Oncology Clinical Nurse Specialist Research Articles

Integrated Oncology Nursing Service (IONS)

In recent years, the clinical context for cancer has changed and it is now characterized by extended survival rates and complex cancer trajectories and symptomatology.The changes in landscape of cancer care have included a shift towards the home setting or the outpatient setting with an increase in the amount of care being delivered at home or transferred to the patient/family themselves.
 According to the literature, societies are confronted with an increasing burden of health care as a result of an ageing population, the growing number of chronic diseases and coronavirus have forced governments and health care to seek new models in order to organize health care cost-effectively, without losing the current quality of care.Multi-professional and multi-agency interventions are now needed compared to when single specialities used to suffice.We need holistic care delivered in partnership to individuals, by flexible person-centred approaches.
 The Acute Oncology and Community Services have come together to collaborate to provide supportive care to vulnerable cancer patients in the community. The objective of this Integrated Oncology Nursing Service (IONS) role is to refer cancer patients to Community Intervention Team (CIT), post a specialised oncology telephone triage by the Acute Oncology Clinical Nurse Specialist (AO CNSp), to further assess/treat patients in the community. The CIT will provide services such as clinical vitals, phlebotomy, medication administration and psychological support to patients in their home. The AO CNSp. will then link in with the patient at home the next day and continue to consult with the oncology/haematology team to discuss the best way to manage the patient at home. We aim to bring together these separate organisations and place an emphasis on the shared values of timely, efficient and person-centered care. 
 The benefit of this innovation is hoped to
 •Reduce unscheduled presentations and result in admission avoidance for patients accessing the Tallaght Hospital Oncology Services.
 •Improve the quality of patients treatment
 •Bring specialist knowledge to patients
 •Provides support to patients in their own home
 •Provide outreach to unwell patients at home
 
 The network governance model including nursing and clinical governance is shared by the Director of Public Health Nursing, the Director of Nursing of Tallaght University Hospital and the Oncology and Haemtology Consultants in Tallaght University Hospital. 
 We will roll out education and training with competencies before commencing the pilot.
 There will be a dual approach to the evaluation of this initiative focusing on organisational impact and patient outcomes and experiences. A service evaluation has been completed already. A qualitative approach will be utilised to determine the patient’s experience and ethical considerations will be incorporated into the rolling out of the service.
 In conclusion, modern cancer care is mainly delivered on an outpatient basis, meaning that there are many people in the community at risk of side effects of treatment or manifestations of progressive disease that can present as emergencies. This is where the Integrated Oncology Nursing Service is most valuable, providing outreach to acutely unwell patients at home and bringing specialist knowledge to their management.

48 The collaboration of oncology Clinical Nurse Specialists and Public Health Nurses in comprehensive geriatric assessments in patients undergoing Cancer treatment

Abstract Background Cancer is a widespread health issue, with the number of people >70 diagnosed in 2020, reaching 7.2 million (37% of all cases) worldwide. This is expected to double by 2040. Valid and reliable tools to assess older patients undergoing cancer therapy are necessary to reduce toxicities, decrease delays, and better guide dose modifications. There are performance assessment tools used in oncology, however, they are subjective and have limited use for toxicity risk stratification. Currently, patients do not routinely have a frailty assessment in the oncology setting. Public Health Nurses (PHN) often know these individuals before commencing treatment, they may have a therapeutic relationship with the patient and family, and are in a prime position to perform a frailty assessment which can detect vulnerabilities and age related issues associated with mortality. Moreover, collaboration between Acute services and primary care may enhance CGA’s and improve patient care. Methods Two case studies are examined, where collaboration of Acute services and Primary care improved patient outcomes and quality of life. Results Case study 1: PHN identified early toxicities of treatment, Rockwood Scale used, Liaised with acute oncology CNS (Clinical Nurse Specialist) and dose of treatment modified, resulting in completion of treatment and avoidance of unnecessary hospital admissions. Case study 2: CNS contacted PHN as concerned about patient on treatment, G8 frailty score: 7 (very vulnerable). PHN supported a Comprehensive Geriatric Assessment (CGA). On discussion with Oncology team, treatment modified, and supports such as OT, Dietician and Physiotherapy were added. Conclusion Recommendations for practice include a role for combined Geriatric Oncology services, and also the use of in depth assessment tools in older patients to prevent treatment related toxicity. Collaboration of acute oncology and primary care teams may help identify earlier the need for CGA and enhance integration of care pathways.

The Oncology Clinical Nurse Specialist: A Rapid Review of Implementation Models and Barriers around the World.

The role of a clinical nurse specialist in oncology varies greatly between healthcare systems, and implementing this healthcare role with its multifaceted and co-existing responsibilities may prove challenging. While already integrated into healthcare systems and services in several European countries, Asia, Canada, and the United States, other countries are just beginning to develop clinical nursing specialties. The current study aims to provide healthcare policymakers with up-to-date evidence that focuses on the diverse modes of oncology clinical nurse specialist role implementation across several healthcare systems and pertinent implementation challenges as described in the literature. A rapid evidence assessment was carried out in order to provide policymakers with a rigorous review in a condensed timescale. Initially, only items in the English language were included, and "grey literature" was excluded. We searched PubMed between 1 January 2022 and 28 February 2022 and two independent scholars reviewed items. Based on 64 papers, both non-scientific and papers that met the initial criteria of the rapid review, we describe the modes of implementation of the oncology clinical nurse specialist in the United States, Canada, United Kingdom, Japan, Brazil and Australia. Barriers to implementation include conflicts around role boundaries, skepticism and lack of organizational support, as well as fears that oncology clinical nurse specialists will "encroach" on doctors' powers. In contrast, an oncology clinical nurse specialist is found to be universally more accessible to patients and their families and can help physicians deal with difficult workloads, among other advantages. Conclusions: This role offers a myriad of gains for cancer patients, oncology physicians, and the healthcare system. The literature demonstrates that it is a necessary role, albeit one that brings specific implementation challenges.

Personalized Palliative and Survivorship Care for Patients With Metastatic Cancer Treated With Radiation Therapy.

While the benefits of early palliative care for patients with metastatic cancer are well established, cancer survivorship remains inadequately integrated into the care of patients with distant metastases. Moreover, the optimal model of care delivery is poorly defined. A prognostic model previously developed and validated at Good Samaritan University Hospital identified four groups of patients with metastatic solid tumor malignancy having very favorable, favorable, standard or unfavorable prognoses with median survival of 31, 14, 4 and 1 month, respectively. This framework holds promise for the personalized delivery of supportive, palliative and survivorship care services in the context of radiation therapy. We review the published literature providing the rationale for a novel multidisciplinary care model where the radiation oncology Clinical Nurse Specialist identifies and coordinates interventions to address unmet physical and emotional issues faced by survivors with metastatic cancer with the goal of improving quality of life and overall survival.

The Development of an Oncology Clinical Nurse Specialist Fellowship Program.

New graduate clinical nurse specialists (CNSs) face many challenges when starting their new role. To address this, a CNS fellowship program was developed to mentor new CNSs during their first year of practice. This CNS fellowship program would provide opportunities to increase skills related to each of the CNS spheres of influence, including nursing practice, patient care, and systems and organization. Experienced CNSs mentored CNS fellows and identified learning opportunities. The fellows completed an online self-assessment based on the National Association of Clinical Nurse Specialists CNS Competency Checklist during week one of orientation and again at months 3, 6, 9, and 12. The CNS fellows completed and presented three projects designed to explore the spheres of the CNS role, along with a formal onboarding. The results of the fellowship depicted significant competency development within all three CNS spheres at program completion. The CNS fellowship program provided structure and guidance to the newly graduated CNSs and clearly transitioned staff nurses to advanced practice nurses. The fellowship has demonstrated a positive effect on both the new CNSs and the organization in which it was developed.

Smoking Cessation: An Oncology Clinical Nurse Specialist-Led Program.

Healthcare providers often do not have the time to counsel patients on how to quit smoking. Consequently, little emphasis is placed on this pursuit, and no behavioral counseling is done. Using medications approved by the U.S. Food and Drug Administration in combination with behavioral counseling has been shown to be effective in smoking cessation programs. Oncology nurses, and advanced practice nurses in particular, can play a significant role in helping patients to quit smoking. This article details how one oncology clinical nurse specialist created a smoking cessation program at her institution.

Effects of Oncology Clinical Nurse Specialists' Interventions on Nursing-Sensitive Outcomes in South Korea

This study compared outcomes, including pain, fatigue, anxiety, satisfaction, health-related quality of life (HRQOL), ease of access, and unexpected emergency room (ER) visits, for patients with cancer in South Korea who were cared for by an oncology clinical nurse specialist (CNS) with patients with cancer who were not. Self-report questionnaires and semistructured interviews were used to appraise the performance of oncology CNSs, and medical characteristics were obtained through chart review. CNS interventions were found to diminish some intensity scores of pain and fatigue, and to increase HRQOL, satisfaction with trustworthiness, and ease of access. No significant effects were observed on anxiety or unexpected ER visits. The current study provides evidence that oncology CNSs are effective in South Korea, which will be the basis of validating the implementation and expansion of policy for oncology nursing.

Commentary: New Findings Substantiate the Successful Use of Nurse Practitioners and Physician Assistants in Collaborative Practice Models

Commentary: New Findings Substantiate the Successful Use of Nurse Practitioners and Physician Assistants in Collaborative Practice Models

Role of the Oncology Clinical Nurse Specialist

Role of the Oncology Clinical Nurse Specialist

Oncology Certification: What Is in It for You?

Most nurses are confident in their belief that they provide excellent care; however, many find the idea of taking an examination to demonstrate their knowledge frightening. Earning a specialty certification is one of the most important accomplishments a nurse can achieve for oneself, one’s patients, and one’s employer, as it signifies knowledge and practice competency in the specialty (Oncology Nursing Certification Corporation [ONCC], 2008c). This column explains the benefits of certification and solutions to potential barriers to obtaining certification for oncology nurses who are contemplating certification. Certification is a voluntary personal and professional accomplishment that is recognized by patients, their families, peers, other health professionals, and employers. Specialty certification is not limited to health professions; it exists in other occupations such as business, accounting, and information technology. Obtaining a formal credential—Oncology Certified Nurse (OCN®), Certified Breast Care Nurse (CBCN), Certified Pediatric Oncology Nurse (CPON®), Advanced Oncology Clinical Nurse Specialist (AOCNS®), or Advanced Oncology Certified Nurse Practitioner (AOCNP®)—is not only an achievement, but a validation of the nurse’s clinical experience and knowledge. “Certification has been a personal challenge for me. It has helped validate my skills and knowledge in care of oncology patients. It was worth my time and energy to take the test”(Leak and Spruill, 2008). More than 2.9 million people in the United States are RNs (American Nurses Association, 2008). More than 500,000 nurses worldwide are certified in their specialty areas, including advanced practice nurses who have more than one specialty credential (American Board of Nursing Specialties, 2005). ONCC was established in 1984 to develop and administer a certification program in oncology nursing. It currently offers five certification examinations (ONCC, 2008c) (see Table 1). Currently, more than 27,000 nurses are certified, including 23,378 nurses with the OCN® credential, 1,731 CPON®, 1,225 AOCN®, 541 AOCNP®, and 220 AOCNS® (ONCC, 2008c). Table 1 Five Oncology Nursing Certification Examinations Offered by the Oncology Nursing Certification Corporation Since the 1990s, healthcare organizations have placed a higher value on specialty certification for nurses. Many employers now provide and pay for review courses for their employees. Some employers even reimburse their staff for the cost of successful completion of the credentialing examination. The increase in the number of healthcare organizations supporting nurses’ professional development via specialty certification may be partly because of the criteria for Magnet recognition from the American Nurses Credentialing Center (2008), which strongly encourages specialty certification to validate specialty nursing knowledge.

A Care Program for the Anticipated Grief of a Terminal Cancer Patient and Her Husband, with Special Reference to Practice and Coordination of an Oncology Clinical Nurse Specialist

A Care Program for the Anticipated Grief of a Terminal Cancer Patient and Her Husband, with Special Reference to Practice and Coordination of an Oncology Clinical Nurse Specialist

Three Grammar Problems Found by Reviewers

Three Grammar Problems Found by Reviewers

HPNA Develops End-of-Life Core Curriculum

Barbara Volker, MSN, RN, CRNH, and Ashby Watson, MS, RN, CS, OCN, are the co-coordinators of the Core Curriculum project. Barbara is an independent hospice consultant, the Editor of the Practice Review (3rd ed.), and an instructor for HPNA’s Hospice and Palliative Nursing Practice Review Course. Ashby is a Psychosocial Oncology Clinical Nurse Specialist at Massey Cancer Center, Medical College of Virginia Hospitals Health System, Virginia Commonwealth University. Address correspondence to Barbara Volker, MSN, RN, CRNH, Volker Consulting Service, 684 West Stuart Avenue, Fresno, CA 93704-1447.

The lived experience of the oncology clinical nurse specialist

The purpose of this study was to explore what was important and what was unique in the experience of the oncology clinical nurse specialist (OCNS). The sample included eight clinical nurse specialists from one geographical area. One to one interviews focused on reflection on two critical incidents from the OCNSs’ own clinical experience: one which they thought had gone particularly well and one that had not gone well. Thematic analysis of the OCNS narratives revealed the main themes of uncertain ground, boundaries, support, and reflective practice. Issues which evolved from thematic analysis were related to the developmental needs of the OCNSs involved in the study. Some aspects of the uniqueness of the role was apparent. Recommendations for further research are made.

Surviving the era of evidence-based nursing practice: implementation of a research utilization model in practice

Ruud Uitterhoeve Oncology Clinical Nurse Specialist, University Hospital Nijmegen, PO BOX 9101, 6500 HB Nijmegen,The Netherlands Bet ty Ambaum RV, MSN, Coordinator Research, University Medical Centre Utrecht, The Netherlands Correspondence and offprint requests to: Ruud Uitterhoeve This paper describes the application and testing of the Stetler Model for Research Utilization in an out-patient clinic of a University Hospital in the Netherlands. This work was part of a wider project being undertaken jointly by EONS and EUROQUAN, the aims of which were to develop an educational framework for advanced cancer nursing practice and to formulate standards against which to audit cancer nursing practice (Knowles 1999). This paper outlines how the Stetler Model for Research Utilization was tested using Donabedian's framework of structure, process and outcome. The process involved educating clinical nurses in research methodology, selecting a topic of interest, reviewing the literature and formulating and implementing a plan of change. Evidence-based nursing practice (EBNP) is the new paradigm of nursing. It is no longer acceptable to base nursing practice on tradition. 'Because we have always done it that way' is not sufficient anymore. Nursing practice should be based on the best evidence available. When a research base exists it provides the best evidence and should be used to ensure that assessments will be true measures of clinical phenomena and that interventions will lead to intended outcomes. However, the use of available research findings is not as easy as it first appears. Different studies have shown that numerous barriers to research utilization exist. In a recent study by Rutledge et al (1998) oncology staff nurses (N-1100), randomly selected from the members of the Oncology Nursing Society, rated 28 items to the extent they perceived them as barriers to

Programmed Instruction Radiation Therapy

Carrie F. Dunne-Daly is an Oncology Clinical Nurse Specialist in Radiation Oncology, Saint Joseph Hospital Chicago, Illinois, U.S.A.

Radiation Therapy Brachytherapy

Carrie F. Dunne-Daly is an Oncology Clinical Nurse Specialist in Radiation Oncology, Saint Joseph Hospital, Chicago, Illinois, U.S.A. The editor and authors acknowledge special assistance from Karen M. Hassey-Dow, R.N., Ph.D., Nurse Researcher, Beth-Israel Hospital, Boston, Massachusetts.

Identifying spinal cord compression.

Medical Oncology Clinical Nurse Specialist Albert Einstein Medical Center Philadelphia, Pennsylvania

Cancer Nursing Research

is an associate professor, Director of the Oncology Clinical Nurse Specialist Master's Pathway, and Interim Director of the Parent-Child & Nursing Division at the College of Nursing, University of Utah, Salt Lake City.

Burnout in the Medical Professions With Emphasis on Cancer Caretakers

Psychosocial Oncology Clinical Nurse Specialist Massey Cancer Center Medical College of Virginia Richmond, Virginia