Shaping advanced nursing practice in the new millennium.

OBJECTIVES: To provide a review of converging themes and trends that are shaping advanced practice nursing roles in oncology nursing. DATA SOURCES: Review and research articles, text-books, and organization documents. CONCLUSIONS: The current managed care environment provides many opportunities and challenges for oncology advanced practice nurses. Advanced practice nurses have both clinical and organization competencies that enable them to mediate the clinical needs of patients and organization goals within the health care system. IMPLICATIONS FOR NURSING PRACTICE: Advanced practice nurses can help shape their roles and practice by active participation in the development of systems to support access to clinical and financial information for effective decision making, collaboration among disciplines, and incorporating evidence-based care in their clinical practices.

The Oncology Nursing Society: commitment and activities promoting cancer pain relief.

The primary mission of the ONS is promoting excellence in oncology nursing. In its efforts to accomplish this mission, the undertreatment of cancer pain has emerged as a significant issue for clinicians, educators, researchers, and administrators involved in the care of people with cancer. In an effort to promote cancer pain relief, the ONS contributes human, administrative, and financial resources from its existing organizational structure, personnel, and volunteers in the variety of ways described above. The structure of the ONS enables it to support the goal of cancer pain relief from the broadest of policy-making activities nationally to the provision of care by a nurse to a patient and family. The ONS Position Paper on Cancer Pain, other position papers and statements, adopted resolutions, and the strategic planning process will continue to guide the ONS's commitment and contributions to promoting cancer pain relief.

Cancer pain relief: an international perspective.

This article describes several of the key efforts being undertaken to address cancer pain and its relief worldwide. Organizations that incorporate cancer pain relief as part of their mandates include the World Health Organization (WHO), the International Association for the Study of Pain, the International Union Against Cancer (UICC [Union Internationale Contre le Cancer]), the International Society of Nurses in Cancer Care, the Wisconsin Cancer Pain Initiative, and the Oncology Nursing Society. This paper is not an exhaustive description of all of the efforts (individual and organizational) being undertaken to alleviate cancer pain worldwide but is instead an introduction to some of the activities. Readers who wish to enlarge the scope of their cancer pain relief efforts may benefit from reviewing this information.

Conference recommendations: practice, administration, research, education, and healthcare policy.

Small-group discussions following the presentation of papers at the Second Invitational Conference on the Role of the Oncology Clinical Nurse Specialist, held at the National Institutes of Health Clinical Center in Bethesda, MD, resulted in a wide range of recommendations in the areas of practice, administration, research, education, and healthcare policy issues. Recommendations are provided to further delineate the roles of oncology clinical nurse specialists (OCNSs), to increase their visibility, and to promote creative efforts to emply these skilled individuals more effectively in the future.

Clinical nurse specialist and nurse practitioner core curricula survey results.

The American Nurses' Association's Council of Clinical Nurse Specialists and Council of Primary Health Care Nurse Practitioners conducted a survey of all graduate nursing programs in the United States that prepare nurse practitioners and/or clinical nurse specialists. One hundred eight schools responded (73.5 percent), yielding data on 317 programs that could be further analyzed. For the 60 NP and 195 CNS programs analyzed, information was obtained on the following: required courses, number of hours of the required courses, students' clinical training settings and graduates' employment settings. Findings revealed marked similarity between the core curricula of NP and CNS graduate programs. The only significant differences found were that NP programs placed greater emphasis on pharmacology, primary care, physical assessment, health promotion, nutrition and history-taking in their curricula. In both the student clinical settings and graduate employment settings, NPs focused on primary care settings while CNSs focused on secondary or tertiary care settings. Based on the marked similarities between the core curricula of NP and CNS graduate programs, it is suggested that further investigations be conducted to determine whether objectives and/or teaching methods differ, and to further investigate the effects of practice setting on role development. Further, it is suggested that NPs and CNSs continue to interact through forums and conferences to continue the evolution and definition of graduate nursing education and advanced practice.

The clinical nurse specialist and nurse practitioner: core curriculum survey results.

The fall 1986 newsletters of the Council of Clinical Nurse Specialists (CCNS) and the Council of Primary Health Care Nurse Practitioners (CPHCNP) featured an editorial examining the similarities and differences between the advanced practice roles of the nurse practitioner and the clinical nurse specialist. The article, entitled "Editorial on Specialization in Advanced Nursing Practice" and written by Patricia Sparacino, MS, RN, chairperson CCNS, and Barbara A. Durand, EdD, RN, FAAN, of the CPHCNP appeared in Momentum, Volume 4, Number 2/1986, and Newsletter, Volume 9, Number 2/1986. This initial exploration into advanced practice roles in nursing elicited a wide variety of responses from affiliates of both councils which, in turn, prompted the executive committees of both groups to convene a joint meeting. In the spring of 1987 the executive committees of the CCNS and the CPHCNP met to review affiliate response to the editioral, further explore concerns, and plan futher action. At that time it was decided to survey all nursing programs in the United States which provide graduate education for one or both of the advanced practice roles. It was hoped that the information gained from such a survey would provide a basis for future determinations. Survey data was compiled and presented to another joint meeting of the executive committees of the CCNS and the CPHCNP on October 3, 1989. This article reports the data, findings, and reactions of the executive committees of the councils in order to obtain feedback from our colleagues.

Identifying major concerns of persons with acquired immunodeficiency syndrome: a replication.

A descriptive study was conducted at two major medical centers in Boston to identify and categorize major concerns of persons with acquired immunodeficiency syndrome. Thirty-four subjects were interviewed using a semistructured instrument, developed by Spross and her colleagues while at the National Institutes of Health. Obtained by referral from nurses caring for them in inpatient and outpatient settings, the majority of subjects were Caucasian, homosexual males from the Boston metropolitan area. The mean age of subjects was 33.6, with 71% less than 35 years old. Subjects reported an average of 3.2 hospitalizations since the AIDS diagnosis had been made; average time since diagnosis was 8 months. Information obtained from subjects included impact of diagnosis, major concerns and sources/types of support perceived to be helpful. Five themes were identified: uncertainty of the future; desire to maintain health; social unacceptability; fatigue; and weight loss.

Unrelieved cancer pain: selections from the literature.

The words writers have used to characterize unrelieved cancer pain, render the notion of emergency--that which is urgent, requiring prompt action--compelling. This information, together with the knowledge that families whose loved ones died in pain have more difficulty with their bereavement and our ethical responsibility to do no harm cannot be ignored. It is interesting that one can read an account of cancer pain that describes agony, isolation, and preoccupation in a classic work of literature such as The Death of Ivan Ilyich, written in 1886. It is disturbing that contemporary literature, even in works published as recently as 1986, contains accounts of cancer pain that describe similar experiences--experiences with pain that exclude thought of anything else that those who are painfree would associate with life, experiences that suggest one is dying while living rather than living until death. How is it that in 100 years art, which is said to imitate life, does not reflect the significant advances made in the scientific understanding and treatment of cancer pain? Can it be that we are less willing to apply this scientific information clinically than other advances? These lay accounts confirm what clinical experience and professional literature suggest--there is an abyss between the scientific advances that have been made in understanding pain and its pathophysiology, the availability of effective therapies, and the clinical application of this knowledge. Why does this gap exist? In part it exists because many professionals and laypersons believe that that's the way it is, that nothing can be done, that cancer is necessarily a painful disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Committee evolution in a medical center.

Development of the Nursing Research Committee in the Mary Hitchcock Memorial Hospital, Hanover, New Hampshire, is described. Six problems were identified, and ways in which the committee solved the problems are discussed.