Purpose
Oral mucositis is a frequent and dose-limiting side effect of cancer treatment, experienced by 40% of chemotherapy and up to 80% of bone marrow transplant patients. Bone marrow transplant patients rated oral mucositis as the single most debilitating side effect over nausea, vomiting, diarrhea, and fatigue. Oral mucositis increases length of stay an average 5 additional days, and involves costs up to $50,000. No interventions are available to prevent or reduce severity; therefore, effective palliative strategies are needed to decrease the pain and associated distress that accompanies oral mucositis. Cold salt and soda mouthwash is often prescribed as an intervention; however, there is little research to validate the effectiveness of this intervention and the rationale for the intervention is not well described. The model developed explores the physiological basis of cold salt and soda mouthwash as an intervention for pain associated with oral mucositis and offers a model that may be useful in future research.
Rationale
Two models explaining the physiologic rationale of mucositis were located in the literature. One model outlined the cellular-level development of mucositis, describing the process of tissue destruction; the second model outlined the consequences of tissue destruction. Neither model described the pathway of mucositis pain adequately enough to identify the physiologic rationale for the cold salt and soda mouthwash intervention.
Model Development
Literature that was reviewed included the cellular physiology of the mouth, the pathophysiology of cellular damage secondary to chemotherapy, chemical and mechanical nociception in the oral cavity, and the inflammatory process and its contribution to chemical nociception.
Outcome
The model derived to explain the rationale for the intervention theorizes that cold salt and soda mouthwashes interrupt the pain pathway prior to nociception, thus blocking the mechanical and chemical pathway that lead to pain and distress while promoting repair of cellular damage and providing oral hygiene.
Interpretation
A better understanding of the theoretical basis of interventions will help ground clinical practice interventions in scientific principles and can assist in designing and explaining research.
Implications for Nursing Practice
Salt and soda mouthwashes are listed as an intervention for mucositis management in guidelines published by the National Cancer Institute. This model helps to explain the scientific basis of the intervention and can give clinicians confidence when using the intervention in clinical care.
Section Description
This year's annual NACNS conference is planned for Orlando, Fla, March 9-12, 2005. Over 300 clinical nurse specialists (CNSs) are expected to attend, and as with past conferences, attendees will also include graduate faculty from CNS programs, nurse administrators, and nurse researchers. The theme of the conference, CNS Leadership: Navigating the Healthcare Environment Toward Excellence, was selected to showcase the many ways CNSs acquire and disseminate knowledge and innovative practices in their specialty areas. Two preconference sessions are scheduled. One session, sponsored by NACNS Legislative/Regulatory Committee, targets information for CNSs interested in understanding the legislative/regulatory process as it deals with the practice of nursing, and will also help build skills CNSs need to engage in the process. The second session, sponsored by NACNS Education Committee, focuses on CNS education issues, and as with the education preconferences of past years, anticipates informative dialogue and much sharing among CNS educators around curriculum design, teaching strategies, and indicators of quality in the curriculum that link to the NACNS education standards to program review and excellence. The conference planning committee is proud and pleased to have Jeanette Ives Erickson, MS, RN, CNA, Senior Vice President for Patient Care Services and Chief Nurse Executive of Massachusetts General Hospital as the opening keynote speaker. She will begin the conference by highlighting the importance of CNS practice on patient safety. The planning committee is equally proud and pleased to have NACNS past-president Rhonda Scott, PhD, RN, Chief Nursing Officer of Grady Health System as the closing speaker. Dr Scott will challenge attendees to use the information from the conference to shape quality care delivered in a safe environment and to advance the profession of nursing through direct care to clients, influencing standards of care delivered by other nurses, and influencing the healthcare delivery system to be to support innovative, cost-effective, quality nursing care. A total of 64 abstracts for podium and poster presentations were selected in addition to graduate student posters. The abstracts address the 3 spheres of CNS practice with a strong emphasis on clinical practice improvements. As you will note from the abstracts published in this issue of the journal, specialty practice areas represented in the abstracts include children, adults, and gerontological patient groups; hospital, outpatient, and home care settings, and community health. In addition, a wide variety of specialty topics including smoking cessation programs, end-of-life care issues, and protocols outlining nursing approaches to improved diabetes, cardiovascular and ventilator management. A number of the abstracts described hospital and healthcare system level innovations that resulted from CNS practice. Collectively, these abstracts reflect the breadth, depth, and richness of CNS contributions to the well-being of individuals, families, groups, and communities. The following abstracts are from those presenters who elected to have their work published in the journal so those who are unable to attend this year's conference can share in the knowledge of the conference. As you read each abstract, consider the talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to improved outcomes for patients and healthcare organizations. You may want to contact individual presenters to network, collaborate, consult, or share your own ideas about these topics. Watch for next year's call for abstracts and consider submitting an abstract for presentation at NACNS's next conference in Salt Lake City, Utah, March 15-18, 2006.