v european conference on survivors and chronic cancer...
TRANSCRIPT
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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
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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
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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.
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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
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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).
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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
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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
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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
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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."
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Future challenges
Increase in chronic diseases
Cancer
Diabetes
Cardiovascular diseases
COPD
More older citizens
Multidisease
Highly specialized hospitals
Shorter admission
Pressure on primary settings
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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?
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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
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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
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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
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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
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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
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Thank you for your attention!