Oncology Nursing During a Pandemic: Critical Reflections in the Context of COVID-19.

OBJECTIVES: To provide a critical reflection of COVID-19 in the context of oncology nursing and provide recommendations for caring for people affected by cancer during this pandemic. DATA SOURCES: Electronic databases, including CINAHL, MEDLINE, PsychINFO, Scopus, professional web sites, and grey literature were searched using Google Scholar. CONCLUSION: Nurses are key stakeholders in developing and implementing policies regarding standards of care during the COVID-19 pandemic. This pandemic poses several challenges for oncology services. Oncology nurses are providing a pivotal role in the care and management of the novel COVID-19 in the year landmarked as the International Year of the Nurse. IMPLICATIONS FOR NURSING PRACTICE: It is too early to tell what shape this pandemic will take and its impact on oncology care. However, several important clinical considerations have been discussed to inform oncology nursing care and practice.

Nurse Navigator Core Competencies: An Update to Reflect the Evolution of the Role.

BACKGROUND: The Oncology Nursing Society published Oncology Nurse Navigator (ONN) Core Competencies in 2013. However, a 2016 role delineation study (RDS) indicated that the role had evolved since their release. The RDS also indicated that a growing number of nurse navigators have extensive oncology and navigation experience. OBJECTIVES: The update to the competencies was undertaken to identify current responsibilities of ONNs and differentiate novice from expert practice. METHODS: A list of competencies was developed based on a literature review, evaluation of the 2013 competencies, and input from six expert ONNs. These draft competencies were vetted through field and expert review, with subsequent updates. FINDINGS: The 2017 competencies include 52 competencies.

The State of Cancer Rehabilitation in the United States.

The field of cancer rehabilitation and prehabilitation has grown significantly over the past decade. Advancements in early detection and treatment have resulted in a growing number of cancer survivors in the United States (US), expected to reach 26 million by 2040.1 Health care professional graduate education is trying to catch up with anticipated clinical demand by increasing the number of cancer rehabilitation fellowship training programs and introducing rehabilitation/prehabilitation concepts earlier in training. Numerous national organizations have issued guidelines for cancer rehabilitation research and posttreatment cancer health care. As treatment modalities evolve, so too must research on side-effects and multisystem management over the continuum of care. Current research strategies address different cancer types with a broad focus on timing of interventions, cost effectiveness, efficacy of rehabilitation, and improving screening and assessment tools. A collaborative, interdisciplinary research model is paramount to deepen impact and broaden reach. Policy supports could advance cancer survivorship and rehabilitative care. Funding to advance evidence-based practices for distress screening, psychosocial support, survivorship care planning, and rehabilitation services remains critical. Current social policies and health care access protections must be expanded to best serve the growing number of cancer survivors in the US. Equitable health care access, health care experience and health care outcomes remain a critical area for research and policy supports. The cost of cancer treatment requires significant reform to ensure access to all. Rehabilitation services are elements of standards of care for many neurological, cardiovascular and orthopedic diagnoses, but currently are not standard for actual or potential dysfunctions among cancer survivors. Both the disease process and the variety of therapeutic modalities increase risks of dysfunction, impairments, poor survival, and diminished quality of life. Rehabilitation focuses on optimizing quality of life and maximizing function throughout the continuum of cancer care. Health care professionals are urged to integrate high quality interdisciplinary care to promote collaboration and dissemination of knowledge which will yield better care for cancer survivors. Prehabilitation has the potential to play key roles in reducing or eliminating many cancer-related impairments and disabilities.

Evolving nursing science and practice in cancer survivorship.

OBJECTIVES: To review the status of cancer survivorship care planning and delivery, resources and tools available to advance care, and explore professional nursing's potential to affect the quality of care available to cancer survivors. DATA SOURCES: Published peer reviewed literature, web-based resources, and cancer-related professional organizations' resources. CONCLUSION: The population of cancer survivors is characterized as "booming," and available resources are also booming. Professionals involved in planning and delivering cancer survivorship care have access to tested tools, resources, information, and data useful for programmatic strategic planning and individualized survivor care plans. There are significant challenges to implementation, but there are also hopeful indicators that holistic care and services can be both cost-effective and used to improve care and quality of life for survivors. IMPLICATIONS FOR NURSING PRACTICE: Nurses have significant roles in the planning and delivery of survivorship care. There are as yet no clearly defined pathways, guidelines, and standard metrics that reflect the value of these nursing roles, though there are interesting and intriguing early indicators of value that should stimulate the imagination of oncology nurses regardless of care setting, geographic location, and population to be served.

Cancer survivorship advocacy.

OBJECTIVES: To review the advocacy initiatives of major cancer-related organizations and coalitions that are working to effect funding, planning, and implementation of care and services for cancer survivors. DATA SOURCES: Web sites of cancer-related member organizations, advocacy associations' policy staff representatives, and published peer-reviewed health policy literature. CONCLUSION: Health care reform creates near endless opportunities for nurses to participate in and contribute to the development of public policy to support meeting the needs of cancer survivors. IMPLICATIONS FOR NURSING PRACTICE: Emerging public policy initiatives, including legislation and regulation created with professional nursing's contributions are most likely to reflect the needs of cancer survivors.

Patient navigation in the oncology care setting.

OBJECTIVES: To review the evolution and current status of patient navigation in cancer care settings, discuss challenges as navigation evolves, and suggest education and research needs to optimize outcomes associated with navigation processes and nurse navigator roles. DATA SOURCES: Literature review, association publications, and government and non-governmental documents. CONCLUSION: Since its inception over two decades ago, navigation programs have been established in hospitals in the United States, Canada, Australia, and other nations. Despite wide-spread implementation, challenges remain in defining the navigator processes and navigator roles, preparation, qualifications, and job descriptions. Scientific efforts are needed to craft and codify these definitions. IMPLICATIONS FOR NURSING PRACTICE: Nurses and organized nursing must identify the needs reflected by the navigation processes and support role delineation, identification, and validation of educational curriculum and competencies.

Development of a breast navigation program.

OBJECTIVES: To review the development of a navigation program in a major US academic health care institution, and provide guidance for navigation programmatic development in other settings. DATA SOURCES: The Johns Hopkins Breast Center Steering Committee minutes, Hospital Cancer Registry; administrative data, and literature. CONCLUSION: Incorporating navigation services throughout the cancer continuum, from diagnosis to survivorship, provides guidance for patients with cancer. Navigation processes and programs must remain dynamic, reflecting patient and community needs. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses have traditionally performed many tasks associated with navigation, including patient education, psychosocial support, and addressing barriers to care. This article provides an exemplar for nurses developing or enhancing comprehensive breast programs.

Cancer nursing: the modern era.

PURPOSE/OBJECTIVES: To identify critical elements of the major shift in cancer nursing practice, education, and the expectations of professional nursing immediately following World War II that were precursors of contemporary oncology nursing preparation and practice. DATA SOURCES: General healthcare, medical, and nursing literature, particularly in the American Journal of Nursing, published after World War II and before the inception of the Oncology Nursing Society (ONS); archival materials in the collection of ONS; nursing history literature; and personal communications. DATA SYNTHESIS: Nurses in a wide variety of practice settings with varied levels of experience, including staff nurses, homecare nurses, and high-level leaders and decision makers of the time, were responsible for bringing attention to and addressing the challenges and joys of cancer nursing. CONCLUSIONS: Professional nursing in general and cancer nursing in particular underwent significant changes and a distinct paradigm shift in cancer nursing education and practice in the period of time surrounding World War II, which promoted the advancement of cancer nursing. IMPLICATIONS FOR NURSING: This historical review provides lessons for contemporary cancer nursing clinicians, executives, researchers, and educators with regard to imagining ways to approach issues, the necessity of collaboration and public-private partnerships, and maintaining the passion for this increasingly complex nursing specialty.

Advanced cancer: emergence of a new survivor population.

OBJECTIVES: To summarize the scientific and technologic advances contributing to the increasing number of people who are living with advanced cancer, associated economic costs, psychosocial burdens, and public policy. DATA SOURCES: Published books and journal articles, web resources, newspapers and news magazines. CONCLUSION: Scientific and technologic advances, combined with unidentified inherent traits, allow some people with advanced cancer to live for varying and increasingly long periods of time. Public policy, provisions for care, and service delivery lag behind the science, thereby excluding this emerging population from the attention now being paid to survivors with potentially curable cancer. IMPLICATIONS FOR NURSING PRACTICE: Nurses in clinical practice settings must be attuned to the unique needs associated with living with advanced cancer. Nurses in all settings must advocate for and participate in nursing research efforts to identify needs, gaps and shortcomings in care delivery, and development of interventions, services, programs, and resources to address the needs of this growing population. Finally, awareness that this population has unique needs and burdens prepares nurses to lead and/or participate in efforts to craft public policy that promotes optimal health and well-being among people living with advanced cancer.

Advanced cancer: a mind-body-spirit approach to life and living.

OBJECTIVES: To present the nursing theory of Modeling and Role Modeling as a holistic theoretical basis for identifying needs, planning and implementing care and services, and measuring and enhancing outcomes of programs and interventions to meet the needs of people living with advanced cancer. DATA SOURCES: Published books and journal articles, web resources, newspapers and current events magazines, and trade publications. CONCLUSION: The growing number of people living with advanced cancer has numerous unique, multi-dimensional, and interrelated needs that are underexplored, generally unmet, and require a holistic approach to be adequately addressed. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses in clinical practice and research settings must be informed, aware of and prepared to assess and intervene to address the needs of the rapidly emerging subpopulation of cancer survivors. Using a holistic nursing theory promotes our understanding of human responses to illness and provides a way to holistically approach health, wellness, and healing among people living with advanced cancer.

Living to the end: Merging holistic and evidence-based strategies to meet the needs of people living with advanced cancer.

With advances in the treatment and long-term management of cancer, the number of people living with metastatic and advanced cancers has continued to grow. Yet their issues and concerns, and those of their family caregivers, are often neglected. Despite the paucity of high levels of evidence for best-practice care of this distinct survivor population, we can and must start now to consistently address their needs, changing or adapting practice as new evidence becomes available. This article provides a review of the literature focusing primarily on the needs of patients/caregivers and highlights holistic nursing activities and programmatic services that are suggested by available data.

Cancer nursing: past, present, and future.

This article explores the context and nursing care that was provided to people facing the challenges imposed by cancer diagnoses throughout history and issues that influence cancer nursing as it continues to evolve in the twenty-first century. Considerations and potential strategies for the nursing profession to address these issues are offered.

Healing with horses: fostering recovery from cancer with horses as therapists.

Nearly 10 years ago, I looked at a poster exhibit for a nonprofit organization's camping experience for cancer survivors. One of the images in particular remains with me to this day. It was of an elderly man wearing a cowboy hat and the great grin on his wrinkled face as he stood next to a beautiful sorrel horse. The woman at the poster told me the story behind the picture: The man had advanced cancer and had already entered a hospice program, even though he was still physically active. He'd told many people that his biggest regret in life was that he'd never gotten to ride a horse. The photograph was taken the day his wish to ride had finally come true, and he died only weeks later. At that moment, I started thinking about how to describe the benefit the equine experience had given that man. A growing number of experiential programs offer cancer survivors, primarily children, the opportunity to ride horses as one of many recreational activities. But, that man had experienced something that surpassed a momentary recreational thrill. That started a quest that, after 10 years, is coming to fruition.