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NURSING PEOPLE WITH CANCER IN SCOTLAND
A FRAMEWORK
02 The Framework
CHAPTER 4: LEADERSHIP
4.1 The Scottish Cancer Plan,
Cancer in Scotland (SEHD, 2001a), calls for nursing services to be:
... better focused and co-ordinated to maximise opportunities for development of services, to enhance continuity of care and to secure continuous improvements in cancer care generally.
4.2 The successful implementation of the actions in this Framework will go a considerable way to ensuring this aspiration is met. But this will require focused effort and strong leadership. Ongoing monitoring and evaluation of the actions' fitness for purpose and the introduction of measures to tackle new issues as they arise will also be necessary.
ACTION |
A.1 The Scottish Executive Health Department should 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. |
4.3 Leadership is necessary across all types of service - clinical, management, education and research - and at all levels of service - national, regional and local. A strong leadership presence will help to ensure that nursing is able to influence the direction of care and services for people with cancer and their carers in MCNs, in Regional Cancer Advisory Groups, and within the Scottish Executive Health Department (SEHD). Strong representation at these levels will be key to ensuring 'better focused and co-ordinated' nursing services to patients and their carers.
ACTION |
A.2 The Scottish Executive Health Department and NHS Boards should ensure that nursing leadership is explicit within all decision-making forums for cancer care in Scotland and at all levels - local (NHS Boards), regional (Regional Cancer Advisory Groups and MCNs), and national (SEHD). |
4.4 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. This has particular relevance for nursing people with cancer and their carers, which is delivered across a number of different settings and applies itself to a wide range of physical, psychological, social and spiritual issues.
ACTION |
A.3 Nursing leaders should support high standards of nursing care, consistent with best evidence, for people with cancer and their carers and ensure that relevant quality assurance and audit mechanisms are integral components of ongoing evaluation of services. |
4.5 Nurses across Scotland, many of whom care for people with cancer and their carers, have benefited from leadership development programmes put in place through
Caring for Scotland (SEHD, 2001b). These kinds of initiatives need to be developed and extended through education and performance appraisal mechanisms and by the promotion of a culture that welcomes innovative practice and nurtures nurses' leadership potential (see
Chapter 8).
4.6 Nursing is already benefiting from strong leadership within services for people with cancer. Lead Cancer Nurse posts have been established in NHS Board areas to provide strategic leadership for cancer nursing services, and Consultant Nurse in Cancer posts have also been created.
4.7 Evaluations of the role of the Consultant Nurse in Cancer are beginning to emerge. The initial signs are that the role is popular with patients and their carers and that Consultant Nurses are proving to be a valuable resource within clinical, education, management and research settings.
4.8 The Scottish Executive strongly supports and encourages the development of the Consultant Nurse role across the profession, presenting an excellent opportunity for the creation of new Consultant Nurse in Cancer posts throughout Scotland. New Consultant Nurse in Cancer posts, held by nurses with the requisite skills, knowledge, qualifications and experience who can provide services shaped to meet the needs of defined populations, would be likely to strengthen the body of nursing leadership throughout the country.
ACTION |
A.4 Directors of Nursing should take steps to increase the number of posts for Consultant Nurses in Cancer, in line with Scottish Executive Health Department policy on increasing the number of Consultant Nurse posts in Scotland. |
4.9 The relative positions of Lead Cancer Nurses and Consultant Nurses in Cancer need to be considered. Each role currently provides opportunities not only to focus and co-ordinate cancer services, education and research, but also to strengthen and develop nursing leadership. Consultations involving Lead Cancer Nurses and Consultant Nurses in Cancer throughout Scotland have concluded that over time, the role of Lead Cancer Nurse may develop into the role of Consultant Nurse in Cancer, and that any newly created posts for leaders in cancer nursing should be positioned at consultant level.
ACTION |
A.5 The Scottish Executive Health Department and NHS Boards, working with relevant stakeholders, should explore a process to facilitate the evolution of the role of Lead Cancer Nurse to Consultant Nurse in Cancer. The process should reflect the need to support Lead Cancer Nurses currently in post who wish to develop their role to that of Consultant Nurse in Cancer. |
4.10 In addition to SEHD and NHS Boards, other stakeholders play a significant part in the development of posts for leaders in cancer nursing, and their active engagement in the process should be sought.
ACTION |
A.6 The Scottish Executive Health Department and NHS Boards should engage with key stakeholders, such as voluntary organisations and trade unions/professional organisations, in furthering the evolution of the role of Consultant Nurse in Cancer. |
CHAPTER 5: ACCOUNTABILITY, SUPPORT AND SUPERVISION
ACCOUNTABILITY
5.1 Managed Clinical Networks in cancer (MCNs) are being developed throughout the country. They are the preferred method of delivering high quality, clinically effective care to people with cancer in Scotland (SEHD, 2001a; SEHD, 2002c).
5.2 Team-working is integral to the effective operation of an MCN, and the multi-disciplinary team is at the core of service delivery. Nurses are vital members of these teams, with a long history of successful co-working with colleagues from across the health and social care professional spectrum.
5.3 MCNs are, however, a relatively new concept, and are taking time to 'bed in'. Nurses will need help and support to understand their roles within MCNs during this transitional period to enhance their contribution to services.
ACTION |
A.7 Regional Cancer Advisory Groups must ensure that the contribution of nurses within MCNs for Cancer Care is clearly understood within the region to maximise nurses' potential in service design, delivery and evaluation. They must also ensure that nurses working within or with MCNs have access to information to help them understand the structure of the MCN and how it operates. |
5.4 The success of MCNs will to a large extent be determined by how effectively professionals work together in teams - communicating with each other, planning jointly and adopting a teamwork ethos that places patients at the centre of service planning, delivery and evaluation.
5.5 But there is no 'one-size-fits-all' model. Individual MCNs and Regional Cancer Advisory Groups (RCAGs) will define the systems best suited to meet their populations' needs. Nurses and their managers will have to ensure they understand the nature of their contribution to MCNs and can contribute effectively to team development to provide services that represent best outcomes for patients and carers and best value for money for NHSScotland.
ACTION |
A.8 Individual nurses and nurse managers should ensure they understand their roles within MCNs for Cancer Care and contribute to team development. |
5.6 Nurses will also need clear lines of accountability and responsibility to enable them to function effectively within MCNs. Ensuring that the nursing contribution within MCNs is transparent will help nurses to develop well-defined accountability and communication lines.
ACTION |
A.9 Regional Cancer Advisory Groups and NHS Boards should ensure that nurses in MCNs have well-defined lines of accountability and communication. |
5.7 It is nurses' accountability to ensure the safety of the people they care for, however, that is paramount. They must not only ensure their practice is safe, clinically effective and up to date (see
Chapter 7), but must also acknowledge the parameters of their competence and recognise when to seek advice or refer patients to more senior colleagues as appropriate (NMC, 2002a).
5.8 A patient focus and public involvement ethos must drive the planning, delivery and monitoring of services within NHSScotland (SEHD, 2000b), and nowhere is this more relevant than in care for people with cancer and their carers. Nurses are aware of the benefits of working with patients and carers as partners. They have enthusiastically adopted the ethos of partnership working and support the development of patient-focused services, based on the foundation of sound communication skills and knowledge of the implications of the Caldicott Guardian and Data Protection legislation. This must continue into the future, with patients being fully informed and active partners (when they so wish) in planning, delivering and evaluating their care.
SUPPORT AND SUPERVISION
5.9 The importance of ongoing support and supervision for nurses and other NHSScotland staff is a key tenet of clinical governance and a prominent feature of the
Staff Governance Standard (SEHD, 2002d). It was also highlighted as an area for action in
Caring for Scotland (SEHD, 2001b).
5.10 Nursing is a profession that exerts a heavy emotional and physical toll on its practitioners. Nursing people with cancer is beset by significant physical, ethical, moral and spiritual considerations that can affect nurses' emotional and physical well-being.
5.11 Nurses facing the challenge of caring for people with cancer and their carers should be able to practise within a culture that recognises the importance of support and supervision, encourages nurses to share their load, and does not brand appropriate disclosure of emotional responses as 'weakness'.
5.12 Effective support and supervision aims to produce benefits for patients, for nurses and for service providers. It sets out to:
serve patients' and carers' best interests by encouraging nurses to reflect critically on their practice and supporting them to develop their skills and knowledge
facilitate nurses to develop deeper insights into their professional roles and identify areas where further education, training and experience are necessary
help organisations achieve better quality services for patients and carers within a clinical governance framework.
5.13 Support and supervision will be especially necessary for those nurses who have just attained their registration, those who are moving to new areas of practice or into new posts, and those who are taking on the challenge of caring for people with cancer and their carers for the first time. But all nurses need support to enable them to support others.
ACTIONS |
A.10 Directors of Nursing should ensure that adequate and appropriate processes (such as clinical supervision, mentoring, preceptorship, critical incident analysis and counselling) are in place to ensure that nurses caring for people with cancer and their carers are effectively supported and supervised to provide effective and safe care. A.11 Directors of Nursing should ensure that these processes are sensitive to the particular needs of nurses who care for people with cancer and their carers. |
5.14 Consultant Nurses and Clinical Nurse Specialists in cancer care (CNSs), Ward Managers and other senior practitioners with relevant expertise and experience or who are leading nursing services for people with cancer have a clear responsibility to provide support, supervision, advice and education to colleagues. Their experience and understanding of the issues at the core of caring for people with cancer and their carers are enormous resources on which less experienced colleagues can draw.
CHAPTER 6: CAREER DEVELOPMENT AND WORKFORCE PLANNING
6.1 The nursing workforce in cancer specialist and non cancer-specific services needs to be appropriately skilled, sufficiently numbered and adequately equipped to meet the needs of people with cancer and their carers.
6.2 The epidemiological, social and professional factors that characterise cancer in Scotland must impact on calculations on workforce development. In particular, it is known that:
cancer predominantly (but not exclusively) affects older people (who commonly have co-morbidities)
people are surviving longer with the disease
most care is delivered by practitioners in non cancer-specific settings
new contracting/employment practices (such as the pay modernisation framework (Agenda for Change), the General Medical Services Contract, the Consultant Contract and the European Working Time Directive) are being introduced to NHSScotland
new opportunities for role development are being offered to nurses, including opportunities to lead certain cancer services.
6.3 Each of these factors has implications for the size of the nursing workforce required, its skill mix and the career development of the practitioners within it. They also have implications for team work; nurses work within teams and patients benefit from team work when the skills within those teams are maximised and used to greatest effect.
ACTIONS |
A.12 Regional Workforce Networks, linking with Regional Cancer Advisory Groups and NHS Boards, should base nursing workforce modelling on the clear understanding that cancer is predominantly a disease of older people (who may have co-morbidities) with lengthening survival times; it should also reflect opportunities presented by role development for nurses and new employment/contracting practices in NHSScotland. A.13 Regional Workforce Networks, linking with Regional Cancer Advisory Groups and NHS Boards, should ensure that workforce modelling for nurses in specialist cancer services and in non cancer-specific settings takes account of the need to meet the needs of local populations and promote opportunities for nurses to lead care for people with cancer and their carers. |
6.4 A flexible workforce that is capable of providing care for patients in a variety of environments - home, care and nursing homes, community hospital, hospice, community-hospital interface, hospital - is required to meet the needs of people with cancer and their carers. Specialist cancer nursing services should be sufficiently flexible to provide and support specialist care in all these environments as appropriate.
ACTION |
A.14 Regional Workforce Networks, linking with Regional Cancer Advisory Groups and NHS Boards, should ensure that specialist cancer nursing services are planned and structured to provide and support flexible services in a variety of environments. |
6.5 There should be a clear link between career development, workforce development and leadership. As nurses develop their careers, their leadership skills should develop accordingly.
CLINICAL NURSE SPECIALISTS IN CANCER (CNSs IN CANCER)
6.6 Significant progress has been made by CNSs in Cancer in Scotland in planning, delivering and evaluating care for people with cancer and their carers. Their number has increased in recent years, their profile has grown, and there are individual examples of excellent services delivered by CNSs in Cancer.
6.7 The CNS in Cancer role in Scotland has, however, developed inconsistently throughout the country. There is little reliable information that would inform estimates of how many CNSs in Cancer are needed, where, and for what purpose.
6.8 Regional and local variation in a country as diverse as Scotland is a positive feature of many services for people with cancer, but it is clear that the diversity in the CNS in Cancer role cannot be accounted for solely on grounds of local need.
6.9 The future direction of the CNS in Cancer role needs to be mapped to offer consistency of approach throughout the country, while maintaining sensitivity to regional and local needs. There must be a strong focus on how the role of the CNS in Cancer shapes up nationally, and how the role offers opportunities to develop excellence and expertise in areas such as:
leadership
developing autonomous practice
developing nurse-led services
developing new CNS in Cancer roles.
ACTION |
A.15 The Scottish Executive Health Department and NHS Boards, working with relevant stakeholders, should consider launching a review of the role, remit, preparation and outcomes of the Clinical Nurse Specialist in Cancer. Any such review would be taken forward within the context of the Consensus Statement on New Nursing Roles (Facing the Future Group/SEHD, 2003). |
CHAPTER 7: CONTINUING PROFESSIONAL DEVELOPMENT AND EDUCATION
CONTINUING PROFESSIONAL DEVELOPMENT
7.1 The importance of nursing interventions to people with cancer, and nurses' accountability to patients for the care they deliver, means that nurses must ensure their knowledge, skills and competencies are up to date.
7.2 In common with other areas of nursing practice, nurses at a variety of levels caring for patients with cancer and their carers would benefit from being able to benchmark their clinical practice and education needs against a competency framework. A competency framework could also be used nationally in work carried out as part of the process of implementing the pay modernisation framework, Agenda for Change.
7.3 In Scotland, NHS Education for Scotland (NES) has taken the lead in supporting practitioners to develop competency frameworks across a range of practice areas. NES is now facilitating and supporting the development of a competency framework for nurses caring for people with cancer.
7.4 Ongoing Continuing Professional Development (CPD) will ensure that competencies are maintained and developed and that practice is informed by current knowledge. CPD activity can be encouraged and supported through, for instance:
the provision of support for attendance at CPD events and individual study
availability of appropriate education courses and activities
support for nurses through the application process for courses of formal study and throughout the duration of the course
personal development planning.
This would ensure that individual nurses' CPD activity is directly relevant to caring for people with cancer and their carers.
ACTIONS |
A.16 Individual nurses caring for people with cancer and their carers must ensure their knowledge, skills and competencies are regularly updated; as a minimum, this should ensure compliance with Nursing and Midwifery Council (NMC) statutory requirements for re-registration (NMC, 2002b). A.17 Regional Cancer Advisory Groups, NHS Boards, NES, education providers
1 and Directors of Nursing should ensure that nurses are supported to access opportunities to develop their knowledge, skills and competencies through planned CPD activity. |
1 'Education providers' refers to those in both the higher and further education sectors.
7.5 The 'face' of cancer in Scotland is changing. As has been noted, it is predominantly a disease of older people and some cancers are more common among people from socially deprived communities. Increased survival rates through early detection and advanced treatments mean patients are now living for prolonged periods with cancer. Cancer is tending to present in conjunction with other conditions - for example diabetes, rheumatoid arthritis and Parkinson's disease - and in association with mental illness and learning disabilities. Greater understanding of the causes of cancer has heightened the role of health promotion in prevention and early detection.
7.6 These demographic changes, augmented by heightened patient and public expectations of health services and the changing framework within which cancer services are delivered, provide catalysts for change in professional healthcare roles. Nurses and others are being presented with opportunities to develop their current repertoire of skills and services to best meet patients' needs, which has implications not only for the way nurses work, but also for their CPD.
ACTION |
A.18 Education providers, NES and those responsible for facilitating and supporting CPD within NHS Boards should ensure their plans for cancer-related CPD activities reflect technological advances and the changing epidemiological and social features of cancer in Scotland within individual regions and areas. Training issues raised by nurses adopting new and extended roles in delivering patient services should also be addressed. |
7.7 For some nurses working in non cancer-specific settings, contact with people with cancer may be occasional or sporadic. These nurses, however, tend to see people with cancer and their carers at crucial times - for instance, when suspicion of cancer first appears, during the diagnostic process, while investigations are being carried out, following a course of treatment, at recurrence of disease, or as end of life approaches. It is essential that they are equipped with effective communication skills, are prepared to encourage patient involvement in their care, and can effectively manage the day-to-day anxieties and crises patients and carers may experience.
ACTION |
A.19 NHS Boards, working with NES and education providers, should ensure that nurses in non cancer-specific settings who have contact with people with cancer and their carers at significant times have access to appropriate CPD and education opportunities on issues such as communication, patient involvement and cancer-related topics. |
7.8 It has been established that most nursing care for people with cancer and their
carers is delivered by nurses in non cancer-specific settings, but the CPD needs of nurses in specialist cancer settings nevertheless require attention. This will affect a relatively small number of nurses caring for people with cancer and their carers, but they are an important group with very specific needs in relation to ongoing CPD and career development support. While nurses in non cancer-specific settings generally engage with CPD aiming to develop their skills in caring for people with cancer over a wide range of areas, those in specialist cancer settings tend to focus on discrete areas of practice.
ACTION |
A.20 NHS Boards, education providers and NES should work together at national level to address the CPD needs of nurses in specialist cancer settings. |
7.9 The nature of modern cancer care and the structure of MCNs demand that nurses develop their skills in working as part of multi-disciplinary teams. This is an area in which CPD effort is liable to pay significant dividends.
ACTION |
A.21 NHS Boards, NES, education providers and those responsible for facilitating and supporting CPD activity at local levels should explore the possibility of providing/facilitating CPD activity for nurses in relation to developing multi-disciplinary team-working skills. |
EDUCATION
7.10 Whichever branch of nursing students enter - adult general, mental health, care of children or care of people with learning disability - they will encounter people with cancer in the course of their work and will need to develop knowledge of cancer prevention and screening strategies. All nurses therefore require an understanding of how cancer affects people in a variety of contexts.
7.11 Awareness of the complexities of living with cancer and cancer prevention and screening should be promoted within pre-registration nursing programmes. Nurses emerging from these programmes should have a grounding in the physical, psychological, social and spiritual sequelae of cancer, how it can be prevented and detected, and how nursing practice (in both non cancer-specific and specialist settings) supports people with cancer and their carers.
ACTION |
A.22 Education providers, NES and the Scottish Executive Health Department should ensure that pre-registration nursing programmes in Scotland prepare nursing students with an understanding of cancer, its prevention and detection, its effect on people, and how nurses can respond effectively to meet their needs. |
7.12 At post-registration level, the issues discussed above in relation to technological advances, the epidemiological and social characteristics of cancer in Scotland and the changing roles of nurses should influence the way education in cancer care is developed. It is important that an understanding is reached on how effectively post-registration education programmes are currently addressing these issues, with action being taken to correct anomalies.
7.13 In addition, national consultation conferences held to inform the development of this Framework, and which involved nurses from a wide variety of backgrounds, identified key issues on which education at post-registration level should focus. Prominent among these was a desire to ensure that clinical roles have links with formal education programmes, and that education and service areas should work closely in developing, delivering and evaluating education programmes.
ACTIONS |
A.23 NES, education providers and NHS Boards should work collaboratively to review information on cancer nursing post-registration education, map it against current epidemiological and social data on the characteristics of cancer in Scotland, the changing roles of nurses and key areas of education need as defined by the national consultation conferences, and ensure action is taken to address anomalies. A.24 NES, education providers and NHS Boards should ensure that clinical roles in cancer nursing at all levels are linked with identified education programmes, and that education and service sectors co-ordinate on curriculum development and programme delivery and evaluation. |
CHAPTER 8. RESEARCH, EVIDENCE-BASED PRACTICE, DEVELOPMENT AND INNOVATION
RESEARCH
8.1 Nurses have been active in both uni-disciplinary and multi-disciplinary research into the care of people with cancer and their carers for many years. Despite this, nursing can still not claim to be a fully research-based discipline whose practitioners consistently deliver services based on sound research evidence.
8.2 There are several reasons for this, many of which equate with deficiencies in other areas of nursing research:
critical appraisal and research awareness skills are not universal among the nursing population
while funders of cancer research are keen to provide resources to support nursing research, proposals submitted by nurses in cancer care are relatively few in number, and often are not robust
research carried out by nurses into cancer care is often small-scale and non-replicable; this means that while the research may be of interest to nurses and others, the implications for practice cannot reliably be extended to a wider arena
the driver for research too often seems to be personal interest rather than engagement with a common, agreed cancer nursing research agenda.
8.3 The result is that there is not a great store of valid, reliable evidence on which to base nursing practice in caring for people with cancer and their carers.
8.4 The situation is changing, however. Cancer nursing research societies and networks have been set up locally, nationally and internationally. The number of peer-reviewed journals specialising in cancer nursing has grown significantly in recent years. National and international cancer conferences offer nurses the opportunity to meet, learn and network with colleagues from different areas of practice. In Scotland, the Cancer Care Research Centre has been established within the Department of Nursing and Midwifery at the University of Stirling.
8.5 Perhaps most significantly, the national strategy for research and development in nursing and midwifery,
Choices and Challenges (SEHD, 2002b) (see Box 8.1), offers a route map for the further development of nursing and midwifery research in Scotland.
Box 8.1.
Choices and Challenges (SEHD, 2002b) |
The national strategy for research and development (R+D) in nursing and midwifery in Scotland was launched in December 2002 following recommendations in
Caring for Scotland (SEHD, 2001b). It sets out a series of recommendations relating to four key areas: developing R+D infrastructure adopting a focused approach to R+D building an evidence-based culture promoting dissemination.
Central to the strategy's design is the concept of Research Consortia. These are likely to be 'virtual' bodies working on a collaborative model involving partnerships of NHS Boards, academic and clinical researchers and their teams, other disciplines, and Scottish, UK and international organisations. They will reflect national research and policy drivers in devising and implementing carefully co-ordinated and focused programmes of uni- and multi-disciplinary research and will implement dissemination strategies to ensure the widest possible impact for research findings and the promotion of an evidence-based culture. |
8.6 The Scottish Executive, working in partnership with the Chief Scientist Office, NHS Education for Scotland, the Scottish Higher Education Funding Council and other stakeholders, has made significant progress since the publication of
Choices and Challenges (SEHD 2002b), on a number of fronts, including maximising nursing's capacity to develop clinical/academic career pathways and strengthening research leadership in nursing.
8.7 For cancer nursing research to fully benefit from the advances made and to contribute to advances in future, it needs to:
become an integral part of the wider cancer research agenda through articulating with national research priorities for cancer defined by the Scottish Executive
explore opportunities for research partnerships involving patients and their carers, practitioners, academics and managers at local, regional, national and international levels
explore the potential of integrating research programmes within Research Consortia
explore opportunities for multi-disciplinary, multi-sectoral research
offer research training to selected nurses caring for patients with cancer and their carers, and ensure that they maintain clinical responsibilities within their roles
disseminate research findings to nurses caring for people with cancer and their carers in an organised and co-ordinated manner using a variety of appropriate media.
8.8 Nursing research has a great deal to offer cancer care, particularly in addressing patients' and carers' experience of care - an area which, while not so far attracting significant funds for research, nevertheless has a significant impact on the daily lives of people with cancer and their carers. It is therefore imperative that nursing research in cancer care is refined and developed.
ACTIONS |
A.25 The Scottish Executive Health Department and NHS Boards should encourage and facilitate nursing research into caring for people with cancer and their carers in Scotland. A.26 The Scottish Executive Health Department, education providers and NHS Boards, working with Research Consortia within Scotland, should ensure that nursing is fully engaged with the commissioning process for research on cancer priorities and in the development of future priorities. A.27 NHS Boards, in partnership with education providers, should offer opportunities to appropriately motivated, prepared and experienced nurses to undertake research training programmes while continuing to carry clinical responsibilities. |
EVIDENCE-BASED PRACTICE AND DEVELOPMENT
8.9 Nurses caring for people with cancer and their carers should ensure, whenever possible, that their practice is based on reliable research evidence.
8.10 A variety of organisations and resources have been introduced in recent years to support the endeavours of nurses and others to keep abreast with current knowledge and develop their practice through the application of reliable research - the NHSScotland e-Library, the Nursing and Midwifery Practice Development Unit (NMPDU) (now incorporated into the Practice Development and Clinical Effectiveness Support Division of NHS QIS), the Nursing, Midwifery and Allied Health Professions Research Unit (NMAHPRU) (formerly known as the Nursing Research Initiative for Scotland (NRIS)), and Managed Knowledge Networks within MCNs, for instance.
8.11 Nurses contribute to and have access to a wide range of clinical standards and guidelines from organisations such as NHS Quality Improvement Scotland (NHS QIS), the Scottish Intercollegiate Guidelines Network (SIGN), NHS Health Scotland and the National Institute for Clinical Excellence (NICE) that have direct relevance to caring for people with cancer. There are also numerous cancer-specific protocols, guidelines and integrated care pathways devised at local, national and international levels by a variety of organisations in the statutory, voluntary and independent sectors.
8.12 To deliver on a consistent basis quality care that is clinically effective, nurses must be encouraged and facilitated to access and use resources such as these.
ACTIONS |
A.28 Nurses caring for people with cancer and their carers must ensure that, whenever possible, their practice is informed and guided by reliable research evidence. A.29 NHS Boards and Directors of Nursing should ensure that nurses caring for people with cancer have access to research materials, organisations, guidelines, standards, protocols and care pathways that will help them deliver practice that is clinically effective and evidence based. |
INNOVATION
8.13 While much modern health care is rightly governed by guidelines, protocols and standards, innovation, when backed by reliable evidence, will always have a place in the delivery of nursing care. This is perhaps particularly the case in nursing care for people with cancer and their carers, which so often calls for flexible, innovative responses to situations.
ACTION |
A.30 NHS Boards and Directors of Nursing should support and encourage evidence-based innovative approaches that challenge traditional practice and thinking. |
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