Strategies for Improving Adult Oncology Care

Background

It has been recorded that 1 in 2 Australian men and women will be diagnosed with Cancer by the time they turn 85 (Cancer Council, 2019). Statistics provided by the Australian Institute of Health and Welfare also recorded that there were over 1.2 million cancer-related hospitalizations in 2016 and 2017 which accounted for approximately 1 in 9 hospitalizations in Australia (Australian Institute of Health and Welfare 2019. Cancer in Australia., 2019). Previous research conducted based upon the views of oncology patients suggests that health status, individualized care, and nursing care quality were all found to be improved when patients had more of a trusting relationship with the healthcare professionals “trust in nurses is influenced by the provision of individualized care” (Charalambous et al., 2016). Oncology patients are also highly subjected to experiencing major symptoms of fatigue, depression, and anxiety when it comes to their illness and their treatments (Kim & Na, 2017) therefore it is vital that nurses and other healthcare professionals deliver intensive care and support to oncology patients and their associated family members. The Registered Undergraduate Students of Nursing (RUSON) model is a program implemented to employ 2nd and 3rd-year students to start general nursing care activities under the direction of registered nurses. “Students are employed in a role which complements their studies and, in turn, supports the provision of more timely care whilst also relieving workload pressure for the nursing team.” (Australian Nursing and Midwifery Federation. (2018). The RUSON program could be the answer for oncology patients in metropolitan Melbourne cancer centres in regard to establishing the support needed for the oncology patients and their families to better improve their mental, physical and social wellbeing through treatment.

Research Question

How does the RUSON project at a Metropolitan Melbourne Cancer Centre improve the care provided to adult oncology patients and their families, in comparison to not having the project?  

Aim

To understand how the RUSON project improves patient care (if at all) to adult oncology patients and identify the aspects of care that have improved or decreased. This will enable stakeholders of the project to assess whether the project has been successful in improving patient care, and thus help identify in the future whether a RUSON project should be taken on.

Method

The research will be conducted using the qualitative method of focus group interviews with hospital staff, patients and their families who are inpatients on the adult oncology wards. The rationale for conducting focus groups is that it helps researchers understand the perspectives and opinions of a particular group on a particular topic (Jayasekara, 2012). In this case, it will help understand how the staff, patients and their families believe the RUSON project has benefitted and improved patient care on the ward (if at all). There will be 9 focus group interviews conducted, to ensure data saturation is achieved (Guest, Namey, McKenna, 2016). The categories include hospital staff, patients, and family members. Each focus group will be run with groups of 4 participants for each category. Having separate categories will enable participants to discuss in confidence their opinions, for example, families may feel uncomfortable talking about how their burden of care has decreased in front of their loved one. The focus groups will be held two weeks after the RUSON project has begun, in order to enable participants to compare how the project has impacted care. The questions asked will be open-ended engagement questions to facilitate discussion among the group (Engard 2017), while exploration questions will be used to delve deeper into the reasons why/why not care has improved, and in what aspects (Engard 2017). The focus groups will be held on-site at the hospital to enable easy access to participants and will be audio recorded with transcripts written up afterwards. Thematic analysis will be used to identify the common themes that arose in the focus groups, which will help identify common beliefs among the population interviewed in order to answer the research question (Maguire & Delahunt, 2017). This data will then be analyzed to discover whether there was more positive or negative feedback of care provided, in order to determine whether the project improves patient care.

Ethical Considerations

Informed consent must be acknowledged by the participants prior to the beginning of the research (National Health and Medical Research Committee, 2018). Consent is the process of participants of the research learning the facts and process of a research project before deciding whether to take part (Bowrey & Thompson, 2014). Non-maleficience is another ethical consideration nurses must abide by when conducting research, meaning to do no harm (National Health and Medical Research Committee, 2018). To abide by this ethical consideration, follow up care should be provided that takes into account the conduct of the research (National Health and Medical Research Committee, 2018). Due to working with people who have dealt with cancer, the research raise any difficult emotions or memories, so for this project the follow up care may involve debriefing and a follow up call with a mental health nurse. Due to the method outlining the process of an audio recording of the interviews, safe storage of this data needs to be considered due to privacy and confidentiality of the participants (National Health and Medical Research Committee, 2018). This media must be stored correctly and securely, de identified as much as possible, and only to be handled by authorized staff members (National Health and Medical Research Committee, 2018).

Anticipated Benefits

Practice

Benefits of a registered undergraduate student of nursing on the oncology ward can have the anticipated benefits of diminishing the fatigue and stress of the nurses. Encouraging readily available time for the nurses to focus on patient care. With the anticipated benefits of improved care provided on the wards with the addition of RUSON’s, it would be probable that undergraduate students have an increased ability to practice their hands-on skills in the hospital environment outside of short periods of placement. Studies have shown that compassion, caring, and empathy are required attributes for a nurse to learn. (Percy, Richardson & Hughes, 2015). Skills as well as building a therapeutic relationship with patients is a potential anticipated benefit to the RUSON’s as working within a hospital environment and having time to talk to the patient can create and reinforce confidence for their future practice.

Policy

The hospital’s vision statement states to strive for excellence coinciding with evidence-based clinical practice also providing a patient-centred practice. This research project has the anticipated benefits of making sure that within the nursing sector of patient care this is delivered with the RUSONS working alongside nurses to adhere to this vision of hospital used for this study. In addition, this pilot program will help other healthcare facilities have the ability to assess the research and the successes it brought, and decide whether to implement the RUSON project on their wards.

Research

This pilot program has the research benefits of the future of nursing care towards oncology patients, that from this program it is anticipated that patients will greatly benefit with an extra pair of hands, as well as another set of ears to listen to their needs. As stated that ‘Patient of older age and that of more critical care are greatly vulnerable during hospital stays’ (Urden, Stacy and Lough, 2018). By also creating this pilot program it is also increasing student interest in the oncology sector of nursing. Lastly this pilot program with add to the body of knowledge in nursing research. Particularly on the topic of the impact of having RUSON’s on the ward- an area of knowledge that is lacking research studies to determine their effectiveness.

References

• Australian Institute of Health and Welfare. (2019). Australian Institute of Health and Welfare 2019. Cancer in Australia: In brief 2019. [Ebook] (p. 11). Canberra. Retrieved from https://www.aihw.gov.au/getmedia/f4f2b22f-8189-4c51-9e2a-66384cbca683/aihw-can-126.pdf.aspx?inline=true
• Australian Nursery and Midwifery Federation. (2018). Work as a nurse while you study. Retrieved from https://otr.anmfvic.asn.au/articles/work-as-a-nurse-while-you-study
• Bowrey, S., & Thompson, J. P. (2014, Jan). Nursing Research: Ethics, consent and good practice: NT. Nursing Times, 110, 20-3. Retrieved from https://search-proquest-com.ezproxy.lib.swin.edu.au/docview/1493807636/fulltext/4566D9EDC78B475BPQ/1?accountid=14205
• Cancer Council. (2019). Facts and Figures – Cancer in Australia. Retrieved from https://www.cancer.org.au/about-cancer/what-is-cancer/facts-and-figures.html
• Charalambous, A., Radwin, L., Berg, A., Sjovall, K., Patiraki, E., & Lemonidou, C., Katajisto, J., & Suhonen, R. (2016). An international study of hospitalized cancer patients’ health status, nursing care quality, perceived individuality in care and trust in nurses: A path analysis. International Journal Of Nursing Studies, 61, 176-186. doi: 10.1016/j.ijnurstu.2016.06.013
• Cranmer, P., & Nhemachena, J. (2013). Ethics for Nurses (1st ed., p. 55). Berkshire: Open University Press.
• De Kors, N. (n.d). Nurse Helping Patient Photo [Image]. Retrieved from: https://burst.shopify.com/photos/nurse-helping-patient?q=cancer+patient
• Engard, B. (2017). How to create effective focus group questions. Retrieved from: https://online.jefferson.edu/business/create-effective-focus-group-questions/
• Guest, G., Namey, E., McKenna, K. (2016). How Many Focus Groups Are Enough? Building an Evidence Base for Nonprobability Sample Sizes. Field Methods, 29(1), 3-22. doi: 10.1177/1525822X16639015
• Jayasekara, R. (2012). Focus groups in nursing research: Methodological Perspectives. Nursing Outlook, 60(6), 411-416. DOI: 10.1016/j.outlook.2012.02.001
• Kumar, R., Kumari, L., & Kumar, V. (2016). Ethical consolidations in medical practice and research. Journal of Evolution of Medical and Dental Sciences, 5(7), 343+. Retrieved from http://link.galegroup.com.ezproxy.lib.swin.edu.au/apps/doc/A469639374/AONE?u=swinburne1&sid=AONE&xid=06065f56
• Maguire, M., Delahunt, B. (2017). Doing a Thematic Analysis: A Practical, Step-by-Step Guide for Learning and Teaching Scholars. All Ireland Journal of Teaching and Learning in Higher
• National Health and Medical Research Council. (2018). National Statement on Ethical Conduct in Human Research. Canberra, Australia: Commonwealth of Australia.
• Percy, M., Richardson, C., & Hughes, J. (2015). Introducing nursing practice to student nurses: How can we promote care compassion and empathy (35th ed.). Elsevier.
• Princeton University. (2019). Research Integrity & Assurance: Best Practices for Data Analysis of Confidential Data. Retrieved from https://ria.princeton.edu/human-research-protection/data/best-practices-for-data-a
• Urden, D, L., Stacy K, M., & Lough E, M. (2018). Critical Care Nursing. (8th ed.). Retrieved from https://books.google.com.au/books?hl=en&lr=&id=VIglDgAAQBAJ&oi=fnd&pg=PP1&dq=Urden,+D.,L,+Stacy,+M.,+K,+Lough,+E.,+(2017)+Critical+Care+Nursing:+Diagnosis+and+Management&ots=jQvgPeayNf&sig=YuBlFHQdhwdjqQp5X7wmtRKcUPc#v=onepage&q=Urden%2C%20D.%2CL%2C%20Stacy%2C%20M.%2C%20K%2C%20Lough%2C%20E.%2C%20(2017)%20Critical%20Care%20Nursing%3A%20Diagnosis%20and%20Management&f=false
• VGstockstudio. (n.d). Cancer Patient on a Wheelchair [Image]. Retrieved from:https://www.shutterstock.com/image-photo/cancer-patient-on-wheelchair-woman-daughter-1180040659