Contributions of Pediatric Oncology Nursing to Advance Care and Reduce Disparities Among Children and Adolescents with Cancer: Introduction

ObjectiveHighlight examples of pediatric oncology nursing's accomplishments during the past 2 decades with attention to specialized practice, patient/family education, research/evidence-based practice, and advocacy and how these efforts can be leveraged to reduce disparities in the cure and care of children and adolescents with cancer.Data SourcesReview of currently published literature, guidelines, and websites documenting pediatric oncology nursing's contributions.ConclusionOver the past 20 years, the collective work of pediatric oncology nurses across the world has improved the care of children with cancer and their families and brought attention to areas of disparities.Implications for Nursing Practice: Although work remains to reduce disparities, current evidence from nursing science and practice is available to address disparities and guide advocacy efforts for children and their families as well as the nurses who care for them.     

Global Oncology Nursing Recruitment and Retention: A SWOT Analysis

ObjectivesThis article documents the current status of global recruitment and retention of oncology nurses. A strengths, weaknesses, opportunities, and threats model was used to identify internal-to-nursing recruitment and retention factors/influences and external opportunities and threats as well as strategies and initiatives to improve the current situation.Data SourcesData sources include published and grey literature from around the world.ConclusionDespite the increasing cancer burden threatening public health worldwide, recruitment and retention of oncology nurses remains challenging. Nursing strengths include action by oncology nursing associations, prelicensure nurse recruitment and preceptorships, and models of hospital shared governance. Nursing weaknesses include nurse bullying, practice models that curtail clinical nurses’ autonomy, and hierarchical and inflexible nursing leadership. External to nursing are opportunities exemplified by international partnerships in oncology care and international oncology conferences for networking and learning. Examples of external threats are a lack of oncology nursing faculty, disrespectful media portrayal of nurses, community misconceptions about cancer curability, and hazards of cancer nursing.Implications for Nursing PracticeGovernments and hospital authorities wishing to successfully address cancer control must strategically plan for the recruitment and retention of an adequate nursing workforce. Opportunities such as government recognition of oncology specialty training, shared governance, continuing specialized education, advanced practice nursing roles and career paths, and participation in national cancer control planning will increase and sustain a critical oncology nursing workforce.     

The History of Clinical Trials Research: Implications for Oncology Nurses

ObjectiveTo discuss the major milestones in the history of clinical research and how these correlate with the role of the clinical research nurse.Data SourcesGovernment Web sites, published articles, and grey literature.ConclusionThe history of clinical research, drug development, and the regulations has come of age, and as a result clinical oncology research has a more defined scope and purpose. With the Oncology Nursing Society and the International Association of Clinical Research Nurses recognizing the scopes of practice for clinical research nursing, such roles are becoming more prevalent and integrated in oncology.Implications for Nursing PracticeIt is vital for all clinical research nurses to understand and adhere to the laws and regulations related to clinical trials and human subject protection. The clinical research nurse must ensure good clinical practice and compliance with the regulations to ensure the integrity of the study. There are different types of clinical research, including behavioral, therapeutic, and nontherapeutic studies, where clinical research nurses must understand the treatments and the drug development process to better serve their patients.     

Practice nursing: A systematic literature review of facilitators and barriers in three countries

BackgroundPractice Nurses (PN) play an increasing role in chronic disease management, however, this role is poorly defined.QuestionHow do Practice Nurses in New Zealand, Canada and the United Kingdom manage chronic disease?AimThis systematic review aims to identify the barriers and facilitators for practice nurses in New Zealand (NZ), Canada and the United Kingdom (UK) when caring for patients with a chronic disease. To determine how Practice Nurses in three high income countries manage chronic disease.MethodsWe searched Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, (CINAHL), and MEDLINE in February 2021. The initial search yielded 495 articles. Four hundred and sixty-four articles were excluded because they did not address the research question or included the community nurse or nurse practitioner. Nine articles with a total sample size of 1050 PN participants met the inclusion criteria.FindingsSix main themes were identified that outline the barriers and facilitators to the role of the practice nurse when managing chronic disease: financial incentives, funding, power differences between the nurse and patient and the nurse and doctor, time, education, and role ambiguity.DiscussionPolicy initiatives across the three countries were replicated with similar barriers and facilitators to the PN role.ConclusionWorking within a context driven by incentive funding and competing demands can be prohibitive to the effective management of chronic disease by the PN.     

肿瘤专科护士临床实习需求的调查分析

目的：调查肿瘤专科护士学员临床实习需求现况,为教学基地临床带教的改进提供依据。方法：自制调查问卷对中华护理学会2011年肿瘤专科护士培训班的96名肿瘤专科护士学员进行调查,并对结果进行统计分析。结果：肿瘤专科护士学员中71.88%希望在专科医院进行实习,在实习安排方面新技术新业务的学习需求最高,其次为示范操作、专科护理诊疗技术;需求较低的为临床护理教学、护理会诊及论文撰写、辅助检查技能。结论：学员对临床护理实践技能方面的需求较高,而对教学与科研能力重要性的认知与临床对肿瘤专科护士的要求有较大差距。     

江苏省肿瘤专科护士培训实践及体会

护理专科化是临床护理实践发展的方向,江苏省肿瘤医院作为江苏省肿瘤专科护士培训基地,经过几年的探索,从理论培训、实践培训、考核评价等方面逐步形成了完整、规范的培训体系,培训工作取得了良好的效果,但在实际培训工作中我们仍然要重视专业理论架构专科化、专科护士角色多元化、护理实践能力及科研能力兼顾、机制建设等方面的问题,努力培养出高素质的肿瘤专科护士,促进江苏省肿瘤专科护理的发展.     

Leveraging a funding collaborative to develop more PhD prepared nurse scientists and leaders

BackgroundOver its almost 50 year history, The Robert Wood Johnson Foundation (RWJF) has provided about $500M to nursing initiatives focused on education, practice, policy and leadership development. While RWJF was most often the sole funder of many of these initiatives, it has also joined with others to create a larger and more sustained impact on particularly challenging nursing, health, and health care issues.PurposeThe purpose of this article was to describe the challenges and opportunities of a unique funding collaborative developed to engage new partners, increase the visibility of doctoral nursing education and increase funding of the RWJF Future of Nursing Scholars program to develop more PhD prepared nurses and nurse faculty.MethodsInterviews were conducted with several members of the FNS Funders Collaborative as well as the scholars they supported. The perspectives of three funders, a regional philanthropy (IBC Foundation) and two health systems (Cedars Sinai and Sharp HealthCare) are presented here. Together they supported 13 nurses to complete their PhD through the RWJF Future of Nursing Scholars program.FindingsRWJF contributed $20 M and 13 other funders contributed an additional $3Mto the initiative. The additional funds supported 42 nurses to earn their PhD degree through the program. Six of the 13 funders are health systems, four are regional or health related philanthropies, and others include United Health Care, Johnson & Johnson, and the Care Institute.DiscussionThere were many lessons learned for RWJF and the other funders. Given the size of RWJF, some other philanthropies were concerned about how contributions would be represented, others wanted their funding to go directly to care improvement. Some health systems were not prepared for their nurses to decrease work time while pursuing further education. The nurse faculty and nurse PhD shortages have persisted now for over a decade. Although FNS made a significant contribution by developing over 200 new nurse PhDs (faculty and leaders), more funding collaborations that engage new and different partners must be developed so that nursing education does not have to focus on the same problems in the next decade.     

Nurses Share Real‐Life Research Experiences

Nursing for Women's Health convened a group of nurse researchers for a roundtable discussion about the relationship of research to the profession of nursing, how research drives evidence‐based practice and how nurses can get involved in research and in its application to the care of women and newborns.     

Building capacity for nurse‐led research

Aim: To discuss factors that have influenced the development of research capacity among nurses in lower and middle‐income countries (LMICs). Background: Concerned health scientists have addressed the importance of building research capacity among health professionals. Strengthening capacity specifically among LMIC nurses has been infrequently discussed. Without the requisite educational preparation or an enabling environment for research, nurses are unlikely to either demand research capacity‐building opportunities or initiate research examining nursing practice and health system challenges. Methods: A scan was conducted of nine internationally funded research capacity‐building initiatives to identify programme targeting and the proportion of nurse trainees. A literature review examined graduate and post‐graduate training opportunities for LMIC nurses, and barriers and enablers to nurses' involvement in research. Informal consultations were held with nurse leaders in 15 LMICs and leaders of eight LMIC nursing organizations. Findings: The scan found a generic targeting of health professionals with a very low percentage of nurse trainees. Programmes specifically targeting nurses did attract and prepare a significant number of nurses. Factors limiting nurses' involvement in research include hierarchies of power among disciplines, scarce resources, a lack of graduate and post‐graduate education opportunities, few senior mentors, and prolonged underfunding of nursing research. Conclusions: Fully engaging LMIC nurses in health services research may yield pragmatic and evidence‐informed service delivery and policy recommendations. Investments in supports for nursing research capacity may enrich global health policy effectiveness and improve quality of care.     

Does education level influence the practice profile of advanced practice nursing?

BackgroundAdvanced practice nursing is recognised globally as central to meeting this community need. Whilst there is increasing recognition that advanced practice nurses should be educated to at least a master degree level, there is scant evidence on the influence of higher education on the practice profile of advanced practice nursing.AimTo investigate the relationship between level of education and domain practice scores of nurses in advanced practice roles.MethodsThe validated Advanced Practice Nursing Role Delineation (APRD) tool was used to measure the practice profile of advanced practice nurses at different postgraduate education levels, across five domains of nursing practice activities. A cross-sectional electronic survey of nurses was used.FindingsAPNs with higher degrees performed at a higher level across all five domains of the APRD tool compared to those who did not hold a higher degree. This was highly significant for the domains of Research and Leadership, followed by the Optimising Health Systems and Education domains, but not significant for the Direct Care domain.DiscussionQuestions are often raised about the benefits of investing in nurses’ education, particularly the need for a higher degree for advanced practice nurses. APNs with higher degrees have a different emphasis in their role activities than those without a higher degree. This difference could be significant given current global health challenges.ConclusionHigher education changes the practice profile of APNs. Those with higher education are more likely to be involved in research and leadership with knowledge integration across all practice domains.     

Differences in nursing practice environment among US acute care unit types: A descriptive study

BackgroundThe hospital nursing practice environment has been found to be crucial for better nurse and patient outcomes. Yet little is known about the professional nursing practice environment at the unit level where nurses provide 24-hour bedside care to patients.ObjectivesTo examine differences in nursing practice environments among 11 unit types (critical care, step-down, medical, surgical, combined medical–surgical, obstetric, neonatal, pediatric, psychiatric, perioperative, and emergency) and by Magnet status overall, as well as four specific aspects of the practice environment.DesignCross-sectional study.Settings5322 nursing units in 519 US acute care hospitals.MethodsThe nursing practice environment was measured by the Practice Environment Scale of the Nursing Work Index. The Practice Environment Scale of the Nursing Work Index mean composite and four subscale scores were computed at the unit level. Two statistical approaches (one-way analysis of covariance and multivariate analysis of covariance analysis) were employed with a Tukey-Kramer post hoc test.ResultsIn general, the nursing practice environment was favorable in all unit types. There were significant differences in the nursing practice environment among the 11 unit types and by Magnet status. Pediatric units had the most favorable practice environment and medical–surgical units had the least favorable. A consistent finding across all unit types except neonatal units was that the staffing and resource adequacy subscale scored the lowest compared with all other Practice Environment Scale of the Nursing Work Index subscales (nursing foundations for quality of care, nurse manager ability, leadership, and support, and nurse–physician relations). Unit nursing practice environments were more favorable in Magnet than non-Magnet hospitals.ConclusionsFindings indicate that there are significant variations in unit nursing practice environments among 11 unit types and by hospital Magnet status. Both hospital-level and unit-specific strategies should be considered to achieve an excellent nursing practice environment in all hospital units.     

The Practice Environment Scale of the Nursing Work Index: An updated review and recommendations for use

ObjectivesThe Practice Environment Scale of the Nursing Work Index (PES-NWI) is an instrument, which measures the nursing practice environment – defined as factors that enhance or attenuate a nurse’s ability to practice nursing skillfully and deliver high quality care. The purpose of this paper is to provide an updated review of the Practice Environment Scale of the Nursing Work Index’s use to date and provide recommendations that may be helpful to nursing leaders and researchers who plan to use this instrument.DesignA narrative review of quantitative studies.Data sourcesPubMed, EMBASE, and the Cumulative Index to Nursing & Allied Health Literature were searched to identify relevant literature using the search terms, Practice Environment Scale of the Nursing Work Index and PES-NWI.Review methodsStudies were included if they were published in English between 2010 and 2016 and focused on the relationship between the Practice Environment Scale of the Nursing Work Index and patient, nurse, or organizational outcomes. Data extraction focused on the reported survey scores and the significance and strength of the reported associations.ResultsForty-six articles, from 28 countries, were included in this review. The majority reported significant findings between the nursing practice environment and outcomes. Although some modifications have been made, the instrument has remained primarily unchanged since its development. Most often, the scores regarding staffing and resource adequacy remained the lowest.ConclusionThe frequency of use of this instrument has remained high. Many researchers advocate for a move beyond the study of the connection between the Practice Environment Scale and nurse, patient, and organizational outcomes. Research should shift toward identifying interventions that improve the environment in which nurses practice and determining if changing the environment results in improved care quality.     

An exploratory model of advance care planning clinical training for oncology nurses: A constructivist grounded theory study

AimThe purpose of this study was to explore and construct the ACP clinical training model for oncology nurses to provide the theoretical references for nursing educators to develop ACP clinical training program for oncology nurses.BackgroundOncology nurses are the primary forces of advance care planning (ACP) clinical practice. However, the systematic ACP clinical training for clinical nurses, especially oncology nurses, is still not visible in mainland China.DesignA constructivist grounded theory study.SettingsThis study included participants from three tertiary hospitals in northeastern China.ParticipantsA total of 23 oncology nurses who directly care for cancer patients.MethodsA constructivist grounded theory approach was adopted to explore the ACP clinical training model for oncology nurses. Semi-structured interviews were completed to collect qualitative data for constructing the theoretical model. A three-level coding procedure with continuous comparisons was adopted to analyze the qualitative data.ResultsAs a result of the study, a total of 32 open coding categories and 13 axial coding categories were extracted and four selective coding categories were formed, namely, external driving forces, self-development, training needs and training key elements. Based on the above categories, the demand-driven ACP clinical training model for oncology nurses was finally developed.ConclusionsOncology nurses have a strong desire for ACP clinical training and their ACP training needs are diverse. The ACP clinical training model provide the theoretical references for nursing educators to develop ACP clinical training programs for oncology nurses to promote high-quality ACP clinical practice.     

US Food and Drug Administration Clinical Investigator Inspections

ObjectiveTo review the US Food and Drug Administration (FDA) Bioresearch Monitoring clinical investigator inspection process from start to final classification to support clinical research nurses in practice.Data SourcesPublished articles, websites, and author's expertise with FDA inspections.ConclusionClinical research nurses should conduct and manage every clinical trial as if it were to be inspected by the FDA. This recommendation is considered best practice for clinical research nurses to prevent last-minute preparations to organize and clean up research data and records retrospectively.Implications for Nursing PracticeThis article will assist the oncology research nurse and interdisciplinary research members at the research site in the preparedness for an FDA inspection.     

Providing Palliative and Hospice Care to Children,Adolescents and Young Adults with Cancer

ObjectivesTo describe palliative, concurrent, and hospice care in pediatric oncology in the United States (US), we present a clinical scenario illustrating palliative and hospice care, including eligibility for concurrent care, insurance coverage and billing, barriers to accessing quality pediatric palliative and hospice care, and implications for oncology nursing practice.Data SourcesPeer-reviewed articles, clinical practice guidelines, professional organizations, and expert clinical opinion examining pediatric oncology, palliative care, and hospice care.ConclusionUnderstanding the goals of palliative and hospice care and the differences between them is important in providing holistic, goal-directed care.Implications for Nursing PracticeOncology nurses play a pivotal role in supporting the goals of pediatric palliative care and hospice care and in educating patients and their families. Nurses form trusting relationships with pediatric oncology patients and their families and are in a position to advocate for best palliative care practices as disease progresses to end of life, including when appropriate concurrent care or hospice.     

Hospital nursing organizational factors,nursing care left undone,and nurse burnout as predictors of patient safety: A structural equation modeling analysis

BackgroundPromotion of patient safety is among the most important goals and challenges of healthcare systems worldwide in countries including China. Donabedian’s Structure-Process-Outcome model implies that patient safety is affected by hospital nursing organizational factors and nursing care process. However, studies are imperative for a clear understanding about the mechanisms by which patient safety is affected to guide practice.ObjectiveThe objective of this study was to explore the impact of hospital nursing work environment, workload, nursing care left undone, and nurse burnout on patient safety.DesignThis was a cross-sectional study conducted in 23 hospitals in Guangdong province, China in 2014. Data from nurses (n = 1542) responsible for direct care on 111 randomly sampled medical and surgical units were analyzed.MethodsWork environment was measured by the Practice Environment Scale of Nursing Work Index. Workload was measured by day shift unit patient-nurse ratio and non-professional tasks conducted by nurses. Nursing care left undone was measured by 12 items addressing necessary nursing activities. Nurse burnout was measured by the emotional exhaustion subscale of the Maslach Burnout Inventory-Human Services Survey. Patient safety was measured by three items indicating nurses’ perception of overall patient safety and nine items addressing patient adverse events. Structural equation modeling was used to examine a hypothesized model that supposed work environment and workload have both direct and indirect effects on patient safety through nursing care left undone and nurse burnout.ResultsThe findings generally supported the hypothesized model. Better work environment was associated with better patient safety both directly and indirectly. Lower workload primarily indirectly related to better patient safety. Nursing care left undone and nurse burnout were mediators negatively associated with patient safety.ConclusionsImproving work environment, increasing nurse staffing levels, and providing sufficient support for nurses to spend more time on direct patient care would be beneficial to patient safety improvement.