ISNCC Global Classroom

Monthly online lectures from leading global experts in Cancer Care Nursing

ISNCC, in collaboration with Continulus, is making world-expert lectures accessible and convenient for all Cancer Care Nurses globally. Access at a time, pace and place that suits you, without the time, cost, hassle or environmental impact of travel. Plus, each lectures comes with a certificate and 1 CPD point or 1 CEU.

Watch live or recorded; take notes; ask questions; download the slides; discuss in the forums.

Plus, each lecture comes with a certificate and 1 CPD point or 1 CEU (USA).

May 8th is World Ovarian Cancer Day

May 7th, 2020 in Hot Topics, International News

The world faces an unprecedented global health crisis at present, and we’d like to thank all nurses on the front line for your incredibly hard and vital work either looking after people with Covid-19, or patients with other very serious conditions, such as women with ovarian cancer.

The fact that you care so much and are willing and able to undertake such an important role is no surprise to us. We and very many of our patient organisation members know what a key role you play in helping to look after women with ovarian cancer, no matter where they live in the world. Addressing the disparity of nursing roles and utilisation of specialist skills is something we will support you within future, be that fine-tuning and streamlining training across large regions where specialist cancer nurses exist or advocating for the key role that oncology nurses could play in lower and middle-income countries, supporting prevention, screening, early diagnosis, specialist treatment and palliative care.

The wide disparity in roles and interaction with nurses was seen in The Every Woman Study, carried out in 2018 by the World Ovarian Cancer Coalition. 1531 women from 44 countries took part, and during our testing phase, we found it almost impossible to ask a standard set of questions that could be applicable to all, because of the very different duties nurses undertook, and the different levels of interaction with women. The following table showed the wide disparity in nursing contact, in countries where we had more than 40 respondents. Overall 75% of women undergoing treatment for ovarian cancer had some form of contact.

Where nurses are involved in care, on the whole, they are involved in most aspects of care from diagnosis, surgery, chemotherapy, follow up and acting as a contact point. They are more likely to be specialist nurses around the time of chemotherapy (78%), follow up (57%) and answering questions between appointments (60%), than on diagnosis (43%) or at surgery (48%).

Respondents were largely very positive about the role that nurses play in terms of their care, despite the wide variations in tasks and specialisation. Just over half (51.6%) said that nurses were able to provide important continuity of care, and a third of respondents who had nursing care said the nurses were a good source of information on ovarian cancer (35.5%), had more time to spend with them than the doctors (33.8%), we’re able to signpost to other services (31.1%) and that women felt able to ask them questions that they could not ask the doctors (30/8%).

Overall the findings of the Every Woman Study show very wide variations in experiences between and sometimes within countries, and that this provides opportunities to improve the survival and quality of life for women no matter where they are. Similarly, the wide variations in access to and roles of nurses involved in cancer care tell us that much more can be done to strengthen the value nurses bring to the experiences of women with ovarian cancer not just in high but also low and middle-income countries, and that we will support you in this quest as soon as we are all able to focus once again on these matters.

For more information about the Coalition visit and to read the Every Woman Study Report click here.

Nursing experience for severely ill patients with Covid-19

May 5th, 2020 in International News

Jiangxi counterpart support Suizhou anti-epidemic nursing experience sharing

Authors: Jinhua Hong , Dan Luo
Institutions: Jiangxi Cancer Hospital, Jiangxi Hospital of Traditional Chinese Medicine and Western Medicine

At the beginning of 2020, after the outbreak of Covid-19 in China, according to the unified deployment of the National Health Commission, Jiangxi Province has sent three batches of 389 medical team members to help Suizhou City, Hubei Province.25 cases of severely ill patients and 50 cases of critically ill patients have been managed in Suizhou Central Hospital. The nursing experience is now reported as follows:

  1. Higher nursing manpower requirements.
    Because it takes time to put on and take off protective clothing, and, it is inconvenient to move with protective clothing, goggles, and three-layer gloves, the nursing staff consumes a lot of energy, requiring higher manpower. In the Covid-19 Severe Ward, the number of nursing staff is configured according to the bed-to-care ratio of 1: 6, and each shift is 4 hours to ensure that the nursing work is carried out in an orderly manner. Through our selection, all intensive care personnel have been trained in intensive care and have intensive care experience
  2. Characteristic schedule with collocation of nursing staff in Jiangxi and Suizhou.
    Due to different cultures, different ward environments, and different dialects, we use characteristic schedule method. Nurses from Jiangxi are mainly responsible for patients; the local nurses in Suizhou are responsible for office work and coordinate with external. Each shift must have at least one local nurse.
  3. Closely observe the changes.
    The condition of critically ill patients change rapidly, the patient condition should be observed at least every half an hour. Focus on monitoring body temperature, breathing rhythm, frequency and depth, and blood oxygen saturation. Accurately record the amount of 24 hours in and out, observe the vomit and stool frequency, nature and amount. Nursing staff should fully understand the patient’s condition, be familiar with the results of various tests performed by the patient to provide information and evidence for treatment and care. For patients with high fever, it is better to use traditional Chinese medicine acupressure coordinated with physical cooling.
  4. Oxygen inhalation.
    Severe patients can be given oxygen by a high-flow nasal cannula or mask according to the situation. Patients receiving oxygen by nasal catheter should wear surgical masks.
  5. Strengthen respiratory management.
    Strengthen the patients turning over, back kowtows, and suction, follow the doctor’s advice to cooperate with prone position to improve lung ventilation and promote sputum excretion. Patients using non-invasive ventilator should adjust the parameters of inspiratory pressure, expiratory pressure and oxygen concentration according to the doctor’s orders. For patients who need to establish an artificial airway by tracheal intubation or tracheotomy, the nurses need to adopt closed-type sputum suction and perform artificial airway management under the implementation of three-level protection measures.
  6. Keep patients comfortable and dignified.
    Strengthen communication with patients, produce dialect-specific cards; implement patient skincare, oral care, etc. Pay attention to patient privacy, and keep patients clean, comfortable, and dignified.
  7. Provide emotional support and humane care.
    Considering patients with Covid-19 are quarantined from their loved ones for a long time, they are in lack of family and social support, often show anxiety and fear. Nursing staff should accurately assess the patient’s psychological state and needs, provide appropriate emotional support and humane care, help patients to contact with their families by telephone, WeChat or video, and give support and encouragement. At the same time comfort the patient’s family.
Figure 1. Patients with anxiety and difficulty breathing in the Covid-19 ICU ward of Longmen District of Suizhou Central Hospital. Psychological counselling was conducted by Hong Jinhua to guide patients to adjust their breathing and relax.
Figure 2. In the Covid-19 ward of Wendi District of Suizhou Central Hospital, Luo Dan performed closed suction for the patient and observed the color, nature, and volume of the sputum.

The tailored meticulous nursing management dealing with COVID-19

April 2nd, 2020 in Hot Topics, International News

Sharing the experience of Huanggang City, China

Authors: Xuying Li, Yongyi Chen, Bo Xu, Boyong Shen
Institutions: Hunan Cancer Hospital, Oncology Nursing Committee of Chinese Nursing Association

During the global pandemic of COVID-19, the nursing managers from Hunan Province of China were appointed to Huanggang City of Hubei Province. Under the wholehearted support of nursing team from the hospital, they have established a custom-made meticulous nursing management system, 47 emergency plans & procedures, and an innovative nursing model based on the epidemic situation of Huanggang. With their counterpart aid, the epidemic prevention work of hospitals in five counties of Huanggang has made a significant achievement. No Infection has occurred in health care workers; more than 600 patients in severe condition have discharged from the hospitals uneventfully. This meticulous nursing management system has strongly enhanced the quality of patients’ care and ensured the occupational safety, which worth promoting and spreading.

  1. Set up temporary “anti-epidemic” wards to bridge gaps in diagnosis and treatment

The Hunan medical team was allocated to rebuild four isolation wards and a new intensive care unit in Dabie Mountain medical center, as well as establish isolation wards in the other 4 counties of Huanggang including Hong ‘an, Luotian, Macheng and Yingshan. Boyong Shen, one of the members of Hunan medical team, was mainly responsible for design of the ward layout, the establishment of nursing systems, processes and standards for the ward. She carried out homogenized and standardized management according to the 9S standard of fine nursing management of “SEIRI, SEITON, SEISO, SETKETSU, SHITSUKE, SAVE, SERVICE, SAFETY, SATISFACTION”. Totally, eight isolation wards and one ICU were built up with the concerted efforts. The nursing expert team supervised all the medical staff to strictly obey the hospital infection prevention and control, try ways and means to enhance the work efficiency, and ensure the safety and security of patients and health care workers to the most extent.

2. Develop various systems to guarantee the quality of care

Firstly, the nursing expert team formulated standardized job description for every position and shift to make sure that every worker fully understands and consciously follow their duties, work objectives, work content, and work requirements. Secondly, they made requirements for nursing documentation of COVID-19 to offer rule-based regulations for nurses, avoid the randomness of work.

3. Formulate workflow to guide clinical nursing work

In order to better meet the clinical need, the practical and operable document: The Prevention and Control Workflow Version 2.0 for nurses dealing with COVID-19 were developed by the team. 47 commonly used clinical nursing and hospital infection control procedures were included to provide advice for clinical nurses. Meanwhile, Training was strengthened to constantly improve the professional level and competencies coping with COVID-19 of nurses.

4. Humanized shift arrangement to ensure the dynamic of nurses

Group scheduling was deployed in the isolation area which reasonably divided nurses into different groups according to the work experience and background. Experienced head nurses or nurse backbone served as group leaders who were in charge of the group. The primary nurses were responsible for patients’ care. They collaborated on 6-8 patients respectively. Additionally, professional ICU nurse specialists led nursing team members to provide better care to patients in severe conditions and reduce the workload of nurses. Finally, to further specify the division of responsibilities and support nurses entering into the isolation area, five shifts including the information shift, general affairs shift, infection control shift, treatment shift, and coordination shift were set up in the clean area.

Figure 1. The establishment of the temporary isolation ward in Hong ‘an County

5. Enhance training to improve capacity of nurses facing COVID-19

On one hand, pre-job training were carried out to all nurses including the proper use of personal protective equipment (PPE), intensive care, first aid skills, contingency plan, etc. Only the ones who passed the pre-job examination could be deployed to the post. On the other hand, special training was organized in the morning shift meeting. The principal contents included the post responsibilities, work processes and standards, intensive training of key skills, and quality assurance. Updated content according to corresponding requirements (e.g., renew knowledge to the prevention and control of COVID-19 and the regulations). Secondly, internet based learning was used to promote mutual discussion, work briefing, and problem feedback and rectification.

6. Conduct nursing rounds to improve the patient care

Firstly, adopt multidiscipline nursing rounds comprised of medical and nursing team members, to further identify patient’s conditions and treatment plan for the next stage. Secondly, head nurses were required to be familiar with the condition and nursing process of all patients, as well as carry out nursing rounds for patients with severe and complicated conditions. Thirdly, focus on the problems of patients, nursing experts analyzed carefully, figured out a detailed care plan, and tracked the implementation and effect of nursing measures.

7. Implement humanistic care to improve patient satisfaction

Use social media to strengthen doctor-patient communications. Wechat groups were determined for online consultations, mutual support, and psychological decompression. The online interactions helped increase the social support. Under huge pressure, some patients might endure mental disorders, nurses paid attention to their psychological status and observed their emotions, words and deeds, mentality and other abnormal situations. Nurses would chat with patients about the daily life in every nursing interval, listen to them, and introduce successfully cured examples to strengthen their confidence. To enhance the continuity of care, nurses would connect with communities when discharging to strengthen post-discharge rehabilitation guidance.

Figure 2. The morning shifts in Dabie Mountain medical center

8. Set up evaluation system to guarantee the safety of patients and health professionals

In order to assure the safety of medical staff, professionals in charge of hospital infection were arranged to assist and guide the occupational protection of medical staff. Before entering the isolation wards, special personnel were assigned in clean area for 24 hours to ensure the correct wear on/take off of PPE according to the checklist. A series of nursing quality assurance forms were developed for scientific assessment and continuous quality improvement. On-site supervisions were supplied by the nursing expert team every day to guide strict implementation in accordance with the standards and procedures. Head nurses of isolation wards carried out “five inspections a day” to improve standardized nursing care and patients’ satisfaction.

International Childhood Cancer Day in the Year of the Nurse

February 14th, 2020 in Hot Topics, International News

Submitted by Rachel Hollis, RN (Child). MHSc, FRCN, Leeds Teaching Hospitals NHS Trust

The 15th of February is International Childhood Cancer Day, and this year it is particularly significant for nurses looking after children and adolescents with cancer across the globe. 2020 is the year when the World Health Organisation (WHO) Global Initiative for Childhood Cancer (GICC) converges with the WHO and International Council of Nurses’ Year of the Nurse and Midwife. We have an unprecedented opportunity to bring childhood cancer, and children’s cancer nurses, to the attention of policymakers, service providers, physicians, and our nursing community.

Cancer is almost universally thought of as a disease of adulthood, but it is also a leading cause of global childhood mortality from non-communicable diseases, affecting approximately 300,000 children and adolescents annually. In high-income countries like the UK, it is the number one cause of death in children 1 to 15 years of age. However, the burden of childhood cancer falls most heavily on low and middle-income countries (LMIC), with higher populations of children and adolescents and where many are never even diagnosed of their disease; many never reach treatment, and those who do have significantly lower survival rates than those treated in high-income countries, where over 80% now survive.

Over 80% of children and adolescents with cancer live in LMIC, where cure rates may be as low as 20%, and it is the shocking inequity in access to treatment, and the outcomes of care which led to the launch of the WHO Global Initiative for Childhood Cancer (GICC) in 2018, funded by St Jude Children’s Research Hospital in the US. The aim of this initiative is to improve the global survival rate of the commonest childhood cancers to 60% by 2030. To achieve that target, capacity building is required in all aspects of childhood cancer care in all LMIC. The workforce is a critical element of capacity building; nurses together with midwives, constitute the largest group of health workers across the globe.

Expert pediatric oncology nurses are fundamental to providing high quality, safe and effective care to children and adolescents with cancer and their families, and yet nurses in LMIC frequently lack specialized training, and hospitals often have inadequate staffing and resources to provide quality care. This is a major impediment to treatment programs and contributes to low survival rates in these settings. The Nurse Specialists of the GICC is a coalition of nurse leaders from across WHO Regions. The group seeks to advocate for nurses caring for children and adolescents with cancer, with an emphasis on nurses in LMIC. We have published an open-access paper on the ethical imperative to provide a safe work environment and specialist training for nurses working in this field.

OPEN ACCESS PAPER: An ethical imperative: Safety and specialization as nursing priorities of WHO Global Initiative for Childhood Cancer

On International Childhood Cancer Day in the Year of the Nurse and Midwife, we call upon all engaged in childhood cancer services to acknowledge and support the critical role of nurses and to provide those in LMIC with the training, resources and leadership opportunities they so richly deserve to contribute to the goal of improving both care and cure.