observes multidisciplinary visitor rounds, inpatient and outpatient assessment, the use of opioid drugs by conventional and novel routes, methods of analgesic studies, cognitive behavioral approaches to pain o:, and a model of supportive care. re is no charge to the nurse participants. Approximately 200 nurses from 40 states and four countries have participated in the program since 1985. 08853924/92/$5.00
W. 7 No. 8 Ahmbei- I992
LJ?h?rs
440
@m-Year Pain Fellowship A l-year clinical practicum, initiated in 1989, is offered to Master’s prepared nurses with a minimum of 2 years experience in oncoIogy nursing. One nurse fellow can be accomodated each year. This program attempts to prepare qualified nurses to function as clinical specialists in their own institutional and community settings. The long-term goal is to have an identified nurse expert or cadre of such experts in each hospital or health-care delivery system, who can act as information resources and as educators in pain management, analgesic studies, and supportive care. The nurse fellow is given the opportunity for “hands on” experience with the pain consultation team, supportive care program, and pain research program. Funding for the first 3 years of this program (which provides the nurse with a stipend for living expenses) has come from the generous support of the Society of Memorial Sloan-Kettering Cancer Center. There is no charge to the nurse fellow. The source of future funding for this program is still under review. Our most recent nurse fellow has been funded by her parent institution, and it is hoped that at least partial funding for future nurse fellows will come from similar sources. These programs are not expensive. They are incorporated into the day-today activity of the interdisciplinary pain team and require no extra staE or space. However, a commitment is required from the institution of the participating nurse to provide both time and travel expenses. Some pharmaceuti-
her&y&amine
ViitingRelated
for Nausea and
to Cancer
Chemothemlbywith Ciqdatin To the Editor: In a previous study’ we found that diphenhydramine (DHM) is not a useful adjuvant antiemetic drug when it is added to high doses of metoclopramide (MCP).Also it does not prevent completely the extrapyramidal side effects of MCP.’ DHM,2n3 an
cal companies have been heipful in providing travel expenses to some participants and in the development of educational material. The success of these programs suggests that there are a variety of practical solutions to the need for continuing education of nurses in pain management and supportive care. Nonetheless, hospitals and nursing schools have been slow to recognize that pain assessment and management require a specific lcnowledge base and level of expertise. Unless this recognition develops, funding will not be provided for nurses to participate in such and professionals who are not programs, qualified will continue to teach in this area. Nessa Coyle, RN and Jean Adelhardt, RN Department of Neurology, Pain Service Memorial Sloan-Kettering Cancer Center New York, New York
1. Ferrell BR, McCaffery M, Rhiner W. Pain and addiction: an urgent need for change in nursing education. J Pain Symptom Manage 1992;7:117-124. 2. McCaffery M, Ferrell BR, Page EO, Lester M, Ferrell BA. Nurses’ knowledge of opioid analgesics and addiction. Cancer Nurs 1990;13:21-27. 3. Spross J, McGuire D, Schmitt R. Oncology Nursing Society position paper on cancer pain. Oncol Nurs Forum 1990;17:595-614. 4. Hamiton J, Edgar L. A survey of nurses’ knowledge of pain control. J Pain Symptom Manage 1992;7:1819. 5. Watt-Watson J. Nurses’ knowledge of pain issues: a survey. J Pain Symptom Manage 1987;2:207-211.
antihistaminic agent, was intended to potentiate the antiemetic efficacy through blocking of histamine receptors in the brainstem and to counteract any extrapyramidal reaction induced by MCP.5 In other trials,**sMCP and DHM were used in combination with dexamethasone (DXM), so we continued our study using three drugs (MCP, DXM, and DHM). A group of 47 hospitalized patients who received previous cisplatin-based chemotherapy at a dose of 100 mg/m2 of body
