Bruna DiMonte, RN, BScN, has been a pediatric oncology nurse for 33 years and has spent 25 of those working double duty at The Hospital for Sick Children in Toronto and with POGO as the Senior Database Administrator and Co-Privacy Officer. Every April, oncology nurses celebrate their profession, this year with the theme “Excellence in Oncology: Our Patients, Our Passion.” Here’s what Bruna shared about nursing excellence, her passion for her patients and more.
Excellence in Pediatric Oncology Nursing
Excellence in oncology nursing is about demonstrating a high level of compassion, empathy and pediatric oncology speciality expertise in caring for kids with cancer and their families. Nurses incorporate evidence-based literature and research in our clinical practice, and we are excellent resources to allied health teams and the field of pediatric oncology. We advocate for resources to meet the challenging needs of kids with cancer, families, pediatric oncology nursing and the childhood cancer care system.
Her Passion for Her Patients and Her Work as an Oncology Nurse
My career has been devoted to working on the frontlines and in doing so, I’ve always strived to provide compassionate care to kids with cancer. While it’s hard to choose, I would say that one of the most rewarding things has been finding time in a day to play with a child and distract them from the complex cancer treatment I still have to provide. Every day brings a new set of challenges and however a child’s story plays out, I can only hope I’m making a positive difference in their life and their family’s.
POGO Values Pediatric Oncology Nurses
I have had the pleasure of helping POGO support pediatric oncology nurses in making valuable contributions to the pediatric oncology community. I am the staff representative on the POGO Nursing Committee and have worked with Committee members on such special projects as POGO guideline documents about telephone practices (telepractice) and the safe handling of antineoplastic agents. The Committee has also had the opportunity to contribute to publications, abstracts, presentations at conferences of health organizations like the Association of Pediatric Hematology/Oncology Nurses (APHON), The International Society of Pediatric Oncology (SIOP), and POGO education events like AfterCare Education Day, the Annual Multidisciplinary Symposium on Childhood Cancer and Nursing Pre-Symposia education events. Through POGO, pediatric oncology nurses also have the opportunity to advocate on a policy level, and in the past actively supported POGO’s recommendation of the nurse coordinator position and acquisition of the Interlink Nursing program. POGO also proactively seeks preceptorships with nursing student placements at the POGO office and with the POGO Interlink Nurses at their hospitals.
Other Career Achievements of which Bruna is Most Proud
This is another difficult question as I have had many wonderful opportunities to support novice pediatric oncology nurses, as well as data managers and researchers. I hope I have helped empower others to provide excellent clinical care. And, in collaborating with researchers using POGONIS data for epidemiological research and data analysis, I hope I have adequately supported their policy planning and program development goals for pediatric oncology, and inspired them to collect accurate provincial population data for these needs.
We sat down to chat with Jane Cassano, MSW, and Cindy van Halderen, MSW, about the role pediatric oncology social workers play in the care of children with cancer and their families. Jane is a past member of POGO’s Psychosocial Services Committee and Cindy is a past co-chair of that committee and former member of POGO’s Board of Directors. They work together at McMaster Children’s Hospital in Hamilton. Here’s what they shared.
Describe the role of a social worker and the specific practice of a pediatric oncology social worker. Social workers are skilled at assessing and helping individuals, couples and families who are faced with a variety of challenges. The social work role can be found in hospitals, mental health clinics, schools, child welfare and community service agencies, and private practices.
Pediatric oncology social workers are heavily involved in supporting children, and their families, facing both a cancer diagnosis and the demands of treatment. Ideally, we meet a family at diagnosis so that questions and concerns can be addressed from the outset. Some of the early interventions include assistance with employment issues and applying for benefits, and making referrals to community partners, like POGO for the POGO Financial Assistance Program. Throughout the cancer journey, we provide emotional support and counselling, and monitor how the child and family are coping. We also provide resources for any family member who may be struggling, especially siblings.
What difference do you think social workers make in the lives of kids with cancer and their families? Parents have identified that having a social worker has eased the burden of managing applications for government funding, employment benefits and community resources. There are many programs available in Ontario to support a child with cancer and their family, and they can be difficult to navigate. Social workers are skilled at liaising and advocating with community partners. Parents have said it is a relief to have someone who has knowledge about what is out there and can help them navigate it all.
In such a rapidly evolving field, how do pediatric oncology social workers stay current about the issues of childhood cancer?
Pediatric oncology social workers stay in close contact with community partners like POGO. Ongoing training and education through POGO keep us and our colleagues at other Ontario hospitals up to date with current practices and standards. Through POGO, we have a voice at the provincial level, working as part of a multidisciplinary team to ensure pertinent psychosocial issues are addressed and acted on.
They say, “teamwork makes the dream work.” How is that true for pediatric oncology social workers and POGO? Pediatric oncology social workers and POGO work hand in hand, especially when it comes to the POGO Financial Assistance Program. Families often experience financial distress when their child is diagnosed with cancer. Many parents need time off work and they lose income or there is a major gap before supports begin. Many families are travelling from a distance, which creates a financial strain. Some benefits of the POGO Financial Assistance Program are that it provides stays at Ronald McDonald House and pays for child care for siblings. This support is provided immediately, which is when the need can be the greatest. Families have told us this has made a world of difference.
Jillian Ross, RN, MBA, BScN, is now POGO’s Chief Executive Officer. Previously, Jill was the Director, Cancer System Quality Improvement Initiatives at Cancer Care Ontario (CCO) where she oversaw work on new models of cancer care delivery, quality measurement and system-level improvement initiatives. Additionally, she established new provincial programs and was instrumental in expanding and formalizing CCO’s approach to engaging clinicians in its work. Jill has worked in the hospital sector and other healthcare settings, holding positions as a frontline nurse and clinical educator, as well as leadership roles.
“Jill brings to POGO impressive expertise in patient care, health services administration, and policy and government relations, as well as a commitment to client-centred, data- and evidence-driven improvement in healthcare services,” says Stephen Goudge, President, POGO Board of Directors. “The Board has no doubt that under her leadership POGO will continue to see innovations in our programs, services, and community partnerships that benefit all of Ontario’s children with cancer, their families and the healthcare professionals who care for them. We invite our supporters to join us in welcoming Jill to POGO.”
Ms. Amanda Sherman, BA, MA, PhD(c), discusses her POGO-funded research study.
Your study looked at overprotective and overcontrolling parenting. Can you give us some examples of these two parenting styles?
I would define overprotection as a style of parenting that does not allow the child or emerging adult to experience stressful things. These parents might try to reduce harm even where the situation doesn’t require it. An overprotective parent might call their child’s friends to solve a problem or insist on driving them to destinations where they can easily walk or ride a bike. It is excessive care. Overcontrolling parenting has more to do with discipline and getting a child to behave in a specific way. A parent might say, “You can’t go out tonight because I don’t like some of your friends.” It is excessive control.
What is non-productive coping?
Coping strategies that are not effective in helping that person feel better (worrying, swearing,
avoidance and isolation, for example) are nonproductive because they may lead to more distress and anxiety. In children, one correlate of the development of anxiety disorders is overprotective parenting.
Are childhood cancer survivors more at risk for depression and anxiety?
When looking at levels of depression, we did not find that our sample differed significantly from normative populations; but we did find that anxiety levels were markedly higher than the general population—participants’ scores on our questionnaire were within one standard deviation from the mean score of people with anxiety disorders. That was surprising to me and something we don’t yet know how to account for. Maybe for this population so much of their childhood was focused on getting better, that learning to cope with stress was less important than getting by and managing their illness. Now they are emerging adults and they are facing the potential late effects of their childhood disease, as well as regular life stresses, and perhaps they are less equipped to cope. These are hard questions to answer.
Ms. Amanda Sherman, BA, MA, PhD(c) was the recipient of the 2013 POGO Fellowship Award. Her research focused on maternal overprotection/overcontrol and its relationship to coping strategies, anxiety and depression in survivors of childhood cancer. Her study looked at 109 survivors aged 18-30 attending the POGO AfterCare Clinic at Princess Margaret Cancer Centre. POGO AfterCare Clinics monitor survivors at regular intervals so that potential long-term effects of treatment can be identified as early as possible.
You are doing your PhD in psychology. How did your career path lead you to study childhood cancer patients?
I did a practicum placement with Norma D’Agostino at Princess Margaret, where I was doing therapy exclusively with young adult survivors of childhood cancer. We noticed that problems with lack of autonomy, separating from parents and non-productive coping strategies kept coming up.
What can we take away from this research?
Now that we have this evidence that says overprotective parenting and anxiety are an issue in this population, we can target those parents and teach them how to socialize coping in their children. Even the oncologist can spend five minutes asking the parents and children a few targeted questions to
determine if there is a bigger issue, flag it, and refer the family to a psychologist to help them develop better coping skills.
What do you hope will come from your study?
This is preliminary research but even posing the question is opening doors and people are looking for potential issues when perhaps they weren’t looking for them before. Next steps from a research standpoint: our measure of overprotective and overcontrolling parenting needs to be validated and the study needs to be replicated with a non-cancer control group. I want to disseminate this research any way I can.
What does this POGO Fellowship Award do for your career?
This grant has allowed me to have time, space and community to do research. What I have enjoyed so much about POGO is how open minded everyone is about psychosocial issues, and psychosocial development. It has been nice to be accepted and encouraged for studying these kinds of issues, and working with medical professionals has helped provide a different perspective. It has been humbling, rewarding and encouraging at the same time.
POGO works to provide the best care possible for all of Ontario’s children with cancer, in part, by identifying gaps in childhood cancer care. In recent years, a POGO priority has been to focus efforts on enhancing culturally relevant care for First Nations, Inuit and Métis (FNIM) children, as FNIM families often face barriers to culturally appropriate healthcare.
POGO’s focus has been on building relationships, identifying current opportunities to improve the care of FNIM children with cancer as well as opportunities that might result in a more efficient system, and assembling the expertise needed to assess the issues, gaps and advances anticipated.
In 2017, POGO collaborated with Cancer Care Ontario to launch Pediatric Oncology, a new course in the recently refreshed series of Aboriginal Relationship and Cultural Competency (ARCC) courses offered by Cancer Care Ontario. ARCC courses stress the importance for frontline healthcare professionals to understand and apply FNIM cultural safety to provide effective person-centred care.
POGO and Cancer Care Ontario know that cultural safety is a critical component for improving patient experiences and outcomes. Through video and text, the Pediatric Oncology course examines the differences between childhood and adult cancer, one family’s experience of the journey for FNIM children with cancer, and the role POGO plays in helping to navigate this journey with a unique whole-life approach to childhood cancer care told from the frontline experience of a POGO Interlink Community Cancer Nurse.
The 13 ARCC courses are ideal for healthcare providers, those working with FNIM people, and anyone who wants to better understand FNIM history and culture. The courses are interactive, free of change and open to anyone. Each course in the Self-Learning program has been certified by the College of Family Physicians of Canada for Mainpro+ credits.
Watch the video featured in Pediatric Oncology