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NURSING PEOPLE WITH CANCER IN SCOTLAND
A FRAMEWORK
EXECUTIVE SUMMARY
The Cancer Nursing Sub-group of the Scottish Cancer Group identified a Steering Group to take forward the work of developing the Framework on its behalf.
The Steering Group decided to adopt a slightly modified version of the 'key drivers' identified in the national strategy for nursing and midwifery,
Caring for Scotland, as the basis of the Framework:
leadership
accountability, support and supervision
career development and workforce planning
continuing professional development and education
research, evidence-based practice, development and innovation.
The Framework complements
Cancer in Scotland: Action for Change (the Scottish Cancer Plan) by:
focusing on patient/public needs in relation to cancer
emphasising the nursing contribution to the care of people with cancer and their carers
recognising nurses' ongoing education, training and professional development needs in caring for people with cancer.
It links with relevant Scottish Executive documents and policies, such as
Patient Focus and Public Involvement,
Partnership for Care, and
Health Improvement in Scotland: The Challenge. The Framework recognises the primacy of the Managed Clinical Network (MCN) model in the delivery of services to people with cancer and their carers in Scotland.
While the contribution of nurses working in cancer specialist settings is recognised as significant, most care for people with cancer and their carers is delivered by practitioners in non cancer-specific settings in all sectors. The Framework therefore addresses nursing services for people with cancer and their carers across the age spectrum, wherever care is offered and whoever is involved in its planning, delivery and evaluation.
ACTIONS
The chapters in Section 2 of the Framework contain specific recommendations for action at a number of levels.
The Scottish Executive Health Department is urged to use existing NHSScotland reporting systems to monitor and evaluate the implementation of the recommended actions in this Framework, and to ensure that evaluations of impact are carried out.
1. LEADERSHIP
Nursing needs strong leadership at all levels to ensure it is able to influence the direction of care and services for people with cancer and their carers. Essential components of leadership within nursing are the promotion of high standards of care and ongoing monitoring of the effectiveness of practice through appropriate quality assurance and audit processes.
New Consultant Nurse in Cancer posts would be likely to strengthen the body of nursing leadership throughout the country, but the relative positions of Lead Cancer Nurses and Consultant Nurses in Cancer need to be considered. Over time, the role of Lead Cancer Nurse should evolve into the role of Consultant Nurse in Cancer.
2. ACCOUNTABILITY, SUPPORT AND SUPERVISION
Nurses and their managers should understand the nature of their contribution to MCNs and how they can contribute effectively to team development. Ensuring that the nursing contribution within MCNs is transparent will help nurses to develop well-defined accountability and communication lines.
Nursing is a profession that exerts a heavy emotional and physical toll on its practitioners, and those who face the challenge of caring for people with cancer and their carers should be able to practice within a culture that recognises the importance of support and supervision. Adequate and appropriate processes should be in place to ensure that nurses are effectively supported and supervised.
3. CAREER DEVELOPMENT AND WORKFORCE PLANNING
Cancer is predominantly a chronic disease of older people, and survival rates are increasing. Workforce modelling for nursing in specialist and non cancer-specific settings should reflect these characteristics and should be sufficient to meet local needs. It should also reflect opportunities presented by role development for nurses and new employment/ contracting practices in NHSScotland, and promote opportunities for nurses to lead care for people with cancer and their carers.
The Clinical Nurse Specialist in Cancer role in Scotland has developed inconsistently, and its future direction needs to be mapped to offer consistency of approach throughout the country. Consideration should be given to a review of the remit, preparation and outcomes of the role.
4. CONTINUING PROFESSIONAL DEVELOPMENT AND EDUCATION
Nurses in specialist and non cancer-specific settings should have access to appropriate education to enable them to provide effective care and to develop their leadership potential within cancer care. They would benefit from being able to benchmark their clinical practice and education needs against a competency framework. NHS Education for Scotland is facilitating and supporting the development of a competency framework for nursing people with cancer.
Nurses should be supported to access opportunities to develop their knowledge, skills and competencies through planned continuing professional development (CPD) activity, which should reflect technological advances and the changing epidemiological and social features of cancer in Scotland. Students on pre-registration nursing programmes in Scotland should be prepared with an understanding of the fundamentals of nursing people with cancer; post-registration education should be mapped nationally to ensure it remains fit for purpose.
5. RESEARCH, EVIDENCE-BASED PRACTICE AND INNOVATION
Nursing research into caring for people with cancer and their carers in Scotland should be supported and facilitated at national level, and should be fully engaged with the commissioning process for research on cancer priorities, including the development of future priorities.
Nurses caring for people with cancer and their carers should ensure, whenever possible, that their practice is based on reliable research evidence. They should have access to resources that will help them deliver clinically effective and evidence-based practice.
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