Cepero Defines the Importance of a Holistic Approach to Pediatric Oncology Care

Jesus Cepero, PhD, RN

An essential component of revolutionizing hospital culture must prioritize making holistic environments a key focus, especially for pediatric oncology nursing, according to Jesus Cepero, PhD, RN.

“[A] holistic care approach has to continue to be coached and mentored to evolve and grow,” Cepero said. “Training and growing our future nurse leaders in this [way] is going to be essential to making it live in the future. For me, spending time rounding on the units, talking to new leaders, and continuing to support and sponsor this type of approach is where we all need to be.”

In an interview with Oncology Nursing News®, Cepero, senior vice president and chief nursing officer at Stanford Children’s Health, who has spent nearly 40 years working in nursing and 25 years in leadership, discussed how to integrate a holistic approach to care and how oncology nurses play such a unique role in facilitating these caring environments.

“Our oncology nurses are unique because they take care of patients for days, weeks, months, and sometimes years, so the connection they have with their patients is something that I’m so proud to see,” Cepero said. “They know their [patients’] names, their birthdays, they celebrate events with them while they’re in the hospital.”

“I truly value and respect the work that our pediatric oncology nurses do.”

Oncology Nursing News®: What does a holistic care environment look like?

Cepero: A holistic care environment is one where the philosophy of the staff and the organization manages the patient and their family with an emphasis on mind, body, and spirit. They are not there [solely] for their illness or their injury to be cared for. When we are caring for them, we’re also assessing and managing their mind, their mental health state, and their spiritual needs. If you do, the patient experience [will be] overwhelmingly much better.

In addition, research has shown that outcomes are improved in those type of holistic care environments, where are family members [are] key members of how decisions about care are made for a patient’s hospitalization.

We’re not only taking care of the patient, but interacting and allowing family members to participate. In a holistic environment we recognize that siblings are part of the care team as well. We allow family visitation to not only foster and improve the care of the patient, but [to improve] healing process as well.

In a holistic environment, [we recognize] that spirituality means a lot to the patient and the family and [that we need] resources and space available for them to practice their spiritual beliefs.

How do you engage siblings during care?

We have wonderful trained social workers and a child life specialist to help explain why their brother or sister is in the hospital and why we’re doing care for them. It is nonthreatening and, in a way, the more information they have the less anxiety they have post that session. For us, managing the whole family in this holistic approach is so important. [For] siblings at home who don’t see their brother or sister, when their parents say they’re going through cancer treatment, if they don’t really understand what's happening, that might create a lot of anxiety.

I believe that having access to our child life specialist, or our service animals, makes a difference. When the service animal comes into the session and the siblings or the patient starts to pet the dog, it decompresses that anxiety in that room.

How do nurse leaders play a role in creating these spaces?

It starts from the beginning; recruiting the right individuals who understand the importance of having that philosophy of care. If you’re truly a scientist that only cares about managing disease, medications, and treatments, and don’t get the importance of the holistic approach [you] might not be the right fit for this unit.

There are differences between adult and children’s hospitals. In a children’s hospitals, especially in cancer care, [the] philosophy is not only holistic, but caring. You have to have that caring culture or attitude.

[Additionally], it is not just about nurses, technicians, or registration [staff], it has to be a team approach. Partnering with our physicians in this model is essential. As nurse leaders, our role is to coordinate all those activities to be able to have everyone as they say “rowing in the same direction” in this approach to care.

At your institution, what trainings and skill sets do you make sure that all members of the unit have?

[For spirituality] we have our chaplain team and our director of chaplain services come in and do training to our staff on other cultural beliefs and spiritual beliefs. Having that knowledge is important because how do you meet a patient's mind and spiritual needs if you don’t understand a Buddhist patient’s beliefs or a Jewish patient’s beliefs.

We do a lot of training on different cultural beliefs in care as well as spiritual beliefs and we have seen that that makes a difference not only in just patient experience and satisfaction, but also outcomes.

How do you envision the delivery of cancer care to continue to evolve?

I believe that cancer care is going to evolve into more of a home care environment.

We have to stop thinking of cancer services as just the hospital-based programs; we have to create processes and people to be able to deliver more cancer care at home. Infusion services has struggled over the years, [as we] try to get better at delivering infusions at home. I see opportunities to create environments in the home where patients can receive their care as well as they do in the hospitals.

I believe we’re going to evolve into hospitals being a higher acuity type cancer [for] patients. How do we provide services at home in a better way? [Answering that question] is as holistic as you can get because the best place for [an individual] to get care is at home where they’re more comfortable and they’re surrounded by their loved ones.

What advice can you offer on empowering the next generation of nursing leaders?

We have wonderful leaders that are coming into health care today that have the approach of wanting to meet the patient’s needs. Continuing to recruit and hire those type of individuals is going to be essential now that we’re going into a health care shortage for staff. Going into colleges or even high schools to begin to place in the younger generations minds as to why they should seek nursing or pharmacy or social work professions, is something we have to do now because the nursing and healthcare staff shortage is going to get more difficult in the next 5 to 10 years. That is more important now than ever.

As a teenager, I never envisioned myself as becoming a nurse it was only through mentors that I got to understand what nursing was and began my passion for nursing and supporting patients. If you do’'t have those type of mentors out there, we could be in for some serious trouble as far as shortages in the future.