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- Case studies | Cancer Australia
- Better outcomes, better experiences: why cancer nursing is a job for specialists
- Oncology Nursing
Communication only works out if everybody is respected and valued. Then a productive discourse can take place between equal partners and the best solution can be found. A care-pathways working group might be as many as 15 people — doctors, nurses, social workers — and still have a nurse as the lead of that group, and it is fine by all group members. Some countries are now doing more to recognise the role of specialist nurse — and reaping the benefits for patients. The Netherlands seems to be leading the way, as the only country with a one-year cancer nursing programme, based on a national curriculum.
There is also a MSc degree in Advanced Nursing Practice, different from the one-year cancer nursing programme, which qualifies you as a nurse specialist. The nurse practitioner role was trialled for five years. In many countries, however, while postgraduate qualifications in cancer nursing exist, they are not officially recognised and confer no change in status, role or pay.
Austria is a case in point, says Spalt. In Portugal, the Ordem dos Enfermeiros National Nursing Board gives specialist certification in six healthcare areas, but cancer is not one of them. Joana Silva works at an outpatient unit at the Vila Nova de Gaia central hospital, where she administers chemotherapy and immunotherapy and helps patients manage the side effects. What frustrates her most is the lack of career opportunities to use the additional knowledge and skills she has.
Not so long ago, she says, getting a specialist nursing qualification would almost automatically fast-track you into a management position, which gave added responsibilities and higher pay, but no opportunity to actually use your specialist skills to benefit patient care. Nowadays, nurses get more of a chance to use their specialist skills, but often without formal recognition of the higher value of their contribution within the care team. What this means for her own career options, says Silva, is she can either apply for a job in her specialty area, at a psychiatric day care unit or a psychiatry ward, which would mean no longer focusing her work with cancer patients.
Or she can stay where she is, not use her additional skills and not get a pay rise. Or she can stay where she is, try to apply her additional mental health and psychiatry nursing skills, and hope she will get rewarded with higher pay. But official recognition [of cancer nursing as a specialism] would mean that specialist nurses received professional training and became more aware of the disease, its treatment, the side effects of that treatment and also safety measures.
It would be enormously better for the health of the patients. In some countries, in the absence of any leadership from governments, specialist oncology training schemes are being implemented independently by educational bodies and cancer nursing societies. This is what happened in Austria, where universities and colleges took the initiative to organise a nationwide cancer nursing education programme, without any input from the government. Passing the programme entitles a nurse to be called a certified cancer nurse, says Christine Schneider-Worliczek, a registered nurse working in the oncology department of the University Hospital of Salzburg.
The groundwork for establishing national cancer nurse courses and qualifications has already been done by EONS. Its Cancer Nursing Education Framework identifies the fundamental knowledge and skills required for a nurse working in cancer care, and can be used as guidance for developing a national training programme. But we have a catch situation: if, despite demonstrably improving patient care, specialist knowledge and skills are not recognised with formal qualifications and status, that lack of respect for the value of the specialist nursing contribution makes it hard to convince the authorities to introduce such qualifications.
The four countries had in common that cancer nurses are devoted to their jobs, they have important relationships with patients and their families, and they are overloaded with work. Important differences were found in: tasks and responsibilities, levels of education, recognition, professional status and autonomy, career possibilities, safety issues, teamwork and support. Germany is an example of a country with strong political opposition to higher education for nurses. The Care Professions Reform Act Pflegeberufereformgesetz , which passed in , originally represented a move away from specialism, with plans to merge the three previously separate care qualifications in nursing, paediatric care and geriatric care.
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It caused controversy because of concerns that, if all nurses had the same generalist training, they could move between roles more easily and that nurses in the badly-paid field of geriatric care would switch to a different occupation. The idea of reducing this risk by paying geriatric nurses more does not seem to have featured in the debate. In the end, legislators compromised by creating a two-year generalist qualification, to be followed by a third year, where nurses can choose whether to specialise or continue with general training. The idea of encouraging nurses to specialise in cancer care through the creation of a clear career path and appropriate remuneration, however, seems very far away.
Contrast that with the neighbouring Netherlands and its official cancer nursing programme. There was political opposition there too, says Suzan Ras, but doctors played an important role in supporting the professional recognition of cancer nurses. Gordana Lokajner, former medical director for nursing and care at the Ljubljana Institute of Oncology, in Slovenia, argues that the lack of a career path and a failure to recognise and reward specialist nurses appropriately is a major driver behind a shortage of nurses in her country.
Standards of cancer nursing are still high, she insists, but only thanks to the enormous effort put in by staff, which is simply not sustainable. The strategy requires investing in nursing services, including rewarding advanced knowledge and skills and greater responsibilities with higher pay.
Even in the comparatively well-paid Netherlands, says Suzan Ras, pay has not increased to reflect the added value nurses contribute as a result of their specialist training and expanded roles. Wages have kept up with inflation, but the job is more difficult. Patients have other diseases, intersecting problems, and you have to treat everything. Nurses should be paid more because it is hard work, physically and mentally.
Many arrange their working week to fit in their other jobs, which means hour shifts are common. This all reduces the time spent on self-development, resting and positive attitudes. Irritated and tired nurses do not do their best work or communicate properly with patients or colleagues. They are burning out. Spalt believes that this comes back to false assumptions about nursing.
At the moment, the expert knowledge of nurses in oncology is not adequately recognised, either by doctors or by patients. Challenging these assumptions is the focus of phase 3 of the RECaN project, which is looking at how to better promote cancer nursing as a recognised speciality across different political or health contexts within Europe. Key to this advocacy will be the evidence generated by the RECaN literature review and the case studies comparing cancer nursing in the UK, Netherlands, Germany and Estonia.
Sharp is optimistic that the project will help change attitudes and policies.
Case studies | Cancer Australia
It replaces the Post-Basic Cancer Nursing Curriculum, which had been created in and revised many times over the following years. It identifies the knowledge, skills and competencies required by nurses who care for people affected by cancer, and can be used as the basis for developing national curricula. A checklist based mainly on the standards of the Joint Commission International JCI was developed to evaluate 50 medical records in the medical area.
These are the standards evaluated:. After the pre-test, the working group worked 4 h per week from May to October to identify a set of the most frequent and common cancer patient outcomes among medical, surgical, and critical nursing areas. From March to November , all nurses working at the European Institute of Oncology IEO were educated on this new tool, and it was implemented in all clinical wards.
The ONMDS was also presented and shared with physiotherapists, psychologists, clinicians, and dieticians.
Fifty newly completed nursing records were analysed with the same checklist used in the pre-test to obtain an objective evaluation. When this new tool is implemented in all departments for at least one year, we will be able to perform another focus group analysis to compare the subjective evaluation of the pre-test. Experienced nurses sharing their clinical experiences found 49 NSOs recognised as the most common and frequent oncology outcomes regardless of treatment that patients undergo.europeschool.com.ua/profiles/xuriqoh/aplicaciones-de-conocer-chicas.php
Better outcomes, better experiences: why cancer nursing is a job for specialists
These outcomes were clustered into 15 categories: gastro-intestinal outcomes, genito-urinary outcomes, respiratory outcomes, skin outcomes, fluid and electrolyte balance outcomes, neurological outcomes, safety, functional status, vascular access outcomes, nutritional status, pain, psychosocial distress, activity daily living ADL , instrumental activity daily living IADL , and self-care outcomes.
Table 1. Several outcomes were defined in collaboration with other professionals; the psychological area has been explored with a group of psycho-oncologists to identify the most frequent and common outcomes that could become the essential data in regard to NMDS. It is assessed with an international validated measuring instrument, which allows the patient to give a name to his emotions. Physiotherapists and dieticians have assessed other outcomes included in the ONMDS that make an important contribution to both the evaluation and the management of the outcomes. Table 2.
JCI standards satisfaction.
An NMDS is a structured information system designed to collect uniform, standardised data, which are the most used by the most nurses in different care settings. It has been developed internationally not only to obtain essential nursing data but also to increase the visibility of nursing in the healthcare system. NSO, in contrast, is a behaviour, condition, or a measurable perception of the patient or his family that is achieved through or is significantly influenced by nursing intervention. The Oncology Nursing Society identified nursing-sensitive patient outcomes as effects or consequences of nursing care.
We proposed a set of 49 NSOs that are the most frequent and common to all cancer patients regardless of the treatment that they have undergone. The results of the pre—post study show that working with this tool allows nurses to plan care and to survey patients by obtaining more quality data in nursing records.
The ONMDS would also be an important tool to implement epidemiological, organisational research and to monitor quality of nursing care. We observed that it promotes a new way of collecting nursing data that can be used to perform epidemiology research on health priority needs. Sharing an ONMDS provides a standard for the description of NSOs using a common terminology among oncology nurses working in different areas medical, surgical, and critical and ensures a standardised and shared data source.
As our results show, this tool lets nurses plan tailored nursing care that is updated and modified on the basis of outcomes evolution achieving a continuity of care. The next step could be the sharing of the ONMDS among different oncology centres to obtain a National and International consensus on it to achieve an important widely used database useful for research. We would like to thank Alvisa Palese for her important contribution to the training of personnel involved. English Spanish. Login Register. Haematology oncology. Hepatobiliary pancreatic. Journal information Charges Editorial board Founding editors Contact us.
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