Advanced Practice Pediatric Oncology Nursing as Imagined or In Place in Four Lower- and Upper-Middle-Income Countries

OBJECTIVES

The implementation of pediatric oncology advanced practice nurse (s) roles in low- and middle-income countries (LMICs) presents opportunities and challenges. The authors explore the implications of pediatric oncology advanced practice nursing roles in Pakistan, Cameroon, Turkey, and Mexico. Potential benefits and drawbacks of advanced practice nursing roles, impacts on nursing care, and strategies for advanced practice nursing role development in LMIC settings are considered.

METHODS

Information from scholarly articles, policy documents, and four LMIC pediatric oncology nurse expert perspectives on existing and imagined advanced practice nursing roles in pediatric oncology in LMIC were synthesized.

RESULTS

Current literature and policies point to efforts across LMICs to establish a wide variety of advanced nursing practices, not necessarily aligned with internationally accepted advanced practice nursing standards of practice or education. The LMIC nurses describe a wide range of national general nurse education and government advanced practice nurse recognition/licensing. Challenges to achieving or strengthening advanced practice nursing roles include, for example, healthcare professional resistance, government unwillingness to recognize/license advanced practice nurses, and lack of advanced practice nursing faculty. To promote a pediatric oncology advanced practice nursing role in LMICs requires navigating the national nursing scope of practice and nursing culture.

CONCLUSION

The strategic introduction of pediatric oncology advanced practice nursing roles in LMICs has the potential to significantly enhance patient care by, for example, addressing healthcare workforce shortages and facilitating timely care delivery. However, challenges related to role complexity, resistance from traditional healthcare structures, and role overlap must be considered. Tailoring these roles to local contexts and fostering stakeholder collaboration are essential for successful implementation.

IMPLICATIONS FOR NURSING PRACTICE

The adoption of advanced practice nursing roles can lead to improved quality of care for pediatric oncology patients and their families in LMICs, where cancer care is challenging. The positive impact of pediatric oncology advanced practice nurses on patient outcomes and healthcare delivery cannot be discounted but must align with local nursing and healthcare culture and expectations.

Evaluating Pain Management Practices for Cancer Patients among Health Professionals: A Global Survey

Background: Cancer incidence in the world is predicted to increase in the next decade. While progress has been in diagnosis and treatment, much still remains to be done to improve cancer pain therapy, mainly in underserved communities in low-income countries. Objective: To determine knowledge, beliefs, and barriers regarding pain management in both high- and low-income countries (according to the WHO classification); and to learn about ways to improve the current state of affairs. Design: Descriptive survey. Setting/Subjects: Fifty-six countries worldwide; convenience sample of 1639 consisted of 36.8% physicians; 45.1% nurses, and 4.5% pharmacists employed in varied settings. Results: Improved pain management services are key elements. Top barriers include religion factors, lack of appropriate education and training at all levels, nonadherence to guidelines, patients' reluctance to report on pains, over regulation associated with prescribing and access to opioid analgesics, fear of addiction to opioids, and lack of discussions around prognosis and treatment planning. Conclusion: The majority of patients with cancer in low-income countries are undertreated for their pain. Promoting cancer pain accredited program of training and education on pain management for physicians and nurses is crucial, as well as advocating policymakers and the public at large.

Achievements and pitfalls in improving Pediatric Oncology Nursing standards: A public-private partnership project

RATIONALE

Approximately 8,000 new cases of pediatric cancer arise annually in Pakistan. However, there is a dire survival rate of 30-35% due to various factors, especially a lack of competent nurses in pediatric oncology care. Public-private partnerships (PPP) supported by a My Child Matters (MCM) Grant from Sanofi Espoir Foundation was granted to Indus Hospital & Health Network (IH&HN) to improve pediatric nursing standards.

METHODS

Starting in 2016, nurses from hospitals across Pakistan were enrolled in a continuing education program, which included a comprehensive, hands-on training component. A group chat was created following the training for communication and mentorship regarding challenges faced locally.

RESULTS

Seventy-seven pediatric oncology nurses were successfully trained by IH&HN over three years.

DISCUSSION

Challenges included lack of government funding, shortage of specialist nurses, frequent shifting of nurses away from pediatric care, and indifferent attitudes. Success of the project could have been maximized if trained nurses were motivated and retained by hospitals.

CONCLUSION

Development and maintenance of PPP in national healthcare systems is essential to improve pediatric oncology nursing care.

Development and Content Validation of an Instrument to Measure Baseline Standards for Pediatric Oncology Nursing in Low- and Middle-Income Countries

The Nursing Working Group of the International Society of Pediatric Oncology developed baseline standards for pediatric oncology nursing care in low- and middle-income countries. The standards represent the foundational support required to provide quality nursing care and address barriers such as inadequate staffing, lack of support, limited access to education, and unsafe nursing environments. The purpose of the current study was to develop and validate an instrument to accurately measure the standards. Content validity was assessed by a panel of expert pediatric oncology nurses from all geographical regions of the World Health Organization. The experts were informed about the study's purpose and provided the publications used to develop the instrument. The experts rated how well each criterion measured the corresponding standard by using a 4-point scale. A content validity index (CVI) was computed by using the percentage of total standards given a score of 3 or 4 by the experts. A CVI of .98 was obtained from the panel's evaluation. A CVI of more than .80 is recommended for a newly developed instrument. On the basis of the panel's recommendations, minor modifications were made to the instrument. We developed and validated the content of an instrument to accurately measure baseline standards for pediatric oncology nursing care. This instrument will aid future research on the effect of nursing standards on clinical outcomes, including mortality and abandonment of treatment, with the potential to influence health policy decisions and improve nursing support in low- and middle-income countries.

Correction to: Human Development Index and its association with staff spiritual care provision: a Middle Eastern oncology study

Incorrect family name of Layth Mula-Hussain.

International Society of Paediatric Oncology Nurses Working Group: Supporting and Learning From Colleagues in Limited-Resource Countries

Abstract 44

Purpose:

Globally, nurses caring for children and adolescents with cancer work in diverse practice settings. Nurses in low- and middle-income countries (LMIC) are challenged by the limited scope of their professional practice, resources and education. Opportunities for education, networking and professional growth inspire and empower nurses to improve the care of patients and families. Nurses are key members of the International Society of Paediatric Oncology (SIOP), which provides ongoing professional development. In 2010, the SIOP Pediatric Oncology in Developing Countries Committee's Nursing Working Group was formed to support and learn from nurses working in LMIC.

Methods:

Utilizing the Cure4Kids website from St Jude, the group holds monthly business and educational meetings and continues to network and collaborate on numerous projects. PODC Nursing Working Group recently published baseline standards for pediatric oncology nursing care in LMIC. A survey will now assess the implementation of baseline standards. LMIC nurses are being mentored to write abstracts and grants to increase global recognition of their work. In addition, an education repository of teaching materials is being established.

Summary:

The PODC Nursing Working Group and project groups are well established and achieving project deadlines. Educational programs including topics on abandonment, nursing in LMIC and abstracts have been well received by both nurses and physicians from LMIC and HIC. Challenges have included internet connectivity and scheduling meetings during daylight hours across the multiple time zones. Following the launch of monthly meetings in late 2015, our membership has increased by 20% from 61 to 76 members from 29 countries.

Conclusions:

The SIOP PODC Nursing Group has created a sustainable nursing community and continues to work collaboratively beyond the annual conference. The compassion and commitment to support patients and their families by providing the best care possible is the common thread for pediatric oncology nurses.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST:

No COIs from the authors.