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 Diversity of roles, titles and qualifications Shift of care from hospital to home/family Specialty not recognised at European level Research at clinical level 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 Education is part of the answer 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
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!