Nurse-led models of chemotherapy care: mixed economy or nurse-doctor substitution?

Impact of advanced nursing practice through nurse-led clinics in the care of cancer patients: A scoping review

OBJECTIVE

This scoping review aims at exploring the effectiveness of nurse-led advanced practice for patients with cancer.

METHODS

This review followed the PRISMA extension for scoping reviews. Randomised controlled trials on cancer nurse-led clinics for patient outcomes, costs, service utilisation and other outcomes were included. Databases such as MEDLINE, CENTRAL, CINAHL, EMBASE and PsychINFO were searched based on MeSH terms. Thematic analysis was used to synthesise results of the included studies.

RESULTS

Seventeen articles were included, published between 2001 and 2019. There were methodological shortcomings with a number of the studies reviewed. Five themes were identified including (1) rationale for developing nurse-led clinics, (2) mode of delivery of nurse-led clinics, (3) the content of nurse-led clinics, (4) exploring patient outcomes and (5) satisfaction with nurse-led clinics.

CONCLUSIONS

The results support the effectiveness of nurse-led clinics in improving self-reported responses such as distress levels, satisfaction, quality of life, depressive symptoms, concerns and vomiting among cancer patients. Following a sound protocol for both the study and the reporting is recommended, and future studies should focus more on costs and effectiveness of different models of care administered by advanced practice nurses. Effectiveness of nurse-led clinics needs further evaluation with stronger trials and wider focus on nursing-sensitive clinical outcomes and costs.

The Effect of Watson's Human Caring Model on Meaning of Life and Symptom Management in Cancer Patients Undergoing Chemotherapy

PURPOSE

The purpose of this study was to determine the effect of Watson's Human Caring Model on the meaning of life and symptom management in cancer patients undergoing chemotherapy.

DESIGN

The study was conducted using a real test model featuring a pretest and posttest and a control group.

METHODS

The sample consisted of 158 adult cancer patients (79 in both the experimental and control groups). The sample size was determined and the participants were allocated to groups using power analysis and a random sampling method. For the pretest, both groups completed an introductory questionnaire, the Life Attitude Profile, and the General Symptom Inventory. Then, the experimenter visited the experimental group patients' homes three times, at 2-week intervals, to provide nursing care based on Watson's model. Finally, after 8 weeks, a posttest was conducted by having both groups complete the Life Attitude Profile and General Symptom Inventory once again.

RESULTS

In the experimental group, the mean total posttest score for the Life Attitude Profile was determined to be 164.21 ± 36.5, and the mean total General Symptom Inventory score was 55.06 ± 13.19; however, in the control group, the mean total Life Attitude Profile score was 127.31 ± 10.61 and the mean total General Symptom Inventory score was 136.91 ± 16.20. The mean differences between the groups were statistically significant (p < .001).

IMPLICATIONS FOR PRACTICE

Care based on Watson's model increases the sense of meaning in life and decreases symptom levels for patients undergoing chemotherapy.

Non-medical prescribing of chemotherapy: engaging stakeholders to maximise success?

AIM

This study report examines the views and experiences of professional stakeholders about non-medical prescribing (NMP) of chemotherapy.

BACKGROUND

The introduction of open formulary NMP has created opportunities to radically change health-care delivery. For chemotherapy services, the most recent advice from the National Chemotherapy Advisory Group [Department of Health (2009) Chemotherapy Services in England, ensuring quality and safety: a report from the National Chemotherapy Advisory Group, London Her Majesty's Stationary Office] clearly endorses the development of nurse- or pharmacist-led chemotherapy clinics. This is very much welcomed but is based on very limited evidence as to their effectiveness.

DESIGN

A fourth-generation evaluation study.

METHODS

A purposeful sample of 23 stakeholders connected with the chemotherapy service was used. A serial data collection technique with individual interviews followed by uni-professional focus groups was adopted. Finally, a multi-professional focus group was held to determine the strategic way forward. Data were collected in 2009-2010.

RESULTS

The study illuminated the key features necessary to maximise success of NMP in chemotherapy clinics and captures the importance of good working relationships. Whilst different practice models will emerge, fundamental and core to services is the need for good team working, established and effective communication strategies, and most importantly avoiding isolation in practice. This study additionally reinforced any evaluation takes place within preexisting political contexts and in particular medical dominance. Not all medical colleagues agreed with or wanted NMP for their patients, highlighting difficulties of developing new models of working within a resisting culture.

CONCLUSION

No objections to NMP of chemotherapy were found, but, clearly, the context of practice needs to be agreed and supportedby all professional stakeholders. What is already known about this topicOpen formulary non-medical prescribing has been rapidly introduced over the past decade.Little research has been conducted in acute care and none in the chemotherapy setting.Cancer policy recommends the introduction of nurse-led chemotherapy clinics.What this paper addsNon-medical prescribing (NMP) in chemotherapy is appropriate with the right model of practice.Well-established professional relationships are a key to success.NMP is not appropriate in isolation of the multidisciplinary team (MDT).Implications for practice and/or policyNurses need to demonstrate the value of non-medical prescribing in chemotherapy using available metrics.Models of practice need to ensure good communication channels, MDT working, and transparency of prescribing.

Critical care outreach--a meaningful evaluation

Advances in medicine and changes in health care provision have resulted in increasingly innovative methods of delivering health care, such as the development of critical care outreach teams (CCOTs). These teams aim to respond to the needs of the critically ill patient, regardless of the patient's location within the acute hospital. The aim of this audit was to assess one aspect of the effectiveness of the Outreach team by examining the attitudes and opinions of the hospital clinical staff towards the outreach service provided. A questionnaire designed to investigate staff attitudes to and the use of the outreach team was sent to health professions staff at the acute hospital in which the outreach team was based. Anonymous responses were analysed using descriptive statistics and free text content analysis. One hundred questionnaires were returned (33% response rate) from staff of different professional backgrounds and departments. The results demonstrated a positive response from members of the multi-professional team, who believed that the CCOT was approachable and enhanced clinical care by providing help and advice, improving access to critical care services and facilitating development of critical care skills in clinical areas. In response to the findings, the number of hours per day in which the team operates has been increased. The findings demonstrated a belief by staff that the CCOT was instrumental in enhancing clinical care within the institution. While the findings of this audit are an informative addition to routine activity data, further studies are required to assess the acceptability of the service to patients and the impact of the service on patient outcomes.

Advanced nursing practice – the influences and accountabilities

The past two decades have seen a proliferation of new, advanced clinical roles for nurses in the UK which has resulted in much debate about the nature of advanced practice as these new roles involve many tasks that were traditionally considered the remit of doctors. This article critically analyses the professional accountabilities of working at an advanced level and the influences which are driving the NHS modernization agenda with particular reference to the role of the Community Matron. It concludes that advanced nursing practice presents an opportunity for the combination of the art of nursing and advanced tasks, but emphasizes that new roles must develop within a recognized framework which takes account of the educational, ethical and legal accountability issues and clarifies the scope and remit of roles for health professionals, patients and indemnifying agents.

Supportive care for patients with oesophageal and other upper gastrointestinal cancers: The role of a specialist nurse in the team

The care pathway of patients with upper gastrointestinal cancers is complex. We retrospectively evaluated the patients' opinions of support and supportive care given by a specialist nurse who led the care of such patients. A study-specific questionnaire addressed the support given by the specialist nurse and other professionals in the team before, during and after treatment. Virtually all 73 responders considered the support of the specialist nurse important (87-94%). This support seemed more appreciated than that of outpatient clinic (P = 0.00) and surgical ward staff (P = 0.01) during the diagnostic phase, and during the follow-up it became more important than that of all other team professionals. A second study-specific questionnaire assessed the supportive care. Of 49 patients, 71-94% completely agreed that the supportive care given by the specialist nurse was satisfactory, and 90-100% considered it important. Whereas 10% had difficulty in understanding physicians' information, none had such problems regarding information given by the nurse (P = 0.09). Review of documented contacts between the specialist nurse and 75 patients with oesophago-gastric cancer revealed that contacts were frequent during follow-up, and nutritional problems predominated. Thus, specialist nurses can be recommended as leaders of the care pathway of patients with upper gastrointestinal cancers.