Author: Yongyi Chen (RN, PhD), Hunan Cancer Hospital / the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University
With the advent of an aging society, chronic wounds have become a global health problem. According to the statistics, there were an estimated 463 million adults living with diabetes all around worldwide(Sen, 2021).Globally, diabetic burden was highest in China (89.5 million) with India (67.8 million), United States (30.7 million), Indonesia (21.0 million), and Mexico (13.1 million) following behind(Sen, 2021).In the United States, 3% of the population older than 65 years have open wounds, and chronic wounds as a whole cost the medical system over US$25 billion per year(Han and Ceilley, 2017).In China, there were nearly 100 million diabetic patients, which is the country with the largest number of patients in the world(Wei and Yiying et al., 2018).and the lifetime incidence rate was 25% (Tchanque-Fossuo and Wishy et al., 2018).The incidence of malignant wounds of malignant tumor is 5%-10% in cancer patients (Xiaolong and Qixia, 2014). Once chronic wounds occur, the symptoms of massive exudation, smelly, easy bleeding, pain, and other symptoms seriously affect their quality of life of patients. At the same time, there were one million patients with stoma, with nearly 100 thousand patients increase every year (Yanming, 2017).Patients not only suffered from the inconvenience caused by the change of the normal excretion route of feces, but also, they suffered by the complications caused by improper stoma care, which seriously affected the quality of life of patients(Zelga and Kluska et al., 2021).However, the allocation of wound nursing staff in China is insufficient, and the distribution of medical and nursing resources in urban and rural areas is uneven, which cannot meet the needs of patients. Therefore, it is urgent to establish a continuous nursing platform for the care of patients with wound or stoma.
After literature search, qualitative interviews, group discussions, and expert consultation, we determined the content of the continuous nursing platform for the care of patients with wound or stoma, and in conjunction with information technology personnel, an Internet-based continuous nursing platform for the care of patients with wound or stoma has been developed. It contains two platforms, Healthcare portal and Patient portal respectively. Patients login in the system by entering their ID number/phone number and password. Healthcare workers login in the system by work account and password. The Internet-based continuous nursing platform connects the external network, internal network and client, breaking down information barriers. The platform includes four modules of Basic Information, Wound/Stoma Information, Healthcare-patient Interaction, and Health Education. The Basic Information’s content includes name, age, height, weight, diagnosis, place of residence, education, etc. The Wound Information Module includes date of wound formation, cause, size, base color, exudation, treatment, dressing selection, etc. The Stoma Information Module includes date of stoma operation, type of stoma, surrounding conditions of stoma, stoma complications, stoma home caregivers, use of stoma chassis and accessories, etc.
With respect to the application of the continuous nursing platform for the care of patients with wound or stoma, when a patient with wound or stoma seeks special advice in our clinic of wound and stoma for the first time, an archive will be established. Log in to the platform and add a new patient case with stoma or wound, then enter patient’s ID number, synchronize HIS system to get the patient’s information. Then complete new cases and establish detailed case archives of patient with stoma or wound and collect and input the patient’s information. The opportunity to establishing follow-up archives is as follows: regularly review of the patients’ wounds weekly. If the condition of wound changes within one week, the patient’s wound should also be reviewed, until the patient’s wound heal or die. The other is stoma patients need to establish archives every time when they come to the hospital for a follow-up visit. A total of 1,166 cases of wound stoma had been documented by the end of 2021.770 cases of wound and 396 cases of stoma have been established. Lots of patients have online consultation by healthcare workers, which have effectively promote comprehensive rehabilitation of patients.
The Internet-based continuous nursing platform for the care of patients with wound or stoma can manage patient’s data conveniently, and a lot of patients have online consultation by healthcare workers, which have effectively promote comprehensive rehabilitation of patients.
This study was presented at ICCN2022 virtual conference. Registration for ICCN2022 virtual library now open. For more information, please access https://www.iccn2022.com/registration/
References
Han, G. and R. Ceilley (2017). “Chronic Wound Healing: A Review of Current Management and Treatments.” Adv Ther 34 (3): 599-610.doi: 10.1007/s12325-017-0478-y. Epub 2017 Jan 21.
Sen, C. K. (2021). “Human Wound and Its Burden: Updated 2020 Compendium of Estimates.” Adv Wound Care (New Rochelle) 10 (5): 281-292.doi: 10.1089/wound.2021.0026.
Tchanque-Fossuo, C. N. and A. M. Wishy, et al. (2018). “Reclaiming Autologous Amputated Tissue for Limb Salvage of a Diabetic Foot Burn with Underlying Critical Limb Ischemia.” Adv Skin Wound Care 31 (1): 596-600.doi: 10.1097/01.ASW.0000526604.26748.3d.
Wei, W. and W. Yiying, et al. (2018). “Application progress of silver ion dressing in the treatment of diabetic foot.” Chinese Journal of Modern Nursing 24 (30): 3718-3720.doi: 10.3760/cma.j.issn.1674-2907.2018.30.032
Xiaolong, Q. and J. Qixia (2014). “Research progress on the assessment and management of odour in malignant fungating wounds.” Chinese Nursing Management 14 (04): 435-437. doi: 10.3969/j.issn.1672-1756.2014.04.033
Yanming, D. (2017). Ostomy Nursing. Beijing, People’s Health Publishing House.
Zelga, P. and P. Kluska, et al. (2021). “Patient-Related Factors Associated With Stoma and Peristomal Complications Following Fecal Ostomy Surgery: A Scoping Review.” J Wound Ostomy Continence Nurs 48 (5): 415-430.doi: 10.1097/WON.0000000000000796.
Author: Huifen Wang, Yining He, Xiaocheng Huang, Yongyi Chen, Bo Xu Institutions: Hubei Cancer Hospital, Oncology Nursing Committee of Chinese Nursing Association
In order to deal with the outbreak of pandemic of COVID-19 in Wuhan, China has established 16 mobile cabin hospitals to treat patients infected by COVID-19 with mild symptoms. Mobile cabin hospital is a kind of modular health equipment, which has many functions such as emergency rescue, surgical treatment, and clinical test. With good mobility, rapid deployment, strong environmental adaptability, it could undertake many emergency medical rescue missions. The establishment of a mobile cabin hospital can effectively relieve the pressure of the shortage with the medical resource in Wuhan and will become a veritable cabin of life. Since the outbreak of the epidemic, nurses at Hubei Cancer Hospital have actively applied for front-line services, and a total of 100 outstanding nurses have been selected to fight the epidemic, providing care for patients with COVID-19. The innovative nursing management in a mobile cabin hospital is distinctive from that in other general hospitals.
Setting up of the mobile cabin hospital Three medical teams from Hubei Cancer Hospital took over three mobile cabin hospitals. The 1200 beds in Wuchang mobile cabin hospital are divided into three parts including Area A, B, and C. Hubei Cancer Hospital was responsible for the construction of A1 area which was comprised of 120 beds, 20 doctors and 40 nurses. Nurses undertook treatment, care, psychological support, health education, infection control, meal ordering, food delivery and distribution of living materials in this ward unit. They also were responsible for the management of Hongshan mobile cabin hospital containing 120 beds, 17 doctors, and 31 nurses. The team has been responsible for it for 60 days. Finally, 364 mild patients have recovered successfully under meticulous care. They also have established the party school mobile cabin hospital and were in charge of the F1 area with 65 beds, 20 doctors and 30 nurses, and 93 mild patients.
Preparations of the mobile cabin hospitals within 48 hours There were two days for preparatory works of the mobile cabin hospital. Before the admission of patients, they might furnish medical area and living area with all kinds of cabinets, camp beds (not beds), bedside tables, treatment vehicles, blood pressure monitors, blood oxygen monitors, infusion racks, medicines, disinfection facilities, bedding, and toiletries for patients, etc. They tried their best to place the ward units to meet a criterion of hospital standards. They reasonably divided the whole place into several functional areas like clean area, potential pollution area, contaminated area, medical staff channel, patient channel, etc, and posted corresponding signs in each area. In order to better meet the clinical need, they formulated the workflow to guide clinical nursing work, including how to receive, treat, nurse, check and take medicine.
The environment and medical supplies management of the cabin We accepted patients and inputted their information into internet. After they settled in their beds, we do some assessments, take temperatures, take oxygen saturations, draw blood and gather pharyngeal swab, do health education, bed unit sorting and so on. They also distributed meals, masks, fruit, milk, towels, clothing, etc. for daily use to patients. At the cabin hospital, they were responsible not only for the care of the patients but also for the management of the cabin and the daily life of the patients.
Humanized shift arrangement At the beginning of the shift, nurses worked in the cabin for 6 hours. If we include the time of wearing and taking off the protective clothing, handing over and other works, it was approximately about 9 hours of working time. After a long time of working with PPEs, the nurses might suffer from chest tightness, nausea and vomiting, hypoglycemia, dizziness, as well as other discomfort symptoms. Some nurses often missed meals in the cabin, they could not get enough energy they need.”It can’t be going on like this.” According to the actual situation, several investigations were arranged among nurses and managers. Considering some of the nurses might feel uncomfortable after a long period working in the cabin, the working time was adjusted accordingly. The 4-hour shift system was finally determined. Four-hour shifts, six shifts a day, four to six people per shift, one or two more people for throat swabs or blood collection. A group leader was responsible for the management of rescue beds in the ward unit, and a senior nurse was arranged as rescue nurse. Each group also has one nurse in charge of a fire evacuation. In addition, each shift will have a mobile nurse. They would take the place in case there be a situation of someone sick or things like that.
Psychosocial support The patients admitted to a mobile cabin hospital were those who’s virus detection result was positive for COVID-19 with no severe symptoms. Due to the unfamiliar environment and simple living conditions, many of them will feel anxious, suspicious, fear, hopeless, and isolation. Nurses would do a psychological assessment and deliver psychological support to the patients. Psychological counsellors would be appointed to offer them a face-to-face conversation to release their pressure. Also, volunteers would be available to connect with their family members and increase their social support. Additionally, kinds of activities to relieve physical and mental pressure was arranged for them. A temporary library was set up to provide a variety of books also.
Figure 1. The establishment of Wuchang mobile cabin hospital
Figure 2. The nurses were drawing blood
Figure 3. The nurses were making ward rounds with doctors
On behalf of the ISNCC Board of Directors, it is with great regret that we announce that the International Conference on Cancer Nursing (ICCN 2020) will be postponed until early March 2021.
This decision was taken after close monitoring of the rising global risk assessment by the World Health Organization of the COVID19 outbreak. Although the risk of transmission of the COVID-19 Virus is currently assessed as moderate in the United Kingdom and enthusiasm for ICCN 2020 has remained high, the global situation is changing every day in unpredictable ways.
We recognize the need to care for the health and welfare of our participants and of the host community. We are cognizant of the travel restrictions that are being extended on a daily basis and impacting our colleagues’ ability to attend ICCN 2020 and we want to express our support for our colleagues who are in the frontlines of caring for their patients. We also are aware that health institutions, organisations and education facilities are restricting employees and students travel and participation in upcoming conferences.
Ariesta Milanti, BSN, RN, MHC, Public communication committee, Indonesian Oncology Nurses Association
In the global map of the tobacco issue, Indonesia holds some prominent figures. According to the World Health Organisation data, Indonesia ranked first in the prevalence of tobacco smoking (76.2% among males aged 15 years) (WHO, 2015). This number is estimated to keep increasing by up to 82.5% by 2020 (WHO, 2015). More than 97 million Indonesian people are exposed to the tobacco smoke (Ministry of Health Republic of Indonesia, 2013). On the other hand, Indonesia is the 6th leading tobacco-producing country in the world (FAO, 2017), and in the top five countries with the highest level of tobacco industry interference (Assunta, 2019). Additionally, Indonesia is the only country in Southeast Asia that has not ratified the Framework Convention on Tobacco Control/FCTC (WHO FCTC, 2018).
In Indonesia, more than 230,000 tobacco-related deaths occur every year; in which lung cancer contributes as the highest cause of cancer death (Ministry of Health Republic of Indonesia, 2015). With the increasing trend of smoking in a younger population less than 15 years old, this figure is very likely to increase (National Development Bureau Indonesia, 2017). Most smokers in Indonesia are those with lower levels of education and socio-economics and live in the villages.
The above overview may give a hint on how severe the tobacco problem is and how arduous it can be for tobacco control advocacy in Indonesia. Despite the myriad challenges, Indonesian nurses through the Indonesian Oncology Nurses Association (IONA) are keen to contribute to it. That is why we take the ISNCC position statement on tobacco control very seriously. In our national meeting, we learned it and decided to translate its key points into our national agenda. We are compelled by the statement that nurses should take the lead in tobacco control activities.
Therefore, we organised a tobacco-control campaign in seven provinces throughout Indonesia (link to the article here). It was a major event to mark IONA’s anniversary. The cancer nurses conducted public education talks about tobacco control at the hospitals and community and called the attendees to write down their anti-tobacco commitment statements. It was both exciting and rewarding for us to be able to do more for the community, apart from our daily practices at the oncology wards or units.
But as the event was concluded, so was our tobacco control advocacy book. We had no idea on how to sustain the agenda or how to implement a more comprehensive intervention encompassing the educational and cessation programs – let alone advocating policy. We may be powerless – or even clueless – in public health advocacy.
Reflecting on our attempt to create an advocacy program for tobacco control which embarked on the ISNCC position statement, we come up with several questions. Which area of tobacco control advocacy should we start with and how? How can we build our capacity on this matter? How to mobilize resources? How can we build a base of support locally and internationally? We have a strong hope for ISNCC to lead an orchestrated effort for the cancer nurses in Indonesia, as in other low- and middle-income countries, to carry out tobacco control advocacy. Despite having the main focus to strengthen our cancer nursing competency, in our national cancer nurse organization, we are aware of the importance to spare our energy for urgent public health issues such as tobacco problems in our country. We cannot wait until we are fully ‘enhanced’ as the cancer nurses, but around us, more Indonesians start smoking at a very young age and keep smoking until they are old, and more patients are suffering and dying from tobacco-related cancer. We need to do better.
References
Assunta, M. (2019). Global Tobacco Industry Interference Index. In Global Center for Good Governance in Tobacco Control (GGTC). Retrieved from https://exposetobacco.org/wp-content/uploads/2019/10/GlobalTIIIndex_Report_2019.pdf
FAO. (2017). Tobacco.
Ministry of Health Republic of Indonesia. (2013). Riset Kesehatan Dasar (RISKESDAS) 2013. Laporan Nasional 2013, 1–384. Retrieved from http://www.depkes.go.id/resources/download/general/Hasil Riskesdas 2013.pdf
Ministry of Health Republic of Indonesia. (2015). Data and information on cancer situation (Data dan Informasi Kesehatan Situasi Penyakit Kanker). Buletin Kanker, 1(1), 1–5. https://doi.org/10.1007/s13398-014-0173-7.2
National Development Bureau Indonesia. (2017). Modul sinkronisasi RPJMD-RPJMN bidang kesehatan dan gizi masyarakat (Module of development plan synchronisation in public health and nutrition).
WHO. (2015). Tobacco use data by country. Retrieved from http://apps.who.int/gho/data/node.main.65
WHO FCTC. (2018). Progress report on regulatory and market developments on electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS): Report by the Convention Secretariat. Retrieved from http://www.who.int/fctc/cop/sessions/cop8/FCTC_COP_8_10-EN.pdf
Mark Foulkes RGN, BSc (Hons), MSc (Nurse Consultant and Macmillan Lead Cancer Nurse – Royal Berkshire NHS Foundation Trust)
Welcome to my latest blog in the run up to the ICCN 2020 in London, where I am giving our international guests a flavour of the main issues in UK oncology nursing.
“In line with many other countries, here in the UK we are experiencing increased demand for the delivery of SACT (Systemic Anti-Cancer Therapies) as the number of agents available becomes larger and more lines of therapy for patients with a cancer diagnosis are possible.”
This puts increasing demand upon our chemotherapy nurses and the skills that they need to utilise to keep patients safe. As a board member of the UK Oncology Nursing Society (UKONS) one of our proudest and most important achievements has been the development and implementation of thin e UKONS SACT Competence Passport (the Passport). This project has been led by Dr Catherine Oakley, Past President of UKONS and Chemotherapy Nurse Consultant at Guy’s and St Thomas’, London and received funding support from the Capital Nurse programme. The Passport is a patient-centered assessment document that ensures SACT clinicians demonstrate knowledge and skills to safely and autonomously administer SACT and care for patients receiving SACT.
Historically there was considerable
variation in the way chemotherapy nurses were trained to administer SACT and frequently
nurses in the UK had to repeat local training programmes when they changed
employer. Since 2017, the Passport has been implemented in SACT-provider
healthcare organisations throughout the UK, supported by ‘UKONS
Train-the-Trainer’ workshops.
In addition to the Passport, Dr Verna Lavender, UKONS President and Head of Guy’s Cancer Academy, published the UKONS SACT Competence Learning Outcomes Framework (the Framework) with Dr Oakley. The Framework is fully aligned to the Passport and was adopted by the National Health Service (NHS) in England in February 2019, so that on successful completion of the Passport clinicians working in the NHS can be added to the national SACT competence register. This allows SACT competent nurses to move between employers without needing to re-train. If you have registered or plan to register for ICCN 2020, and you wish to know more about teaching and assessment of SACT theory and practice in the UK, you can register to attend the UKONS Pre-Conference Program on 28 March 2020, which is free to ICCN2020 delegates. This full-day session is entitled ‘Standardising Systemic Anti-Cancer Therapy and Acute Oncology’ and will have a focus on the standardization of cancer services including sessions on the UKONS SACT Competence Passport and learning Outcomes Framework.
If you have registered or plan to register for ICCN 2020, and you wish to know more about teaching and assessment of SACT theory and practice in the UK, you can register to attend the UKONS Pre-Conference Program on 28 March 2020, which is free to ICCN 2020 delegates. This full-day session is entitled ‘Standardising Systemic Anti-Cancer Therapy and Acute Oncology’ and will have a focus on the standardization of cancer services including sessions on the UKONS SACT Competence Passport and learning Outcomes Framework. For more details, please visit the ICCN website. The UKONS SACT Competence Passport can be accessed here.
The UKONS SACT Competence Learning Outcomes framework accessed via the UKONS Website on the ‘SACT MIG pages’.
