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.
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:
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
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.
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.
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.
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.
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.
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.
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.
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.
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
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
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.
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.
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.
Ariesta Milanti, BSN, RN, MHC, Public communication committee, Indonesian Oncology Nurses Association
Indonesian Oncology Nurses Association (IONA) organized a simultaneous anti-tobacco campaign on the 18th of October 2018 in seven provinces throughout Indonesia. The campaign marked the IONA’s anniversary and responded to the call of the International Society of Nurses in Cancer Care (ISNCC) tobacco position statement that nurses should take the lead in tobacco control activities.
The campaign was held successfully at Dharmais Cancer Hospital, Jakarta; Bantul 2 Public High School, Yogyakarta; Dr. Karyadi Hospital and Tugurejo Hospitals, Semarang, Central Java; Sanglah Hospital, Denpasar, Bali; Dr. Wahidin General Hospital Sudirohusodo, Makassar, South Sulawesi; Dr. Soetomo Hospital, East Java; and Adam Malik General Hospital, Medan, North Sumatra. In all sites, we conducted public education on the dangerous effects of tobacco smoke and called the public to protect themselves from tobacco use and exposure. We also played a short video illustrating the ‘epidemic’ of tobacco smoke in Indonesia. In the video, a former heavy smoker described his process to quitting tobacco smoking. We invited people to build their personal commitment to fight tobacco smoke and to sign in our anti-tobacco declaration.
Our message was to take action against tobacco smoke.
In addition to those programs, each IONA chapters created their unique approaches as well. IONA chapter Yogyakarta successfully gathered 100 high school students in Bantul 2 High School and held a photo contest with the theme of an anti-tobacco movement. The photos were uploaded to the @himponidiy Instagram account to be more visible by the young people, the most vulnerable population targeted by the tobacco industry. IONA Yogyakarta will also conduct a continuous community service activities in this high school to sustain the program’s impacts.
The high school students recorded their anti-tobacco declaration and sent it to the local police office as proof of their commitment to avoid tobacco smoke.
IONA chapter Makassar-South Sulawesi held a series of anti-tobacco campaign programs at RSUP DR Wahidin Sudirohusodo. A total of 50 patients and their families enthusiastically participated in the education on the effects of tobacco smoke and signed their anti-tobacco declaration. Our anti-tobacco video was played continuously at the general polyclinic televisions.
Meanwhile in Bali, the anti-tobacco campaign day was also a huge success. The education and signing of the anti-tobacco declaration were attended by dozens of people. The local committee also released the balloons into the air as a symbol to stay away from the dangers of cigarettes.
The simultaneous anti-tobacco campaign was also carried out successfully by the IONA chapter North Sumatra. The activity began with the signing of the declaration “Supporting the Anti-Tobacco Movement” by the patients, family and hospital staff of the Adam Malik Hospital, the public education, and the coloring competition for the children with cancer. The participants said that the anti-tobacco campaign greatly motivated patients, families and all employees to stop smoking and support the anti-tobacco movement.
On the day of the campaign there were several participants who were committed to quitting smoking.
IONA Chapter Central Java organized the anti-tobacco campaign in two places at once, namely Dr. Karyadi hospital and Tugurejo hospital, Semarang, Central Java. The public education and the signing of the anti-tobacco declaration were attended by dozens of patients and families in the polyclinics of the two hospitals.
Meanwhile, IONA chapter East Java installed the large banners displaying the anti-tobacco movement at Dr. Soetomo General Hospital and FKP Airlangga University, Surabaya, East Java. They held a community education on tobacco smoke dangers and its prevention in November 2018.
In Jakarta, the anti-tobacco campaign day was hugely celebrated at the Dharmais National Cancer Center. The entire board of directors of RS Dharmais initiated the signing of the anti-tobacco declaration. Patients, families, nurses, doctors, and staff enthusiastically joined the education program, flash mobs, and various entertaining activities.
Among the feedback from the participants was the intention to spread the dangers of tobacco smoke information to their families and the plan to bring the heavy smokers in the family to get smoking cessation interventions.
This campaign demonstrates the strong intention of IONA to be at the forefront of tobacco control in Indonesia as one of the cancer prevention activities Tobacco smoke and exposure have proven to cause various types of cancer and other serious diseases. We hope to sustain and scale up the campaign across Indonesia.