Defining the scope of haematology nursing practice in Europe

The Evolving Role of Haematology Nursing Practice: A Cross-Sectional Survey

Background And Objectives

The scope of haematology nursing practice is dynamic and must respond to advances in treatment, patients' needs and service requirements. Little is known, however, about the different roles of haematology nurses across the European setting. The purpose of this study was to identify the professional practices of haematology nurses.

Method

A cross-sectional online survey design was used to investigate practice elements undertaken by haematology nurses. Frequencies and descriptive statistics were calculated for demographic variables and chi-square tests to examine relationships between practice elements, nursing role and country.

Results

Data is reported from 233 nurses across 19 countries, working as Staff Nurses (52.4%), senior nurses (12.9%) and Advanced Practice Nurses (APNs) (34.8%). Most frequently reported activities included medication administration - oral/ intravenous (90.0%), monoclonal antibodies (83.8%), chemotherapy (80.6%), and blood components (81.4%). APNs were more commonly involved in nurse-led clinics and prescribing activities (p < .001, p = .001, respectively); however, other nursing groups also reported performing extended practice activities. Patient and carer education was a significant part of all nurses' roles; however, senior nurses and APNs were more often involved with the multidisciplinary team (p < .001) and managerial responsibilities (p < .001). Nurses' involvement in research was limited (36.3%) and frequently reported as an out-of-work hours activity.

Conclusions

This study describes haematology nursing care activities performed in various contexts and within different nursing roles. It provides further evidence of nursing activity and may contribute to a core skills framework for haematology nurses.

Nurse-led education of people with bleeding disorders and their caregivers: A scoping review

INTRODUCTION

People with bleeding disorders (PwBd) and their caregivers face many challenges in developing viable self-management strategies for living with the condition. Nurse-led education can support them to overcome these challenges. However, it is often unclear what educational needs are addressed, how nurses educate PwBd and what didactic concepts they follow.

AIM

To gain deeper insights into nurse-led patient education in haemophilia care and provide a basis for a more systematic and evidence-based approach to this task.

METHODS

A scoping review methodology was used. A systematic search for relevant publications on this topic was conducted in various databases between November 2020 and April 2021. Data sets were analysed following the PRISMA-ScR-checklist and using content analysis.

RESULTS

Of 588 studies identified, 23 sources of evidence met the inclusion criteria. The educational needs of PwBd and their families are extensive, multifaceted, and variable but rarely assessed systematically. These needs were met at certain times throughout their lifetimes. Nurse-led education differed in content, duration, and modality, including interventions such as information, consultation and instruction. An improvement in treatment-oriented self-management and self-efficacy was the most reported outcome. The didactic concepts on which the educational interventions were based were rarely specified.

CONCLUSIONS

There is a lack of systematic approaches in assessing and addressing the educational needs of PwBd and their caregivers. High variability was found in the literature regarding nurse-led patient education in haemophilia care. This suggests that more research is needed on this topic - not least on the interventions' conceptual foundations and impact models.

[A description and consensus on the role of the professional in the integral management of the haematology patient: Results of a national multicentre Delphi study]

BACKGROUND AND OBJECTIVE

The Haematology Service has undergone significant advances in recent years. Given the vital part played by the nurse in the care of the haematology patient, ensuring optimal management by adapting their role to meet the current healthcare needs is a priority. The aim of this study was to evaluate the level of agreement among professionals of the Haematology Service regarding the role of the nursing professional and their importance in the comprehensive management of these patients in a multidisciplinary work setting.

PATIENTS AND METHOD

A national multicentre Delphi study with haematology specialists and nursing professionals. A two-round questionnaire was used, and consensus was reached when > 75% of the panellists scored on the same tertile (1-3: disagreement, 7-9: agreement), and the interquartile range of the median of the responses was ≤4.

RESULTS

A total of 33 professionals from the Haematology Department were invited to participate, of whom 19 were haematology specialists and 14 were nursing professionals. In the first round, 25 panellists responded (14 haematology specialists and 11 nursing professionals), and in the second round, 22 panellists responded (12 haematology specialists and 10 nursing professionals). The panel of experts agreed that haematology nurses should have specific training in haematology (96%) and on the definition of the role of nursing in the care process of the haematology patient, except in the possible participation in decision-making with regard to the most appropriate oncological treatment for a patient (58%). The role of the nursing professional as a reference for the patient throughout the healthcare process and their involvement in the process at the time of diagnosis were agreed upon in the second round (72.7% and 68.2%). Their role in the control of nutritional status (100%), visit compliance (96%), and health education for the patient and the family (96%) were included in the highly agreed upon aspects. The panel considered the improvement of adherence to treatment (96%), and the role as consultant for specific care of the haematology patient within the hospital (96%) as important aspects. Together with health education and patient follow-up, a total of 88% of the panellists considered that the haematology nurse reduces patient visits to the emergency department as well as physical visits to the outpatient clinics of the health centre.

CONCLUSIONS

The current profile of the haematology nursing professional implies a high level of specialisation. The competencies of the haematology nursing professional are aimed at guaranteeing an integral management of these patients; with important healthcare functions, as well as a key element in the flow of information, and are framed within a multidisciplinary work setting.

Nursing workload in hematopoietic stem cell transplantation: a cohort study

Objective Measure nursing workload required by patients submitted to autologous and allogeneic hematopoietic stem cell transplantation (HSCT) and analyze the Nursing Activities Score (NAS) of the nursing team during the hospitalization period for HSCT. Method A prospective cohort study conducted from January 2013 to April 2014 with 62 patients hospitalized in the HSCT unit of a university hospital in Campinas, São Paulo, Brazil. The workload was measured through NAS and data analysis was through chi-square test or Fisher's exact test, Mann-Whitney test and Spearman's correlation coefficient; with 5% significance level. Results Mean nursing workload was 67.3% (SD of 8.2) in autologous HSCT patients and 72.4% (SD of 13.0) in allogeneic HSCT patients (p=0.1380).Monitoring and titration showed, in more than 50% of the time, patients demanded intensified care, requiring two hours or more in a nursing shift for reasons of safety, severity or therapy. Conclusion The nursing workload and the NAS items with the highest scores reflect the magnitude, complexity and specificity of care required by patients submitted to HSCT.

Acute leukaemia: making sense of a complex blood cancer

Acute leukaemia represents a diverse group of blood cancers that affect both children and adults. Treatment schedules for these haematology cancers are often prolonged, with many associated side effects and complications. Nurses caring for patients with acute leukaemia require an anticipatory approach, where care is aimed at minimizing the side effects of treatment and being constantly vigilant for any impending adverse effects. Moreover, patients require support for the psychosocial issues that can arise for patients during their illness. This article provides an overview of acute lymphoblastic leukaemia and acute myeloid leukaemia. Nursing considerations in the care of patients being treated for acute leukaemia are also explored.