MA17.06 The Specialist Lung Cancer Nurse and Self-Management for People Living with Lung Cancer: A Model of Engagement

Abstract

There is increasing evidence that patient self-management strategies, used as adjuncts to traditional pharmacological interventions, can improve symptom control for people living with lung cancer. While it is acknowledged that the specialist lung cancer nurse (SLCN) is well positioned in the multidisciplinary team to facilitate patient self-management education (PSME), limited guidance is available to SLCNs on this role. The aim of this study was to understand the knowledge and skills required of SLCNs to facilitate PSME and how such skills might best be developed. The intent was to develop a pedagogy that enhances SLCN-patient interactions so that patients can be better supported to make self-care decisions and to act on these decisions. The epistemological lens of the study drew on the sociocultural works of Vygotsky and Leontiev. Fifteen participants were purposively recruited through the Australia and New Zealand Lung Cancer Nurses Forum. The sample comprised Australian registered nurses employed at the level of clinical nurse consultant. Eligibility for the study required participants have a minimum of 5 years lung cancer nursing experience. Of the sample, the average was 13 years’ experience. Through individual, face to face interviews, a biographical approach to data collection focused on participants’ work and non-work lives. The theoretically informed analysis generated understanding about the salient influences on SLCN learning and how and why these influences shaped PSME. PSME is an inherently complex activity. Although seeking to facilitate patient learning to empower patients to self-manage, the SLCN experiences challenges in the contemporary health care environment. Entrenched power relations, professional boundaries, minimal practice guidelines and issues of resourcing of lung cancer and lung cancer nursing are key factors that shape PSME. A model of engagement was designed to reflect the pedagogy that underpins optimal interactions between SLCNs and patients. The model brings forth the socially situated contexts of the SLCN and patient as central to the interaction. A reflective mode of practice creates a teaching and learning environment inclusive of sociocultural and individual processes on learning and thus the mechanisms of co-constructing knowledge for the purpose of shaping patient behaviour. The study assumes the strategic importance of addressing how best the SLCN workforce can support people living with lung cancer to self-manage. A key strength of the research is the focus on understanding the individual and social interrelatedness of SLCN learning for the purpose of enhancing educational interactions in complex environments with people living with lung cancer.