The role of an outreach oncology nurse practitioner: a case study evaluation

Managing diabetes during treatment for breast cancer: oncology and primary care providers' views on barriers and facilitators

Purpose

Diabetes is a prevalent comorbid condition among many women with breast cancer. The roles and responsibilities of managing diabetes during cancer care are unclear, as oncologists lack interest and clinical expertise and many patients stop seeing their primary care providers (PCPs). Uncertainty around who should manage diabetes for cancer patients can result in gaps in care for survivors. We sought to elicit the perspectives of providers about a novel diabetes care delivery intervention for women undergoing chemotherapy for breast cancer.

Methods

We conducted nominal group sessions with PCPs and breast oncologists across the USA. We introduced a novel care delivery model, which involved a nurse practitioner (NP) specifically trained in diabetes to work within the oncology team to manage diabetes for women during chemotherapy. PCPs and oncologists were asked to identify potential barriers and facilitators to the intervention’s success and then vote on the top three most important barriers and facilitators, separately. Votes were aggregated across sessions and presented as frequencies and weighted percentages.

Results

From November to December 2020, two 60-min sessions with PCPs and two 60-min sessions with breast oncologists were held virtually. In total, 29 providers participated, with 16 PCPs and 13 breast oncologists. At the health system level, financial support for the NP-led intervention was identified as the most important barrier across both provider types. Clearly defined roles for each care team member were identified as the most important facilitator at the care team level. At the patient level, lack of cancer-specific diabetes education was identified as an important barrier.

Conclusion

Our findings underscore the need to engage various stakeholders including policy makers, institutional leadership, care team members, and patients to improve diabetes care for patients undergoing chemotherapy for breast cancer. As such, multi-disciplinary interventions are warranted to increase awareness, engagement, and self-management practices among breast cancer patients with diabetes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-022-07112-4.

The evaluation of complex interventions in palliative care: an exploration of the potential of case study research strategies

BACKGROUND

Complex, incrementally changing, context dependent and variable palliative care services are difficult to evaluate. Case study research strategies may have potential to contribute to evaluating such complex interventions, and to develop this field of evaluation research.

AIM

This paper explores definitions of case study (as a unit of study, a process, and a product) and examines the features of case study research strategies which are thought to confer benefits for the evaluation of complex interventions in palliative care settings.

RESULTS

Ten features of case study that are thought to be beneficial in evaluating complex interventions in palliative care are discussed, drawing from exemplars of research in this field. Important features are related to a longitudinal approach, triangulation, purposive instance selection, comprehensive approach, multiple data sources, flexibility, concurrent data collection and analysis, search for proving-disproving evidence, pattern matching techniques and an engaging narrative. The limitations of case study approaches are discussed including the potential for subjectivity and their complex, time consuming and potentially expensive nature.

CONCLUSIONS

Case study research strategies have great potential in evaluating complex interventions in palliative care settings. Three key features need to be exploited to develop this field: case selection, longitudinal designs, and the use of rival hypotheses. In particular, case study should be used in situations where there is interplay and interdependency between the intervention and its context, such that it is difficult to define or find relevant comparisons.

The diagnosis and treatment decisions of cancer patients in rural Western Australia

BACKGROUND

People living in rural areas who have a diagnosis of cancer have poorer outcomes than people living in urban centers. The reasons for this are unclear. Little is known about the impact that living in a rural area has on the diagnosis and treatment decisions of these people and how these may in turn impact on care outcomes.

OBJECTIVES

This study explored the reasons why people living in rural areas may delay diagnosis and what issues affected the decisions they made regarding their cancer treatment.

METHODS

In depth, semistructured interviews were conducted with 18 participants from 3 rural Western Australian health regions. Content analysis was used to develop themes.

RESULTS

Four themes were identified to describe the rural cancer experience. The first 3 themes, Experiences of Diagnosis and Referral, The Treatment Journey, and Managing your own Care, relate to the experiences of rural cancer patients during their journey through the health care system. The final overarching theme, Implicit Faith, described the level of confidence that rural cancer patients had in the health system, often despite delays and inconveniences.

CONCLUSIONS

There is a need to improve primary health care and care coordination for rural cancer patients living in Australia and to promote self-advocacy and consumer empowerment for rural cancer patients.

IMPLICATIONS FOR PRACTICE

Rural patients need help and support throughout their cancer journey, including through the process of diagnosis.

The primary care nurse practitioner and cancer survivorship care

PURPOSE

To examine the important role that primary care nurse practitioners (NPs) have in providing long-term surveillance and health maintenance for breast, prostate, and colorectal cancer survivors throughout the continuum of cancer care.

DATA SOURCES

MEDLINE, CINAHL, MD-Consult, and Cochrane's databases were utilized with the inclusion of primary research and critical research reviews from January 1995 through March 2008. Select organizational websites were also cited.

CONCLUSIONS

Cancer patients experience changes in the focus of their care when management shifts from the treatment of cancer to management of treatment side effects and outcomes, to survivorship care, and to secondary cancer treatment. NPs have a strong impact on cancer survivorship care by serving in various roles and settings throughout the cancer trajectory to improve patient outcomes.

IMPLICATIONS FOR PRACTICE

Cancer survivorship care expands beyond specialty settings, into primary care. NPs have a key role in ensuring continuity of care for patients with cancer. Models of care that promote continuity and high quality of care for patients with cancer include the shared-care and nurse-managed health center models. The formal collaborative plan of care is essential in long-term cancer survivorship care.

Expected roles and utilization of specialist nurses in Japan: the nurse administrators' perspective

AIM

This study explored (1) expected roles for specialist nurses in Japan and (2) nurse administrators' experience-based management strategies for effective implementation of these roles. Background In Japan, specialist nurses have begun to be recognized as valuable human resources. However, managerial issues in utilizing specialist nurses, including unclear roles and lack of reports on effective management strategies, remain.

METHOD

Three focus-group discussions were conducted. Nine nurse administrators participated. Data were analysed using qualitative content analysis techniques.

RESULTS

The expected roles for specialist nurses were: (1) facilitating general nurses' learning; (2) monitoring and improving the patient care standard; and (3) developing new roles for nursing. Two management strategies were: (1) enhancing specialist nurses' influence, and (2) enhancing specialist nurses' motivation.

CONCLUSIONS

Specialist nurses are important human resources able to assume responsibility for process improvement in nursing care. Effective ways to enhance specialist nurses' influence and motivation include developing their management and communication skills, and coordinating their workload and relationships with other health care professionals.

IMPLICATIONS FOR NURSING MANAGEMENT

Process improvement indicators may be useful for evaluating specialist nurses' work. Nurse administrators can contribute to effective implementation of specialist nurses' roles not only by clarifying their roles but also by empowering them to keep up with changing organizational needs.

Introduction of the primary care cancer nursing role in a GP practice

Nurses have always had an important role in the care of cancer patients and many specific nursing roles in cancer services have been developed. A qualitative research strategy using semi-structured interviews was adopted in this case-study of the implementation of a primary care cancer nurse (PCCN) role in a general practice. The implementation of the PCCN role is reported in order to shed light on the extent to which integration of the role into existing systems of care had taken place; and to explore facilitating factors and barriers to the implementation of a new primary care role. Three major themes emerged from the data: the management of change; systems of care; and the complexity of professional interfaces. It is evident that the effective implementation of innovative nursing roles in primary care can present many challenges to the role holder and to the health and social care professionals with whom they come into contact. The importance of communication and consultation in the role implementation are emphasized.

Stoma coloproctology nurse specialist: a case study

AIMS AND OBJECTIVES

The aim of this paper is to provide insight into the role of a Stoma Coloproctology Nurse Specialist. This paper presents the findings of an in-depth case study of a stoma coloproctology nurse specialist employed in one health board area in Northern Ireland. This case study was part of a larger study exploring innovative nursing and midwifery roles in Northern Ireland.

BACKGROUND

Specialist nursing roles have evolved and developed in response to changing health care needs, patient expectations, changes in professional regulation and government initiatives.

DESIGN

A case study approach was adopted.

METHOD

Semi-structured interviews with the post holder (PH), her line manager and the human resource manager were undertaken. Non-participant observation of the PH's practice was also carried out. Analysis was undertaken on secondary data such as job specification, annual reports and other documentation relating to the post.

RESULTS

Findings illustrate the PH's function and the impact of the role on patient care. Examples of innovative practices relating to providing care, support and guidance for patients and their families were identified; however, limitations to her role were also identified.

CONCLUSIONS

The PH provides an invaluable service to patients, demonstrating a positive impact on care. However, the findings suggest the importance of establishing clear role boundaries, which may lead to professional growth and practice development.

RELEVANCE TO CLINICAL PRACTICE

Although this study provides a valuable insight into the role of a Stoma Coloproctology Nurse Specialist a number of challenges exist, as the CNS role requires policy and appropriate educational preparation to practice at an advanced level. Further research investigating the development of the CNS role in the clinical setting and its relationship to members of the multi-professional team would be beneficial.