RTT advanced practice and how it can change the future of radiotherapy

The radiation therapy (RT) landscape is continuously evolving, necessitating adaptation in roles and responsibilities of radiation therapists (RTTs). Advanced Practice Radiation Therapists (APRTs) have taken on a proactive role in expanding services and assuming responsibilities within multi-professional teams. A European Society for Radiotherapy and Oncology (ESTRO) brought geographically diverse and experienced RTTs together, to discuss how advanced practice (AP) in the RTT profession should be future-proofed and create a global platform for collaboration. Challenges in achieving consensus and standardisation of APRT was identified across jurisdictions, emphasising the importance of international collaboration. Whilst highlighting the pivotal role of APRTs in driving innovation, improving patient care, and navigating the complexities of modern RT practice, this position paper presents outcomes and recommendations from the workshop. Discussions highlighted the need for standardised role definitions, education frameworks, regulatory support, and career development pathways to enable the advancement of APRT effectively. Increasing networks and collaboration is recommended to ensure APRTs can shape the future of RT.

Case study: the development of specialist nurse roles in Malta

Specialist nurses play a significant role in healthcare. This study investigated and evaluated the primary and extended roles and the development of specialist nurses in Malta.

METHODS

A qualitative case study design and purposive sampling techniques were used to gain a deep understanding of the complex issues surrounding specialist nurses from multiple data sets. A survey of the total specialist nurse population in 2013 (n=27), in-depth interviews with a group of specialist nurses (n=9) and four focus groups with key professionals and policy stakeholders (total n=28) were carried out. Data were collected between 2013 and 2015 and analysed using thematic analysis.

FINDINGS

Three themes emerged: the roles and attributes of specialist nurses in Malta; the development of specialist nurses; and the influences on the advancement of specialist nursing practice in Malta. Although these data are nearly a decade old, no further research has been carried out.

CONCLUSIONS

A legally accepted set of definitions as well as preparation and evaluation of the specialist nurse role from a national policy perspective is needed. Attitudes and systems that limit specialist nurses need to be challenged.

[Advanced practice nurses in geriatric traumatology : A scoping review]

BACKGROUND

Older and very old persons have an increased risk of traumatic injuries as well as comorbidities and multimorbidities. The standardized workflow in hospitals can increase the occurrence of typical geriatric complications, such as challenging behavior and delirium, which can result in highly complex care situations. The application of advanced practice nurses (APN) is an international response to such challenges. In Germany, the scientifically based development of APN has so far lagged behind the international standard.

METHOD

For this scoping review, a systematic search in the databases PubMed and CINAHL and a supplementary hand search was conducted for the period 2010-2022.

RESULTS

Tasks and role profiles for the scope of practice of APN in geriatrics and traumatology already exist in the literature. There is a lack of scientifically proven tasks and role profiles for APN in geriatric traumatology in the literature.

DISCUSSION

Based on the current state of research it is not yet possible to derive specific tasks and role profiles for APN in geriatric traumatology. The transferability of tasks and profiles from geriatrics and traumatology seem to be possible. The development of tasks and role profiles for geriatric traumatology APN requires further research, especially to identify the specific needs of geriatric traumatology patients.

Reporting radiographers in Norway - A qualitative interview study

INTRODUCTION

A number of Norwegian radiographers have attended an advanced programme of education and training in musculoskeletal reporting, some in the UK and some in Norway. The aim of this study was to examine how reporting radiographers, radiologists and managers experienced the education, competence, and role of reporting radiographers in Norway. To our knowledge, the role and function of reporting radiographers in Norway has not yet been explored.

METHODS

The study had a qualitative design and was based on eleven individual interviews of reporting radiographers, radiologists, and managers. The participants represented five different imaging departments from four hospital trusts in Norway. The interviews were analyzed using inductive content analysis.

RESULTS

The analysis identified two main categories: "Education and training", and "The reporting radiographer". The subcategories were: "Education", "Training", "Competence", and "The new role". The study found the program to be demanding, challenging, and time-consuming. However, the reporting radiographers described it as motivating because they gained new competence. The competence of reporting radiographers was regarded as adequate. The participants found that reporting radiographers had a unique competence in both image acquisition and reporting, and they were described as a missing link between radiographers and radiologists.

CONCLUSION

Reporting radiographers are experienced as an asset for the department. Reporting radiographers not only contribute to musculoskeletal imaging reports but are also important for collaboration, training, and professional development in imaging, and in collaborating with orthopedics. This was seen to increase the quality of musculoskeletal imaging.

IMPLICATIONS FOR PRACTICE

Reporting radiographers are a valuable resource in image departments, especially in smaller hospitals where the shortage of radiologists is noticeable.

Process evaluation of a multi-disciplinary complex intervention to improve care for older patients with chronic conditions in rural areas (the HandinHand Study): study protocol

BACKGROUND

To improve health care in rural areas, especially for increasing numbers of people with chronic diseases, academically qualified nurses could take over expanded roles to meet the challenges of an ageing society and a decreasing number of General Practitioners (GPs). In the project "HandinHand" (HiH), qualified nurses (Expert nurses, ENs) will carry out home visits to older people with chronic diseases over a period of six months. ENs will prepare a care plan in cooperation with GPs to stabilise the care situation and avoid unplanned hospital admissions and GP visits. The process evaluation aims to provide an in-depth analysis of the implementation process and gather important information on barriers and facilitators to the implementation of ENs as a complementary health care structure in primary care, taking into account several context factors.

METHODS

Based on the Medical Research Council (MRC) Framework for complex interventions, a logic model was developed and applied as the basis for data collection. Qualitative and quantitative data will be collected during the study. A mixed methods approach should allow to gain important insights from participants (e.g. ENs, GPs, patients) involved in the study as well as relevant stakeholders. Semi-structured interviews and surveys will be conducted. Data analysis will be based on the logical model, combining qualitative and quantitative data. Qualitative data will be analysed inductively-deductively using qualitative thematic framework analysis.

DISCUSSION

The process evaluation will provide guidance and conclusions on further development and transferability. Of particular interest is the expanded role of ENs in primary care, which has barely been implemented in Germany and can be seen as a precursor to the development of an Advanced Practice Nursing (APN) role in primary care.

A study to investigate undergraduate diagnostic radiographer preferences and expectations of clinical role development: Quantitative findings

INTRODUCTION

Whilst United Kingdom (UK) student ambitions for role development have been surveyed previously, no literature has explored their specialisation preferences. This study aimed to explore these ambitions and preferences in final year diagnostic radiography undergraduates at a Higher-Education Institute (HEI) in the North-West of England.

METHODS

University ethical approval was granted for a survey-based study. A questionnaire consisting of 4 closed questions and 6 open questions was distributed in paper format after a taught session. Responses were collated and summarised in Excel (descriptive statistics), and transferred into SPSS (inferential statistics).

RESULTS

The response rate was 75.6% (n = 34/45). Respondents were predominantly female (73.5%), had A-level as their highest qualification (79.4%) and were of 'school-leaver' age (76.5%) at the start of the degree. By overall total, preferences were for reporting (n = 24/101; 23.8%), computed tomography (CT) (n = 20/101; 19.8%) and MRI/ultrasound (both 12/101; 12.5%). CT had more first choices (n = 8) than reporting (n = 7). 73.5% anticipated specialising in less than 2 years, and 100% within 4 years.

CONCLUSION

Other than a larger percentage having A-level as their highest qualification, the participant demographics were similar to the UK radiography workforce. Reporting, CT, MRI and ultrasound are the specialisation preferences of final year undergraduate diagnostic radiography students. Expectations for the timeline of role development were slightly more ambitious than previously found.

IMPLICATIONS FOR PRACTICE

Identification of reporting as the preferred area of specialisation is a novel finding in the context of UK HEIs. Harnessing this ambition will help meet the goals of successive government policy. Ensuring the ambitions of graduate diagnostic radiographers can be satisfied has clear implications for staff retention within the NHS.

Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice

Background

Transitions in healthcare delivery, such as the rapidly growing numbers of older people and increasing social and healthcare needs, combined with nursing shortages has sparked renewed interest in differentiations in nursing staff and skill mix. Policy attempts to implement new competency frameworks and job profiles often fails for not serving existing nursing practices. This study is aimed to understand how licensed vocational nurses (VNs) and nurses with a Bachelor of Science degree (BNs) shape distinct nursing roles in daily practice.

Methods

A qualitative study was conducted in four wards (neurology, oncology, pneumatology and surgery) of a Dutch teaching hospital. Various ethnographic methods were used: shadowing nurses in daily practice (65h), observations and participation in relevant meetings (n=56), informal conversations (up to 15 h), 22 semi-structured interviews and member-checking with four focus groups (19 nurses in total). Data was analyzed using thematic analysis.

Results

Hospital nurses developed new role distinctions in a series of small-change experiments, based on action and appraisal. Our findings show that: (1) this developmental approach incorporated the nurses’ invisible work; (2) nurses’ roles evolved through the accumulation of small changes that included embedding the new routines in organizational structures; (3) the experimental approach supported the professionalization of nurses, enabling them to translate national legislation into hospital policies and supporting the nurses’ (bottom-up) evolution of practices. The new roles required the special knowledge and skills of Bachelor-trained nurses to support healthcare quality improvement and connect the patients’ needs to organizational capacity.

Conclusions

Conducting small-change experiments, anchored by action and appraisal rather than by design, clarified the distinctions between vocational and Bachelor-trained nurses. The process stimulated personal leadership and boosted the responsibility nurses feel for their own development and the nursing profession in general. This study indicates that experimental nursing role development provides opportunities for nursing professionalization and gives nurses, managers and policymakers the opportunity of a ‘two-way-window’ in nursing role development, aligning policy initiatives with daily nursing practices.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00613-3.

An examination of Advanced Clinical Practice: Qualitative insights from therapeutic radiography advanced and consultant practitioners based in England

INTRODUCTION

Therapeutic radiographers play a vital and changing role in the delivery of radiotherapy services treating patients with cancer. Advanced Practitioners (AP) and Consultant Practitioners (CP) in radiotherapy have developed advanced clinical skills and specialisms, enhancing the ability of the profession to offer a greater depth of cancer services and ease pressure elsewhere in the system.The aim of this study was to define the opportunity and potential for Advanced Clinical Practice (ACP) roles in oncology services. Specific objectives were to explore local profiles, role development and opportunities for standardisation of ACPs in therapeutic radiography and to determine resource requirements to roll out and ensure continuation of the existing and new roles.

MATERIAL AND METHODS

The research was addressed through a qualitative study design using focus groups. Convenience sampling was used to recruit therapeutic radiography advanced and consultant practitioners (N = 36) from the respective radiotherapy departments in England to participate in regional focus groups. Four regional areas were identified for inclusion. Data generated was analysed thematically.

RESULTS

The findings are presented in four themes: ownership of professional identity, desire for standardisation and guidance, drivers of role development and self-directed educational routes.

CONCLUSION

Key findings from the focus groups indicated the need for standardisation in job descriptions, roles and responsibilities and a key understanding of career progression. The professional identity of the AP is acknowledged by independent, autonomous working; however, this can only be facilitated if the correct training is undertaken and the necessary support structures are in place to enable career progression. Challenges associated with role development are 1) lack of career and pathway guidance, 2) lack of clear educational routes, 3) lack of standardised roles.

A Canadian experience of palliative advanced practice radiation therapy TIPS: Training, implementation, practice and sustainability

The concept of the Advanced Practice Radiation Therapist (APRT) was created in 2004, in response to pressures on the radiation treatment sector in Ontario. This led to development, piloting and integration of the Clinical Specialist Radiation Therapist (CSRT) into Ontario's cancer care framework. A national certification process, competency profile and protected title of APRT(T) were established in 2017, under the Canadian Association of Medical Radiation Technologists (CAMRT), in collaboration with Cancer Care Ontario/Ontario Health. This report describes the approach to development, validation and measuring impact of the CSRT role in Ontario, specifically in palliative care (pCSRT). It also presents information to assist jurisdictions interested in developing a pCSRT position, describing competency development, assessment, and assumption of practice, and providing some keys to success. This is foundational for consistent expansion of the pCSRT role to other regions to continue to increase system capacity while improving the quality of cancer care.

Evaluation of a urology specialist therapeutic radiographer implemented radiotherapy pathway for prostate cancer patients

INTRODUCTION

The role of the Urology Specialist Therapeutic Radiographer (USTR) was introduced to support a busy NHS uro-oncology practice. Key objectives were to improve patient preparedness for and experience of radiotherapy, focussed on prostate cancer. Pre-radiotherapy information seminars were developed, and on-treatment patient review managed by the USTRs. To evaluate the revamped patient pathway and direct further improvements, a patient experience survey was designed.

METHODS

An 18-point patient questionnaire was produced. The questionnaire captured patient experience and preparedness; pre, during and at completion of treatment. The patient population comprised men receiving radiotherapy for primary prostate cancer within one UK Trust.

RESULTS

Two-hundred and fifty-one responses were received. Seventy-three percent of patients felt completely prepared for radiotherapy, higher in those who attended a seminar (77%) compared to those who did not (61%). Eighty-nine and eighty-six percent of respondents were completely satisfied with verbal and written information received prior to commencing radiotherapy respectively. Seventy-three percent of responders would have found additional resources helpful. With respect to on-treatment clinics; eighty-five percent were seen on time or within 20 minutes, eighty-three percent felt fully involved in decisions regarding their care and ninety-one percent reported complete satisfaction with the knowledge of the health care professional reviewing them. The follow-up process was completely understood by eighty-eight percent and overall patient experience rated excellent by eighty-five percent of responders.

CONCLUSION

The revamped pathway implemented by USTRs has achieved high levels of satisfaction at all stages of the prostate patient's radiotherapy. By diversifying the format of information giving, the USTRs hope to further meet the information needs of patients.

IMPLICATIONS FOR PRACTICE

Validation of a prostate cancer radiotherapy pathway which employs USTRs and utilises a patient preparation seminar. This model could support the introduction of Specialist Therapeutic Radiographers in other Trusts and treatment sites.

Registered nurse perceptions of factors contributing to the inconsistent brand image of the nursing profession

•

An outdated brand image projects nurses as lacking in influence and autonomy.

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Nurses could use branding principles to develop and promote their desired image.

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Branding is most effective when members agree on a set of shared values.

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A strong brand message is built on “consistency of message and action over time.”

•

Research is needed which could inform an accurate brand image for nursing.

Background

Nurses have been overlooked as autonomous healthcare providers due to an inaccurate image which projects them as caring and trusted, yet lacking in influence and autonomy. It is important for nurses to understand the image their profession wishes to convey, how the image falls short, and what can be done to improve it.

Purpose

To examine responses of Registered Nurses (n = 286) describing factors influencing nursing's inconsistent brand image.

Methods

Qualitative data were thematically coded, analyzed, and grouped into eight influencing factors.

Findings

Factors contributing to nursing's inconsistent image included: variety of education/credentials, image not a priority, lack of leadership development, lack of professionalism, portrayals in the media and online, patients’ personal experiences, treatment by other professional colleagues and gender role assumptions.

Discussion

A strong brand image could dispel outdated and inaccurate views while communicating new visionary leadership which aligns with priorities for the nursing profession.

Developing the advanced nurse practitioner role in a memory service

This article describes how one NHS trust in northern England developed the advanced nurse practitioner (ANP) role within its memory services. It discusses how ANP roles were developed and implemented across four localities of a large NHS trust that provides a number of locally based memory services to improve the diagnostic pathway for people referred to the service and their carers. Advanced practice is considered more broadly followed by a review of the literature related to the role of the ANP and non-medical prescriber in mental health and, more specifically, memory assessment and diagnostic services. Challenges to gaining the requisite competency to work as an ANP are discussed. The need for a clear agreed strategy to ensure practitioner competence and effective governance for the introduction of these roles is described. It is argued that using this model allowed for mental health nurses within memory services to make a major contribution to the transformation of such services and receive recognition for the expansion of their role and appropriate remuneration linked to national NHS employment role profiles. The potential benefit of the ANP role more broadly in mental health services is discussed, together with factors that may have previously hindered their contribution to the transformation of services. The strategic development and planning process that led to implementing the ANP role within memory services is presented, together with a description of how the relevant higher level clinical skills required for the roles were achieved and formally accredited.

Developing the advanced nurse practitioner role in a memory service

This article describes how one NHS trust in northern England developed the advanced nurse practitioner (ANP) role within its memory services. It discusses how ANP roles were developed and implemented across four localities of a large NHS trust that provides a number of locally based memory services to improve the diagnostic pathway for people referred to the service and their carers. Advanced practice is considered more broadly followed by a review of the literature related to the role of the ANP and non-medical prescriber in mental health and, more specifically, memory assessment and diagnostic services. Challenges to gaining the requisite competency to work as an ANP are discussed. The need for a clear agreed strategy to ensure practitioner competence and effective governance for the introduction of these roles is described. It is argued that using this model allowed for mental health nurses within memory services to make a major contribution to the transformation of such services and receive recognition for the expansion of their role and appropriate remuneration linked to national NHS employment role profiles. The potential benefit of the ANP role more broadly in mental health services is discussed, together with factors that may have previously hindered their contribution to the transformation of services. The strategic development and planning process that led to implementing the ANP role within memory services is presented, together with a description of how the relevant higher level clinical skills required for the roles were achieved and formally accredited.

Implementing a holistic approach to a radiographer-led Hysterosalpingogram (HSG) service: A review of impact and patient perception

INTRODUCTION

Radiographer role development has touched boundaries across the multidisciplinary team and more recently branched into the field of gynaecology. Radiographers are now able to perform tasks that were traditionally performed by radiologists and gynaecologists to implement a radiographer-led Hysterosalpingogram (HSG) service. The aims of the study were to (i) implement a radiographer-led HSG service with a view to decreasing waiting times. (ii) To determine ladies perceptions and satisfaction levels.

METHOD

Local clinical guidelines were developed with the radiologist/gynaecologist and trainee HSG radiographers. A robust system of work was initiated which required maintaining comprehensive log books to record examinations performed and reports written. These were audited and compared with those of the radiologist. Audit cycles were monitored through Q Pulse to ensure good practise was maintained. Patient satisfaction surveys were developed and distributed to 100 consecutive ladies attending for HSG over a 6 month period from January-July 2017.

RESULTS

The radiographer-led service has increased the number of appointment slots offered for HSG's throughout the year as the service now runs every week. HSG's were performed by 5 staff members but now only require 3 staff. A 75% response rate was achieved from the questionnaire survey and shows high patient satisfaction levels. Ladies reported being better informed about their examination resulting in decreased anxiety, concerns and discomfort.

CONCLUSION

The implementation of this service has successfully reduced waiting lists for HSG examinations from 14 to 0 weeks. The Trust has saved £15,000 on staff salaries per annum since the service started.

The framework for developing nursing specialist roles in the health care system of Iran

BACKGROUND

A key step to the development of a roadmap for developing nursing specialist roles is to create its framework based on the immediate context.

PURPOSE

This study aimed to create the framework for developing nursing specialist roles in the health care system of Iran.

METHODS

This was a descriptive qualitative study. A purposeful sample of 81 nursing and nonnursing experts was recruited. The directed content analysis approach was used for data analysis.

FINDINGS

The framework for developing nursing specialist roles in the health care system include eight main categories. These categories are role titles, prioritization of the necessary specialties, the necessary competencies of nurses at specialist level, the scope of nursing specialist practice, expected authorizations, requirements for role development, and its barriers and facilitators.

DISCUSSION

Creating a context-based framework for nursing specialist role development based on the characteristics of each country is recommended.

TRUFU: Therapeutic radiographer undertaking follow up for prostate cancer patients

INTRODUCTION

A study was proposed to examine the impact to patients and the Oncology review team, of extending the role of the Therapeutic Radiographer to undertake follow up review of prostate cancer patients who have completed a radical course of external beam radiotherapy treatment.

METHOD

A total of 30 patients attending for routine radiotherapy follow up were included in an observational study. Patients were assigned for review with a Doctor or a Therapeutic Radiographer using 1:1 randomisation and a number of time points were recorded and analysed.

RESULTS

Of the 44 patients screened, 30 patients were recruited. Average time from scheduled appointment time to departure from clinic was 36 min for both the doctor and Therapeutic Radiographer. The average length of Consultation was 19 min for the Therapeutic Radiographer and 10 min for the Doctor. Average length of wait for patients from scheduled appointment time to being taken for review was 17 min for the Therapeutic Radiographer and 25 min for the Doctor. Of the patients who completed questionnaires, 23/28 had no preference of reviewer, 2/28 declared a preference to be seen by a doctor, whilst 3/28 stated a preference for review with a Therapeutic Radiographer.

CONCLUSION

The results of the study are encouraging and should be further investigated in an attempt of developing what would be a very rewarding aspect of the Therapeutic Radiographers role.

Advanced and extended scope practice of diagnostic radiographers in Scotland: Exploring strategic imaging service imperatives

INTRODUCTION

The development of diagnostic imaging services manifests features specific to the Scottish environment, in particular development of the radiographic workforce through implementing skills mix and role developments to enhance outcomes for patients. A component of a College of Radiographers Industry Partnership Scheme (CoRIPS) supported study, this research investigates perspectives of strategic service managers with Health Board responsibility for service delivery.

METHOD

A questionnaire survey was administered to strategic service managers across Scotland (N = 14), followed up with telephone interviews. There was a return rate of 57% (n = 8) for the questionnaires and n = 4 agreed to be interviewed. Data collected related to radiographer roles across their Board area; awareness and understanding of service development issues and features as well as perspective on opportunities and barriers in the context of Scottish Government policy, workforce logistics, attitudes and inter-professional relationships.

RESULTS

The results indicate evidence of financial, logistical and political barriers to service evolution, offset by a sense of optimism that scope for beneficial change may be approaching. There are a range of significant initiatives in place and an appetite exists to pursue the development of radiographer roles and skill mix for the benefit of service users more generally.

CONCLUSION

The difficulties in achieving change are well understood and there are basic issues related to finance and industrial relations. There are also however, cultural elements to contend with in the form of attitudes demonstrated by some radiographers and significantly, the radiological community whose influence on the practice of independently regulated radiographers seems incongruent.