English - the European Oncology Nursing Society

Dungeons and dragonsExploring the EU policy context of cancer nursingSara Faithfull, EONS presidentOver the summer I have been working with an Erasmus studentfrom Germany who has been visiting the UK & Belgium as part ofa 3 month educational exchange to EONS as an Erasmus graduateapprentice from Saarland University. It has been an enlighteningexperience as we have both explored the “dungeons and dragons”of EU policy. I have marvelled at the bravery of my colleague ofleaving family and friends, going overseas and living in anotherculture. Although a novel experience and one that widens horizonsand challenges beliefs it is still scary. Differences in culture andhealth roles are much more than just in what people are called orwhat nurses are able to undertake in terms of nursing practice. Itmakes one examine what we also believe about Europe and multidisciplinaryworking. Learning the living language (i.e. the slangor colloquial talk) eating new foods and understanding differenthealth systems is part of learning from that experience. Despite allthese wider experiences our Erasmus/ EONS project is to map thepolicy context of cancer specialist nursing and identify how far nationalmember states have met or undertaken change as responseto these EU directives. It has been so far a journey of discovery.Our first step has been exploring the dungeons of EU policy. Letme explain going back to EU cancer policy basics.The Commission of the European Communities (CEC) Europeagainst cancer (EAC) programme identified the need for effectiveeducation and training in its first action in 1987. This wasreaffirmed in the second action plan 1990-94. The commissionrecognised the vital role of the different health professionalsboth in prevention and early diagnosis of cancer and encouragedundergraduate and postgraduate training on screening methods,counselling appropriate methods of treatment, rehabilitation andterminal care (EU 1997). The third action plan 1996-2000 consolidatedthis and encouraged new training initiatives such as theinclusion of psychosocial care. However it should be rememberedthat at that time that nursing was and still is largely a non graduateprofession in many countries and that these recommendationsreflect exchanges within centres of excellence and development oftraining networks. These networks have largely not been accessedby nurses.Later policy reflects discussion papers in relation to areas of needsuch as cancer care in the Baltic member states or specific tumourgroups such as cervical screening. They also reflect a predominantlypreventative strategy. Layered on top of this EU level arethe World Health and global propositions providing a complex mazeof guidance and policy. Furthermore, local and national initiativesneed to be considered at the level of cancer plans and cancerhealth service provision. No wonder few of us understand the EUpolicy context for cancer provision let alone in support of cancernursing!The dungeons of the game are that much of EU policy is in theform of recommendations i.e. providing guidance to member statesrather than binding. Policy is like a maze in that there are severalforms of advice from white and green papers providing discussionto that of directives becoming legally binding at a national level.Deciphering these levels is important in realising the power ofsuch statements in making or directing change and then finding ifany part relates to the provision of specialist cancer nursing. Thisis like exploring the dungeon without a light! Visiting EU policyexperts and talking with those developing new EU cross borderpolicy has been insightful. However, I can tell you so far we havefound that cancer nursing is mainly invisible at a policy context.The focus on prevention and cure leaves little discussion abouthealth care packages, communication skills, symptom managementor supportive care. Nursing is neither defined nor appraisedas part of prevention or treatment provision. We now come to ourdragons “multidisciplinary care”. What this means in EU speak isthe breadth of medical provision from surgeons to oncologists andnot encompassing nurses or health care providers. Even the recentSlovenian document, challenging the future burden of cancer care(2008) had chapters written by clinicians, patients and psychologistsbut not a nurse amongst them when considering the provisionof future care. Where are the nurses and why can’t they be seen?Partly I think this relates to the valuing (or lack of value) of specialistcancer nurses in many countries within Europe, but also thepaucity of firm outcome evidence that specialist cancer nursingprovides benefits for patients. Where such evidence exists forexample in breast care then nurses are visible within policy guidance.However nurses are largely seen as a supporting roles ratherthan professionals in their own right. You may feel offended by thistake on why nursing is invisible but how many of us have lobbiedpoliticians for nursing issues, written in to policy statements orinvolved ourselves at national policy level. To get out of the socalled dungeon we need to respond to policy statements, developour evidence that specialist cancer nursing maters and provide theleadership to make nursing count. Start by responding to the UICCworld cancer declaration 2008 (www.uicc.org) and make this a callfor action.newsletter fall 2008 -7