Specialist Oncology Nurses Research Articles

Exploring the scope of oncology specialist nurses’ practice in the UK

PurposeRevolutionary changes have taken place to nurses’ roles and clinical responsibilities over the past decade, leading to new ways of working and higher levels of nursing practice. However, despite the development of nurse-led clinics and services within oncology there has been little formal evaluation. MethodsA survey of 103 UK oncology specialist nurses was undertaken to explore their scope of practice, with emphasis on nurse-led services. ResultsThe survey highlighted significant developments within nurses’ roles and nurse-led services, although there was a distinct lack of clarity between nurses’ titles and their roles/responsibilities. Most nurses had extended their role. However there were significant differences in the nature of clinical practice, such as clinical examination and nurse prescribing. Overall, new roles were greatly valued by the multidisciplinary team, reducing waiting times and providing benefits for patients. However other nurses felt frustrated by deficiencies in infrastructure and support, which often overshadowed potential benefits. ConclusionsThere is a great diversity in oncology specialist nurses’ roles; however lack of clarity in titles, training, competencies and responsibilities is creating confusion. Role developments and nurse-led clinics have been ad hoc and poorly evaluated. The introduction of a competency framework, national standards and a system of clinical appraisals seems key to providing increased transparency and vital safeguards for both nurses and patients. Without further exploration and evaluation of nurse-led initiatives it is difficult to fully appreciate their impact on patients, staff and service delivery.

Caring for cancer patients on non-specialist wards

As cancer is the leading cause of death worldwide, every nurse will be required to care for patients with the condition at some point in his/her career. However, non-specialized oncology nurses are often ill-prepared to nurse patients suffering from cancer. This literature review aims to provide an overview of current trends and developments in cancer care nursing in an attempt to identify the range of previous research pertaining to caring for patients with cancer on non-specialist wards. The review finds that non-specialized cancer nurses report a lack of education and training with regard to cancer care and cancer treatments, which acts as a barrier to providing quality nursing care. Emotional and communication issues with patients and their families can also cause non-specialist nurses significant distress. International research has shown that specialist oncology nurses make a considerable difference to physical and psychosocial patient care. It is therefore paramount that non-speciality nurses' educational needs are met to develop clinical competence and to provide supportive holistic care for both patients and their families.

Health state utilities for non small cell lung cancer.

BackgroundExisting reports of utility values for metastatic non-small cell lung cancer (NSCLC) vary quite widely and are not all suitable for use in submissions in the UK. The aim of this study was to elicit UK societal based utility values for different stages of NSCLC and different grade III-IV toxicities commonly associated with chemotherapy treatments. Toxicities included neutropenia, febrile neutropenia, fatigue, diarrhoea, nausea and vomiting, rash and hair loss.MethodsExisting health state descriptions of metastatic breast cancer were revised to make them suitable as descriptions of metastatic NSCLC patients on second-line treatment. The existing health states were used in cognitive debrief interviews with oncologists (n = 5) and oncology specialist nurses (n = 5). Changes were made as suggested by the clinical experts. The resulting health states (n = 17) were piloted and used in a societal based valuation study (n = 100). Participants rated half of the total health states in a standard gamble interview to derive health state utility scores. Data were analysed using a mixed model analysis.ResultsEach health state described the symptom burden of disease and impact on different levels of functioning (physical, emotional, sexual, and social). The disutility related to each disease state and toxicity was estimated and were combined to give health state values. All disease states and toxicities were independent significant predictors of utility (p < 0.001). Stable disease with no toxicity (our base state) had a utility value of 0.653. Utility scores ranged from 0.673 (responding disease with no toxicity) to 0.473 for progressive disease.ConclusionThis study reflects the value that society place on the avoidance of disease progression and severe toxicities in NSCLC.

The experiences of patients and nurses with a nurse-led peripherally inserted central venous catheter line service

Nurse-led Peripherally Inserted Central Venous Catheter (PICC) services are becoming commonplace in cancer centres across the UK. Research has shown that these services are cost-effective and are associated with fewer catheter-related complications, including infection and thrombosis, than skin-tunnelled catheters. This exploratory study aimed to explore patients' and nurses' experiences of a nurse-led PICC line service. Recorded interviews were conducted with 10 cancer patients with PICC lines inserted, five hospital-based nurses and five community-based nurses experienced in caring for patients with these lines. Respondents' recorded accounts were transcribed, coded and analysed to determine patients' and nurses' perceptions of the service and the extent to which collaborative practice was promoted. Findings were synthesized into five themes: Education, Formation of Expectations, Confidence, Sensory Experience and Adaptation. All respondent groups were positive about the PICC line service and the specialist oncology nurses working within it. The findings did identify some aspects of the service which could be improved, including the timing of information given to patients and the use of more innovative educational approaches. This study has informed the development of a potential flexible service structure which may be incorporated into established and differing care settings using existing resources.

1301 Cancer nursing practice: State of the art

The overall incidence of and mortality from cancer has increased during the past 15 years. Each year there are 1,300,000 new cases of cancer in the European Union. Moreover, cancer is responsible for one quarter of all deaths in Europe. At the same time, survival rates for the most common tumours have increased slightly. Given these facts it is not surprising that more and more nurses have become involved in the care of patients with cancer. In the practice setting oncology nurses may act in a variety of roles such as: direct care provider, researcher and manager. These roles are continuously influenced by changes like scarcity of financial resources, the evolution of multi-cultural societies, increased demands for quality care and quality of life, etcetera. In the direct care setting many nurses have taken the opportunity to specialize in cancer care and have undertaken post graduate programmes to prepare them to function as specialist oncology nurses. Demographic changes, changing attitudes and expectations of society mean that cancer prevention, health promotion, geriatric oncology, cancer as a family experience, complementary care and rehabilitation are challenging issues for nurses. Nowadays oncology nurses may be involved in scientific nursing research or participate in medical studies. Since an increasing number of nurses are educated at masters or PhD level, the number of publications on cancer nursing research (e.g. symptom distress) is increasing steadily. Special attention is warranted for the implementation of the outcomes of nursing studies in the practice setting. From a management point of view, standards of care, based on research and clinical practice, are (being) identified. This enables criteria for quality control to be developed. Cancer care delivery systems focus on continuity of care and early discharge planning. This has important implications for cancer nursing practice. Oncology nursing is an important and established specialty in nursing. As this field continues to expand, the need to keep up to date is very apparent. The state of the art and science is changing continuously.