The Role of the Acute Care Nurse Practitioner in the Implementation of the Commission on Cancer's Standards on Palliative Care

Interprofessional Collaboration in Palliative Care-The Need for an Advanced Practice Nurse: An Ethnographic Study

OBJECTIVES

The literature highlights the importance of an interprofessional approach in palliative care to improve the quality of care, favoring an effective use of resources. Members of the interprofessional team include all professionals involved in patient care; in some contexts, the advanced practice nurse (APN) has a clearly defined role. This study aimed to define the possible role of the APN within the interprofessional palliative care team in our context.

DATA SOURCES

A focused ethnographic approach was taken involving participant observation and semistructured interviews.

CONCLUSION

From the participant observations, interaction of the participants, discussion content, and styles of meeting management were described. From the thematic analysis of the interviews, 15 themes emerged, grouped into four macro-themes: interprofessional collaboration, the interprofessional meeting, nurse's role, and developments.

IMPLICATIONS FOR NURSING PRACTICE

The study has identified current nursing practice within the interprofessional palliative care team and areas where interprofessional collaboration can be improved. These are both organizational (role definition and team meeting management) and professional (development of nursing culture, expanded nursing role, and introduction of the APN within the team). Nurses must develop advanced skills to ensure more effective care for patients and caregivers. The introduction of an APN could be appropriate to address this need.

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.

Optimiser les soins palliatifs précoces aux patients atteints d’un cancer hématologique recevant une greffe de cellules souches : rôle de l’infirmière praticienne

La greffe de cellules souches hématopoïétiques (GCSH) est une approche thérapeutique intensive des hémopathies malignes qui s’accompagne d’un important risque de morbidité et de mortalité. Malgré la lueur d’espoir qu’elle apporte aux patients, les traitements sont longs et pénibles, tant du point de vue physique que psychosocial. Habituellement, la greffe de cellules souches hématopoïétiques a une visée curative qui laisse peu de place à un partenariat éventuel avec les services de soins palliatifs et, lorsque ces derniers sont proposés, il est souvent trop tard pour en tirer un bénéfice notable. Il faudrait donc systématiser le recours aux soins palliatifs pour les patients atteints d’hémopathie maligne qui reçoivent une GCSH; cependant, il demeure difficile de trouver la meilleure voie pour établir un tel partenariat. Les infirmières praticiennes, qui sont de plus en plus nombreuses, possèdent les connaissances et les compétences requises pour combler les lacunes dans la prestation de soins palliatifs aux patients recevant une GCSH. L’algorithme de soins palliatifs précoces dispensés par les infirmières praticiennes aux patients recevant une GCSH (dit NEST en anglais, pour « Nurse-Practitioner-Delivered Early Palliative Care for Stem Cell Transplant ») vise justement à faire le pont entre les services palliatifs et les équipes d’hématologie et de greffe afin d’offrir aux patients les meilleurs soins possible.

Optimizing the delivery of early palliative care for hematology patients receiving a stem cell transplant: A role for a Nurse Practitioner

A hematopoietic stem cell transplant (HSCT) is an intense treatment approach for patients with a hematologic malignancy and brings a significant risk for morbidity and mortality. HSCT brings hope of cure for patients; however, treatments are lengthy and burdensome from both a physical and psychosocial perspective. As the culture of HSCT has traditionally been cure-oriented, it leaves little room for a potential partnership with palliative care services, and when palliative care services are introduced, it is often too late for significant benefit. The need to standardize palliative care involvement for patients with hematologic malignancies receiving a HSCT has become necessary, yet there are challenges with the best way to create such a partnership. Nurse practitioners are a steadily growing professional body possessing the knowledge and skill necessary to fill the gap in palliative care delivery for HSCT patients. The proposed Nurse Practitioner Early Palliative Care for HSCT patients (NEST) algorithm will seek to provide a pathway in which to foster a partnership between hematology/HSCT teams and palliative services to yield the best care possible for patients.

Acute Care Pediatric Nurse Practitioner: The 2014 Practice Analysis

INTRODUCTION

Practice research serves as the certification framework for validating advanced practice roles and updating national qualifying examinations. This national study describes the current practice of the acute care pediatric nurse practitioner (AC PNP) to inform an update of the Certified Pediatric Nurse Practitioner-Acute Care (CPNP-AC) examination content outline.

METHOD

A descriptive analysis was performed of the responses of 319 pediatric nurse practitioners, practicing in an acute care role, who completed a practice survey in 2014.

RESULTS

Respondents were primarily White women with a mean age of 40 years; 75% had been formally educated as AC PNPs, compared with 48% in 2009. Regional practice was most heavily concentrated in the Southeast (28%) and Midwest (27%). Most respondents (81%) practiced in urban areas. Respondents reported spending 75% of practice time in inpatient settings. The most frequently cited areas of practice were critical care (36%), followed by emergency department (9%) and subspecialty practices.

DISCUSSION

This third analysis of AC PNP practice 10 years after initiation of the CPNP-AC certification examination demonstrates changes in clinical practice and educational preparation.

How to implement a geriatric assessment in your clinical practice

Cancer is a disease that mostly affects older adults. Other health conditions, changes in functional status, and use of multiple medications change the risks and benefits of cancer treatment for older adults. Several international organizations, such as the International Society of Geriatric Oncology, the European Organization for Research and Treatment of Cancer, recommend the conduct of a geriatric assessment (GA) for older adults with cancer to help select the most appropriate treatment and identify any underlying undetected medical, functional, and psychosocial issues that can interfere with treatment. The aim of this review is to describe what a GA is and how to implement it in daily clinical practice for older adults with cancer in the oncology setting. We provide an overview of commonly used tools. Key considerations in performing the GA include the resources available (staff, space, and time), patient population (who will be assessed), what GA tools to use, and clinical follow-up (who will be responsible for using the GA results for developing care plans and who will provide follow-up care). Important challenges in implementing GA in clinical practice include not having easy and timely access to geriatric expertise, patient burden of the additional hospital visits, and establishing collaboration between the GA team and oncologists regarding expectations of the population referred for GA and expected outcomes of the GA. Finally, we provide some possible interventions for problems identified during the GA.