Developing a nurse-led survivorship service for patients with lymphoma

PurposeThere are two million people in the UK living with cancer and this figure is rising each year. The consequences of cancer and its treatment are devastating and many patients suffer long-term effects for years after completion of treatment. National UK policy recognises that current follow-up fails to meet patients' survivorship needs and new methods of service-delivery are required. An analysis of local service provision in a London teaching hospital demonstrated that the needs of patients with lymphoma were not being met. The aim of this project was to develop a nurse-led service that would provide comprehensive survivorship care for patients with lymphoma.MethodA nurse-led survivorship service was implemented using a comprehensive service development framework and was evaluated through a variety of methods such as a patient satisfaction questionnaire, note audit, waiting time audit and an analysis of patients comment and suggestions.ResultsThe project was successfully implemented with risk management and advanced practice requirements addressed. It was demonstrated that patients were satisfied with the new service, the quality of documentation had improved and waiting times were reduced.ConclusionThis work adds to the current survivorship knowledge-base and provides evidence that nurses can provide safe and effective survivorship care for patients with lymphoma.     

Providing Leadership Through Patients as Partners: Improving Australian Colorectal Survivorship Care Through Perspectives from a Nurse Who Became a Cancer Patient

ObjectiveTo provide contemporary real-world, real-life insights into gaps in supportive care experiences for people affected by colorectal cancer. For the first time, this article includes a patient as a coauthor, with the aim to identify future priorities to improve care and recovery in colorectal cancer survivorship.Data SourcesElectronic databases, peer-reviewed literature, and real-life professional and personal experiences were used.ConclusionThere are several problematic areas in providing supportive care for people affected by colorectal cancer that could be improved by wider access to colorectal specialist nurses, coordinated multidisciplinary teams, patient collaboration, linking survivorship care outcomes to national standards, and developing supported self-management care plans.Implications for Nursing PracticeA patient-led insight has underscored some fundamental failings in current service delivery among people affected by colorectal cancer. Partnering with consumers in research and service redesign is essential to stratify future priorities to optimize care and person-centered recovery.     

Telephone first post-intervention follow-up for men who have had radical radiotherapy to the prostate: evaluation of a novel service delivery approach

The increasing prevalence of prostate cancer places pressure on services, leading to questions about how best to configure services, so as to maintain quality and best utilise the skills of the multi-disciplinary team. There have been positive evaluations of specialist nursing roles, nurse-led service provision and telephone consultations, leading us to consider whether telephone follow-up led by a specialist nurse might be an acceptable alternative to traditional follow-up in hospital-based out-patient clinics for patients receiving radical radiotherapy for prostate cancer. Thirty-six men were included in a pilot introduction of telephone follow-up, evaluated via a questionnaire survey. The evaluation explored patients' satisfaction with practical arrangements; satisfaction with the nurse; acceptability of telephone follow-up and acceptability of this being nurse-led. Patients reported high levels of satisfaction with practical arrangements. Thirty-five patients considered the nurse to be knowledgeable and found nurse-led care acceptable. Only one patient was unhappy with telephone follow-up, whilst 27 were "very happy". Only one patient felt that telephone follow-up was poorer than traditional follow-up, whilst 27 found it "as good" and three "better". Particular advantages were reported in terms of convenience and time savings. Telephone follow-up appears to have potential for this patient group and merits wider, research-based consideration.     

An examination of senior nursing roles: challenges for the NHS

Wellhouse NHS Trust moved its inpatient services to the new Barnet General Hospital in 1997 and merged with Chase Farm Hospital NHS Trust in 1999. To assist with the trust's management of resulting changes in care provision, a short project was conducted to examine the nursing services provided by ward managers (20) and senior nurses (27), that is nurses who undertake specialist/ advanced nursing practice. The project also aimed to present the views of the stakeholders (66) with regard to nursing in the trust and nurse-led services. The project involved two stages of data collection--focus groups and postal questionnaires. The project provided a great deal of information about the nursing service within the trust: a profile of the senior nurses, roles and responsibilities, skills and competencies, training and development, and support needs for their roles. The findings considered a number of issues: (i) employment--diversity of grading for posts; (ii) work roles--conflicts in role composition; (iii) stakeholders--perspectives of stakeholders on nursing. It is anticipated that the findings are not unique to the one trust and that they will contribute to the development of new clinical career pathways for senior nurses within the trust.     

The specialist nursing workforce caring for men with prostate cancer in the UK

Prostate cancer is the most common cancer in men in the UK accounting for 25% of all new cases of cancer. It is predicted to become the most common cancer overall by 2030. A national survey of the specialist nursing workforce caring for men with prostate cancer was completed across the four countries of the UK during June and July 2014. In total 302 specialist nurses completed the survey and data from 285 was used in the analysis. This is the biggest whole population survey of this workforce in recent years. The most common job title was clinical nurse specialist (185) and the most common band was agenda for change band 7 (174). However in Scotland 50% of the respondents stated that they were paid on band 6. Over half the group (158) had worked in prostate cancer care for more than 10 years. Few (48) had come into specialist posts from a specific specialist nurse development role. There is wide geographic variation in the provision of specialist nursing for men with prostate cancer. This is reflected in available hours and caseload sizes. The respondents reported frozen and vacant posts across the UK. This equated to 58·3 full time equivalents. The work of specialist nurses caring for men with prostate cancer is clinically complex and appears to cover most key times in the cancer journey. However workload appears to be limiting the care that the nurses are able to provide with over half the respondents (163) saying that they left work undone for patients.     

The practical use of the Patient Enablement and Satisfaction Model in nurse-led outpatient cardiac clinics

BackgroundThe Patient Enablement and Satisfaction Model (PESM) developed in primary care, theorises the mechanisms through which nurses may impact upon patients’ experience of satisfaction and enablement, enhancing their capacity to manage their health.AimTo evaluate the applicability of the PESM in an ambulatory chronic care setting.MethodsWe applied Corbin and Strauss’ criteria for evaluating the practical value of a conceptual model in diverse clinical settings, to inform our framework analysis of nurses’ perceptions of the applicability of the Model. An education session and resource was provided to nine nurses who worked in four nurse-led outpatient cardiac clinics in an Australian city in July 2017. These same nurses were interviewed before and after implementing The Model in clinical practice.FindingsThe PESM was practical and useable in all four clinics. It aligned with the clinics’ chronic disease self-management aims and was viewed as realistic and flexible in response to patients’ needs. The Model stimulated discussion about scope of practice, identifying differences in education between those with chronic disease management training and those without, and ways to address these gaps.DiscussionUse of the PESM facilitated the provision of a consistent, person-focussed approach to chronic disease management in this study. While the PESM resonates with other chronic disease models, we believe its grounding in patient-centred nursing research enhances its natural fit in nurse-led clinics.ConclusionThe PESM and accompanying education resource provides a concrete knowledge translation tool to support evidence-based chronic disease management practice in outpatient cardiology clinics.     

Self-reported competence in long term care provision for adult cancer survivors: A cross sectional survey of nursing and allied health care professionals

BackgroundCancer survival is increasing as patients live longer with a cancer diagnosis. This success has implications for health service provision in that increasing numbers of adults who have received cancer therapy are requiring monitoring and long-term health care by a wide range of practitioners. Given these recent trends there is a need to explore staff perceptions and confidence in managing the consequences of cancer diagnosis and treatment in cancer survivors to enhance an integrated cancer service delivery.ObjectiveThis study examines the self-reported perceptions of competence in nurses and professionals allied to medicine providing survivorship services caring for adults after cancer treatment in both secondary and primary care.DesignA cross sectional survey of the adult cancer workforce using a self-assessment tool for assessing confidence in providing long-term cancer patient management. This study was a health service evaluation.SettingThe study was conducted within the United Kingdom.ParticipantsRespondents were 618 health care professionals of these 368 were specialist adult cancer nurses in oncology and the community setting and 250 cancer allied health professionals.MethodThe survey tool was developed with experts in cancer management, nurses professionals allied to medicine such as physiotherapists and dieticians, educationalists, patient groups as well as health service managers. Competence was assessed in 4 domains clinical practice, symptom management, care co-ordination and proactive management. Perceptions of training needs were also ascertained. Data were collected using an Internet survey distributed through cancer services, community settings and professional institutions.ResultsIn total 618 practitioners who responded were providing services for adults’ 1-year post cancer therapy. Practitioners felt confident in managing psychosocial care and communicating with patients. Deficits in self-reported confidence were found in long-term medications management, care planning, long-term and complex symptom management, for those providing dimensions of care coordination and proactive care. Differences in confidence were seen between practitioner groups. Community nurses felt less skilled in managing adult cancer patients long-term.ConclusionsNurses and allied health professionals self-reported confidence, in managing all areas of care for adult cancer survivors, is variable with deficits in important areas of practice. Despite this being a small proportion of practitioners who are working in cancer care, those responding had perceived gaps in knowledge and educational needs. In providing cancer aftercare there is a requisite shift to proactive care, supported self-management and collaborative management if patient's long-term consequences of cancer and its treatment are to be addressed.Implications for practiceIf health care providers are to transform cancer survivor services then investment is required in education and capability planning across nurses, allied health professionals in both the hospital and the community setting.     

Specialist practice in community mental health nursing

Community mental health nurses (CMHNs) work in an increasingly complex health and social care environment. Over recent years, the evolving direction of general health service and specific mental health policy has directed CMHNs towards: the provision of clinically-effective interventions; a closer attention to meeting the needs of people experiencing severe and long-term mental health problems; the simultaneous provision of services to meet the needs of people experiencing a wide range of mental health problems presenting in primary care settings; greater collaboration with workers representing other disciplines and agencies; and the development of active partnerships with mental health service users. This paper explores the context within which CMHNs practise, and within which education programmes preparing specialist practitioners in community mental health nursing have been developed. One recently-validated specialist practice course for CMHNs is described in detail, with the intention of stimulating discussion and debate surrounding the practice of, and the educational preparation for, community mental health nursing.     

Are nurse-led chemotherapy clinics really nurse-led? An ethnographic study

BackgroundThe number of patients requiring ambulatory chemotherapy is increasing year on year, creating problems with capacity in outpatient clinics and chemotherapy units. Although nurse-led chemotherapy clinics have been set up to address this, there is a lack of evaluation of their effectiveness. Despite a rapid expansion in the development of nursing roles and responsibilities in oncology, there is little understanding of the operational aspects of nurses’ roles in nurse-led clinics.ObjectivesTo explore nurses’ roles within nurse-led chemotherapy clinics.DesignA focused ethnographic study of nurses’ roles in nurse-led chemotherapy clinics, including semi-structured interviews with nurses.SettingsFour chemotherapy units/cancer centres in the UKParticipantsPurposive sampling was used to select four cancer centres/units in different geographical areas within the UK operating nurse-led chemotherapy clinics. Participants were 13 nurses working within nurse-led chemotherapy clinics at the chosen locations.MethodsNon-participant observation of nurse-led chemotherapy clinics, semi-structured interviews with nurse participants, review of clinic protocols and associated documentation.Results61 nurse-patient consultations were observed with 13 nurses; of these 13, interviews were conducted with 11 nurses. Despite similarities in clinical skills training and prescribing, there were great disparities between clinics run by chemotherapy nurses and those run by advanced nurse practitioners. This included the number of patients seen within each clinic, operational aspects, nurses’ autonomy, scope of practice and clinical decision-making abilities. The differences highlighted four different levels of nurse-led chemotherapy clinics, based on nurses’ autonomy and scope of clinical practice. However, this was heavily influenced by medical consultants. Several nurses perceived they were undertaking holistic assessments, however they were using medical models/consultation styles, indicating medicalization of nurses’ roles.ConclusionsFour different levels of nurse-led chemotherapy clinics were identified, illustrating disparities in nurses’ roles. Although clinics are run by nurses they are often controlled by medical consultants, which can reduce nurses’ autonomy and negatively impact on patient care.     

Palliative care in the community for children with cancer in South East England.

In-depth interviews and discussions were held with 40 different professionals in South East England involved in managing palliative care for children with cancer in the community. Participants included paediatric oncologists and outreach nurse specialists in tertiary centres, paediatricians in shared care units, children's community nurses, general practitioners, social workers and child psychologists. The research examined palliative care services available in the region, exploring attitudes to both current provision and possible service improvements. Providing palliative care in the community involves multi-agency collaboration and the study highlighted a range of different approaches to case management with the diversity of resources available. Key improvements proposed by health-care professionals included: better communication and liaison between all the professionals involved; clearer allocation of roles and responsibilities; 24-hour availability of specialist advice on palliative care for children with cancer; faster access to social work and psychology services at the community level; continuity of nursing and respite care. The provision of specialist local palliative care services for children with cancer was generally rejected. The participants favoured improving community palliative care for all children with life-limiting or life-threatening conditions with community nursing teams providing continuity of care and outreach nurses providing specialist advice and support.     

Nurse perceptions of person-centered handovers in the oncological inpatient setting: A qualitative study

BackgroundDeficient communication during shift change can cause negative patient outcomes and hinder person-centeredness in care. Person-centered handover is performed together with the patient at bedside, with the intention of providing a safe and efficient handover while promoting patient participation. The knowledge about nurse perspectives on handover models that involve patient participation is sparse.ObjectiveTo describe registered nurses’ perceptions of person-centered handover in an oncological inpatient setting.DesignA qualitative interview study.SettingThe study was undertaken at two oncological inpatient wards at the Karolinska University Hospital, Stockholm, where person-centered handover was implemented in 2015.ParticipantsRegistered nurses who had worked at the wards for at least six months. We aimed for a full sample investigation. All eligible nurses (n = 13) were approached, and 11 chose to participate. Participants’ age ranged from 23 to 60 years, the mean work experience was 10 years, and 4 out of 11 nurses were oncology nurse specialists.MethodsSemi-structured interviews were performed by an independent researcher. The data was analyzed using content analysis with an inductive approach.ResultsThree main themes with ten subsequent subthemes emerged from the data. The main themes were: clinical communication and assessment; opportunity for patient participation; consequences for nursing care. In general, the nurses were positive towards person-centered handover, but they expressed concerns regarding patients’ integrity and insecurities regarding bedside communication. All nurses described how they aimed at enhancing patient participation and viewed person-centered handover as an opportunity, but still perceived it difficult to succeed due to drawbacks and factors hindering nursing care. Overall, the nurses were positive regarding the involvement of patients in the handover procedure. Information provision from nurse to patient, as opposed to information exchange, was predominant.ConclusionsThe intentions of person-centered handovers differed from the way it was actually performed, especially in regards to the obtained levels of patient participation, as described by nurses. Professional insecurity in relation to bedside communication with patients and their visitors is a novel finding that should be considered when implementing person-centered handovers. Overall, the perceptions of person-centered handovers, as expressed by the nurses, enhance our understanding of what to consider when implementing the model and why compliance may vary.     

Reinstating district nursing: A UK perspective

As policy directives gather pace for service provision to be delivered in primary care, district nursing has not been recognised as a valuable asset to facilitate this agenda. Investment in district nursing and specialist district nursing education has fallen. This is concurrent with an ageing district nursing workforce, a lack of recruitment and growing caseloads, as district nursing adapts to meet the challenges of the complexities of contemporary healthcare in the community. The district nurse role is complex and multifaceted and includes working collaboratively and creatively to coordinate care. Redressing the shortages of specialist district nurse practitioners with increased numbers of health care support workers will not replace the skill, knowledge, experience required to meet the complex care needs of today's society. District nursing needs to be reinstated as the valuable asset it is, through renewed investment in the service, research development and in specialist practice education. To prevent extinction district nurses need to be able to demonstrate and articulate the complexities and dynamisms of the role to reinstate themselves to their commissioners as a valuable asset for contemporary practice that can meet current health and social care needs effectively.     

上海地区开展糖尿病护理门诊现状调查与分析

目的 调查上海地区糖尿病护理门诊开展情况并进行分析。方法 2016年2月-2016年12月,将二级以上医院正在开展糖尿病护理门诊的医院列为研究对象,由出诊护士完成调查问卷,内容涉及门诊基本信息、就诊患者信息、出诊护士信息、护士自身评价。结果 （1）门诊基本信息：28家医院的护理门诊设立时间6个月—9年,平均（4.82±3.77）年;其中18家医院由护士独立出诊（占64%）并收费,其他为医护联合门诊并免费;年门诊量三级医院12-480人次（年平均158.12±125.08人次）,二级医院24-1200人次（年平均262±462.86人次）;患者教育/咨询时间10-120分钟/人（平均35.71±23.32分钟）等。（2）就诊患者信息：就诊病人中医生转介占64%,就诊病种不局限于糖尿病,内容广泛,护理门诊所提供服务包括个体咨询、健康教育、行为指导和直接护理。（3）出诊护士信息：出诊护士均为大专以上学历,高级职称占61%,由护士长兼护理门诊工作有占71%,所有护士均通过糖尿病专科护理相关培训并获得合格证书。（4）护士自身评价：所有护士对门诊工作满意,认为实现了自身价值并对今后发展充满信心。结论 上海地区糖尿病专科护理门诊正在稳步发展,不仅为患者提供了集咨询、教育、护理、管理为一体的高品质综合服务,也满足其从生理到心理等多方面的健康需要,对临床治疗和疾病改善发挥积极作用。为了完善服务机制和深化服务品质,护理门诊的服务形式、流程、评价、随访和管控机制有待规范和完善。     

Training nurses in contraceptive implant procedures: implications for practice in Australia

BackgroundThe contraceptive implant is a long-acting, effective method of contraception. Low uptake in Australia may be partially due to limited clinicians trained in implant procedures. Internationally, nurse-led implant procedures are accepted practice; however, this is not common in Australia.AimAn evaluation was undertaken to determine the effectiveness of implant training for nurses and consider the implications for clinical service delivery.MethodsParticipating nurses (n = 5) completed pre- and post-training surveys, and three were subsequently interviewed. Supervising doctors and nurses (n = 5) were also interviewed. A file audit was conducted to review implant procedures undertaken post-training.FindingsNurses undertook implant training to acquire new skills and meet patient demand. After the training, all nurses self-reported feeling ‘very confident’ in inserting the implant and at least ‘a little confident’ in removing the implant; the latter had minimal impact on removal success, as indicated in the file audit. Overall, nurses and supervising doctors and nurses felt that nurses could play a greater role in the provision of contraceptive implant procedures in Australia.DiscussionNurse-led procedures would increase access to the contraceptive implant for women, and have a positive impact on service delivery in different healthcare settings; however, funding constraints for nurses remain a significant barrier.ConclusionNurses are well placed to undertake contraceptive implant procedures. This would increase access to this method of contraception for women. These findings may inform models of care that promote nurse-led contraceptive procedures in Australia.     

Rehabilitation and specialist palliative care

Enabling individuals to achieve their maximum potential and quality of life following a diagnosis of advanced cancer, has long been a stated aim of palliative care. Increased life expectancy and the introduction of specialist palliative care to patients at an earlier stage of their illness presents professionals in the specialty with new challenges in meeting the need for rehabilitative care. This article examines some of the recent developments affecting the provision of rehabilitative care and describes one specialist palliative care unit's response to the challenge, highlighting the role of a nurse-led clinic within the service framework.     

Nurse-led ward rounds: a valuable contribution to acute stroke care

Stroke is a devastating condition. The Royal College of Physicians (2008) highlights that integrated stroke care can improve patient care. Nurses are an integral part of the multidisciplinary team, providing 24/7 stroke care from planning and implementing care to the evaluation of the patient's condition. To improve the way nurses manage stroke patients in an acute setting, a nurse-led ward round was initiated to look at essential nursing care. The Imperial College Healthcare Trust stroke senior nursing team, consisting of a clinical nurse specialist, a ward manager, and a charge nurse, have organised a weekly stroke nurse-led ward round. The team takes rounds to each stroke patient in the ward to examine and evaluate the essentials of nursing care (e.g. oral care, skin integrity, continence, bowel and bladder management), and current stroke outcome measures. During the rounds, the team address nursing issues, make appropriate nursing goals, and discuss their plans with the nurses and other members of the team. A nurse-led ward round has addressed nursing issues in a timely proactive fashion. The initiative has been successful in improving clinical communication between nurses and patient involvement in their care planning. It has also empowered nurses to make decisions within their professional arena, and its contribution has had an impact on patient care and safety through early detection and prevention of stroke complications.     

Emerging and Ongoing Survivorship Challenges Among Childhood Cancer Survivors and Providing Risk-Based Focused Follow-Up Care

ObjectivesTo provide a summary of the emerging and ongoing survivorship challenges facing childhood, adolescent, and young adult cancer survivors and their families.Data SourcesResearch and review articles, websites, and clinical guidelines specific to childhood cancer survivorship were used.ConclusionMany challenges exist in assuring quality long-term follow-up and risk-based screening for childhood cancer survivors. Although many childhood cancer survivors survive well into adulthood, they are at risk for a vast number of later complications of their cancer treatment necessitating annual cancer surveillance. In addition, many childhood cancer survivors are not engaging in long-term follow-up recommendations for clinic attendance, risk-based surveillance, and screening for potentially life-ending events. Pediatric oncology nurses and advanced practice nurses have played an enormous role in the design of childhood cancer survivorship programs and are an integral member of the multidisciplinary health care team who care for this population. Nurses have an obligation to continue to advance the survivorship care of childhood cancer survivors and lead interventional opportunities to improve the lifelong health-related quality of life and overall physical health.Implications for Nursing PracticePediatric oncology nurses and advanced practice registered nurses must have a working knowledge of the many late effects that childhood cancer treatment has on the long-term health of childhood cancer survivors. Nurses are well-placed in positions to continue the efforts begun more than 2 decades prior by pediatric oncology nurses who saw the value and necessity of designated survivorship programs.