Core competencies for bone marrow transplantation nurse practitioners

Advanced Practice Nursing Titles and Roles in Cancer Care: A Scoping Review

OBJECTIVES

Advanced practice nursing roles in cancer care are diverse and exist across the cancer care continuum. However, the titles used and the scope of practice differ across countries. This diversity is likely to be misleading to patients and influence nurses' contribution to health care. An understanding of the current state of advanced practice nursing roles in cancer care internationally is needed to inform opportunities for future role development and enhance cancer nursing career pathways.

METHODS

This scoping review included a systematic search of four databases: MEDLINE, CINAHL, PsycINFO, and Academic Search Complete. Independent screening for papers meeting the review's inclusion criteria was undertaken using online screening software. Data extraction, coding, and mapping were undertaken in NVivo 12.

RESULTS

Of the 13,409 records identified, 108 met the review's inclusion criteria. A variety of roles in cancer care settings were described. The United States and the United Kingdom had the most titles for advanced practice nursing roles. Tumor-specific roles were described and integrated into different phases of the cancer care continuum. Trends in continuing professional development for advanced practice nurses in cancer care included the rise in Fellowship programs in the United States and practice-based education in the United Kingdom.

CONCLUSIONS

The differences in advanced practice nursing roles in cancer care allow regional and institutional variation to meet the needs of patient populations and health care system demands. However, a lack of clarity surrounding titles and roles results in confusion and underutilization of these nurses' highly specialized skill sets.

IMPLICATIONS FOR NURSING PRACTICE

Incongruence in titles and scope of practice internationally will ultimately result in a merging of roles. There is a need for international agreement on education requirements for advanced practice nursing roles to promote career pathways.

[Role of advanced practice nurse within a cellular therapy unit: Guidelines from the Francophone Society of Bone Marrow Transplantation and cellular therapy (SFGM-TC)]

Like the "nurse practitioner" in Anglo-Saxon countries, the French health authority validated on January 2016 the creation of an intermediate grade called advanced practice nurse (APN). They are authorized to carry out an assessment of the person's state of health, through a complete clinical examination. They can also prescribe additional examinations necessary for the monitoring of the pathology, and carry out certain acts for diagnostic and/or therapeutic purposes. Given the specificities of cellular therapy patients, the content of university professional training doesn't seem sufficient to assure an optimal management by the APN of these patients. The Francophone society of bone marrow transplantation and cellular therapy (SFGM-TC) had already published two works regarding what was initially called "the transfer of skills" between doctors and nurses in the follow-up of transplant patients. In the same way, this workshop attempts to address the question of the place of APNs in the management of patients undergoing cellular therapy treatment. Beyond a delegation of tasks as proposed by the cooperation protocols, this workshop produces recommendations to allow an autonomous activity of the IPA in the follow-up of these patients, in close collaboration with the medical team.

Interprofessional Team-based Care of the Hematopoietic Cell Transplantation Patient With Hepatic Veno-occlusive Disease/Sinusoidal Obstruction Syndrome

Hepatic veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is a well-recognized complication of allogeneic and autologous hematopoietic cell transplantation (HCT). The diagnosis and treatment of VOD/SOS require the involvement of multiple specialists covering a wide range of expertise. Interprofessional team-based medical care is standard practice for patients undergoing HCT and has been shown to improve patient and provider satisfaction, enhance efficiency, and improve patient outcomes, particularly for patients in complex medical situations like those with VOD/SOS post-HCT. Interdisciplinary team-based models focus on the synthesis and harmonization of knowledge and methods from different disciplines to create an integrative approach to patient care that both maximizes the expertise of each involved specialist and encourages thought beyond each specialist's discipline. Multidisciplinary team members provide additive support and work collaboratively with the core team to provide knowledge from their field. The composition of the interdisciplinary HCT team should center on the needs of the patient and institutional resources and involve the expertise of additional multidisciplinary team members based on clinical needs. This review focuses on interdisciplinary and multidisciplinary team-based care of patients with VOD/SOS post-HCT and provides an example of a collaborative VOD/SOS team that includes transplant physicians, nurses, pharmacists, nutrition/dietary specialists, and intensive care teams.

The Evolving Role of Haematology Nursing Practice: A Cross-Sectional Survey

Background And Objectives

The scope of haematology nursing practice is dynamic and must respond to advances in treatment, patients' needs and service requirements. Little is known, however, about the different roles of haematology nurses across the European setting. The purpose of this study was to identify the professional practices of haematology nurses.

Method

A cross-sectional online survey design was used to investigate practice elements undertaken by haematology nurses. Frequencies and descriptive statistics were calculated for demographic variables and chi-square tests to examine relationships between practice elements, nursing role and country.

Results

Data is reported from 233 nurses across 19 countries, working as Staff Nurses (52.4%), senior nurses (12.9%) and Advanced Practice Nurses (APNs) (34.8%). Most frequently reported activities included medication administration - oral/ intravenous (90.0%), monoclonal antibodies (83.8%), chemotherapy (80.6%), and blood components (81.4%). APNs were more commonly involved in nurse-led clinics and prescribing activities (p < .001, p = .001, respectively); however, other nursing groups also reported performing extended practice activities. Patient and carer education was a significant part of all nurses' roles; however, senior nurses and APNs were more often involved with the multidisciplinary team (p < .001) and managerial responsibilities (p < .001). Nurses' involvement in research was limited (36.3%) and frequently reported as an out-of-work hours activity.

Conclusions

This study describes haematology nursing care activities performed in various contexts and within different nursing roles. It provides further evidence of nursing activity and may contribute to a core skills framework for haematology nurses.

Veno-occlusive disease nurse management: development of a dynamic monitoring tool by the GITMO nursing group

Veno-occlusive disease (VOD) is a complication arising from the toxicity of conditioning regimens that have a significant impact on the survival of patients who undergo stem cell transplantation. There are several known risk factors for developing VOD and their assessment before the start of conditioning regimens could improve the quality of care. Equally important are early identification of signs and symptoms ascribable to VOD, rapid diagnosis, and timely adjustment of support therapy and treatment. Nurses have a fundamental role at the stages of assessment and monitoring for signs and symptoms; therefore, they should have documented skills and training. The literature defines nurses’ areas of competence in managing VOD, but in the actual clinical practice, this is not so clear. Moreover, there is an intrinsic difficulty in managing VOD due to its rapid and often dramatic evolution, together with a lack of care tools to guide nurses. Through a complex evidence-based process, the Gruppo Italiano per il Trapianto di Midollo Osseo (GITMO), cellule staminali emopoietiche e terapia cellulare nursing board has developed an operational flowchart and a dynamic monitoring tool applicable to haematopoietic stem cell transplantation patients, whether they develop this complication or not.

Exploring palliative care provision for recipients of allogeneic hematopoietic stem cell transplantation who relapsed

PURPOSE/OBJECTIVES

To quantify the characteristics of patients who die in the hospital from relapse after allogeneic hematopoietic stem cell transplantation (alloHSCT), explore palliative care integration and end-of-life (EOL) care, and benchmark standards of care.

DESIGN

Retrospective chart review cohort study; a cross-sectional survey design guided a national survey.

SETTING

A chart review was conducted in a large tertiary hospital in Australia. The survey was distributed to leading alloHSCT centers in Australia and New Zealand.

SAMPLE

The chart review sample group was patients in the hematology department who had received an alloHSCT, relapsed, and died in the hospital (N = 40). The survey sample group was the most advanced nurse involved in patient care at each facility (N = 14).

METHODS

A quantitative data collection tool created for chart review, as well as patient notes written by the physician, were examined. The quantitative data collection tool was created for the survey, which was conducted via email or telephone.

MAIN RESEARCH VARIABLES

The chart review measured patient demographics, palliative care integration, EOL care, and symptoms. Survey topics included services available, referrals to palliative care services, EOL discussions, and symptom management.

FINDINGS

About half of the patients were seen by the palliative care service. Many patients experienced severe symptoms in the terminal phase. Survey participants felt EOL discussions were left until the terminal phase. Participants believed early palliative care integration was beneficial for patients and their family.

CONCLUSIONS

The chart review demonstrated late integration of palliative care and poor standards of EOL care. Survey results reiterated this and reflected that nurses are supportive of earlier integration of palliative care and improving EOL care.

IMPLICATIONS FOR NURSING

Palliative care should be integrated earlier, and nursing roles have the potential to address unmet needs for these patients.