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Courtesy of Susan Schneider	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
Susan Schneider, Ph.D., director of the oncology program at the Duke University School of Nursing, adjusts a pair of goggles for patient Darlene Oakley, RN, as part of a study she is directing on breast cancer patients who use virtual reality as a distraction during chemotherapy.

As long as there’s been pain and discomfort, patients have sought to distract themselves through everything from reading to meditation to prayer. The latest tool showing promise is computer software.

At Duke Comprehensive Cancer Center, Darlene Oakley, RN, participated in a study of breast cancer patients who used virtual reality as a distraction during chemotherapy. Many of the women experienced fewer adverse effects and fatigue, according to a study published in January in the Oncology Nursing Forum.

Oakley, an employee of the Duke center’s apheresis department since 1987, was diagnosed with breast cancer in October. She started chemotherapy in December.

Like many facilities, the Duke facility’s infusion room often serves many patients simultaneously. Patients may find themselves focusing on the sickest person in the room, heightening their own anxiety and distress symptoms which can include nausea, vomiting, an inability to concentrate and fatigue.

To distract themselves, some patients already listen to music or read during treatment. The treatment that Oakley and others are receiving is more novel.

On the first day of treatment, at the invitation of Linda Hood, nurse coordinator for the virtual reality project, Oakley donned a pair of I-Glasses SVGA, or audio/video glasses, positioned a pair of ear pads and explored a computer-generated scuba dive, engaging several of her senses at once.

“You’re completely engrossed, not aware of your surroundings and the treatment you’re being given,” Oakley said. “I’ve brought my laptop and watched a movie. That would keep me entertained for a little bit, but because I was not interacting with it, I was still looking at people around me and more easily distracted.”

The ability of computer simulations to engage patients make them uniquely suited to help in the chemotherapy process, said Susan Schneider, Ph.D., director of the oncology program at the Duke University School of Nursing, and lead author and director of the study.

Schneider, an oncology nurse for the past 25 years, noticed that in a clinical setting—especially in the bone marrow or leukemia unit—patients did better when they brought in an activity, such as a game or a computer.

She also noticed research about the effectiveness of using guided imagery, but because 20 percent to 30 percent of patients cannot focus on an image or must practice to do so, nurses needed a better way for some of those patients to block out the external environment.

The right combination

The first major study began in the fall of 1999 when Schneider was still at Case Western Reserve Comprehensive Cancer Center, then continued in July 2000 when she moved over to Duke.

The January report reflects samplings of younger women (aged 18 to 55) at Case Western. The findings reinforce the results of other studies that Schneider has conducted with pediatric cancer patients and breast cancer patients older than 55.

Schneider took care to select the proper computer simulations. Simulations requiring too much focus on details, such as a flight simulator or a game requiring rapid mouse clicks, can be overly demanding on chemotherapy patients or produce unwelcome nausea.

“We needed to choose scenarios where they could go through things at their own pace, like going through an art museum or deep-sea diving,” Schneider said. “We didn’t want to put people on a roller-coaster ride.”