Focus on Pediatrics: Binder puts cancer info in its place
Standardized teaching with room for special inserts
When children are diagnosed with cancer, a lot of education needs to take place. Yet it doesn’t happen all at once, but over time through several hospital admissions and outpatient clinic visits.
That is why the AFLAC Cancer Center at Children’s Healthcare of Atlanta uses a three- ring binder filled with all the information — both generic and specific — needed to teach families.
"It makes it easy for staff because instead of having to pull all the information individually each time a patient is diagnosed, it is all in one place," says Winnie Kittiko, RN, BSN, MS, a clinical educator at the AFLAC Cancer Center. The binder also provides a checklist for teaching, because all the topics to be covered are included in the binder.
The sections in the binder cover many topics. One covers the roles of the health care team members. Included is the family support team, which consists of a chaplain, social worker, child-life specialist, and schoolteacher. Also reviewed are the daily routine of the hospital and the plan of care.
Another section covers the diagnostic workup that is done when trying to diagnose the disease and how to prepare the child for the appropriate procedures. However, this is taught before families receive the binder. "We don’t give the binder to the family until we know for sure there is a cancer diagnosis," says Kittiko.
The binder has information on the informed consent process because about 90% of children are treated for childhood cancer on a clinical trial or at least a treatment protocol, she says. Children’s Oncology Group in Bethesda, MD, is the primary research organization for childhood cancer and directs all the treatment protocols. The consent forms average 12 pages.
After the informed consent section, there is a section that prompts the review of the child’s treatment protocol and the road map. To qualify for a clinical trial, a child’s lab test must be within a certain range, and he or she must have good kidney and liver function. "If children don’t meet all the qualifications, they can still be treated according to the protocol, but they won’t be entered in the study," says Kittiko.
The road map explains such things as what point the child will be given certain drugs and what tests he or she may need. During the education on the treatment protocol, families learn about the drugs the child will be taking and their side effects. There usually are many side effects to cover, says Kittiko. These include anemia, loss of appetite, weight loss, nausea, vomiting, and diarrhea.
Other topics covered include home care, such as giving intravenous fluids and pain management.
Routine medical information also is covered, such as immunizations, because children with cancer usually don’t keep their regular pediatrician appointments during the treatment.
Although all patients need education on the topics in each section, the specific information is not the same for all patients. For example, patients will have different tests and be given different drugs. In such instances, individual teaching sheets are given to families to insert in the proper section of their binder.
A file cabinet contains information on each drug and easily is accessible for teaching purposes. Nurses also have access to teaching sheets online. Frequently used sheets can be ordered from the materials management area in packets of 100, yet staff is encouraged to pull the sheets offline and print as needed to ensure that the latest information is being given.
Currently, the information in the binder is being standardized, with the two hospitals within the system merging their manuals so all patients receive the same information. During this process, a patient and family education record is being developed. The five-page document mirrors the headings on the binders and health care professionals can look in those binders for specific details on what was taught.
It is an interdisciplinary record, so the chaplain, social worker, and child-life specialist document on the sheet in addition to other disciplines such as nursing.
In addition to teaching sheets, parents are given copies of lab results and test results to keep in the binder. It is Kittiko’s goal to eventually have the entire binder translated into Spanish.
Source
For more information on creating a binder for pediatric cancer patients to standardize education, contact:
- Winnie Kittiko, RN, BSN, MS, Clinical Educator, AFLAC Cancer Center, Children’s Healthcare of Atlanta, 1001 Johnson Ferry Road N.E., Atlanta, GA 30342-1600. Telephone: (404) 250-2368. [email protected].
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