[Development of advanced practice nursing in oncology and hematology-oncology in France: Early status report]. / Développement des infirmiers en pratique avancée en oncologie et hémato-oncologie en France : état des lieux précoce.

BACKGROUND: Advanced practice nursing was introduced in France in 2018, in response to health needs. The first advanced practice nurses were graduated since 2019 and were trained in one among four medical areas including oncology and onco-hematology. The purpose of this article is to make an early assessment of the development of the profession of oncology Advanced Practice Nurse in France. METHOD: An exploratory study was conducted. A sample of 44 onco-hematology IPA graduated in 2019 and 2020 was recruited from June 2021 to end of July 2021. The 44 participants completed a questionnaire, by phone interviews or self-administered. RESULTS AND CONCLUSION: The distribution of the 44 participants concerns 12 of the 13 regions of metropolitan France. This profession shows an employability for 86% of the first graduates. These professionals practice in health care institutions and rather in oncology, 71% in the framework of an organizational protocol established with the oncologist. They appear to be well accepted by patients and oncology teams. Further studies on performance and quality indicators will make it possible to evaluate the added value of the oncology Advanced Practice Nurses in the cancer patient's pathway.

Síndrome metabólica em profissionais de enfermagem que atuam na assistência oncológica: prevalência e fatores associados / Síndrome metabólico en profesionales de enfermería que actúan en la asistencia oncológica: prevalencia y factores asociados / Metabolic syndrome in nursing professionals working in oncology care: prevalence and associated factors

RESUMO Objetivo: avaliar a prevalência da síndrome metabólica e os fatores associados em profissionais de enfermagem que atuam em oncologia. Método: estudo transversal com 231 profissionais de enfermagem, de um centro de alta complexidade em oncologia do Estado do Rio de Janeiro, Brasil, entre junho de 2013 e junho de 2015. Realizou-se entrevista para coleta de dados sociodemográficos, profissionais, antecedentes pessoais, hábitos e estilos de vida e condições de saúde. Foram realizadas medida da circunferência da cintura, peso, altura, pressão arterial casual e Monitorização Ambulatorial da Pressão Arterial, além da glicemia plasmática de jejum, triglicerídeos e lipoproteína de alta densidade. Avaliou-se a síndrome metabólica de acordo com a I Diretriz Brasileira de Diagnóstico e Tratamento da Síndrome Metabólica. Regressão de Poisson com variância robusta foi realizada, sendo a presença da síndrome metabólica ou não o desfecho. Resultados: a prevalência da síndrome metabólica foi de 25,1% e esta condição se associou ao maior tempo de formação profissional (4,0%; IC95%:1,05-1,07), à maior pressão diastólica na Monitorização Ambulatorial da Pressão Arterial do período de sono (3,0%; IC95%:1,01-1,05), presença de sobrepeso (2,84%; IC95%:1,93-6,70) e obesidade (4,94%; IC95%:2,08-11,77). Conclusões: observou-se alta prevalência da síndrome metabólica nos profissionais avaliados, e associação com excesso de peso e alteração da pressão no período de sono. Os resultados apontam para necessidade de intervenções para controle de fatores de risco para doenças crônicas não transmissíveis na população estudada.

RESUMEN Objetivo: evaluar la prevalencia del síndrome metabólico y los factores asociados en profesionales de enfermería que actúan en oncología. Método: estudio transversal con 231 profesionales de enfermería, de un centro de alta complejidad en oncología del Estado de Rio de Janeiro, Brasil, entre junio de 2013 y junio de 2015. Se realizó entrevista para recolección de datos sociodemográficos, profesionales, antecedentes personales, hábitos y estilos de vida y condiciones de salud. Fueron realizadas medida de la circunferencia de la cintura, peso, altura, presión arterial casual y Monitoreo Ambulatorio de Presión Arterial, además de la glucemia plasmática de ayuno, triglicéridos y lipoproteína de alta densidad. Se evaluó el síndrome metabólico de acuerdo con la I Directriz Brasileña de Diagnóstico y Tratamiento del Síndrome Metabólico. Fue realizada Regresión de Poisson con varianza robusta, siendo la presencia del síndrome metabólico, o no, el resultado. Resultados: la prevalencia del síndrome metabólico fue de 25,1% y esta condición se asoció al mayor tiempo de formación profesional (4,0%; IC95%:1,05-1,07), a la mayor presión diastólica en elMonitoreo Ambulatorio de Presión Arterial del período de sueño (3,0%; IC95%:1,01-1,05); presencia de sobrepeso (2,84%; IC95%:1,93-6,70) y obesidad (4,94%; IC95%:2,08-11,77). Conclusiones: se observó alta prevalencia del síndrome metabólico en los profesionales evaluados, y asociación con exceso de peso y alteración de la presión en el período de sueño. Los resultados señalan la necesidad de intervenciones para el control de factores de riesgo para enfermedades crónicas no transmisibles en la población estudiada.

ABSTRACT Objective: to evaluate the prevalence of metabolic syndrome and associated factors in nursing professionals working in oncology. Method: cross-sectional study with 231 nursing professionals from a high complexity oncology center in the State of Rio de Janeiro, Brazil, between June 2013 and June 2015. An interview was carried out to collect sociodemographic, professional, personal history, habits and lifestyles, and health conditions data. Waist circumference, weight, height, casual blood pressure, and Ambulatory Blood Pressure Monitoring were performed, in addition to fasting plasma glucose, triglycerides, and high-density lipoprotein. Metabolic syndrome was evaluated according to the I Brazilian Guideline for the Diagnosis and Treatment of Metabolic Syndrome. Poisson regression with robust variance was performed, the outcome being the presence or not of metabolic syndrome. Results: there was a 25.1% prevalence of metabolic syndrome and this condition was associated with longer professional training (4.0%; 95%CI: 1.05-1.07), with higher diastolic pressure in Ambulatory Blood Pressure Monitoring during sleep (3.0%; 95%CI:1.01-1.05), overweight (2.84%; 95%CI:1.93-6.70), and obesity (4.94%; IC95%: 2.08-11.77). Conclusions: there was a high prevalence of metabolic syndrome among the evaluated professionals, and an association between excess weight and changes in pressure during sleep. The results point to the need for interventions to control risk factors for chronic non-communicable diseases in the studied population.

[Place of coordination of complex pathways in oncology by coordinating private nurses]. / Place d'une coordination de parcours complexes en cancérologie par des infirmiers libéraux coordinateurs.

BACKGROUND: The complexity of the hospital-city care pathway is a real challenge because of the lack of coordination and communication between many stakeholders. As part of a call for projects from the General Directorate of Healthcare Provision, an experiment involving private oncology coordinating nurses was developed to address this issue. To our knowledge, there is no evaluation so far of such a protocol . METHODS: This single-center retrospective study focused on data from the ONC'IDEC program between 2015 and 2018, where 28 private nurses provided a 24/7 hotline. The objective was to qualitatively assess the coordination of this system. The nature and number of calls, patient satisfaction and medico-economic parameters were assessed. RESULTS: More than a hundred patients (n=114) were included in this device (mean age: 72 ± 12 years). The most frequent reasons for calls concerned the patient's general condition (35 %) and home treatment follow-ups (13 %) but also referrals to the primary doctor (4 %), which helped avoiding hospitalizations. The patients were satisfied with the experiment (overall score of 8.4/10). DISCUSSION: Thanks to the ONC'IDEC program, patients were able to benefit from more appropriate care through a privileged interlocutor by making their care pathway more fluid and avoiding hospitalizations. It would be interesting to confirm these results by means of a study with a higher level of evidence, by comparing this protocol to conventional hospital coordination.

COVID-19 Vaccines: Preparing for Vaccination in the Context of Clinical Oncology Care.

BACKGROUND: In the environment of an infectious pandemic, vaccines are a primary public health strategy to prevent the spread of disease. With the COVID-19 pandemic, there is heightened interest in safe and effective vaccines and their use in the context of clinical oncology practice. OBJECTIVES: This article provides foundational information about vaccines in general and vaccines developed to protect against the SARS-CoV-2 virus in the United States, as well as clinical nurse strategies to apply vaccines in clinical oncology practice. METHODS: The article is based on a review of public health literature and reputable websites about vaccines and their development in clinical care. FINDINGS: This foundational information about vaccines reviews their history and development, as well as the development of COVID-19 vaccines specifically, and discusses COVID-19 vaccines as part of clinical oncology care. Supporting best practices in clinical oncology care, nurses can provide factual, evidence-based information about vaccine safety, effectiveness, and safe administration.

Defining Expertise in Cancer Nursing Practice.

BACKGROUND: Thirty-five years ago, Benner defined an expert nurse as one who applies deep knowledge and experience across different contexts and clinical situations. Since that time, there has been little exploration of expertise in cancer nursing. OBJECTIVES: To explore and describe characteristics of expert cancer nurses and to consider whether Benner's typology of an expert nurse remains relevant in today's complex oncology settings. METHODS: An exploratory, descriptive study using audio-recorded focus group methodology was undertaken. Audio-recordings were transcribed, and an inductive thematic analysis approach applied to the data. Nurses also documented key characteristics of expert practice on Post-it notes to illustrate dominant characteristics. RESULTS: Twenty-four registered nurses from a comprehensive cancer center in Australia took part in 1 of 3 focus groups. Seven key themes were identified: knowledge, leadership, adaptability, communication, motivation, patient-centered care, organization, and culture. Key word cloud characteristics included knowledge, compassion, motivation, experience, and communication. CONCLUSIONS: Many of the expert characteristics identified in this study reflect traits common to other nursing specialty groups. Of particular relevance to cancer nurses was "adaptability," reflecting the complexity of contemporary cancer care and reaffirming Benner's definition of an expert nurse as one who can fluidly connect knowledge and experience to unfamiliar practice contexts. IMPLICATIONS FOR PRACTICE: Understanding characteristics of expert cancer nurses may help inform and support professional practice advancement and guide future research about select characteristics of expert cancer nurses to patient- and system-level outcomes.

A COVID-19 screening tool for oncology telephone triage.

PURPOSE: Symptoms associated with COVID-19 infection have made the assessment and triage of cancer patients extremely complicated. The purpose of this paper is to describe the development and implementation of a COVID-19 screening tool for oncology telephone triage. METHODS: An Ambulatory Oncology Clinical Nurse Educator and three faculty members worked on the development of an oncology specific triage tool based on the challenges that oncology nurses were having with the generic COVID triage tool. A thorough search of the published literature, as well as pertinent websites, verified that no screening tool for oncology patients was available. RESULTS: The screening tool met a number of essential criteria: (1) simple and easy to use, (2) included the most common signs and symptoms as knowledge of COVID-19 infection changed, (3) was congruent with the overall screening procedures of the medical center, (4) included questions about risk factors for and environmental exposures related to COVID-19, and (5) assessed patient's current cancer history and treatment status. Over a period of 3 weeks, the content and specific questions on the tool were modified based on information obtained from a variety of sources and feedback from the triage nurses. CONCLUSION: Within 1 month, the tool was developed and implemented in clinical practice. Oncology clinicians can modify this tool to triage patients as well as to screen patients in a variety of outpatient settings (e.g., chemotherapy infusion units, radiation therapy departments). The tool will require updates and modifications based on available resources and individual health care organizations' policies and procedures.

A Time to Reflect and a Time to Move Forward.

The winter solstice marks the astronomical moment when the sun is aligned over the Tropic of Capricorn. On December 21, those who live in the Northern Hemisphere had the shortest day and longest night of the year. This was accompanied in 2020 by a rare alignment of Jupiter and Saturn, which appeared as a singular bright point of light in the night sky for the first time since the Middle Ages. Although many cultures celebrate the winter solstice, the solstice is mostly overlooked in the United States, largely because of the multitude of other holidays around this time of the year. However, the shortest day and longest night seems like a metaphor of sorts for a year like no other in the memory of most-a fitting end and a pause. From the stillness, we can reflect in the space between the past and the future, reviewing the year behind us while appreciating the challenges to be faced in 2021.

Virtual Conferences: Optimizing Oncology Nurses' Experience.

One casualty of the COVID-19 pandemic was in-person professional conferences. Organizations, including the American Society of Clinical Oncology, American Association for Cancer Research, and Oncology Nursing Society, had to quickly pivot and radically transform the delivery of the traditional in-person conference to a virtual offering accessible to thousands of oncology healthcare professionals. However, what may have felt catastrophic has revealed unique opportunities to engage individuals in professional offerings, including those who, because of cost or travel, may not have previously participated. In this article, the authors present insights into how to optimize virtual learning experiences during the COVID-19 pandemic and beyond.

Calidad de la muerte percibida por los cuidadores de pacientes en cuidados paliativos / The quality of death perceived by caregivers of patients in palliative care

OBJETIVO: Determinar la calidad de la muerte y del proceso del morir en población oncológica avanzada, y analizar su asociación con el sufrimiento y la calidad de la atención al final de la vida. MÉTODO: Estudio descriptivo, correlacional, de corte transversal en el que participaron los cuidadores principales de los pacientes oncológicos fallecidos en cuidados paliativos. Para la evaluación de la calidad de la muerte y del proceso del morir se utilizó la versión española del Quality of Dying and Death Questionnaire. El sufrimiento fue evaluado con el Mini-Suffering State Examination y la calidad de la atención al final de la vida con la Palliative care Outcome Scale. RESULTADOS: 74 cuidadores familiares de pacientes paliativos fallecidos participaron en este estudio. La puntuación media de la versión española del Quality of Dying and Death Questionnaire fue de 65,58 (± 20,98). Se encontró una correlación negativa entre la calidad de la muerte y el sufrimiento (r=-0,63) y positiva entre la calidad de la muerte y la calidad de la atención al final de la vida (r=0,62). CONCLUSIÓN: La calidad de la muerte de los enfermos oncológicos avanzados en cuidados paliativos se relaciona positivamente con la calidad de la atención al final de la vida y negativamente con el sufrimiento. La atención paliativa contribuye a alcanzar niveles satisfactorios en la calidad de la muerte y del proceso del morir de los pacientes oncológicos avanzados

OBJECTIVE: To determine the quality of dying and death in an advanced oncology population, and to analyze the association with the suffering and the quality of attention at the end of life. METHODS: A cross-sectional, descriptive, correlational design was used. For the evaluation of the quality of dying and death, the Spanish version of the Quality of Dying and Death Questionnaire was used. Suffering was assessed with the Mini-Suffering State Examination and the quality of end-of-life care was evaluated with the Palliative care Outcome Scale. RESULTS: 74 relatives of deceased patients were included in this study. The mean total score of the Spanish version of the Quality of Dying and Death Questionnaire was 64.58 (± 20.98). A negative correlation between the quality of dying and death and the suffering was found (r = -0.63), and a positive correlation between the quality of dying and death and the quality of the attention at the end of life was found (r = 0.62). CONCLUSION: Quality of dying and death in advanced cancer population is positively related to the quality of of the attention at the end of life and negatively related to suffering. Palliative care can contribute to achieving a satisfactory quality of dying and death of advanced cancer patients

Building a Research Team in Adolescent/Young Adult Oncology Nursing.

Introduction: Participation on a collaborative team is an attractive option for conducting research, especially in pediatric hematology/oncology nursing, where the patient population is small. The Consortium to Study Symptoms in Adolescents and Young Adults with Cancer (CS2AYAC) is a nursing research team that has been in existence for over a decade. Purpose: The authors share the process by which CS2AYAC formed and describe key features that contribute to its sustainability. Results: While the team developed organically rather than via the tenets of team science, key aspects of success include principles related to mentorship, communication, building trust, establishing shared goals, and managing conflict. Conclusions: This description of one team's experience may help other nurses build their own teams for research. Strong, collaborative research teams will advance pediatric hematology/oncology nursing science and scholarship and can be an important source of collegiality and support.

Causes and Consequences of Chemotherapy Delays in Ambulatory Oncology Practices: A Multisite Qualitative Study.

PURPOSE: In oncology, chemotherapy treatment delays potentially jeopardize patient safety and impede progress toward disease remission. The purpose of this study was to examine the causes and consequences of chemotherapy treatment delays and possible solutions to improve quality of care. PARTICIPANTS & SETTING: The current authors selected a purposive sample of eight ambulatory oncology practices for ethnographic site visits, which lasted five days each. METHODOLOGIC APPROACH: The authors conducted 290 observation hours, including clinician shadowing, and 46 semistructured interviews with clinicians (oncology nurses, physicians, and advanced practice providers). Deductive and inductive thematic analysis was performed on all data. FINDINGS: The authors identified four primary themes from the analysis that affect delays. IMPLICATIONS FOR NURSING: Future investigations should examine nurses' communication practices in the context of timely chemotherapy administration because communication and documentation technologies within healthcare settings continuously evolve.

Championing eHealth in Clinical Care.

Since 1959, the rate of technological advancements, which has been buoyed by the evolution of microprocessors that stimulate innovation, has grown exponentially, doubling every 12 to 18 months (Roser & Ritchie, 2020). In 2020, it is impossible to walk down the street without seeing people checking their smartphones. However, it was only four decades ago that the personal computer was first introduced into the marketplace. It has been a little more than a decade since the first smartphone-the iPhone by Apple-was released in 2007, followed by the release of the iPad in 2010 (Zimmermann, 2017). As of 2019, an estimated 269 million people in the United States use smartphones (Holst, 2019). Increased technological advancements, as well as the widespread availability of these technologies and their application to Americans' daily lives, have become the norm. In the clinical nursing care of patients with cancer, the use of technology is also gaining momentum. This supplement to the Clinical Journal of Oncology Nursing explores how technology in health care can extend and enhance clinical oncology nursing care.

Access to Care: Using eHealth to Limit Location-Based Barriers for Patients With Cancer.

BACKGROUND: Rural and urban communities may encounter barriers to care, which can lead to delays in timely screening, diagnosis, and treatment. eHealth interventions, such as televisits and remote patient monitoring, are being used increasingly to improve patient access to quality clinical cancer care and to support patient-provider communication. OBJECTIVES: This article describes how eHealth can bridge gaps in patient access to cancer care and provides insight into successful eHealth program implementation. METHODS: Articles that evaluate access to care and eHealth program implementation were summarized. Two case studies illustrate eHealth as a strategy to improve care delivery and access. FINDINGS: Integrating eHealth into clinical practice can help to transform care delivery and improve patient access to quality cancer care by limiting barriers.

Supportive Care and eHealth: A Narrative Review of Technologies, Interventions, and Opportunities for Optimizing Care in Patients With Cancer.

BACKGROUND: Cancer can be distressing for patients and families. eHealth interventions have the potential to lessen this distress by creating opportunities for providing supportive care resources to patients at home. OBJECTIVES: This article reviews supportive care eHealth interventions in cancer and emerging opportunities to optimize these interventions for diverse populations across the cancer trajectory. METHODS: A narrative literature review was conducted to evaluate eHealth supportive care for patients with cancer, including effective interventions, accessibility and interactivity issues, patient-reported outcomes, and strategies to improve care for older adults. FINDINGS: To ensure that patients with cancer and their family members benefit from supportive care eHealth interventions, nurses need to understand how to leverage such interventions to improve care.

Oncology Nurse Navigation: Expansion of the Navigator Role Through Telehealth.

BACKGROUND: Residents of communities without local access to clinical oncology care face significant challenges that can be addressed through the use of technology. Teleoncology uses secure, interactive video- and audioconferencing and telephone communication to remotely deliver quality cancer care. OBJECTIVES: This article introduces the role of the oncology nurse navigator (ONN) as a collaborative caregiver and virtual resource for patients and teleoncology providers. METHODS: The literature on telehealth, nurse navigation, and teleoncology was reviewed to describe the ONN role and its integration with eHealth technologies. FINDINGS: As a member of the interprofessional provider team, the ONN works collaboratively with patients and their family members and serves as a virtual resource. The ONN also provides clinical communication among clinical oncology providers and support staff. The ONN supports eHealth as a method of providing clinical care to patients close to their homes.

Oncology Nursing Considerations when Developing Outpatient Staffing and Acuity Models.

OBJECTIVES: Objectives include review of existing benchmarks and nurse-sensitive indicators relevant to the ambulatory care setting. Applying the data to existing ambulatory staffing models with consideration of multiple clinic settings that include medical oncology, infusion, and stem cell transplant clinics. And to describe key considerations needed to optimize oncology care efficiently with an acuity-based staffing model. DATA SOURCES: Published literature indexed in PubMed, CINAHL, textbooks. CONCLUSION: In today's complex oncology environment, optimization and utilization of outpatient facilities is essential in providing high-quality care and improving satisfaction of patients as well as providers and staff. IMPLICATIONS FOR NURSING PRACTICE: Nurse leaders should utilize benchmarking data to ensure staffing levels are appropriate, given the size and scope of their facility. Staff nurses should be engaged to ensure that acuity tools are developed in accordance with their experiences and perceptions of patient care.

Implementing a pediatric oncology nursing multisite trial.

PURPOSE/BACKGROUND: The Parent Educational Discharge Support Strategies (PEDSS) nursing study includes 16 magnet pediatric oncology institutions across the United States and one in Saudi Arabia, evaluating a nurse-led parent educational discharge support strategy for families experiencing a child newly diagnosed with cancer. METHODS: During the first 3 months of the study, a research implementation survey was administered electronically to each site principal investigator to evaluate facilitators and barriers in the research process for this multisite nurse-led pediatric oncology study. RESULTS: Facilitators included nursing leadership support and commitment from the nursing staff. Common barriers reported were the Institutional Review Board process, the consent process, the timing of the intervention, data collection, as well as nursing time for the study. Results from the survey suggest nurse-led research teams were motivated and felt the intervention was easy to deliver. PRACTICE IMPLICATIONS: Nursing practice is enhanced when nurses participate in research and generate evidence regarding best practices within pediatric oncology nursing care. CONCLUSION: Nursing research endeavors focusing on collaborative approaches for implementation can lead to successful nursing studies with careful planning, training and administrative support.

Impact of interruptions on the duration of nursing interventions: A study in a chemotherapy unit.

OBJECTIVE: To investigate interruptions during nursing interventions in a chemotherapy unit (sources and causes); measure their frequency, duration and the total elapsed time to complete the interventions. METHOD: This is an observational analytical study performed using a digital stopwatch. It was conducted in a teaching hospital between 2015/2016. The interventions performed and their interruptions were mapped and classified according to the Nursing Interventions Classifications (NIC) taxonomy. RESULTS: There were 492 interruptions recorded in the 107 hours observed, especially in indirect care interventions. They were mainly caused by nursing professionals (n = 289; 57.3%) to supply materials (n = 65; 12.8%) and exchange care information (n = 65; 12.8%). The duration of interruptions ranged from 0:08 to 9:09 (average 1:15; SD 1:03) minutes. On average, interventions took 2:16 (SD 0:27) minutes to complete without interruption; however, the average was 5:59 (SD 3:01) minutes when interrupted. CONCLUSION: The interruptions were constant during the nursing work in the chemotherapy unit, including during the preparation and administration of medications, and increased the time to complete the interventions by an average of 163.9%.

Oncology Research: Clinical Trial Management Systems, Electronic Medical Record, and Artificial Intelligence.

OBJECTIVE: To discuss the implications of electronic systems and regulations regarding the use of electronic systems implemented during the conduct of a clinical trial and identify the impact of such platforms on oncology nurses' responsible for providing care to the research participant. DATA SOURCES: Peer-reviewed journal articles, internet, book chapters, and white papers. CONCLUSION: Electronic systems are being increasingly used in the conduct of clinical research. Electronic systems enable the capability to streamline data transfer, remote enrollment capabilities, greater transparency of the trial conduct, improved research documentation, and clearer audit trails. The oncology nurse is at the center of implementation of electronic systems to support the conduct of clinical research and enables safe and effective care to the research participant. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses are vital to the successful outcome of clinical research studies and are key members of the clinical research team. Electronic systems move beyond traditional data collection in clinical trials with multiple benefits. Such systems may enhance the successful completion and adherence of the clinical trial and maintain the safety of the individual consented to research trial.

National Cancer Institute: Restructuring to Support the Clinical Trials of the Future.

OBJECTIVES: To describe the evolution and structure of the National Cancer Institute clinical trials programs, their notable accomplishments, nurses' roles in these accomplishments, and the essential role of nursing today and in the future. DATA SOURCES: Manuscripts, government publications, websites, and professional communications. CONCLUSION: Change is inevitable and a constant factor in the world of advancing science and clinical research. Nurses' contribution to research and evidence-based practice will continue to grow and is vital as the scientific landscape evolves. IMPLICATIONS FOR NURSING PRACTICE: As the understanding of cancer biology increases and clinical trials evolve, nurses will need to remain key team members and leaders in National Cancer Institute Community Oncology Research Program and National Cancer Trials Network trials and their associated infrastructure.