Abstract
The American Nurses Credentialing Center (ANCC) is the single most trusted organization in the US for quality nursing practices. It is the most prestigious nurse credentialing organization in the world and is a subsidiary of the American Nurses Association (Nursecredentialing.org N.D). ANCC has developed the Magnet Recognition Program which recognizes health care organizations exercising quality patient care and excellence in nursing. The Magnet Program is also responsible for giving awards to medical institutions that provides innovations in the nursing practice. This program is highly trusted by US consumers and experts that it is the only program used by the US News & World Report in their competency indicator. The assessment ranked 5,000 hospitals in America and listed the best medical centers for 16 specialties.
Introduction
Oncology is the study of tumors. Simply said, Oncology is a branch of medicine that deals with cancer. Oncologists (medical professional practitioners of oncology) are concerned with the diagnosis of a person that might have any form of cancer. Oncologists also conduct therapies on diagnosed cancer patients and follow-up check-ups after a successful treatment.
Diagnosis can be done in several ways. First and most popular is biopsy which can be incisional or excisional. The second diagnostic method is endoscopy which deals with either the upper or lowers gastrointestinal tract, bronchoscopy and or nasendoscopy. Oncologists may also perform X-rays, CT Scans, MRI Scans, PET Scans, Ultrasounds and other techniques that involve radio waves to detect tumors in patients. Also included in the list of methods available are Scintigraphy, Single Photon Emission Computer Tomography, Positron Emission Tomography, and other techniques in nuclear medicine (Cadth.ca N.D). Lastly, oncologists have the option to conduct blood tests in patients to detect any increase in the tumor size.
Oncology is a hot topic in the field of medicine as it deals with an incurable disease. Ethical issues regarding oncology are more personal and relate more to the patient’s personality, religion, culture, and even his family life. Caring for patients with cancer require a certain degree of sensitivity and good communication. This is where oncology nursing comes in. Like many fields, oncology nursing is a broad one but what you need to know is that oncology nurses play a vital role in a patient’s journey while still in treatment.
Oncology nurses develop a really deep connection with their patients and often get too emotionally attached to them. They are with the patients almost all the time. Oncology nurses care for patients beyond medical ways. They help patients while they are recovering from their treatments and give them comfort when they need to. The usual role of nurses in the care of patients has expanded and now varies greatly depending on certain situation and factors.
Oncology nurses in the United States practice in a variety of settings that includes outpatient clinics, private offices of oncologists, radiation therapy facilities, home healthcare organizations and acute-care hospitals. 35% of oncology nurses work in a hospital system, 40% work in outpatient centers, and 20% work on radiation oncology (Biij.org N.D). However, the majority of these oncology nurses works directly or is involved with direct patient care.
In general, oncology nurses encompass the roles of a caregiver, educator, consultant, researcher, and administrator. These nurses perform their tasks at a specific degree of understanding and emotion to provide utmost care for patients.
Oncology nurses are at a position to persuade patients into taking oral cancer therapies regularly and that they adhere to these therapies. Oncology nurses are also tasked to proactively manage the side effects of cancer treatments to patients and understand and solve the problems that stop patients in adhering to regimens. When oncology nurses are successful in their tasks, the clinical outcomes are greatly improved.
Oncology Nursing: Not Just another Job
The study was conducted using convenience sampling. Participants in the study included nursing professionals and patients diagnosed with cancer. There were 200 patients and 40 nurses that took part in the study from day 1 until it was successfully completed.
The nurses who took part in the study were all asked individually and all qualified in the given criteria. Each nurse must have been able to work on oncology wards for at least six months prior to the interview. Coincidentally, all participating nurses were able to work on two oncology wards. These nurses agreed to participate in the study in the interview.
Participating patients were also chosen using the same method used in picking the nurses. Each was individually asked to join in a series of interviews conducted over a period of several days. The patients must pass criteria that includes them to be of age greater than 15 years old and that they were diagnosed with cancer of any kind. The criteria also required the patients to be able to answer the questions both physically and mentally and that they perfectly understand the English language. An initial sample of 610 patients was selected but only 10 passed the basic criteria. During the interview phase, 10 patients refused to participate because of tiredness and symptoms. Therefore, only 200 patients were able to participate in the study.
As the study is about the effects of oncology nursing to patients, the selected patients were all diagnosed with any form of cancer. Most of the participants have been diagnosed for several months and undergoing therapy while others have just started their own chemotherapy.
This study of nursing care behavior is an important research as there is still few works documenting how the patient and the nurse react and perceive one another. Having to know several factors in their relationship will help in the increase of knowledge in the caring nature of oncology nursing. This would lead to the formulation of a better plan based on the caring behaviors and perceptions of both parties.
What is more important than developing a plan in oncology nursing is to improve the overall quality of nursing care? Understanding the relationship of patients and nurses will show the determining factors that make the former satisfied with the care given by the latter. Some of these factors are socio-demographic background of the patient and his expectations on the nursing care. Furthermore, the interpersonal relation between the patient and the nurse and competence of the nurse would also come into play. The aim of the study is to identify the nursing care behaviors that patients and nurses think are most important to provide the highest quality care to the patient and make the patient feel cared for.
Nursing interventions that were studied includes sleep promotion and education, counseling, distraction and relaxation, and exercise. These nursing interventions are the most common actions and activities that nurses help their patients with.
Cancer patients undergoing chemotherapy will most likely have cancer-related fatigue symptom. The 200 patients in this study are not all affected by this symptom but majority of them are. Those unaffected are still in the process of starting their chemotherapy sessions. In this respect, the study will also be able to help identify what interventions are best to be used in patients with this symptom.
The initial results show that sleep promotion, counseling, and education interventions give positive results but the magnitude of the effect is immaterial and is, in general, insignificant. Exercise, distraction, and relaxation intervention results show that they only work for a very short period of time after which the patient goes back to its former emotional state. The results of the study will be able to help in deciding what combination of nursing intervention is more appropriate to be used in specific situations. However, the study was not able to test nurses who perform a combination of the given interventions on patients during their cancer treatment.
As mentioned in the earlier part of this paper, the participants were selected through convenience sampling. 200 patients out of the 610 original proposed patients took part in the study as they were the only remaining candidates after the evaluation of the criteria and the initial interview. The 40 nurses who took part in the study have experiences in relating and giving care to patients with cancer for over 6 months before the study was conducted.
Each participant was given special time conversation for the instruction and the overall briefing for the study. The participants were individually approached about the study and were given their instrument pack which includes consent form, directions for scoring, and a data sheet. Each participant is required to answer all the questions in the given questionnaire. Nurses were given different questions than their patients but the questions were deeply rooted to one another.
Data were analyzed using the SPSS softer with version 13.0. The answered questionnaires were individually coded into the statistical analysis tool to get the result. The mean scores were calculated and the Mann-Whitney U analysis was used to compare the scores of the patients and the nurses (Zamanzadeh et al. June 15, 2010).
According to the data results, the different oncology nursing interventions provide different levels of patient satisfaction.
Sleep promotion still showed insignificant results but it is a promising intervention nonetheless. The study showed that the fatigue that patients experience during chemotherapy decrease with sleep promotion but the difference is very small. However, it is important to note that the 200 patients in the study is too small to really form a conclusion in this critical matter.
Education and counseling is an intervention that almost all nurses do. It is a typical nursing intervention that patients greatly appreciate. Studies show that patients love to know how to cope up with their stress, emotional ride, and journey in their treatment.
Meanwhile, exercise and distraction interventions seldom work and if they do, their effect is only short term. Almost all the patients answered in the same magnitude about the effectiveness of these interventions. However, many of the patients say that these short-term interventions are still good to be acted upon by nurses especially in their grave situations.
It must be understood that the study was conducted over a short period of time and with a limited number of participants. A number of patients have claimed that the short period of time to answer their questionnaires put pressure on them. Many of them have answered fast and this may affect the general result. This alone is one of the greatest limitations of the study. The small number of nurses that were selected put the balance between the two groups into disarray. The unequal sizes of the two groups are disadvantageous to the study and may put the results into a critical point. However, there was not anything that could be done with it.
The convenience sampling that was used in selecting the participating patients and nurses dealt with two wards. Being said that, the results of the study could not be assumed for other oncology centers or hospitals.
The number of studies regarding nursing interventions is steadily growing. Still, these studies are not enough to determine what nursing interventions are working better or have more positive impacts that last longer in the patients. Further research is still needed in order to maximize the effects of oncology nursing and to be able to reach positive outcomes in patients.
Continuing the education and training in nurses in terms of patient handling especially in areas where there is a greater number of cancer patients. This will be important to do as not all nurses are exposed to extreme conditions where their abilities can be tested. Continued education will be able to help oncology nurses in determining the basic actions and the most recent interventions that studies show are effective to use. Nursing training will help nurses to determine the course of action to take under certain situations.
The number of organizations putting up facilities to accommodate the rapidly growing number of cancer patients gives the nurses a different challenge. Many of the nurses taking care of cancer patients do not even have experience handling simple cancer symptoms and treatment side effects. Several education programs for nurses focusing in oncology are seldom found especially outside major cities. Oncology nurses need to take an active role in the prevention and treatment programs for cancer. In major US cities where programs for oncology nursing are abundant, the results were great. Thus, implementing education and training in specific areas will greatly help the quality of nursing care.
When thorough education and training are to be given in nurses, they will have the knowledge to decide on the actions to be undertaken during specific situations. Nurses who will undergo continuous education in oncology and cancer patient handling will have more techniques and methods in mind acquired from the education system. This knowledge is vital for the nurses to provide utmost care to their handled patients by equipping them with more ideas on patient handling. Furthermore, the change in the outpatient administration of chemotherapy has greatly increased the need or accurate patient and family education. This can be done by the oncology nurse especially with the education that is given to him.
Training will serve as a test and field-work sample to the nurses who will take part in it. Education is not enough to help nurses give the care needed by cancer patients. Oncology nurses will be more effective in providing care when they know and when they have experience on a situation. Nurses can easily identify what intervention is more appropriate for a situation almost automatically because of their acquired experience. Overall, the quality of nursing care will be greatly improved through education and training.
Conclusion
The study which involved oncology nurses and diagnosed patients has been able to determine that the high extent of agreement between the nurses and the patients is a very important factor in nursing care. The results also showed that patients’ value explanation and facilitation more compared to the nurses. Therefore, it is important for nurses to observe their patient’s behavior and be able to apply their valued traits in clinical work.
The perceptions of the patients with regards to nursing care and behavior are factors in improving the overall quality of nursing care. Information regarding what the patient would like to experience and what behavior they like best must be given to oncology nurses. This information will help them enhance their way of caring for the patients. In general, the study implies that nurses need to be highly sensitive and observant of their patient. This is needed for them to come up with solutions and determine if their intended caring method have positive outcomes or not.
The study conducted was also able to examine the nursing interventions that will have the best positive outcome in patients. However, due to the limitation in the selection of the study participants, it is recommended that further research be conducted.
Certainly, there is no method known to be effective in all cases. Cancer patients need almost a personalized method and intervention program from nurses as each individual perceive nursing care and behavior in a different light. The improvement in the quality of nursing care begins with the nurse and the good relationship that the nurse can develop with his patient.
References
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Zamanzadeh,Vahid Roghaieh,Azimzadeh, Rahmani, Azad,1 and Valizadeh, Leila (June 15, 2010) Oncology patients' and professional nurses' perceptions of important nurse caring behaviors Web. Retrieved December 14, 2011 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902470/
Biij.org (n.d.) Expanding the role of the oncology nurse Web. Retrieved December 14, 2011 from http://biij.org/2008/3/e34/e34.pdf
