V European Conference On Survivors and Chronic Cancer Patients

The Nursing Role in Models

Cristina Lacerda

RN., Specialist Nurse

Head Nurse Day Hospital IPOLFG

Coordinator of Nurse Research Unit IPOLFG

President AEOP

EONS Executive Board Member

The presentation

Brief Presentation of EONS

Important Data in Cancer (Cost and Survivorship)

What is cancer nursing and how should it evolve

Present future challenges

Explore impact of changes in the role and competencies

for nurses

To discuss the importance of educating nurses to

deliver high quality care for the patients and relatives

EONS Vision

www.cancernurse.eu

EONS

EONS Mission

The Mission of EONS is to promote a healthier future for people affected by cancer, ensuring that they will benefit from the care of well educated, perceptive and proficient cancer nurses.

EONS Board 2013-2015

Members of the Board

Erik van Muilekom: President

Birgitte Grube: Past President

Danny Kelly: President Elect

Mary Wells : Board Secretary

Cristina Lacerda: Treasurer

Paul Trevatt

Patrick Crombez

Lena Sharp

Andreas

Charalambous

Cancer Cost in Europe

Cancer in Europe

Male: 55% Female: 45%

Prostate 24.4% Breast 29,7%

Lung 15.6% Lung 7,4%

Colorectal 13.8% Colorectal 13.5%

Countries with highest incidence rate Belgium, Denmark, France, Iceland, Ireland, Norway

Countries with lowest incidence rate and lowest mortality rate

Cyprus, Greece, Malta, Turkey

Countries with highest mortality rate Czech Rep, Hungary, Poland, Slovakia, Slovenia

Economic burden of cancer

across the European Union

New cases 2.45 million people

Deaths 1.23 million of people died because of cancer in 27 EU countries.

Cancer cost the EU €126 billion in 2009

Cost per citizen €102, but in Bulgaria is €16 and in Luxembourg €184

Luengo-Fernandez R. et al. (2013).

Cancer Nursing

Nurses are the largest group of healthcare providers in Europe

Promote health, prevent disease and provide care

Nursing should be strengthened to provide better care for all European citizens

Ensuring equitable access to cancer care

What is cancer nursing?

It’s the people with cancer and their relatives

Cancer care is an unique area in nursing

A special nerve that is difficult to explain to outsiders

Many factors have influenced the development and definition

Identification of the need for specialized knowledge

Development of training programs

Is cancer nursing different from nursing?

Coordinate services using and applying technical knowledge of cancer treatment

Acting as the key accessible for the interdisciplinary team (case management)

Using empathy, knowledge and experience to assess and alleviate the psychosocial suffering of cancer

Respond to patients need by using technical knowledge and patient personalised cancer treatment having in consideration the experience and support needs of patients and their families.

Maintaining dignity in the end of life

situations

Maintaining realistic hope with

patients and family

It is about reducing pain, and

symptom management

Cancer nursing is about respecting

patient privacy

Understand patient’s needs and the

importance of integrity and empathy

A definition of cancer nursing

In 2010 the National Cancer Action Team NHS "Cancer Nursing Specialist (CNSs)“ wrote:

“CNSs in cancer care registered nurses, who have graduate level nursing preparation and who would usually be expected to be prepared at Master’s level. They are clinical experts in evidence-based nursing practice within a specialty area."

Future challenges

Increase in chronic diseases

Cancer

Diabetes

Cardiovascular diseases

COPD

More older citizens

Multidisease

Highly specialized hospitals

Shorter admission

Pressure on primary settings

Changes in Care

Fast changing treatments

Personalized medicine

Chemotherapy– targeted

therapy

Radiotherapy

Surgery – new technology

Shift of care from hospital to

home/family

Telemedicine

Role of the specialist cancer

nurse

Increasingly complex

treatment regimes

Disadvanges groups Inequality in health and social matters

”The best educated gets the best treatment”

NCD and comorbidity high incidence in disadvanges groups

Changes of survival lower in underserved groups

Increased site effects

Compliance and adherence issues

Cancer Patients Experience

Not geting optimal care

Compliance

Need for rehabilitation

Often hospitalized

Inadequate information

Not enough focus on prevention

To many contacts

Lack in continuity

Cancer Nurses Experience

Shift of care from hospital to

home/family

Specialty not recognised at European level

Research at clinical level

Diversity of roles, titles and qualifications

Lack of opportunities for education

Quality of education

So how do we as cancer nurses meet these challenges

Organisationel perspective

EONS/EFN/Patients Organisations

Be one strong united voice

Stronger in the multiprofessional arena

Face EU Parliament and governments

Clear message – policy statements

Lobby work

Respond to directive changes

Prove better care - better outcome - research

Prioritize education for cancer nurses

Rapidly changing health care system

Need for high quality care

Shift in care – hospital to homecare

Work together with patient organisations

National perspective

Develop a national cancer group

Work together with other national societies - projects

Make solid strategic plans

Reflect on national problems and the solutions

Approach stakeholders

Analyze stakeholders positions

Genuin and clear communication

Risk management control

Work for a national education for cancer nurses

Why is it important to lobby in EU

• 70-75% of many national health legislation comes from EU initiatives

• Health is being Europeanised organized Globalised

How do we influence EU

Lobby the EU Commission

Lobby the national politicians

Lobby EP members

Cooperate with european unions and

professional organizations

Non Governments Organizations

European Federation of Nurses Associations (EFN)

EU lobby work

Matters of common interest

E-health

Research – (European Nurses Research Foundation

ENRF)

Directive 2005/36/EC on the recognition of

professional qualifications

Patient Organisations

Patients with voices

Must be in the centre of cancer care

Policy statements together

Cancer Nurses

Charing points of view with patients

Listen to them

Collaborate with them

Advocate for them

Allliance facing

Politicians

Other stakeholders

Organisations

The Nursing Role in Models

Extension of the role – Basic nurse

Involves certain skills and responsibilities acquired, but at lower level, integrated into nurse role

Expansion of the role – Nurse specialist

Happens when major responsibilities and duties transferred to the profession. A specially trained nurse can take greater responsibility for a specific patient group

Progress of the role

Advance nurse practitioner

Means that the nurse has clear clinical autonomy and hence requiring training at master’s level. Foreign experience shows good results with this practice

Education is part of the answer

Basic nurses compentencies

Carry out the nursing core competencies such as:

perform, communicate, lead and manage nursing

promote health, prevent disease and alleviate suffering

coordinate the patients pathway

Inform and teach patients and their relatives

A Basic Nurse can not carry out tasks within cancer care

without education

Education at basic nursing level

New skills and responsibilities integrated into existing local induction and training course

Education and clinical training should meet the requirements related to the specific area in cancer care

Nurse specialist

Extension of the role

Identify needs for care

Set up goals, evaluate and adjust nursing

Identify and apply research-based knowledge

Engage in relations, dialogue and interaction

Inform, communicate and support patients

and their relatives

Nurse specialist

A nurse specialist or a clinical nurse specialist in cancer care perform

nursing at a high professional level:

can assess and analyze complex clinical problems with the use

of relevant knowledge

critical thinking and use of new development and research

can articulate and communicate the patients need for care and

treatment in a multiprofessional arena

What should be part of an accredited education for cancer nurses at master level?

Problem and evidence based learning

Theory and practice transfer process

Very practice-oriented training and patient orientated

Leadership and management

Argumentation and presentation

Implementation – how can practice be change?

Advanced nursing practise

Progress of the role

At masters level

Many countries have no formalised education or title

Working at advanced level as

Specialised nurses

Clinical nurse specialist

And other titles

ICN definition

An Advanced Nurse Practitioners or Advanced Practice Nurse is registered nurse who has acquired the expert knowledge base, has complex decision making skills and clinical competencies for expanded practice

A master degree is recommended for entry level

Reducing the financial burden of cancer

Supporting patients to manage their care at home and helping them through the complex system of health care provision we can reduce 10% emergency admissions and reducing the length of stay by 3 days.

National Audit Office, End of Life Care, November 2008

Cancer nurses should

Be leading and educating cancer care

Make independent decisions

Do research in cancer nursing

Be part of the the multiprofessional teamwork

Be responsible for patient-oriented care

Open to new knowledge, and new roles

Always work for high quality standards

High security for patients

Conclusion

It takes political willpower

Acknowledge that cancer nursing is a speciality

Authorize and formalize scope of practice and education

Need for high quality care close to the patient

In their homes

In the clinic

Thank you for your attention!