Alison Richardson

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What is a responsive outpatient cancer service for people with dementia?

Cancer services for people with dementia must be organised, flexible and offer continuity

Nurse network

Establishing a community of practice for clinical nurse specialists

This article describes the development of a community of practice for more than 55 clinical nurse specialists in a large cancer centre. Supported by Macmillan Cancer Support, a year-long development programme addressed individual, organisational and policy requirements to create a community of practice with a clear direction and agreed metrics. The community of practice demonstrates the value of clinical nurse specialists to patients and healthcare organisations.

Enoxaparin

Adherence to low molecular weight heparin treatment by patients with cancer who develop...

Patients with cancer who are diagnosed with venous thromboembolism (VTE) are managed with low molecular weight heparin (enoxaparin), an established treatment. Those with incidental VTE are generally stable and can be treated as outpatients, and their knowledge and ability to self-administer injections contributes to treatment adherence. However, the limited, or absence of, signs and symptoms associated with incidental VTE can affect adherence. This article reports the results of an audit that examined patients’ understanding of VTE, and the information they receive from healthcare professionals to support self-management. The audit found there is a difference in adherence between patients with incidental VTE and those who have symptomatic events. Results demonstrate the need for written information and a clear management pathway.

Cancer Survivor

Can case management improve cancer care?

In 2012, Macmillan Cancer Support partnered with 15 NHS health providers in the UK to fund new ways of delivering supportive care to cancer patients in the community. The project grew out of the work commissioned by the National Cancer Survivorship Initiative to find pathways for supporting people with active or advanced disease. In Southampton, a community-based complex case manager was established to test the assumption that the role could improve health outcomes in a group of patients with specific needs. Those with advanced breast or gynaecological disease were case-managed with the aim of improving self-management and wellbeing. The learning from the pilot can be used to inform the argument for building specialist teams in the community, targeted at people under the age of 75, who are living with cancer as a complex chronic disease.

Is venepuncture in the ipsilateral arm safe?

Surgical advances in the treatment of breast cancer have significantly reduced patient morbidity; however, lymphoedema of the ipsilateral arm remains a concern. At the authors’ centre there was consensus that using the ipsilateral arm for venepuncture and cannulation was safe, but also concern that patient information was confusing. The aim of this project was to understand the variation, if any, in advice published on patient information websites and determine the consistency and strength of the message in relation to avoiding the ipsilateral arm for venepuncture and cannulation. A review of 17 patient information websites was undertaken to understand scope, depth, accuracy and inconsistencies of information provided. In the surgical and radiotherapy sections of websites no information was found about the use of the ipsilateral arm for venepuncture and cannulation. In sections on chemotherapy and lymphoedema, information was scant and differed in strength of message. Inconsistent information was provided about using the ipsilateral arm for cannulation and venepuncture, potentially due to a lack of evidence concerning best practice. In response to these findings the authors’ centre is producing a leaflet that addresses the use of the ipsilateral arm for venepuncture and cannulation.

Information and support for older women with breast cancer

Aim The aim of this study was to explore the information and support needs of older women with breast cancer, and to investigate the types of support they accessed to identify whether there is a role for voluntary organisations in meeting their needs.

Method Twelve women participated in either a focus group or a telephone interview.

Findings Hospital specialists and breast care nurses were valued sources of information and support. However, additional sources of information and support included family, friends and other women with breast cancer. Factors that influenced uptake of voluntary services included a desire to ‘get on’ with life and a lack of awareness about available services.

Conclusion Older women with breast cancer require better assessment of need and direction to appropriate services. Statutory and voluntary sectors should work together to improve awareness of available services.

Dimensions of clinical nurse specialist work in the UK

Aim To model the work of clinical nurse specialists (CNSs) in the UK. Method This article examines data mined as part of a national project. The Pandora™ database was initially collected on a Microsoft™ Office Access database and subsequently, a Structured Query Language database in several iterations from June 2006 to September 2008. Pandora™ recorded CNS activity as a series of events with eight dimensions to each event. Data from this were mined to examine the complexity of CNS work. Result s This study represents the work of 463 CNSs over 2,778 days in England, Scotland and Wales. Clinical work, including physical assessment, referral, symptom control and ‘rescue’ work, accounted for a large part of the CNS’s role. Administration was the second highest workload, with about half of these administrative tasks identified as being suitable for secretarial staff to undertake. Research, education and consultation accounted for less time. A significant proportion of the nurses’ clinical work is undertaken by telephone. Conclusion CNSs in this study spent much of their time doing complex clinical work. Payment by Results (Department of Health 2006) should recognise the work undertaken by CNSs, particularly that done on the telephone. Complex clinical work by CNSs takes place in many different contexts using a wide range of interventions. The role of the CNS is complex and diverse, making comparisons of it difficult. More research needs to be done in relation to quality, safety and efficiency.

Living life after cancer treatment: a nurse-led support service

Until relatively recently, scant attention has been paid to life after cancer treatment in the healthcare system. Given that half the people diagnosed with cancer in the UK now survive more than five years, this article describes a new initiative aimed at enhancing the quality of life of cancer survivors, their families and carers by improving access to appropriate information and providing ongoing support. The initiative is designed to help cancer survivors lead the life they want and to take control of their health. It will be among the first such programmes that contribute evidence on how best to deliver survivorship care.

Dimensions of clinical nurse specialist work in the UK

Aim To model the work of clinical nurse specialists (CNSs) in the UK. Method This article examines data mined as part of a national project. The Pandora™ database was initially collected on a Microsoft™ Office Access database and subsequently, a Structured Query Language database in several iterations from June 2006 to September 2008. Pandora™ recorded CNS activity as a series of events with eight dimensions to each event. Data from this were mined to examine the complexity of CNS work. Results This study represents the work of 463 CNSs over 2,778 days in England, Scotland and Wales. Clinical work, including physical assessment, referral, symptom control and ‘rescue’ work, accounted for a large part of the CNS’s role. Administration was the second highest workload, with about half of these administrative tasks identified as being suitable for secretarial staff to undertake. Research, education and consultation accounted for less time. A significant proportion of the nurses’ clinical work is undertaken by telephone. Conclusion CNSs in this study spent much of their time doing complex clinical work Payment by Results ( Department of Health 2006 ) should recognise the work undertaken by CNSs, particularly that done on the telephone. Complex clinical work by CNSs takes place in many different contexts using a wide range of interventions. The role of the CNS is complex and diverse, making comparisons of it difficult. More research needs to be done in relation to quality, safety and efficiency.

Developing competence: an evaluation of a nurse rotation pilot programme

The South East London Cancer Network Rotation Project established a rotation programme to provide nurses in cancer and palliative care with training across a range of agencies, together with academic study. The pilot programme, comprised of two cohorts of nine nurses, was evaluated to identify whether it fulfilled its aims, and to enable further refinement. Results demonstrated that while there had been challenges for participants and stakeholders, the programme was a success. Rotation nurses gained wider knowledge and skills and, in a relatively short time, established themselves as competent cancer and palliative care nurses. It was widely acknowledged that the programme had served to encourage the different organisations involved to work more closely with one another.

Does bilingual advocacy improve Bengali patients’ satisfaction with cancer services?

This research aimed to establish the efficacy of introducing bilingual health advocates to Bengali cancer patients who could not speak English. Two health advocates from the Bengali community received cancer-specific training and were allocated a group of cancer patients from the Bengali community in east London. Three methods were used to gauge the impact of the advocacy service: General Health Questionnaire-12; the European Organization for Research and Treatment of Cancer QLQ-C30 (EORTC QLQ-C30); and a patient satisfaction questionnaire. Qualitative interviews were also conducted to gather patient and carers views. As a result of this study it is recommended that all hospital-based staff receive training on role and responsibilities of bilingual health advocates.

Communication skills and cultural awareness in the field of cancer care

This article evaluates the impact of a nine-month training programme, developed by a team at Guy’s and St Thomas NHS Foundation Trust and King’s College London, aimed at improving the communication and cultural awareness of 68 healthcare professionals working in the field of cancer, particularly with respect to multicultural issues. Questionnaires at the beginning, end, and three months after the course suggest that this training positively impacted on practice.

Establishing clinical rotation programmes in cancer and palliative care nursing

The establishment of rotational nursing posts for practitioners wishing to develop...

The efficacy of bilingual health advocacy in ethnic minority patients with cancer

Aim This research aims to establish the efficacy of introducing trained bilingual health...