title: Radiation via Intracavitary-Interstitial Pelvic Implants for Gynecological Cancers: Clinical Nurse Specialists Affecting Change.
abstract: OBJECTIVE
  This article describes the value of a clinical nurse specialist (CNS) team in partnering with interdisciplinary stakeholders to improve care for women with gynecological cancers receiving radiation via intracavitary-interstitial pelvic implants (IPI).
  
  
  BACKGROUND
  Intracavitary-interstitial pelvic implants can prolong survival but is associated with significant impacts on quality of life. Intracavitary-interstitial pelvic implants is a complex and invasive intervention that requires patients to be immobile for 3 days and creates challenges related to dignity, hygiene, nutrition, pain management, emotional health, skin care, and overall patient satisfaction. The nursing staff shared concerns with their respective CNSs regarding patients' quality of care. Lack of standardized practice/orders and gaps in knowledge created challenges.
  
  
  BACKGROUND
  Clinical nurse specialist practice requires collaborative efforts within the 3 spheres of influence to improve the care of patients receiving IPI therapy.
  
  
  METHODS
  The CNSs recognized and addressed needs of patients/families, staff, and the organization across the continuum. The team's efforts relied on reflection of nurses' concerns, collaboration, and a unified vision for exceptional care.
  
  
  RESULTS
  This CNS-led initiative was successful in establishing processes to ensure quality care. Improvement in patient care was achieved through creation of standardized order sets, a focused plan of care, and patient/family/staff education. Nurse satisfaction, confidence, and empowerment to provide patient care with dignity and sensitivity have been verbalized.
  
  
  CONCLUSIONS
  The CNS team's broad scope of practice, across inpatient, outpatient, and evidence-based practice, is a strength. Key to the team's success was the recognition of challenges and a unified vision to bring together stakeholders to facilitate improvement of care. Future direction includes evaluating nutritional choices and examining psychosocial aspects of the patient's experience. An interdisciplinary nursing grand rounds is planned to highlight the outcomes of this team.
  
  
  CONCLUSIONS
  The leadership of CNS teams with varied scopes is critical to affecting change within the spheres of influence and improving patient care across the continuum.
authors.affiliation: Author Affiliations: Manager, Nursing Professional Development (Ms Duncan), Oncology Clinical Nurse Specialist (Ms Mason), and Nurse Director, Supportive Care Medicine Program (Ms Thirlwell), H. Lee Moffitt Cancer Center, Tampa, Florida.
authors.forename: Pamela
authors.initials: P
authors.lastname: Duncan
authors.forename: Tina M
authors.initials: TM
authors.lastname: Mason
authors.forename: Sarah
authors.initials: S
authors.lastname: Thirlwell
mesh_terms: D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D005260:Female; D005833:Genital Neoplasms, Female / Q000451:nursing* / Q000532:radiotherapy*; D006801:Humans; D009720:Nurse Clinicians; D015403:Nursing Evaluation Research; D009740:Nursing Staff / Q000523:psychology; D009746:Nursing, Team; D019736:Prostheses and Implants; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D011878:Radiotherapy / Q000379:methods