scholarly journals Early Palliative Care for Oncology Patients: How APRNs Can Take the Lead

2021 ◽  
Vol 12 (5) ◽  
Author(s):  
Heidi Mason, DNP, ACNP-BC ◽  
Mary Beth DeRubeis, MSN, FNP-BC ◽  
Beth Hesseltine, MSN, FNP-C
Keyword(s):  
Palliative Care ◽  
Nurse Practitioners ◽  
Multidisciplinary Care ◽  
Cancer Center ◽  
Advanced Practice ◽  
Early Palliative Care ◽  
Practice Nurses ◽  
Patients With Cancer ◽  
Poor Understanding ◽  
Current Health Care System

Background: Patients with cancer need expert and multidisciplinary care throughout the trajectory of their illness. Palliative care should be instituted early in the course of their disease. Early palliative care enables patients and their families to control physical, psychological, social, and spiritual symptoms of the disease. In our current health-care system, early palliative care is not being integrated due to a lack of education of providers and nurses, an infrastructure that does not support palliative medicine, and poor communication skills among practitioners. Methods and Results: The Palliative Care Quiz for Nursing (PCQN) completed by nurse practitioners at a large Midwest cancer center found that those nurse practitioners had a poor understanding of the basic precepts of palliative care. This is consistent with the current literature. Conclusion: Advanced practice nurses should be educated on the principles of palliative care, as they are perfectly situated to advance the integration of early palliative care in the oncology setting.

Nurses’ roles and responsibilities in the provision of early palliative care: A grounded theory study.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 98-98
Author(s):  
Shan Darrel Mohammed ◽  
Pamela Savage ◽  
Camilla Zimmermann
Keyword(s):  
Palliative Care ◽  
Grounded Theory ◽  
Nurse Practitioners ◽  
Comfort Level ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Structured Interviews ◽  
Early Palliative Care ◽  
Practice Nurses ◽  
Roles And Responsibilities

98 Background: The benefits of providing early palliative care (EPC) are well researched. Few studies have explored the knowledge and skill used by nurses to help patients and families transition to and receive palliative care. In this study, we examine the roles and responsibilities of nurses in the provision of EPC and explore some of the barriers and facilitators they encounter as part of this complicated work. Methods: We drew on constructivist grounded theory to guide our methods and analysis. Nurses were recruited from several ambulatory care clinics in a comprehensive cancer center in Ontario, Canada. Nurses who participated in the study completed semi-structured interviews seeking to examine the roles, responsibilities, knowledge, and skills they utilized to provide EPC. Results: Ten nurse practitioners, six staff nurses, and four advanced practice nurses completed interviews for a total of 20 participants. Participants practiced in a variety of settings such as head and neck, breast, pancreatic, and hematology. The core category Brokering Palliative Care includes three subcategories: (1) Moving backwards and forward – stepping back to assess patients’ willingness to hear about EPC and then proceeding by selling the benefits of palliative to improving everyday function; (2) Addressing misconceptions and stigma – dealing with patients’ assumptions about palliative care as diminishing hope and accelerating the end of life; and (3) Advocating with the interprofessional team – bringing patient concerns forward to the team, managing interprofessional dynamics, and seeding the process of referral to EPC. Conclusions: Oncology nurses play a central role by brokering EPC for patients with serious cancers and their families. They draw on their proximity to patients, relational and communication capabilities, care coordination skills, and advocacy abilities. Brokering palliative care is conditional on nurses’ comfort level, experience, workload, and relationships with other healthcare professionals, especially oncologists. Moreover, the brokering work of nurses must be enacted within the boundaries of the nursing role and their relative position within the healthcare system.

“I’m going to push this door open. You can close it”: A qualitative study of the brokering work of oncology clinic nurses in introducing early palliative care

2019 ◽  
Vol 34 (2) ◽  
pp. 209-218 ◽  
Author(s):  
Shan Mohammed ◽  
Pamela Savage ◽  
Nanor Kevork ◽  
Nadia Swami ◽  
Gary Rodin ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nurse Practitioners ◽  
Oncology Nurses ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Structured Interviews ◽  
Early Palliative Care ◽  
Practice Nurses ◽  
Starting Point ◽  
Psychosocial Processes

Background: Early palliative care improves quality of life during life-prolonging treatment for patients with cancer, but the role of nurses in facilitating the early involvement of palliative care is unclear. Aim: To conceptualize the psychosocial processes involved in the introduction and provision of palliative care by oncology nurses. Design: A constructivist qualitative grounded theory study was conducted. Setting/participants: A total of 20 nurses (6 staff nurses, 10 nurse practitioners, and 4 advanced practice nurses) completed semi-structured interviews. Participants were from multiple ambulatory care oncology clinics (i.e. breast, pancreatic, hematology) in a comprehensive cancer center. Results: The core category, brokering palliative care, represented the overarching concept of the study that linked other subcategories. The other subcategories were as follows: opening the door—creating the possibility of discussing early palliative care at a time when patients show signs of being receptive to this discussion; building trust—establishing relationships with patients as a starting point for open discussions about palliative care; tackling misconceptions—addressing patients’ assumptions about palliative care as signifying death; and advocating with oncologists—seeding the process of referral by bringing patients’ concerns forward. Conclusion: Oncology nurses play a central role in “brokering” the introduction of early palliative care; this process is supported by their relational proximity to patients and their location “in between” the patient and the oncologist. Training all nurses in palliative care and empowering them to have proactive discussions in a collaborative practice context would allow greater access to early palliative care.

scholarly journals Integration of Palliative Care in the Role of the Oncology Advanced Practice Nurse

2021 ◽  
Vol 12 (2) ◽  
Author(s):  
Betty R. Ferrell, RN, PhD, MA, FAAN, FPCN, CHPN ◽  
Rose Virani, RNC, MHA, FPCN ◽  
Elinor Han, BA ◽  
Polly Mazanec, PhD, ACNP-BC, AOCN, FPCN, FAAN
Keyword(s):  
Palliative Care ◽  
Training Program ◽  
Advanced Practice Nurses ◽  
Advanced Practice ◽  
Practice Nurses ◽  
Disease Trajectory ◽  
Barriers To Implementation ◽  
Increasing Demand ◽  
One Year ◽  
Oncology Practice

Numerous organizations have cited the increasing demand for palliative care in oncology and the challenge of a limited workforce to deliver specialty palliative care. Advanced practitioners in oncology can provide generalist or primary palliative care to complement the care provided by specialists and enhance the overall provision of care. This article reports on a National Cancer Institute–funded training program to prepare advanced practice nurses to incorporate palliative care within their practice. One-year follow-up of the first three national cohorts (N = 276) included evaluation of goal achievement as these nurses integrated palliative care within their oncology practice. Goal analysis reported here demonstrates the success of the training program in impacting practice as well as the barriers to implementation efforts. The advanced practice registered nurses’ implemented goals included extensive training of clinicians across disciplines and numerous systems changes to improve delivery of palliative care. Advanced practice nurses will continue to be a valuable source of extending palliative care into oncology care to support patients and families across the disease trajectory.

The Tension Between Regulation and the Pursuit of Quality in Canadian Nurse Practitioner Education Programs

2021 ◽  
pp. 152715442110544
Author(s):  
Eric Staples
Keyword(s):  
Nursing Education ◽  
Nurse Practitioners ◽  
Public Safety ◽  
Advanced Practice ◽  
Practice Nurses ◽  
Program Accreditation ◽  
Fiscal Restraint ◽  
Systematic Planning ◽  
Practitioner Education ◽  
Post Baccalaureate

Nurses in advanced practice roles have existed in Canada for over 100 years, yet only in the last two decades, have nurse practitioners (NPs) been recognized as advanced practice nurses (APNs). During this time, NP educational programs have increased and transitioned from post-baccalaureate level to graduate level. Legislation and national NP regulatory approval processes have contributed to existing barriers to NP role implementation and full scope of practice. While regulation is mandatory and focused on public safety, an emphasis towards quality has led to the introduction of a national voluntary NP program accreditation process. The purpose of this paper is to initiate a discussion between Canadian NP regulators and educators related to proposed regulatory approaches and accreditation processes that balance public safety while promoting quality and excellence in NP education. Having two separate and costly processes has led to tension during a time of provincial fiscal restraint on university budgets coupled with the COVID-19 pandemic and its impact on nursing education. An integrated pan-Canadian approach of regulation and accreditation may ensure public safety, continuity, and consistency in quality NP education, enhance mobility of the NP workforce, and systematic planning to guide successful future NP role development and practice.

Practice Model for Advanced Practice Providers in Oncology

2017 ◽  
pp. 40-43
Author(s):  
Jamie Cairo ◽  
Mary Ann Muzi ◽  
Deanna Ficke ◽  
Shaunta Ford-Pierce ◽  
Katrina Goetzke ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Professional Growth ◽  
Physician Assistants ◽  
Advanced Practice ◽  
Quality Improvements ◽  
Collaborative Relationships ◽  
Practice Model ◽  
Patients With Cancer

According to ASCO, the number of practicing oncologists has remained stable despite growth demands, leading to an overall shortage in many areas of the country. Nurse practitioners and physician assistants are advanced practice providers (APPs) who can assist in the provision of support and care to patients with cancer, but the role of the APP in the oncology setting has not been well defined. There exists a variety of different practice patterns for APPs who work in oncology, and the lack of role definition and absence of an established practice model are considered leading causes of APP attrition. According to the American Academy of Nurse Practitioners, it has been well demonstrated that, when nurse practitioners are allowed to work to the full scope of their education and preparation, there are notable cost reductions and quality improvements in patient care. The focus of APP education and training is on health promotion, disease prevention, and primary care medical management, but most APPs have limited exposure to management of cancer in patients. With this in mind, Aurora Cancer Care developed a practice model for APPs who work in oncology. The goal of the model is to enhance the quality of care delivered to patients and provide a stimulating work environment that fosters excellent collaborative relationships with oncologist colleagues, supports professional growth, and allows APPs to practice to the full extent of their licensure.

Blending Specialist and Practitioner Roles in Psychiatric Nursing: Experiences of Graduates

2003 ◽  
Vol 9 (4) ◽  
pp. 136-144 ◽  
Author(s):  
Kathleen Scharer ◽  
Mary Boyd ◽  
Carol A. Williams ◽  
Kathleen Head
Keyword(s):  
Nurse Practitioners ◽  
Psychiatric Patients ◽  
Advanced Practice Nurses ◽  
Advanced Practice Nursing ◽  
Advanced Practice ◽  
Practice Nurses ◽  
Master Of Science ◽  
Clinical Specialist ◽  
Primary Care Patients ◽  
Adult Nurse Practitioner

BACKGROUND: Blended roles in advanced practice nursing have generated much discussion but little study. As role modifications emerge in nursing, there is a need to explore their implementation. OBJECTIVE: This descriptive study examined the experiences of nurses who were implementing blended roles as psychiatric clinical specialists and adult nurse practitioners. DESIGN: Four master of science in nursing and 10 postmasters nurses who had been practicing in blended roles for 1 to 2 years were interviewed about their experiences in implementing their roles. Interviews were tape recorded, transcribed, and content analyzed. RESULTS: Respondents believed they were practicing holistically, were able to appropriately integrate physical and psychological care of the patient, and found chronic psychiatric patients to have more complex physical illnesses than they had anticipated. In addition, the advanced practice nurses were satisfied with their roles, felt supported by their physician preceptors, and described cross-consultation with physicians and nonpsychiatric nurse practitioners. CONCLUSIONS: There are roles for advanced practice nurses who blend clinical specialist and adult nurse practitioner skills in the care of psychiatric and primary care patients.

Integrating early palliative care into cancer care: A qualitative analysis of implementation models, barriers, and strategies in community settings.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 36-36
Author(s):  
Lynne Slaughter Padgett ◽  
Mary Helen Davis ◽  
Colleen Tallen ◽  
Andrew Jdaydani ◽  
Angela Carrigan
Keyword(s):  
Palliative Care ◽  
Community Setting ◽  
Implementation Strategies ◽  
Models Of Care ◽  
Care Staff ◽  
Cancer Center ◽  
Successful Implementation ◽  
Design Development ◽  
Early Palliative Care ◽  
System Resources

36 Background: There is a paucity of research providing evaluation of implementation strategies contributing to provision of high quality early palliative care. Data from the NCI Community Cancer Centers Program (NCCCP) offers insight into ways in which patients, providers, and systems negotiate the provision of early palliative care in the community setting. The purpose of this project was to test the implementation of early palliative care programs for patients diagnosed with a high lethality cancer in participating NCCCP centers. Methods: Thirteen of 21 NCCCP sites elected to participate. Data on project activities and progress was gathered quarterly between July 2012 and June 2014. Qualitative data were evaluated using inductive and deductive methods and models of care, barriers and strategies were identified. Results: Models of care described included group education visits for patients and caregivers, outpatient clinics, and electronic consultation referral triggers. Irrespective of the model of care, sites reported barriers at the patient, provider and system levels. Barriers included reluctance by both patients and providers to consider palliative care services due to the perception of "giving up," and inadequate staffing and clinic space were also cited as systemic barriers. Strategies for facilitating implementation included integrating palliative care staff into existing cancer center programs (e.g., multi-disciplinary clinics), electronic referrals, and utilizing navigation services, as well as a variety of programs targeted to increase oncologist "buy-in." Conclusions: These results provide guidance for both researchers and clinicians in designing future multi-level interventions to facilitate the delivery of early palliative care, and the importance of identifying and utilizing provider and system resources in program design, development and promotion. Provider buy-in is an essential factor, but patient and system resources are equally important components of a successful implementation strategy.

Knowledge, Beliefs, and Behaviors Related to Palliative Care Delivery Among Pediatric Oncology Health Care Providers

2018 ◽  
Vol 35 (4) ◽  
pp. 247-256 ◽  
Author(s):  
Jessica L. Spruit ◽  
Cynthia J. Bell ◽  
Valerie B. Toly ◽  
Maryjo Prince-Paul
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Providers ◽  
Pediatric Oncology ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Advanced Practice ◽  
Care Providers ◽  
The Public ◽  
Patients With Cancer

The care of pediatric patients with cancer and their families is complex and rapidly evolving. Despite significant advances in outcomes, symptoms of the disease and complications of therapy continue to cause suffering that may improve with the involvement of pediatric palliative care (PPC) services. This descriptive study responds to the observation of great variability in PPC utilization within pediatric oncology. Data collected from 156 health care professionals (nurses, advanced practice professionals, and physicians) from a statewide hematology alliance evaluates the knowledge, beliefs, and perceived barriers to PPC involvement. Data analysis reveals significant variability when comparing respondents from professional roles and practice environments. Despite progress in PPC availability, care delivery remains incongruent with current recommendations. Knowledge gained from this study emphasizes the important role for all health care providers in advocating for support of PPC programs, educating the public, and committing to intentional involvement of PPC services while caring for pediatric oncology patients.

scholarly journals Palliative Care Consultations in Patients With Cancer: A Mayo Clinic 5-Year Review

2011 ◽  
Vol 7 (1) ◽  
pp. 48-53 ◽  
Author(s):  
Arif H. Kamal ◽  
Keith M. Swetz ◽  
Elise C. Carey ◽  
Andrea L. Cheville ◽  
Heshan Liu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Mayo Clinic ◽  
Multidisciplinary Care ◽  
Complex Needs ◽  
Patients With Cancer ◽  
Short Intervention

Patients with cancer often have complex needs that must be met within a short intervention window. The authors highlight opportunities for improved multidisciplinary care for patients with advanced cancer and their families.

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