Nursing Society Research Articles

Implementation of an Evidence-Based, Content-Validated, Standardized Support Surface Algorithm Tool in Home Health Care: A Quality Improvement Project.

The purpose of this quality improvement project was to provide a standardized, repeatable, and easy-to-use process for selecting a support surface for prevention or treatment of pressure injuries (PIs). The Wound, Ostomy, and Continence Nurses Society Support Surface Algorithm was chosen to guide clinicians in selection of an appropriate support surface. These clinicians provide services to approximately 465,000 patients across the nation annually. This quality improvement project aimed to establish clinician knowledge and comfort levels when recommending a support surface and providing a standardized way to identify the appropriate support surface once a patient had been identified as at risk. The support surface algorithm was incorporated into our agency's electronic medical record (EMR); we chose this interactive algorithm to facilitate support surface selection among clinicians with no specialized expertise in PI treatment or prevention. Clinicians reported an increase in knowledge and comfort levels in the ability to select an appropriate support surface following implementation of the clinical decision support tool. Benchmarking data illustrated a decrease in the year over year aggregate (September 2018 to September 2021) trending for the Centers for Medicare & Medicaid Services quality outcome measures surrounding potentially avoidable events related to PIs. Implementing the support surface algorithm assisted clinicians with support surface selection, elevated and standardized clinician practice, and reduced potentially avoidable events. As a result of this project, the Wound, Ostomy, and Continence Nurses Society Support Surface Algorithm Tool has been fully integrated into our EMR and is a standardized part of our clinical assessment.

An Evidence-Based Review of the Safety and Efficacy of Remote Chemotherapy Verification.

In response to the nursing shortage and the emergence of telehealth opportunities, the Oncology Nursing Society used an evidence-based approach to examine current literature and trends for the two-person independent double ch.

The cancer nursing workforce in Australia: a national survey exploring determinants of job satisfaction

BackgroundTo maintain and improve the quality of the cancer nursing workforce, it is crucial to understand the factors that influence retention and job satisfaction. We aimed to investigate the characteristics of cancer nurses in Australia and identify predictors of job satisfaction.MethodsWe analysed data from an anonymous cross-sectional survey distributed through the Cancer Nurses Society Australia membership and social media platforms from October 2021 to February 2022. The survey was compared to national nursing registration data. Data were analysed with non-parametric tests, and a stepwise, linear regression model was developed to best predict job satisfaction.ResultsResponses were received from 930 cancer nurses. Most respondents (85%) described themselves as experienced nurses, and more than half had post-graduate qualifications. We identified individual, organizational, and systemic factors that contribute to job satisfaction and can impact in workforce shortages. The findings include strategies to address and prioritize workforce challenges. There were 89 different titles for advanced practice nursing roles. Managing high workload was a reported challenge by 88%. Intention to stay less than 10 years was reported by nearly 60%; this was significantly correlated with job satisfaction and age. Significantly higher scores for job satisfaction were associated with those who had career progression opportunities, career development opportunities, adequate peer support and a clearly defined scope of role. Conversely, job satisfaction scores decreased the more people agreed there was a lack of leadership and they had insufficient resources to provide quality care.ConclusionCancer nurses are critical to the delivery of cancer care however, the workforce faces multiple challenges. This study provides an understanding of the Australian cancer nursing workforce characteristics, their roles and activities, and highlights important considerations for retaining nurses in the profession.

Position Statement: Range Orders in the Management of Pain

American Society for Pain Management Nursing (ASPMN) supports safe medication practices and the appropriate use of pro re nata (PRN) range orders for analgesics in the management of pain within the scope of nursing practice. Although range orders may apply to many medications prescribed as PRN, the focus of this ASPMN position statement is on PRN analgesic medication. PRN range orders are commonly used to provide flexibility in dosing to meet the analgesic requirements of an individual patient. There are many patient-specific factors that require professional clinical assessment when administering medications to patients. Unfortunately, several myths persist regarding The Joint Commission's (TJC) standard around the implementation of range orders leading many to assume that range orders are not supported or safe. On the contrary, if utilized in a consistent and appropriate manner, PRN range orders can allow nurses to provide optimal pain management while still providing safe administration (Paquette et al., 2022).

An analysis of Plan, Do, Study, Act for a supportive care program for patients with metastatic breast cancer.

376 Background: Patients with metastatic cancer have unique survivorship needs. Recent studies show patients with advanced cancer have unmet needs in the following categories: health information (31%), psychosocial support (27%), symptom management and general wellness support (23%) (Hart, et al., 2022). The Living Well with Advanced Breast Cancer Clinic (LWABC) was established in 2017 to address these unmet needs. This multidisciplinary clinic provides the patient and caregiver(s) an individual visit with a medical oncologist, integrative medicine physician, palliative medicine physician, dietitian, and nurse navigator. The patient is provided in-depth education and personalized supportive care plans. Methods: Over recent years, clinic staff have utilized the Plan, Do, Study, Act (PDSA) (Taylor, et al., 2014 ) methodology to refine operations and improve patient care. In 2021, the plan phase was initiated with incorporation of a nurse navigator and program manager for the clinic. Nurse navigation services have been shown to improve patient and caregiver knowledge as well as quality of life and was deemed an important addition to the program (Oncology Nursing Society, 2018). At the beginning of calendar year 2022, in the “do” phase, the nurse navigator/program manager was hired and implemented pre-visit phone calls as well as navigation services for patients. These services include assessment of needs, patient education, provision of community resources, and assistance with scheduling referrals. At the beginning of calendar year 2023, use of the NCCN distress thermometer and problem list was initiated. The current phase, “study,” includes development of a dashboard for monitoring clinic operations. Review and assessment of distress thermometer data is ongoing. Results: When comparing calendar year 2021 to 2022, the clinic has seen increases in referrals (40 in 2021 to 65 in 2022), number of patients seen (31 in 2021 to 46 in 2022), and unique patient zip codes (28 in 2021 to 42 in 2022). There was also a reduction in late cancellation rates from 15.9% (2021) to 7.2% (2022). Late cancellation is defined as any appointment cancelled 24 hours or less prior to scheduled visit. Conclusions: Utilizing the PDSA cycle clinic staff have seen operational improvements over the last two years. Currently, this supportive care program remains in a “study” phase and will continue to evaluate progress and patient outcomes. Results from the act phase will be utilized to continue expansion of the clinic and services in the future. Further aiding this endeavor is an embedded patient advocate and ongoing outreach and collaboration with patient support organizations.

Testing a Model of Care for Patients on Immune Checkpoint Inhibitors Based on Electronic Patient-Reported Outcomes: Protocol for a Randomized Phase II Controlled Trial.

Management of severe symptomatic immune-related adverse events (IrAEs) related to immune checkpoint inhibitors (ICIs) can be facilitated by timely detection. As patients face a heterogeneous set of symptoms outside the clinical setting, remotely monitoring and assessing symptoms by using patient-reported outcomes (PROs) may result in shorter delays between symptom onset and clinician detection. We assess the effect of a model of care for remote patient monitoring and symptom management based on PRO data on the time to detection of symptomatic IrAEs from symptom onset. The secondary objectives are to assess its effects on the time between symptomatic IrAE detection and intervention, IrAE grade (severity), health-related quality of life, self-efficacy, and overall survival at 6 months. For this study, 198 patients with cancer receiving systemic treatment comprising ICIs exclusively will be recruited from 2 Swiss university hospitals. Patients are randomized (1:1) to a digital model of care (intervention) or usual care (control group). Patients are enrolled for 6 months, and they use an electronic app to complete weekly Functional Assessment of Cancer Therapy-General questionnaire and PROMIS (PROs Measurement Information System) Self-Efficacy to Manage Symptoms questionnaires. The intervention patient group completes a standard set of 37 items in a weekly PROs version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) questionnaire, and active symptoms are reassessed daily for the first 3 months by using a modified 24-hour recall period. Patients can add items from the full PRO-CTCAE item library to their questionnaire. Nurses call patients in the event of new or worsening symptoms and manage them by using a standardized triage algorithm based on the United Kingdom Oncology Nursing Society 24-hour triage tool. This algorithm provides guidance on deciding if patients should receive in-person care, if monitoring should be increased, or if self-management education should be reinforced. The Institut Suisse de Recherche Expérimentale sur le Cancer Foundation and Kaiku Health Ltd funded this study. Active recruitment began since November 2021 and is projected to conclude in November 2023. Trial results are expected to be published in the first quarter of 2024 and will be disseminated through publications submitted at international scientific conferences. This trial is among the first trials to use PRO data to directly influence routine care of patients treated with ICIs and addresses some limitations in previous studies. This trial collects a wider spectrum of self-reported symptom data daily. There are some methodological limitations brought by changes in evolving treatment standards for patients with cancer. This trial's results could entail further academic discussions on the challenges of diagnosing and managing symptoms associated with treatment remotely by providing further insights into the burden symptoms represent to patients and highlight the complexity of care procedures involved in managing symptomatic IrAEs. ClinicalTrials.gov NCT05530187; https://www.clinicaltrials.gov/study/NCT05530187. DERR1-10.2196/48386.

Prioritizing Harm Reduction Services to Reduce the Burden of Substance Use: A Joint Position Statement of the International Society of Psychiatric-Mental Health Nurses and the International Nurses Society on Addictions-USA Chapter.

Prioritizing Harm Reduction Services to Reduce the Burden of Substance Use: A Joint Position Statement of the International Society of Psychiatric-Mental Health Nurses and the International Nurses Society on Addictions-USA Chapter.

Chinese clinical practice guidelines for the prevention and treatment of radiation‐induced dermatitis

AbstractRadiation‐induced dermatitis is one of the most prevalent complications in patients undergoing cancer radiotherapy and poses a significant challenge to cancer therapy. The symptoms include erythema, dry desquamation, and moist desquamation, which are frequently observed in patients with breast, head and neck, anal, and vulvar cancers. Early skin reactions typically manifest within 2–4 weeks following the initiation of radiotherapy. In severe cases, acute dermatitis can cause radiotherapy interruptions, prolong treatment time, and ultimately affect patient outcomes and quality of life. Currently, there are numerous guidelines on radiation dermatitis, including the Multinational Association of Supportive Care in Cancer (MASCC), British Columbia Cancer Agency (BCCA), Oncology Nursing Society (ONS), and UK Society of Radiographers (SCoR) guidelines. In China, dermatology experts have drafted a consensus. However, due to the differing backgrounds of experts, recommendations among guidelines vary. These guidelines were first developed by Chinese radiation oncologists. The evidence‐based guideline in this paper fully considers and adopts China's national conditions; hence, it can be easily applied in daily practice.

What Nursing-Sensitive Outcomes Have Been Investigated to Date among Patients with Solid and Hematological Malignancies? A Scoping Review.

Nursing-sensitive outcomes are those outcomes attributable to nursing care. To date three main reviews have summarized the evidence available regarding the nursing outcomes in onco-haematological care. Updating the existing reviews was the main intent of this study; specifically, the aim was to map the state of the art of the science in the field of oncology nursing-sensitive outcomes and to summarise outcomes and metrics documented as being influenced by nursing care. A scoping review was conducted in 2021. The MEDLINE, Cumulative Index to Nursing and Allied Health, Web of Science, and Scopus databases were examined. Qualitative and quantitative primary and secondary studies concerning patients with solid/haematological malignancies, cared for in any setting, published in English, and from any time were all included. Both inductive and deductive approaches were used to analyse the data extracted from the studies. Sixty studies have been included, mostly primary (n = 57, 95.0%) with a quasi- or experimental approach (n = 26, 55.3%), conducted among Europe (n = 27, 45.0%), in hospitals and clinical wards (n = 29, 48.3%), and including from 8 to 4615 patients. In the inductive analysis, there emerged 151 outcomes grouped into 38 categories, with the top category being 'Satisfaction and perception of nursing care received' (n = 32, 21.2%). Outcome measurement systems included mainly self-report questionnaires (n = 89, 66.9%). In the deductive analysis, according to the Oncology Nursing Society 2004 classification, the 'Symptom control and management' domain was the most investigated (n = 44, 29.1%); however, the majority (n = 50, 33.1%) of nursing-sensitive outcomes that emerged were not includible in the available framework. Continuing to map nursing outcomes may be useful for clinicians, managers, educators, and researchers in establishing the endpoints of their practice. The ample number of instruments and metrics that emerged suggests the need for more development of homogeneous assessment systems allowing comparison across health issues, settings, and countries.

Abstracts presented at Stroke 2023 – The Combined Stroke Society of Australasia and Smart Strokes Nursing and Allied Health Scientific Meeting, 22-25 August 2023, Melbourne, Australia

Abstracts presented at Stroke 2023 – The Combined Stroke Society of Australasia and Smart Strokes Nursing and Allied Health Scientific Meeting, 22-25 August 2023, Melbourne, Australia

Challenges Recruiting and Retaining New Members of a Professional Nursing Organization

BackgroundThe American Society for Pain Management Nursing (ASPMN) began as a nursing-focused pain organization in 1990 and has experienced fluctuations in membership over time. According to the literature, membership to many professional organizations, including ASPMN, are waning. New member recruitment and retention is crucial for maintaining viability and financial strength of an organization. AimThis study explores ASPMN new member attitudes, perceptions, and experiences. The intention was to learn what inspired or influenced nurse participants to join ASPMN, what they expect gain from membership, and how the organization can help fulfill their professional pain management goals. MethodThis IRB-exempted qualitative descriptive study offered participants opportunities to reflect upon and share their member experiences either individually or in small focus groups. Nurses were identified via ASPMN new member lists or referred from ASPMN Chapter leaders. Conversations were recorded and transcribed using virtual technology, validated, then analyzed for recurring themes. ResultsOne key finding was that 0 of 11 participants were fully apprised of member benefits. Key themes were most had motivating factors which prompted their joining ASPMN, and many were seeking organization resources (networking, certification, and new knowledge). Challenging focus group recruitment was likely related to internal and external forces, including post-pandemic fatigue with virtual platforms, time constraints, and a general over-abundance of e-communications. ConclusionsMany professional organizations continue to struggle to recruit and retain members. While there were no material incentives, the focus group or individual interviews promoted collegiality, reinforced knowledge about ASPMN member benefits, and provided a platform to dialog about how the organization can grow while addressing member needs. Findings from this study may benefit ASPMN and other organizations by providing insight into what attracts and maintains new members, creating a platform to learn about members, and ideally, identifying new ways of engagement and initiatives.

Predicting acute radiation dermatitis in breast cancer: a prospective cohort study

BackgroundAcute radiation dermatitis (ARD) is one of the most common acute adverse reactions in breast cancer patients during and immediately after radiotherapy. As ARD affects patient quality of life, it is important to conduct individualized risk assessments of patients in order to identify those patients most at risk of developing severe ARD.MethodsThe data of breast cancer patients who received radiotherapy were prospectively collected and analyzed. Serum ferritin, high-sensitivity C-reactive protein (hs-CRP) levels, and percentages of lymphocyte subsets were measured before radiotherapy. ARD was graded (0–6 grade), according to the Oncology Nursing Society Skin Toxicity Scale. Univariate and multivariate logistic regression analyses were used and the odds ratio (OR) and 95% confidence interval (CI) of each factor were calculated.ResultsThis study included 455 breast cancer patients. After radiotherapy, 59.6% and 17.8% of patients developed at least 3 (3+) grade and at least 4 (4+) grade ARD, respectively. Multivariate logistic regression analysis found that body mass index (OR: 1.11, 95% CI: 1.01–1.22), diabetes (OR: 2.70, 95% CI: 1.11–6.60), smoking (OR: 3.04, 95% CI: 1.15–8.02), higher ferritin (OR: 3.31, 95% CI: 1.78–6.17), higher hs-CRP (OR: 1.96, 95% CI: 1.02–3.77), and higher CD3 + T cells (OR: 2.99, 95% CI: 1.10–3.58) were independent risk factors for 4 + grade ARD. Based on these findings, a nomogram model of 4 + grade ARD was further established. The nomogram AUC was 0.80 (95% CI: 0.75–0.86), making it more discriminative than any single factor.ConclusionBMI, diabetes, smoking history, higher ferritin, higher hs-CRP, and higher CD3 + T cells prior to radiotherapy for breast cancer are all independent risk factors for 4 + grade ARD. The results can provide evidence for clinicians to screen out high-risk patients, take precautions and carefully follow up on these patients before and during radiotherapy.

Whither nursing philosophy: Past, present and future.

A version of this paper was given as the Inaugural Steven Edwards Memorial Lecture at the 25th conference of the International Philosophy of Nursing Society 16th August 2022. Using the literary meaning of 'whither', that is 'to what place', this paper will explore the role of philosophy in nursing, past, present, and future. The paper will begin with some thoughts on the history of nursing philosophy, its development as a subject and the scholarly activities that have led to where it sits today. The establishment of the journal Nursing Philosophy, the Annual Nursing Philosophy Conference, the International Philosophy of Nursing Society (IPONS) and their influence on nursing both in the academy and in practice will be discussed. The concept of nursing philosophy as a discipline will be considered, and how this fits with nursing theory, and nursing knowledge. Philosophical questions central to understanding contemporary nursing in a globalised world will be explored and the use of analytical philosophy and philosophical method in addressing such questions. The paper will conclude by looking to the future; what the role of philosophy might be in shaping nursing as a discipline and in the preparation of future practitioners.

Prioritizing harm reduction services to reduce the burden of substance use: A joint position statement of the International Society of Psychiatric Mental Health Nurses (ISPN) and the International Nurses Society on Addictions (IntNSA)-USA Chapter

Prioritizing harm reduction services to reduce the burden of substance use: A joint position statement of the International Society of Psychiatric Mental Health Nurses (ISPN) and the International Nurses Society on Addictions (IntNSA)-USA Chapter

The Attitudes and Practices Among Neonatal Nurses Regarding Breastfeeding Support in The Neonatal Intensive Care Unit During Covid-19

Objective: Neonatal nurses have a main role which include promote and facilitate breastfeeding in in the Neonatal Intensive Care Unit (NICU). This study was conducted to determine the practices and attitudes of nurses towards breastfeeding support, which has critical importance in breastfeeding for newborns hospitalized in NICU during the Covid-19 pandemics. Material and method: The study was a cross-sectional descriptive survey design conducted with 252 nurses who were members of the Neonatology Nurses Society. The Data Collection Form, Survey Questionnaire, and the Iowa Infant Feeding Attitude Scale (IIFAS) were used for data collection. Results: The IIFAS median score of the participants was 70.0 (IQR=9.0). Statistically differences in the IIFAS scores were found according to age (χ2=11.703, p=0.008), education status in nursing (χ2=9.257; p=0.01), and status of attending to international scientific meetings (Z=-2.360; p=0.018). Participants who were age between 26-30 years (n=76, 30.2%), had post-education degree in nursing (n=32, 12.7%), and attended to international scientific meetings (n=47, 18.6) had higher positive attitudes of breastfeeding. The nurses (n=126, 50%) stated that it was difficult to reach mothers in terms of breastfeeding for newborns, and 61.8% of them (n=156) stated that they had difficulty initiating the mother-baby attachment process in the NICU. Conclusions: Although the attitudes of NICU nurses towards breast milk and breastfeeding were at a moderate level in our study, they struggled to support and maintain the lactation and they implemented to a number of supportive feeding practice in NICUs.

Comparison of nursing doctoral programs in Iran and the University of Massachusetts Boston: A comparative study

Background & Objective: Learning about the world's successful educational systems in the field of nursing education can be helpful in planning, especially in the doctoral program, and lead to an increase in the quality of education in this field. Therefore, the present study was conducted with the aim of a descriptive and comparative comparison of the curriculum of nursing doctoral programs in Iran and the University of Massachusetts Boston. Materials & Methods: The present study is a descriptive-comparative study. To compare the doctoral nursing curricula of Iran and Boston Massachusetts, related articles and resources along with library studies based on Bereday's four-stage model, including description, interpretation, proximity, and comparison were analyzed. Results: Integration of the curriculum with a focus on nurse participation in health policies, educational content related to defined roles and more emphasis on educational courses, admission of undergraduate doctoral students, the existence of part-time and full-time courses, and having the practice-focused program alongside Ph.D. were important features of Boston University curriculum. The nursing doctoral curriculum in Iran is done only full time and from master's degree and in a centralized manner. The educational courses do not meet the needs of society and the only nursing doctoral program in Iran is Ph.D. Conclusion: Boston's nursing Ph.D. curriculum has been developed with a comprehensive view of the real perceived needs of the nursing profession and society. The results of the comparison can be useful in revising Iran's nursing Ph.D. curriculum to improve educational quality.

Importance of physical exercise prescription in patients with chronic kidney disease: results of the survey of the Grupo Español Multidisciplinar de Ejercicio Físico en el Enfermo Renal [Spanish Multidisciplinary Group of Physical Exercise in Kidney Patients] (GEMEFER)

IntroductionDespite the benefits of physical exercise (PE) for patients with chronic kidney disease (CKD), the number of Nephrology services that have PE programs is limited. ObjectivesTo describe the degree of knowledge of PE benefits in patients with CKD among professionals, as well as the level of implementation and characteristics of PE programs in Nephrology services in Spain. MethodsA questionnaire on the degree of knowledge and prescription of PE in patients with CKD was designed and sent to members of the Spanish Nephrology and Nephrology Nursing Societies, as well as to physiotherapists and professionals in the Sciences of Physical Activity and Sport (PASS). Results264 professionals participated. 98.8% agreed on the importance of prescribing PE, but only 20.5% carry out an assessment of functional capacity and 19.3% have a PE program for patients with CKD in their centre. The most frequent programs are performed for haemodialysis patients and strength and aerobic resistance exercises are combined. A physiotherapist or a PASS usually participates in its prescription. The main barriers were the absence of human and/or physical resources and the lack of training. ConclusionsHealthcare workers know the benefits of PE in patients with CKD. However, the implementation of these programs in Spain is low, motivated by the lack of resources and training of professionals. We must establish strategies to guarantee an adequate functional capacity within the care of our patients.

Position Statement on Cancer Nursing Leadership.

The Importance of Nursing Leadership Nurses are essential to effective global cancer control, influencing treatment, education, research, and policy issues—at local, national, and international levels. Empowering cancer nurses to lead and take on key leadership roles across the cancer continuum and within different levels of the healthcare system is imperative to addressing the burden of cancer globally. In some countries, addressing inequalities and dismantling professional hierarchies is central to enabling nurses to exercise their leadership capabilities, even if they are not in a leadership role, to improve cancer care outcomes. Although every cancer nurse will be required to demonstrate skills as leaders, not all will be in leadership roles. More nursing leadership roles are needed at national, regional, and global levels. In some countries, more cancer nursing leadership opportunities are provided/available than in others. For example, in many countries, inequalities and professional hierarchies exist, which often prohibit leadership opportunities for cancer nurses. Investment in developing leadership among nurses at all levels is a global priority.1,2 Leadership is the ability to achieve collaborative effort, enabling people to work together to achieve common goals. It is multifaceted, characterized by the ability to provide and deliver direction and support, motivation, coordination, collaboration, effective communication, and advocacy for patients, communities, and other nurses. Leadership is about interpersonal relationships, and empowering the workforce to be innovative and creative to solve challenges is going to be important moving forward.3 Strengthening nursing leadership in global health (“no one left behind”) is a priority. The consistent messaging in the “Triple Impact Report,”4 the Nursing Now initiative,5 and in the State of the World’s Nursing6 and the Global Strategic Priorities for Nursing and Midwifery7 reports is that influential nurse leaders are more critical than ever. As the most significant global health workforce,8 nursing needs to focus its attention on the development of nurse leaders across clinical care, research, education, policy, and administration if the World Health Organization sustainable development goals9 and the global strategic priorities for nursing are to be met. The Institute of Medicine report on the Future of Nursing: Leading Change, Advancing Health10 and more recently the National Academy of Medicine report on the Future of Nursing 2020-2030,11 both call for nurses to lead interprofessional teams and healthcare systems to benefit patient outcomes and system-level efficiency. Not only has the COVID-19 pandemic powerfully illustrated the knowledge, skills, commitment, and leadership of nurses globally, it has also demonstrated why person-centered, culturally safe, evidence-based care and Universal Health Coverage12 cannot be achieved without nurses and nurse leaders. Nurses, as informal and formal leaders, need to be fostered and recognized across all aspects and levels of nursing work. Nurses work across all health settings and organizations, often at the highest levels of clinical care, but rarely at the highest levels of management where they can use their voice to influence.13 Pathways to develop nursing leadership and nurse leaders need to be fostered and implemented.14 Research in nursing leadership demonstrates clinical- and system-level benefits,15 but more research is needed to strengthen the evidence around nurse leadership and particularly in the context of cancer nursing. What Do We Mean by Cancer/Oncology Nursing? Cancer or oncology nursing is used interchangeably to describe the nurses who practice in the specialty of cancer care/oncology. However, for this position statement, we also include all nurses working with people affected by cancer, whether they are oncology trained or not, as they all have an important leadership role to play. Why Cancer Nursing Needs Effective Leadership Cancer is a common chronic disease with 19.3 million new cases and approximately 10 million deaths reported globally in 2020.16 As healthcare delivery systems change, and new scientific discoveries are integrated into cancer care, the role of the cancer nurse continues to evolve. Cancer nurses work in a variety of roles and settings that were unheard of 10 years ago but are now increasingly common. These include acute care, ambulatory care, the private sector, and home and community services, along with education, research, policy, and advocacy. They practice within a number of oncologic disciplines, including, but not limited to surgery, radiology, gynecologic oncology, pediatric oncology, medical oncology, hematology, transplant, and cancer genetics. The era of precision medicine also presents challenges to achieving universal health coverage (within the sustainable development goals). As the global cancer burden increases in lower-income countries, the leadership of cancer nurses in reducing both inequalities and inequities in access to high-quality care has never been more important. The nursing profession establishes leadership through the practice of individual nurses engaged in patient care, administration, teaching, and research. When empowerment is absent or not utilized, others are more likely to step in and decide what nursing is and what nurses do. Thus, nurses may not identify themselves as leaders or potential leaders. The language of leadership often excludes nurses and has socialized nurses into defining leadership as separate to nursing practice. However, nursing leadership can be “learned.”17 Globally, nurses can provide leadership in patient assessment, patient education, coordination of care, symptom management, palliative care, education, research, advocacy, and policy. Although many also serve in key management positions such as chief executives or directors of cancer services, it is essential that they are empowered and supported to utilize their leadership skills, whether in key management positions, in academic roles, or clinical practice. Strengthening nursing leadership is evident across several international cancer nursing position statements, for example, the Canadian Association of Nurses in Oncology (CANO/ACIO) position statement.18 The CANO/ACIO statement strongly advocates for prioritization of nurse leadership training within academic programs, across cancer care organizations and nursing organizations, who can provide mentorship and coaching. One of the most prevalent opportunities for cancer nurses to influence and lead care is by collaborating and influencing within multidisciplinary teams to address the needs of the patients and family members they care for, often in high-acuity, fast-paced, and under-resourced environments. Many organizations have identified the competencies required for cancer and palliative care nursing leadership, such as the African Palliative Care Association,19 the Oncology Nursing Society,20 the European Oncology Nursing Society,21 and the African Organisation for Research and Training in Cancer.22 The International Society of Nurses in Cancer Care is committed to the promotion and development of cancer nursing leadership around the world because of the following: Effective cancer nursing leadership is required at all levels of clinical care spanning from newly qualified through to advanced clinical practice, advocates, education, research, and senior health service administration. Cancer nurses need the opportunity to practice a range of leadership skills, which includes the following: modeling the way for others, inspiring a shared vision, challenging the process, enabling others to act to their maximum capacity and skills, and encouraging and empowering others.23 Cancer nurses enable implementation of future trends in oncology care. Nurses identify ways to change, grow, and improve; create a culture, infrastructure, and practice environment that supports innovation, advancement of cancer nursing practice, and excellence in patient- and family-centered care. Collaborate on research strategies development lies not only with schools of nursing and individual institutions but also with professional associations that can collaborate to research strategies and develop effective leadership programs that can be integrated into clinical training. Call to Action The International Society of Nurses in Cancer Care is committed to advocating to ensure that cancer nurses can reach their leadership potential for the benefit of patients and their families, and influence local, national, and global cancer control. The International Society of Nurses in Cancer Care recommends the following: All nurses working with people affected by cancer, regardless of where they are working, should be supported and encouraged to develop and utilize leadership skills. Cancer nurses need preparation to be able to mentor and empower other cancer nurses to develop their leadership skills, actively supporting them and providing, where possible, opportunities for leadership development. Leadership skills should be included in formal professional and continuing cancer nursing education, and where possible, leadership fellowships established to develop cancer nurses in a wide range of countries. Examples of cancer nurses as leaders across a range of settings should be made available and shared to encourage and empower cancer nurses. Leadership training for cancer nurses should be developed that links in with national nursing leadership development programs.6 Cancer nurses should be provided opportunities for training in policy development and advocacy, thus enabling them to lead in this capacity. Cancer nurses are enabled to get a “seat at the table” to enable their voice to be heard, at all levels within cancer care, for example, on the ward, in the community, at the administrative levels, and at the national and international levels. International Society of Nurses in Cancer Care members work together to contribute to global efforts to build cancer nursing leadership globally. Nursing leadership is addressed at all national, regional, and international cancer nursing conferences to stress its importance, but also to empower and encourage new and emerging cancer nursing leaders. National, regional, and international cancer nursing and related associations work together to develop cancer nursing leadership globally.

Preparation and Evaluation of a Professional Development Series for Early-Career Oncology Nurses in Europe.

The European Oncology Nursing Society Nightingale Challenge was a professional development program delivered via seven one-hour webinars focusing on leadership, career development, and managing burnout. A total of 151 partici.

Exploring the social accountability challenges of nursing education system in Iran

BackgroundNursing education in Iran is one of the disciplines of medical sciences and it needs a design tailored to the community needs in terms of theoretical and clinical approaches. This system is currently faced with various challenges. This study aims to explore the challenges of Iranian nursing education system to address community needs.MethodsA study was carried out through an exploratory descriptive qualitative design with content analysis method. In-depth semi-structured interviews were conducted with 21 participants from the nursing society, selected through purposive sampling. The interviews were continued until data saturation. Data analysis was performed simultaneous with data collection by using Graneheim & Lundman approach.ResultsBased on the interviews and simultaneous analyses, a total of 471 codes, 14 subcategories, six main categories, and two themes were extracted. The first theme, “system structure," consisted of three categories: "the need for ongoing revision of curriculum," "the need to recruit qualified students," and "the need for a proportionate educational environment." The second theme was “the education process” with three categories "the need for purposive educational design," "the need for purposive monitoring and feedback," and "the need for appropriate and early interaction with the community." The participants emphasized the continuous revision of the educational curriculum based on the current needs of the community and community-based nursing education.ConclusionsIn general, the results showed that Iranian nursing education system is faced with many challenges in the educational system structure and processes. It is necessary to make appropriate plans to enhance the status of the educational system structure and develop educational designs to address community needs using a hospital/community-based approach.