Patients traditionally receive all systemic cancer therapy in hospital. The aim was to deliver safe, shared nursing care, between hospital and community health services, for patients undergoing systemic cancer therapy.
National and regional project management structures were set up to train community nurses, equipping them with the knowledge and skills to safely and competently provide care, at home, for patients undergoing systemic cancer therapy. Training was theoretical and skills based, and delivered over six months.
Inbuilt safety features of the programme included:
- Examination of the community nurses’ knowledge and skills
- Development of a Community Oncology Resource Book to assist nurses in clinically assessing patients
- Development of a referral form
- Commitment from the medical oncologist that patients remain her responsibility irrespective of where nursing care is provided
- Arrangement with the treating cancer unit to receive urgent phone calls and/or admissions from the community nurses.
Background and rationale
A shared care/integrated approach to providing safe nursing services at home for patients who are receiving systemic cancer therapy was developed between hospital and community health services. The rationale for this Community Oncology Nursing Programme included:
Response to patient/family needs
Patients visiting the treating cancer unit for nursing interventions related to their systemic therapy, often have to travel long distances, which puts a burden on both them and their families. Many of these patients are unwell. Some of the interventions take as little as 15 minutes to compete and some of this care could be delivered in the home. This holistic patient care includes management of central venous access devices, medication management, symptom control, disconnection of chemotherapy and blood sampling.
Integration of cancer care between hospital and community health services
The options and demand for systemic cancer therapy are increasing. Hospital throughput and waiting times to start systemic therapy are increasing. In Ireland, all aspects of this treatment are historically delivered in the hospital setting. Although the role of community nurses is to attend to patients within their geographic area, most do not care for patients who are receiving acute cancer treatment as they are not trained in this specialty.
Development of safe and creative ways to manage Ireland’s increasing cancer incidence
Cancer incidence in Ireland will increase by 100 per cent over the next 20 years, due mainly to the ageing population. Hospital resources will remain limited and novel ways to deliver safe care that is appropriate and responsive to patient needs are required. It is a priority of the Health Service Executive (HSE) in Ireland to develop integrated models of care.
The main aim of the Community Oncology Nursing Programme was to ensure that community nurses are competent and confident in caring for a defined group of patients safely in the home (patients who are receiving systemic cancer therapy).
The objectives were to:
- Ensure the community nurses are properly trained to deliver specific nursing interventions related to systemic cancer therapy
- Demonstrate that the patients are cared for safely at home
- Assess the impact of the Programme on the hospital’s treating cancer unit
- Assess the impact of the Programme on the overall community nursing service
- Assess the impact of the Programme on the patients and families
- Make recommendations on the expansion of the Programme nationally.
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