role development in radiation oncology€¦ · 1. radiation oncology nursing is rooted in a...

Oncology Nursing Society 43nd Annual CongressMay 17–20, 2018 • Washington, DC 1Radiation

Susan Behrend, RN, MSN, AOCNFox Chase Cancer Center [email protected]

Key Session Takeaways1. Radiation oncology nursing is rooted in a historical journey. Our

past informs the present and will secure our future. Early roles are focused on clinical trends, symptom management, and the acceptance of radiation oncology as a major treatment modality.

2. Contemporary radiation oncology nursing is based on clinical trends, support for MDTs, structured delivery systems, and supportive evidence to measure success. An emphasis on data acquisition will provide proof to drive shared decision making and secure roles of radiation oncology nurses.

3. The future is focused on clinical excellence, prioritizing patient care, shared decision making, sustainable change, and ensuring MDT models of care. Knowledge of current literature with a focus on EBP will support radiation oncology nursing practice.

Role Development in Radiation OncologySaturday, May 19 • 9:45–11 am

Note one action you’ll take after attending this session: ____________________________________________________

________________________________________________________________________________

ONS 43rd Annual Congress

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©2018 Susan Weiss Behrend – www.oncprofessional.com


Role Development in Radiation Oncology

Susan Weiss Behrend, RN MSN AOCNClinical Nurse SpecialistFox Chase Cancer Center

Philadelphia, Pennsylvania


DISCLOSURESNo additional disclosures.


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HISTORICAL OVERVIEW

First initiativesHow and when

specialty formed

Initial practice paradigm

Defining patient

management

Construct of clinical sites


Past

informs

Present

secures

Future

HISTORICAL JOURNEY


HISTORICAL JOURNEY

Specialization circa.1970’s

Early practice models

Ad HocONS RT SIG

1989


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ROLE DEVELOPMENT

Measuring success

Finding sources for

EBP

Structuring the concept

Rallying support for

MDT

Identifying clinical

paradigmsEarly years


ROLE DEVELOPMENTTHE EARLY YEARS

Clinical Demystifying RT Assembling

team

Developing documentation

systems


ROLE DEVELOPMENTIDENTIFY CLINICAL PARADIGMS

Professional education

Patient/family education

Symptom management

Documentation


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ROLE DEVELOPMENT RALLY SUPPORT FOR MDT

RT: team foundation

Aim for complete buy‐in

Acquire Data


Data

Proof

DecisionChange

ROLE DEVELOPMENT


ROLE DEVELOPMENTCONCEPT & STRUCTURE

Define needAssess viability

Present across disciplines

Flexible Model


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ROLE DEVELOPMENTSUPPORTIVE EVIDENCE

Where is it?

Create it!

PEP essential step

Knowledge of viable literature

Access to search and applicability

Listen intensely

Read


ROLE DEVELOPMENTMEASURE SUCCESS

Does RT Nurse affect

outcomes?

Plan in place

Evaluation tools

cover all domains

Dovetail with QA

Invoke administrative

support


CONTEMPORARY ROLES

Impact of MDT hierarchies

Focus on nurse role

Where is nurse?

Shake hands with RT MDT


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EXPLORING PRACTICE DOMAINSInterviews

Identifying variables

Roles driven by practice

Practice driven by roles

Similarities

Differences


LITERATURE SEARCHNursing roleInterprofessional relationsHierarchyMultidisciplinary team Communication Organizational cultureHealth personnel attitudePublic relationsProfessionalismProfessional role evaluationRole delineation Job analysis Organization and management Organizational climate

Nurse physician relationsPhysician nurse relationsRadiation oncologyRadiation oncology nursingPatient care teamsInterdisciplinary health teamsOncology nursingCancer centerOncology servicesRadiation oncologistProfessional roleOrganizational cultureAdministrativeCancer hospital


LITERATURE THEMES

CNS fundamental (Anderson, 2014)

Non APN staff integral (Barber,

2016)

ONN most prevalent studied (Becze, 2017; Brown, 2012; Cantril,

Haylock, 2013, Cook, 2013,)

ONN: RDS did not indicate certification path (Lubejko, 2017)

ONN: Novice group core competencies (McMullen, 2016)

Clinical Trial Nurses: EB model

multidimensional role (Purdom, 2017)


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LITERATURERole Delineation: ONN/Clinical Trial/CNS

Traditional

Innovative

Nurse Scientist

APN roles lack clarity

CNS transformative

potential

RT APN improves safety culture


ELEMENTS OF PROFESSIONAL RT NURSING MODEL

Determine practice setting

Patient population

Available RT treatment

MDT present

Referral patterns

Schedule of operation

Insurance regulations


RT NURSING MODEL

Education

RN BSN

Certification(OCN) ®

Scope of Practice

assessment educationsymptom

managementresearch

coordinationcounseling

long term follow‐up

leadership initiatives


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RT APN MODEL

Clinical Nurse Specialist

RN MSN

Scope of Practice

clinician site‐specific practice

coordinationeducator mentor consultant research


RT APN MODEL

Nurse Practitioner

RN MSN NP

Certification (AOCNP)®

Scope of PracticeCollaborative with Radiation Oncologist

NP competenciesPhysiologic assessment

Patient care along trajectoryLong‐term follow up reimbursable

Survivorship focusEnd of life careRehabilitation

Research

Options

Doctor of Nurse Practice (DNP)

Doctor of Philosophy

PhD

Advanced Certification

Scope of practice

Clinical, research,

administrative


RT NURSINGAdditional Considerations:

Collaborative/Primary clinical

Practice model

Ancillary hours

Direct patient care hours

Required staff (ACRO guidelines)


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RT NURSINGPosition descriptions

‐based on framework

‐scope of practice

‐reporting structure

‐educational requirements

‐knowledge, skills, abilities

‐responsibilities

‐leadership


EDUCATORPlan Educational Opportunities

assess staff needs

establish objectives

develop outline content

innovative presentation style

include MDT

evaluation tools


MDT CHAMPION


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FOCUS ON COLLABORATION

Identify and solve

Team builder of collaborative practice

Interdepartmental

Who does what?

Who has information?

Who knows what to do with this knowledge?

Promote partnership

Plan educational offerings


COMMITTED TO QUALITY CARE

Standards Structure standards

Process standards

• policies

• procedures

• protocols

Outcome standardsContinuous performance improvement

Documentation


DIMENSIONS OF QUALITY CAREPatient education

Professional education

Research based practice

Knowledge of clinical trials/availability


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LEADER

Every Nurse has leadership potential

Articulate leadership characteristics

Knowledge of leadership models

ONS leadership resources


FUTURE GOALS AND BEYOND

Goal

Clinical excellence

Patient above

everything

Shared decision making models

Sustainable change

Ideal MDT philosophy

Know current

environment

Initiate EBP


WHAT IS OUR CHALLENGE?

Consider RDS Literature absent Study/Reflect/Write Creative modelingDevelop focused collegial exchange


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[Editorial]. Oncology Nursing Forum, 38, 497. Doi:10.1188/11.Onf.497." Oncology Nursing Forum 39(2): 125-125 PMID: 104525962. • Cantril, C. and P. J. Haylock (2013). "Patient Navigation in the Oncology Care Setting." Seminars in Oncology Nursing 29(2): 76-90 PMID: 104284604. • Catania, K., et al. (2012). "From Unit Based to Population Focused: Transforming the Role of Oncology Clinical Nurse Specialists." Clinical Nurse Specialist: The Journal for

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http://www.health.nsw.gov.au/services/Publications/role-delineation-of-clinical-services.PDF.• Hsueh, M. and K. Dorcy (2016). "Improving Transitions of Care with an Advanced Practice Nurse: A Pilot Study." Clin J Oncol Nurs 20(3): 240-243 PMID: • International;, T. A. H. P. (2014). Role Delineation Guide and Matrix: Ihfg Application Guideliens Part B, Appendix A. International Health Facility Guidelines. Dubai, UAE, Total

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PMID: 25035193.• Lemonde, M. and N. Payman (2015). "Perceived Roles of Oncology Nursing." Canadian Oncology Nursing Journal 25(4): 422-431 PMID: 111108623• Levy, S., et al. (2014). "The Nurse Liaison Role in the Cooperative Group Setting." Seminars in Oncology Nursing 30(1): 11-16 PMID: 104028147.• Lopez Guerra, J. L., et al. (2012). "New Perspectives in Radiation Oncology: Young Radiation Oncologist Point of View and Challenges." Reports of Practical Oncology and

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role development in radiation oncology€¦ · 1. radiation oncology nursing is rooted in a...

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