Quo vantis: cancer nursing in Europe

Quo vantis: cancer nursing in Europe

EDI TORI AL Quo vantis: cancer nursing in Europe Only a couple of months ago in the Copenhagen Summit, the European Union was welcoming its new membe...

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Quo vantis: cancer nursing in Europe Only a couple of months ago in the Copenhagen Summit, the European Union was welcoming its new member states, expanding its borders to the east and south of Europe. Never before has nurse mobility been so easy from country to country, and never before the challenges for cancer nurses (old and new ones) more daring. Challenges that often derive from different health care systems, different cultures (and nursing microcultures), different value systems and different financial and human investment in health care. It is clear that there is a large gap between the standards of care and nursing in some northern European countries and the rest of Europe, for example. How we go about shortening this distance is a difficult and complicated task, but we all need to work together on this common goal. One of the fundamental issues is education. Education that produces nurses, who can think for themselves and for their patients, able to work autonomously but also as part of a multidisciplinary team, building on the evidence base of the care they provide. Education that can prepare cancer nurses in developing the appropriate knowledge and skills in caring for their patients in a variety of settings, from community and home care to general hospitals to specialist tertiary care cancer centres and in palliative care. Education that can assist cancer nurses in developing specialist roles, impacting on the quality of care patients receive. Education that helps cancer nurses to move from just being ‘doers’ to combining that with being a ‘thinker’. The EONS Core Curriculum for a post-basic course in cancer nursing (Redmond et al., 2001) is a first good step in this direction. It does however need to be adopted, utilised and implemented by each European country, adjusting it as necessary considering the requirements and needs of each, in order to arrive at a minimum acceptable level of cancer-nursing education across Europe. Our future needs to include a common European certification programme in cancer nursing, delivered in all official languages on-site or through distance learning, accepted by all governments across Europe. Such a programme can lead to a substantive and transferable nursing qualification, similar to the European Journal of Oncology Nursing 7 (1),1^2 # 2003 Elsevier Science Ltd. All rights reserved. doi:10.1054/ejon.2003.0230

one developed in the United States. Exchange programmes are also important in educating cancer nurses from one country in the healthcare delivery of another, enhancing the mutual understanding of issues in cancer nursing across Europe but also sharing best practice experiences. We also need to be able to work in environments where opportunities for continuing education (and lifelong education) are supported and are part of any health care system’s agenda. Funding for this is a major obstacle. Cancer nursing is still not an established or recognised speciality in many countries in Europe. We cannot talk about building excellence in cancer nursing in Europe if the speciality of cancer nursing is not formally recognised throughout Europe. There is a need, therefore, for the countries where cancer nursing is an established speciality (and also for European cancer-nursing organisations), to become political advocates for the less-organised countries, in this respect, and give a voice to those cancer nurses in Europe that cannot be heard enough. Another aspect is the short supply across Europe of cancer-nurse leaders. Leadership issues have not been addressed adequately in a still largely medically dominated health care system in Europe. Developing advanced practitioner roles is imperative, as such practitioners can be politically aware, expert clinicians, educators, researchers, consultants and managers (Knowles et al., 2000), and hold a longterm vision for advancing the status of cancer nursing. In the UK, the recent development of Nurse Consultants combines all aspects of this role and creates a new generation of leaders, but its lack of role clarity and the different agendas they are called upon to take forward may affect its potential. This new generation of leaders will need careful preparation, special training, support and development. We all have a role (and an obligation) to play in creating the cancer-nurse leaders of tomorrow. Without strong leadership, which is wider than national borders, cancer nursing in Europe will remain in disarray. Furthermore, the majority of cancer nurses cannot appreciate research and research findings, which has a detrimental effect on the ability of

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cancer nurses to provide up-to-date care, based on evidence rather than tradition or rituals, and on implementing in practice research findings. Cancer-nursing research priorities in Europe, providing longer-term research foci, have recently been published (Browne et al., 2002). However, creating an active research agenda across Europe is problematic and the reasons behind it are valid and multi-faceted, including staff shortages, language barriers, funding for nursing research, and research preparation of cancer nurses (Molassiotis, 1997). Limited understanding of the concept of evidence-based practice is also common, and its essence (doing the right things right) is often misunderstood. Information technology (IT) is instrumental in the development of nursing and is here to stay, so we should maximise its potential to our benefit. The Internet and IT can assist cancer nurses across Europe to network among each other, share practices, improve the evidence base of their practice, develop new ways of delivering care and receive continuing education. We cannot afford not to be IT literate for long. IT is a key to enhancing practice, improving education and facilitating research. However, the issue is again funding for such resources. Post-basic and continuing education, research, evidence-based practice, leadership, political advocacy, networking, IT: Am I asking too much from cancer nurses who spend 24 h–365 days a year at the patient’s bedside? This involves so muchFcommitted to the care of their patients, working under pressure often with staff shortages and stretched resources, working with dying patients, delivering skilled nursing care, providing emotional support to patients and their families, on many occasions at the expense

European Journal of Oncology Nursing 7 (1),1^2

of their own emotional well-being, making complicated information comprehensible for patients and families, being there for both patients and their families, often with little appreciation? I think the answer is ‘no’ as we need to demonstrate that the care we provide to cancer patients is of the highest quality, based on evidence, knowledge and skills together with passion and commitment, capturing the whole spectrum of the art and sciences of nursing. And to do that, we need to be professionally recognised for what we do, and construct a strong speciality with voice across Europe. We need to build on the achievements and successes of the speciality over the past two decades but also face the new challenges. It is not an easy way, but it will be a rewarding one. Alexander Molassiotis Senior Lecturer in Cancer & Palliative Care University of Nottingham Nottingham, UK REFERENCES Browne N, Robinson L, Richardson A (2002) A Delphi study on the research priorities of European oncology nurses. European Journal of Oncology Nursing 6: 133–144 Knowles G, Kearney N, Webb P (2000) The development of a conceptual framework for advancing cancer nursing practice in Europe. European Journal of Oncology Nursing 4: 227–232 Molassiotis A (1997) Nursing research within bone marrow transplantation in Europe: an evaluation. European Journal of Cancer Care 6: 257–261 Redmond K, Kearney N, Collins R, Foubert J, Gibson F, Vaessen G (2001) The EONS core curriculum revision project. European Journal of Oncology Nursing 5: 26–31