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Faith Gibson, Clinical Professor of Children and Young People’s Cancer Care Advancing care/Advancing Nursing: how do we ensure a balance between the two…….. in children’s cancer care
Faith Gibson, Clinical Professor of Children and Young People’s Cancer Care
Advancing care/Advancing
Nursing: how do we ensure a
balance between the
two…….. in children’s
cancer care
http://www.childrenscause.org/stories
Let’s talk about nursing, using children’s cancer nursing as a case: where the landscape is continually changing……
Landscape of care is documented in many textbooks
Improvements in outcome: why the success?
Improved diagnostic techniques
Knowledge of disease patterns and genetics
Development of basic science
Intensive multi drug chemotherapy regimens
National and international clinical trials
Centralisation of care
Specialist paediatric medical care
Increased multi-professional focus
Specialist nursing care
Delivering holistic care throughout the cancer trajectory
Supportive care
It’s a balancing act……nursing care must keep pace with change……..but what is the work of the nurse
My position on role development is that there is….
The desire by, and for, nurses to develop and advance their practice
There is increasing recognition for nurses to develop and advance their practice
There many opportunities for nurses to develop and advance their practice
These opportunities arise through change……….
Increased complexity of care
Changing health needs
Health policy decisions
Organisational structural changes
New technologies
Delegation by other professions
Advances of medical practice
Changes in medical education
Limited resources
Political interests
But as a result, what we have witnessed is……
Uncoordinated evolution of expanded roles
New roles focused on specific disease-related groups and tasks
Unclear boundaries of practice
Future career paths uncertain
Little preparation for accountability
Education lagged behind clinical practice
Multiple expectations and unrealistic views of the post holder
Poorly resourced role innovations
Supervision/guidance varied
Tension and conflict with other professionals
What added to the confusion…..
Criteria for posts were vague
Preparation for posts were not specific
No coherent view about definitions of roles
Leaving other professionals to be unclear and unsure of the role
Managers were unclear about what the workforce required
No national/international framework for role development
Interchangeable use of the terms expanded/extended/advanced practice, mixed up with role titles, e.g. CNS, ANP
Clarification was needed…..
We have taken a lead in children’s cancer nursing
Offered some definitions…(1)
Extended practice
implies a horizontal movement to encompass expertise from medicine and other disciplines.
Task orientated activities
Drive from managers of the service, rather than clinical staff
Reduce doctors hours, address skill mix and staffing costs
Reallocation of tasks between doctors, nurses, allied health professionals, untrained support staff
Economics driving change
(2)
Advancing practice
suggests a more hierarchical movement encompassing increasing expertise within nursing rather than expansion into other disciplines
Non-traditional roles
Includes some additional skills, depending on field of practice
Carried out within a nursing framework
Brings breadth and depth/thinks more globally
Will be masters (clinical) prepared with extensive clinical experience
Identifies the need for and commissions research
Sees and takes opportunities related to practice development
Is recognised in this role within the multiprofessional team providing care across a broader field
Is a leader within the specialty
We distinguished between………
Role and tasks
Level of practice
And refer to…..the pillars of advanced nursing practice………
Tensions still exist and need to be articulated and described
Medical Paradigm
(concerned with cure of disease)
VERSUS
Nursing Paradigm
(concerned with supportive and psychosocial care)
Move away from the notion of advanced practice as the development of a particular role, more towards the idea of advancing practice as a team of like-minded professionals working together in practice innovation units, for the benefit of the well-being of
patients
Rolfe G 2014
Cancer care in the UK………
Role has at its core child and family need
What might that look like….UK
Caring for the child closer to home
Increasing time child spends at home/school
Supporting/teaching families to deliver nursing care
Delivering nurse led clinics
Physical and psychological assessment of need
Carrying a clinical case load
Shared decision-making with clinicians
Key worker role
Clinical Nurse Specialist
Advanced Nurse Practitioner
Consultant Nurse
So going forward……and the legacy we leave behind……
Limited extension
Limited expansion
‘A watered down doctor’
Major expansion
‘More than a doctor, more than a nurse’
Dowling et al 1995
Let’s not get too bogged down in terminology
Be patient focussed and service orientated
Make and take opportunities, lets not just fill gaps
Continue to challenge the
Take other professionals with us on the journey
Accountability, education, training and competence crystal clear
Use research to both inform and evaluate new roles
