English - the European Oncology Nursing Society

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Developing European Oncology Nurse EducationSara Faithfull, President EONS, Professor of Cancer Nursing Practice, Faculty of Health and Medical Sciences, Surrey University,Guildford, UKIntroductionneglected. Wood and colleagues (Wood et al. 2000) in focus groupsEducation is clearly an important tool in the development of specialist with non specialist staff found six key areas of training that theynursing within Europe. Awareness of cancer and its treatment felt they required 1) an overview of cancer, 2) treatments and sideand the impact it has on individuals and families helps in reducing effects, 3) communication skills, 4) physical and practical issues, 5)negative perceptions and fatalistic attitudes. Education not only care organisations, referral routes and staff roles and 6) finally deathimproves care, but can enhance patient outcomes. However care and dying issues. Similar areas of need were found in communityis becoming more complex with the ever changing and increasing sector staff in Kelly’s (2006) training needs analysis study. Thesecomplexity of cancer treatment delivery, which is demanding wider studies indicate a workforce who would benefit from continuingskills and critical thinking within health care professionals. Individuals professional education in cancer care. This is an area that needswith cancer are being cared for in community and ambulatory to be developed and it is hard to envisage how future home basedsettings, as well as in the traditional cancer centres, and this has chemotherapy and rehabilitation will progress without consideringcreated the need for widening cancer knowledge to nurses working such community staff training needs.in generalist specialities such as community and public health. EUdirectives provided political pressure to ensure the effectivenessand efficacy of cancer care raising the profile by identifying the needto improve knowledge of oncology within the EU member states.The commission identified the vital role of the different professionsin the provision of cancer therapy; rehabilitation and terminal care(EU 1997). The Europe against Cancer programme encouragednew initiatives such as training programmes. This legitimatised theneed to improve the knowledge and skills of health professionals incancer as well as in cancer prevention, counselling and the supportof training networks. Eleven years on and it is time to reflect onhow education has developed and where we should be going for thefuture in modernising cancer nursing education. This paper exploresthe challenges ahead in how we develop our future cancer nursingworkforce.Change in cancer provision; is it challenging educators?Over the last 10 years cancer care has been changing. Developmentsinclude reforms of health care systems, changes in treatment andthe development of consumer focused provision. From all the Is it possible to identify the impact for patients and nurses ofrecent projections and figures we know that with the increasing cancer education?ageing population that cancer burden within Europe will rise over Evidence is limited as to whether current educational provisionthe next 10 years. We also know that those individuals who have is fit for purpose in meeting the new technological and acutecancer are more likely to be surviving their diagnosis and requiring patient agenda for providing 21st century cancer care. There areprolonged monitoring and greater rehabilitation needs (Berino 2007). few evaluation studies of continuing professional cancer nursingResponding to these scientific and technological innovations is education. Ferguson (1994) in a review of the literature to examinedifficult as often health services reform follows major change with the purpose and benefits of continuing professional education forlittle planning or educational provision. The reality is that throughput cancer nurses reported that studies to measure practice benefitsof patients is high within cancer centres, bed stays are short and were inconclusive. Subsequent cancer education studies indicatehospital treatment is increasingly acute. The increased use of similar findings in relation to practice change (Langton 1999, Wyattambulatory care and oral medication has shifted care from hospitals 2007a). Although not oncology based, studies of bachelor nurseto the home where the provision of specialist nursing is often limited programmes have found, that graduate nurses perform significantly(Faithfull 2006). Providing such supportive care requires translation better at decision making than their non academic colleagues (Girotacross disciplines and care settings with multi-agency approaches 2000). Evidence for the effectiveness of education and trainingto care (Boal et al. 2000, Webb 1991). These changes coupled for communication skills in oncology has been well establishedwith ever increasing demands in health care require a constantly (Wilkinson et al. 2002) however the sustainability of their use indeveloping and flexible nursing workforce. Much of the specialist practice has still to be ascertained. Practice outcomes are difficultcancer provision is acute cancer centre based, however clearly much in oncology as such studies require comparators and are scarce,of the care is now being provided in community and general health much of the evidence is based on limited UK or USA educationalcare settings. The need to up skill community and public health provision. It is imperative that in the era of evidence based care,practitioners is a priority for future political agendas but it is unclear educators demonstrate their contribution to clinical outcomes. Oneas to what skills they require and how to identify those who have of the problems for such research is that it is easier to evaluate thetraining needs? Those nurses working in the community are often processes of education than the outcomes (Jordan 2000).34 - newsletter fall 2008
It is not surprising that process evaluations of nurses practiceperceptions has been the most common way of evaluating theimpact of continuing professional education. Studies of the nursesthemselves indicate that continuing professional education improvesconfidence, communication skills and decreases anxiety (Copp etal. 2007) it also has a perceived impact on practice (Wyatt (2007b,Pelletier et al 2004, Steginga et al 2005). A study of a UK healthprovider found that nurses’ perceptions of training needs are oftendifferent from that of health managers and that curriculum contentwas often generic and not adapted to reflect cultural characteristicsof the local health population and health economy (Kelly et al 2006).The wide variation in continuing educational provision has beenseen in specific courses such as in chemotherapy administrationand training with some nurses receiving minimal education in theunderpinnings of knowledge required for safe chemotherapy practice(Verity R et al 2008).Clearly saying is not the same as doing?Developing both processand outcome evaluationof continuing professionaleducation is requiredwithin Europe with aneed to look at specificcancer nursing skill setsand comparator groups.Proving the “value added”nature of educationis essential if we areto develop specialistcancer nursing. As wellas research in this areawe need to identify thecosts and consequencesof up skilling theworkforce for healthservice managers andpolicy makers. There is aneed to recognise suchspecialist skills as partof employment providingfinancial incentives and job satisfaction. In many countries there isno recognition of specialist nursing roles and there is little financialincentive or support for the development of specialist cancer skills(Foubert & Faithfull 2006). Barriers to education and training are notonly financial they can be time related and reflect accessibility (Wyatt2007a). However effective continuing professional development hasbeen linked with enhanced morale, increased motivation and staffretention so also provides benefits for managers (Smith & Topping2001). Unpacking the complexity of these outcomes is essential ifspecialist cancer nursing is to be valued.ConclusionRecognising that the developments within education have been quitedramatic in the last few years more is being required of educators.Furthermore increasing financial constraints in education hasmeant that nurses are finding it difficult to get release and fundfurther continuing professional development within many EU clinicalsettings. There is also an increasing need for short more work-basedprogrammes to enhance accessibility. The development of the EONSpost basic cancer nursing curriculum has made an impact on learningresources providing a gold standard for educational provision withinEurope but requires evaluation of the outcomes that result as part ofthis education. Future development of new specialist curricula andadvancing levels of practice through consensus and expert panelsidentify these curricular as recognised professional education forspecialist cancer nurses. We need more evidence as to the valueof specialist education in outcomes that policy makers and healtheconomists understand. Providing a trained and skilled workforcewill have benefits not only for nurses themselves but in patientcare. Those in nurse education face many challenges not only in theprocesses of how cancer education is provided and to whom, butalso in redefining the skills needed by the cancer workforce to clearlyimpact on the practice outcomes.References:Berino F et al. (2007) Survival for 8 major cancers: results of theEurocare4 study. Lancet Oncology 8(9) 773-783Boal E, Hodgson D, Banks-Howe J, & Husband G (2000) A culturalchange in cancer education and training European Journal of OncologyNursing 9,30-35Copp G, Caldwell K, Atwal A, Brett-Richards M, Coleman K (2007)Preparation for cancer care: perceptions of newly qualified healthcare professionals European Journal of Oncology Nursing 11 159-167European Commission (1997) Public Health in Europe employmentand social affairs, EC LuxembourgFaithfull S (2006) E. Milly L. Haagedoorn Lecture EACE 2006.Developing oncology nurse education and training across Europe. JCancer Educ. Winter; 21(4):212-5.Foubert J, Faithfull S (2006) Education in Europe: are cancer nursesready for the future? J BUON. 2006 Jul-Sep;11(3):281-4.Ferguson A (1994) Evaluating the purpose and benefits of continuingeducation in nursing and the implications for the provision ofcontinuing education for cancer nurses Journal of Advanced Nursing19, 640-646Girot EA (2000) Graduate nurses: critical thinkers or better decisionmakers? Journal of Advanced Nursing 31(2) 288-297Jordan S (2000) Educational input and patient outcomes: exploringthe gap Journal of Advanced Nursing 31 (2) 461-471Kelly D, Gould D, White I, Burridge EJ (2006) Modernising cancer andpalliative care education in the UK: insights from one cancer networkEuropean Journal of Oncology Nursing 10 187-197Langton H, Blunden G, Hek G (1999) Cancer nursing education:literature review and documentary analysis: English National Board forNursing, Midwifery and Health Visiting, LondonPelletier D, Donohue J, Duffield C (2004) Australian nurses’perceptions of the impact of their postgraduate studies on theirpatient care activities. Nurse Education Today 23 434-442Smith J & Topping A (2001) Unpacking the ‘value added’ impactof continuing professional education: a multi-method case studyapproach Nurse Education Today 21 341-349Steginga SK, Dunn J, Dewar AM, McCarthy A, Yates P, Beadle G.(2005) Impact of an intensive nursing education course on nurses’knowledge, confidence, attitudes, and perceived skills in the care ofpatients with cancer. Oncol Nurs Forum. Mar 5;32(2):375-81.Webb P, (1991) Educational initiatives for cancer nursing in Europe. JCancer Educ. 6(1):9-14.Wilkinson S, Gambles M, Roberts A (2002) The essence of cancercare: the impact of training on nurses’ ability to communicateeffectively Journal of Advanced Nursing 40(6) 731-738Wood C & Ward J (2000) A general overview of the cancer educationneeds of non-specialist staff. European journal of Cancer Care 9191-196Wyatt DE. (2007a) The impact of oncology education on practice--aliterature review.Eur J Oncol Nurs. 2007 Jul; 11(3):255-61.Wyatt D (2007b) How do participants of a post registration oncologynursing course perceive that the course influences their practice? adescriptive study European Journal of Oncology Nursing 11, 168-178Verity R, Wiseman T, Ream E, Teasdale E, Richardson A (2008)Exploring the work of nurses who administer chemotherapy EuropeanJournal of Oncology Nursing doi:10.1016/j.ejon.2008.02.001newsletter fall 2008 -35
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English - the European Oncology Nursing Society

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