QUALITY AND SAFETY IN ONCOLOGY: Is oncology specific ?
Sandy Decosterd, Clinical nurse specialist in oncology Marie-José Roulin, Deputy Nursing Director
SAFETY IN NURSING IN SWITZERLAND: nurses’ perspective
Auer et al. (2014) Journal of Nursing Administration
HEALTHCARE PROFESSIONALS’ LIKELIHOOD OF SPEAKING UP ABOUT SAFETY CONCERNS: a Swiss vignette study
Schwappach & Gehring (2014) PloS One
SWISS NATIONAL STRATEGY AGAINST CANCER: TWO PRIORITIES ARE LINKED TO NURSING
Development of quality in medicine and care through the formulation of therapeutic guidelines or tools promoting integrated care.
Participation and development of patients and families competencies
OUR CHOICES FOR THIS PRESENTATION
• Focus on the patient-nurse interface • A Swiss perspective
A general perspective
An oncology perspective
Environment: staffing, legislation, structure, patient trajectory
Nurse
Person centered care
Interprofessionality: coordination, communication, sharing responsabilities
Patient
ETHICAL CARE: ICN code of ethics nursing and the individual • Respect of rights, values, customs and beliefs • Consent for care • Respect of confidentiality
• Equity in access to health care • Respectfulness, compassion, trustworthiness and integrity • Nursing professional responsibility is to the patient ICN code of ethics, 2012, Geneva
ETHICAL CARE: ICN code of ethics nursing and practice/profession
•
Individual responsibility for maintaining competences
•
Ensuring the use of up to date technology and scientific advances
•
Determining and implementing standards of clinical nursing
•
Taking action to safeguard individuals during sensitive care.
ICN code of ethics, 2012, Geneva
Environment: staffing, legislation, structure, patient trajectory
Nurse
Person centered care
Interprofessionality: coordination, communication, sharing responsabilities
Patient
KNOWLEDGE USE: the right information, at the right place, at the right time
It implies • Summarizing and structuring the pertinent
Nursing k nowledge brokers
information for the context • Translating for clinician and management • Disseminating knowledge at the bedside
McCormack et al. (2013) Implementation Science Pool et al. (2015) International Journal of Nursing Studies
SOURCES OF PRACTICE KNOWLEDGE FOR BEDSIDE NURSES: the right information, at the right place, at the right time Coaching at the bedside Regular contacts Nursing rounds In-services Team case analysis Journal club
Examples in oncology Social interaction In-services educational intervention with individual coaching
Protocoles Information in computerised care charts Internet, Service blogs /Tweet/ WhatsApp Newsletters
Guided protocoles for chemotherapy Oncology information flyers Unit based documents Flyers from the national cancer league SOS nursing standards
Estabrooks et al. (2005) Qualitative Health Research Gagnon et al. (2009) Infirmière Clinicienne
BARRIERS TO KNOWLEDGE USE • 4 national languages (french is a minority language)
• Few national guidelines/standards in oncology nursing
• Strong cultural link with neighboring countries
Environment: staffing, legislation, structure, patient trajectory
Nurse
Person centered care
Interprofessionality: coordination, communication, sharing responsabilities
Patient
COMPETENCIES : technical, relational, reflexive
Therapy, surgery, radiotherapy, side effects, procedures,..
Technicity, precision
Patient education, support , enabling self-care, giving bad news, palliative care
Therapeutic communication, emotional support
Developing practice
Reflexive, formalizing knowledge
NURSING COMPETENCIES IN SWITZERLAND Based on the CANMED 2005 Framework Bachelor
Nursing expert
Specialty
Master (CNS)
Ledergerber, C., Mondoux, J., Sottas, B. (2009) Projet de compétences finales pour les professions de la santé HES, disponible sur : http://www.swissuniversities.ch/fileadmin/swissuniversities/Dokumente/FR/FH/Best_practice/1_Competences_finales_pour _les_professions_de_la_sante_HES_rapport_final.pdf
NURSES WITH A NURSING SCIENCES’ MASTER IN SWITZERLAND
21% in oncology
349 nurses (mean age 40)
Somatic hospitals 53% Universities of Applied Sciences 27% Universities 12% Psychiatric hospitals 8% Long term care 5% Home care 3% Schwendimann R., Koch, R. (2013) Masterumfrage, ASI. Disponible sur: http://swiss-anp.ch/w/media/Akutelles/2013_05_20_Masterumfrage_2013_Bericht_4S_final.pdf
Environment: staffing, legislation, structure, patient trajectory
Nurse
Person centered care
Interprofessionality: coordination, communication, sharing responsabilities
Patient
PATIENTS’ CHARACTERISTICS: What are the patients’ characteristics that influence acuity ? Pilot study in four hospital wards •Oncology •General Medicine •Rehabilitation •Psychiatry (crisis unit)
1. Evaluation of the importance of 6 characteristics in a convenience sample of 184 patients 2. Identification of indicators for each characteristic Ansel, Ducloux, Ferreira, Genoud, Gonzales, Hamache, Herrault, Roulin (2015) Preliminary results, pilot study HUG.
IMPORTANCE OF PATIENTS’ CHARACTERISTICS STABILITY
RESOURCES
PARTICIPATION
PREDICTABILITY
VULNERABILITY N=184 COMPLEXITY
oncology (n=46)
Etude pilote HUG: Résultats préliminaires, 2015
VULNERABILITY Susceptibilty to stressors that may affect outcomes such as comorbidities, cognitive problems,…....,
Ansel, Ducloux, Ferreira, Genoud, Gonzales, Hamache, Herrault, Roulin (2015) Preliminary results, pilot study HUG.
SWISS ADAPTATION OF THE ONCOLOGY ACUITY TOOL FROM BRENNAN P
T
Decosterd. Bavaux, Eicher, 2015 (Preliminary results)
Environment: staffing, legislation, structure, patient trajectory
Nurse
Person centered care
Interprofessionality: coordination, communication, sharing responsabilities
Patient
ENVIRONNEMENT legislation, role, staffing, reimbursement No definition of scope of practice.
Federal law in preparation on health professions
TODAY, counseling and teaching must be prescribed by a physician
No recognition of nurses’ autonomy of practice
Change in the health insurance federal law in consultation
Counseling and targeted follow up of patients with oral anti-cancer medication must be prescribed by a physician
NURSES’ PER 1000 INHABITANTS
Panorama de la santé 2011, OCDE
NURSING STAFFING
Aiken et al. (2012) BMJ; 344.e1717
Environment: staffing, legislation, structure, patient trajectory
Nurse
Person centered care
Interprofessionality: coordination, communication, sharing responsabilities
Patient
INTERPROFESSIONALITY Coordinated care, patient trajectory, chronicity Multiprofessional
Other
Interprofessional
Nurse Other
Physician
Knowing the others’
Nurse
Phys.
Patient centered integrated care
DRIVING AND RESTRAINING FORCES
Lack of expertise Communication, teamwork, sharing of responsabilities
Patient and family Complexity, vulnerability, autonomy
Professions Competencies sharing, optimize expertise
Politique Cost control, accountability
Interprofessional practice
Cultural silos Values, perspective, systemic vision
Infrastructure Schedules, rewards, levels, physician based financing
Inspired from Heather et al. (2011) Nursing Outlook
INTERPROFESSIONALITY : Complexity indicators linked to interprofessionality Light patient Medium patient Heavy patient
Non defined Professionals from therapeutic goals/ or in different disciplines definition and services (coordination)
Ethical questions
Divergences or lack of dialogue between professionals
Ansel, Ducloux, Ferreira, Genoud, Gonzales, Hamache, Herrault, Roulin (2015) Résultats préliminaires, étude pilote HUG.
TAKE HOME MESSAGE
Ethical nursing
Quality and security
Quality and security
complex process
Environment: staffing, legislation, structure, patient trajectory
Nurse
Person centered care
Interprofessionality: coordination, communication, sharing responsabilities
Patient
