6 Questions with... Lisa Bernardo, RN, PhD, University of Pittsburg School of Nursing

We spoke with Lisa Bernardo, RN, PhD, associate professor at the University of Pittsburgh School of Nursing, to learn about the research study she is leading, “The Effect of a Continuing Education Program on Oncology Nurses’ Knowledge of and Confidence in Recommending Exercise to Women with Breast Cancer.” She also provided some recommendations for our readers who may be planning to design their own research studies.

1 What is your current perception of the acceptance of online CE for oncology nurses?

Oncology nurses are relatively well studied, and I found quite a few articles when I was writing up the research protocol that tested oncology nurses on whether they used online continuing education. I was very surprised because when my colleagues and I first started doing the research, I was kind of hesitant. We thought, “Maybe oncology nurses wouldn’t be interested in this study.” What we found was that oncology nurses do prefer using online continuing education.

2 Do oncology nurses in general recognize the value of exercise as part of posttreatment regimens for women with breast cancer?

I think it varies based on the area of the country where they practice and what they’re exposed to. Nurses who participate in research for which exercise is a component of a woman’s health during treatment utilize exercise more, and they’re more knowledgeable about it. Nurses in general understand the importance of exercise for everybody, and we’re taught that exercise is a way to maintain health and fitness. However, when you talk to patients, they might see it a little bit differently. From what we’ve heard from [breast cancer] patients, nobody talked to them about exercising during their treatment for breast cancer. I think nurses are knowledgeable, but whether or not they apply that knowledge is also related to the practice recommendations within the hospitals or practices where they work. We’re doing research and we’re finding that women with breast cancer just aren’t told about exercise during their treatment. We’re hoping then, for those nurses who might not currently use exercise as a means to help patients during their treatment, that they might find our continuing education helpful.

3 Can you describe the content of the educational modules nurses will be asked to complete as part of this activity?

There are three modules, and each one runs about an hour including the pre- and post-test and evaluation. The first lecture gives an overview of exercise science. It talks about physical fitness, the components of physical fitness, exercise programming, and the importance of exercise. It looks at cardiovascular exercise and muscular strength and muscular endurance. At the end, there is a vignette scenario in which we go over an exercise prescription based on a patient’s needs. The second module reviews all of the research that’s been done and recommendations on the use of exercise in women during treatment for earlystage breast cancer. We selected earlystage breast cancer because these women are typically healthy; and [while] the treatment is rough, it’s not like advanced-stage [breast cancer] for which they may be hospitalized for a long time. We’re sticking with earlystage breast cancer; stage I, II, and IIa. In this lecture, we go over the current evidence, all of the research this past year, by type of exercise. What we found is that women who were in the study and maintained an exercise program did very well. The exercise helped them to manage their fatigue, it helped them with their cognitive functioning, and it improved their quality of life. This exercise was done under controlled circumstances, so the researchers would bring the women in two or three times a week, walk them on the treadmill, host an aerobics class, or give them a home regimen to do. In the end, we were able to provide recommendations based on the evidence collected from the study.

We take the principles from the first module and apply them to the second module, focusing on exercise during treatment for early-stage breast cancer. The third module discusses exercise after treating for early-stage breast cancer. This is not rehabilitation; it focuses on how women incorporated physical activity and exercise into their daily lives. Again, these are women who were enrolled in clinical trials [that studied] walking and upper body and strength training. The outcomes that were measured included fatigue, cognitive functioning, etc, all of which improved. Every study said, “There were no adverse events. Nobody was injured. Nobody pulled a muscle.” There was [also] a very good adherence rate in participating in the exercises. Women stuck with it.

4 How can an interested oncology nurse participate in your study?

It’s easy and is available at no cost. All they have to do is visit http://www. pitt.edu/~lbe100 to read about me and the study. To participate, they would select the link to read the agreement and click “I agree,” then enter in their name, e-mail address, and the last four digits of their social security number; login and password information is then forwarded to them to begin. Nurses have up to six months to complete the course. This program has been funded by the Oncology Nursing Society Foundation. We’ve gotten quite a bit of interest from it —about 30-40 oncology nurses have signed up so far.

5 If you find online CE isn’t working to make oncology nurses more confident in recommending exercise to breast cancer patients, what other means would you suggest to accomplish this goal?

Oncology nurses need to educate themselves so they can make up their own exercise recommendation for the women they treat. The way to do that is by taking some fitness classes through an exercise science program sponsored by the American College of Sports Medicine or at college or university that has an exercise science program that is affiliated with the American College of Sports Medicine. There, nurses can learn about the science of exercise, and [from] what they know about breast cancer patients and their treatment, put the two together.

Another good thing to do is to look at videos and books that are available to the public, and look at professional organizations. Many have tapes and DVDs with exercises for women who are recovering from breast cancer. There’s a very good program, the Pink Ribbon Program, developed by Doreen Puglisi, an exercise physiologist based out of New Jersey. She teaches nurses and physical therapists very easy exercises. Nurses could go to her programs, which are reasonably priced, to learn proper exercises that can be used with women during and after their treatment for breast cancer. These are all good ways to incorporate exercise into practice. One of the things that we teach in our online program is that a lot of times people think that exercise is jumping up and down, doing jumping jacks, or lifting weights, but that’s not all that exercise is. I think we have to broaden our understanding of what exercise is, and what physical activity is, and that might make nurses feel more comfortable in recommending it.

6 What advice can you give to other nurses who want to get involved with research projects and clinical trials?

The first thing to do is to find a good mentor who is a nurse currently working in cancer research, whether it is breast cancer, a clinical trial with a particular drug, or a clinical trial with exercise or behavioral modification. Nurses should take some classes to learn how to manage clinical trials, and go to the local institutional review board to learn about them and try to sit in on a meeting. There are a lot of good opportunities out there.

Lisa Marie Bernardo, PhD, MPH, RN, HFI, is an associate professor at the University of Pittsburgh School of Nursing. She also maintains a private practice as a Stott-Pilates certifi ed instructor and a 200 hour Registered Yoga Teacher.