“The bell can have so much more meaning and significance than just the end of treatment. So, work with your patients to define what the significance of that bell can mean,” ONS member Monica Cfarku, RN, MSN, BMTCN®, CCM, NE-BC, associate vice president and chief of oncology nursing at Duke Cancer Institute in Durham, NC, and member of the North Carolina Triangle ONS Chapter, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS. Cfarku discussed the ethics of the bell that patients with cancer ring following the completion of their treatment and how her institution has redefined the bell’s ritual. You can earn free NCPD contact hours by completing the evaluation we’ve linked in the episode notes.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: The learner will report an increase in knowledge related to treatment bell meaning and options.

Episode Notes

• The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities.
• Oncology Nursing Podcast Episode 78: Ethical Distress Impacts Nursing Practice
• ONS Voice articles:
  • Four R’s and Resilience Approach Help Oncology Nurses Respond to Morally Distressing Challenges
  • Redefining the Bell Makes the Ritual Inclusive for All Patients With Cancer
  • Use the Evidence to Integrate Ethics in Teleoncology Care
  • How to Have Ethical Discussions in Your Practice
• ONS Moral Resilience Huddle Card™
• MD Anderson Cancer Center: Ringing the Bell Marks a Milestone in Cancer Treatment
• Duke Cancer Institute

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To provide feedback or otherwise reach ONS about the podcast, email [email protected].

Highlights From Today’s Episode

“The bell has typically been associated with completion of treatment, and the patient is now considered free of cancer. The challenge with that is when patients that will never get to experience that—because there are certain cancers now that are essentially chronic conditions—they hear that bell and that is not a good sound for them. That can bring a lot of emotions around how they’re never going to get to that point.” Timestamp (TS) 02:19

“As nurses, it is our duty to recognize an ethical situation and help to determine what that next action or decision is in those situations. We really need to be applying our ethical sensitivity.” TS 04:06

“The bell doesn’t just have to be for the end of treatment. It can be the end of a particular journey, or ringing the bell for courage before you walk in. It can be used for anything.” TS 13:14

“I’ve seen patients ring the bell before walking into the building. . . . I’ve been asked to meet patients at the bell on their last day of treatment so they can ring it in celebration. . . . I’ve seen non-oncology patients that are going into a different part of the campus and their family ring it, and I love to see that, as our bell is being used to inspire hope and courage to so many other patients across Duke University. . . . I’ve seen staff ring it. . . . This little project has really had a reverberating effect that we did not even anticipate.” TS 16:23

“The bell can have so much more meaning and significance than just the end of treatment. So, work with your patients to define what the significance of that bell can mean.” TS 20:45