Author: Ms. Chan Sau Yee
Credentials: RN, MSN, FHKAN (Medicine-Oncology)
Affiliation: Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
Hospital Authority in Hong Kong has adopted and promoted the primary nursing as the care delivery model since 2003. It aims to facilitate a better organization of nursing care and enhance the autonomy in clinical nursing practice so as to enhance the quality of patient care and increase the professional accountability.
In the Department of Clinical Oncology of Pamela Youde Nethersole Eastern Hospital (PYNEH) of Hong Kong, we applied this nursing care model to two specific groups of cancer patient for the purpose of ensuring the patient safety, better adherence to the clinical management plan and the continuity of care.
These two specific groups of patients were: (1) patients with head and neck cancer underdoing radical non-surgical oncology treatment; and (2) patients suffered from neutropenic sepsis. They were selected because severe toxicities were commonly reported during the late phase of treatment among the former, whereas the latter condition was an oncology emergency and potentially fatal. Both of them required intensive medical and nursing management and support.
The primary nurse introduced herself to a cancer patient.
A Primary Nursing Team was developed and 12 qualified oncology nurses were invited to join. The team was responsible for literature review, developed evidence-based nursing care protocol, related workflow and update of nursing care plan. Training to all ward nurses was provided by the team before implementation including care protocol, special assessment and care to enhance engagement and compliance. Electronic documentation was adopted to serve as a care planning template, facilitate better communication among nurses and easy access of patients’ progress by multidisciplinary team.
It was also integrated with the weekly nursing grand round led by the nurse consultant and senior nurses to enhance the nursing standard and render support.
Compliance audit and documentation review were performed before and 3 months after the start of the program. The overall staff compliance rate increased from 73% to 94% for the Neutropenic Sepsis Team; and from 63% to 87% for the Head and Neck Team.
Moreover, documentation review showed that (i) more than 95% of primary nurses were able to assess and provided specific and effective nursing care to patients with head and neck cancer or neutropenic sepsis, (ii) communication among the ward nurses was enhanced, and (iii) documentation was clearer with more essential details.
Furthermore, the value of this program was recognized by the Nursing Service Department (NSD) of our Hospital. We had shared the logistic, roll out plan and essence of the program with frontline nurses of other Departments in the Primary Nursing Workshop organized by NSD in 2016 and 2017 respectively.
Nursing grand round with the primary nurse in an oncology ward to review the clinical care.
Oncology nursing plays a critical role in ensuring patient safety and providing quality care. The implementation of primary nursing care model was challenging; however, it demonstrated the benefits of provision of personalized nursing care that tailor-made for individual patient’s needs, and increasing the satisfaction for both the patients and nurses.
Affecting by the disparity of global economic development, the imbalanced distribution of cancer nursing education resources is a fact. There are insufficient cancer textbooks in low and middle-income countries.
Based on the achievements of the 1st book donation activity, the 2nd book donation activity aims to provide texts to nurses in low and middle-income countries who do not have adequate access to new/relatively new cancer nursing materials.
- Recorded the information of book donators and recipients on the book donation information form.
- This 2nd book donation activity was greatly supported by all the ISNCC members and participants of ICCN 2018 with 56 textbooks in English and 15 textbooks in Chinese donated to nurses from underdeveloped areas, e.g. Kenya,Tonga, Uganda,South Africa , Zambia, Brazil, Nepal,Ghana,India, Indonesia, western region of China.
- The contents of books covered: Clinical Guidelines for Cancer Care, Evidence-based Cancer Care, Cancer Palliative Care Handbook, Vascular Access Devices Guidelines for Cancer, Cancer Targeted Medicine Care, Quality Control of Cancer Care, etc.
- Traced the influence of book donation and invited some of the recipients to write blogs regarding their feelings and thoughts towards this activity.
- Promote the sharing of educational resources.
- Advance the development of cancer care in underdeveloped areas.
- Enhance the internal and external communication of ISNCC.
- Dedicate love to cancer nurses in need globally.
Author: Yongyi Chen
Affiliations: Hunan Cancer Hospital
As the vice president of Hunan Cancer Hospital (HCH), I feel truly honored to attend the Global Academic Programs (GAP) Conference at Stockholm, Sweden from 15-17 May, 2018. HCH is the 31st Sister institution of MD Anderson Cancer Center (MDACC) worldwide, the 5th in mainland China. MDACC and HCH have conducted in-depth cooperation in training medical personnel, transferring international treatment, disseminating medical techniques, sharing medical solutions, etc.
The GAP Conference this year is held by Karolinska Institutet and Karolinska University Hospital in Stockholm. The institute is famous for the Nobel Committee for annual assessment and award of Nobel Prize in physiology or medicine. The theme of GAP Conference 2018 is “Global efforts fighting cancer”. With the joint goal, the annual GAP Conference offers a platform for faculties from MDACC and its Sister institutions to work collaboratively. Experts and scholars form 38 Sister institutions all over the world attended the conference to discuss the progress on cancer treatment and care. The fundamental research, epidemiology, treatment status and progress of oncology were included and deeply analyzed. The experts put forward a series of methods and measures to improve the diagnosis and treatment of cancer. The participants really get great inspirations.
There were over 600 abstract submissions, 16 simultaneous sessions, 155 oral presentations at the conference. Among them, 7 oral presentations and over 20 poster presentations from HCH ware accepted. I delivered an oral presentation “Life satisfaction of cancer patients: what contributes to a better satisfaction with life” at the Nursing Program. Our academic reports were acclaimed by other colleagues from all over the world, which laid a solid cooperative foundation for scientific research.
China Cancer Society Cancer Conference was held from August 17-20, 2018 in Shenyang, Liaoning.
President of the International Association of Oncology Care, Professor Patsy Yates of the Department of Nursing, Queensland University of Technology, Australia, brought a greeting from the International Association of Cancer Care Nurses to Chinese nurses. At the same time, she put forward the important point of the current status of pulse oncology care: nurses should carry out role transformation and provide personalized cancer treatments. Today’s cancer treatment is becoming more and more precise, and the development of technology provides a new approach to care, and nurses play a key role in ensuring the best outcomes and experiences of patients. Nurses should understand the impact of the experiences on patients, customize interventions for patients, and support patients’ self-management.
Then, Professor Kim Alexander of the Department of Nursing at the Queensland University of Technology in Australia gave a detailed explanation of this point, detailing the new approach to cancer care research – personalized symptom care. He exemplified “new measures on understanding experiences” and “new measures on test interventions”. New measures to opening a new way of thinking about cancer care. Bring together wisdom thinking, stimulate innovation vitality, enhance the connotation of disciplines, and improve the level of discipline construction.
Professor Brenda Marion Nevidjon, CEO of the American Society of Cancer Nursing, conducted an exchange on the study of the tolerant behavior of cancer nurses. The professor took the rapid changes in the cancer care industry as an entry point to deeply analyze the psychological state of cancer nurses, from three aspects: thought, behavior, and performance. Provide guidance to nurses working on cancer: strengthen self-cultivation, improve work resilience, and serve human health.
Professor Anne Fitzgerald and Prof. Margaret Hjorth from ICON Medical Group of Australia shared the Australian cancer care model with participants from the three aspects of cancer patient assessment and program development, oncology nursing professional ability training and safety skills training.
Through learning exchanges, Chinese oncology nurses have been enlightened to learn advanced cancer care knowledge and technology to improve the level of cancer care.
LING Wai Man, RN, MSc, FHKAN (Medicine-Oncology), Member of Communications Committee of ISNCC;
CHU Yuek Kei Florence, RN, BN
Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital
The use of subcutaneous (SC) and intramuscular (IM) injection of special drugs in oncology setting is escalating in Hong Kong recently due to the advances in medical science. Some of them are used to treat the treatment side effects, such as the growth factors, whereas some are used to treat the cancer disease itself or its complications, like the hormones or anticoagulant. Nowadays, they have accounted for almost one-fourth of the parenteral injections in our Oncology Department. However, the sophisticated drug preparation and injection techniques of some of these drugs pose significant quality and safety issues in the nursing practice. In 2016, a prostate cancer patient ended up with a local abscess at the injection site and required incision and drainage after an improper subcutaneous injection of a long-acting hormonal drug. Post-incident review identified a number of actual and potential risks associated with the related nursing procedure. Therefore, a workgroup was formed in our Department to formulate and implement the improvement actions for mitigating the risks.
The quality improvement program aims to (i) enhance the accuracy and safety of SC and IM injection of the special oncology drugs identified, and (ii) evaluate the nursing staff compliance to the recommended new injection practice.
We revisited our current practice, performed literature review, developed evidence-based guidelines on SC and IM injection of the drugs identified, and designed a quick reference poster as well as a record sheet for clear documentation. Training was provided to our Department’s nurses before the promulgation of the new practice. It covered the drug preparation process, different injection techniques among drugs, choice of injection sites, importance and sequence of site rotation, proper documentation, and patient education on post-injection care. Clinical compliance audit and staff satisfaction survey were then performed in the 4th quarter of 2017 to evaluate the program.
Poster presented at Hospital Authority Convention 2018, Hong Kong.
Results and Outcomes:
There was no incidence of injection-related adverse reaction reported after implementing the new guidelines. The overall staff compliance rate of the clinical audit was 99.5%. The nurses were able to fulfil the requirements in all the major aspects of clinical practice concerned. They gave positive feedback on the new practice designed and the staff support provided. Moreover, the value of this program was recognized by the nursing colleagues at the ten General Out-patient Clinics of Hong Kong East Cluster. We had been invited to conduct a lunch talk to them in 2017. We shared our guidelines and the quick reference poster with them to improve their practice as well. In May 2018, our program was accepted for poster presentation in the Hong Kong Hospital Authority Convention, which had attracted over 5,600 delegates from Hong Kong and overseas.
Oncology nurses play a significant role in safeguarding the patient care and service standard in clinical practice. Our program has successfully benefitted the patients by mitigating the potential risks associated with these SC and IM injections. We have also helped our service partners of the same Cluster to improve their service by sharing of good practice.