Abstract
Back Ground
The aging population and the need for health systems to manage an ever increasing numbers of patients with chronic conditions has been identified as one of the greatest challenges for health care providers worldwide. New Zealand is no exception, with chronic conditions causing over 80% of all deaths per year (Connolly et al., 2010). Cancer is one such chronic condition, where, the devastating effect of a diagnosis is often coupled with difficulties in navigating the complex health care setting. Hence some areas have seen the development of specialized nursing roles to accommodate the needs of this group of patients. One such role to emerge is that of the Lung Cancer Clinical Nurse Specialist. The question naturally arises as to whether such nurses are indeed assisting patients and demonstrating Advanced Nursing Practice (ANP) in the care they give. Within the literature it is suggested that an evaluation of these roles is necessary, if they are to be fully recognised and valued (Bryant-Lukosius, DiCenso, Browne & Pinelli, 2004; Oliver & Leary, 2012; Vaz & Small, 2007). It is to this area that this study is directed.
Aim
The aim of this study was to explore the impact of an advanced nursing role on lung cancer patient care. In particular eliciting information regarding the functionality of the Clinical Nurse Specialist (CNS) role within the multi-disciplinary team (MDT) within a regional lung cancer service was an important aspect of the research.
Method
There was a need for the study to provide insight into how the role of the Lung Cancer Clinical Nurse Specialist (LC CNS) was viewed and understood by those that work with them (Cowman et al., 2010; Moore et al. 2006).
Phase one was a questionnaire which was sent out to 50 members of the MDT, with the express purpose to elicit information from a variety of health professionals. The questionnaire contained both quantitative and qualitative questions.
Phase two was an audit which involved a quantitative observational, retrospective study of five months of clinical data relating to patients cared for by the LC CNS’s. The data was audited against the Standards of Service Provision for Lung cancer Patients in New Zealand (MOH, 2011)
Findings
From the respondents questionnaire (76%. N=38) the overall opinion was that the LC CNS role was meeting the expected standards. The audit data revealed an age range of patients from 41-79yrs with a median of 60yrs. In terms of the LC CNS the audit data likewise suggested that the role was being fulfilled as expected including psychosocial support, provision of information and care co-ordination.
Conclusion
The LC CNS role clearly fulfills the expectation of the MOH Standards, the MDT with whom they work identify the role as crucial and have suggested that the LC CNS’s are the “glue that makes the system work much better and be more patient centered”. There is recognition that planning is essential when developing advanced nursing practice (ANP) roles, to ensure robust processes are put in place at the beginning of the process. There is evidence that development of these roles in an ad hoc fashion can lead to confusion regarding the intention of the role. The nurses who work within these ANP roles must be able to articulate and clearly define their role (Lewandowski & Adamle, 2009). There is also a need to evaluate the effectiveness of the role, as without robust evaluation there is a tendency to underestimate their crucial clinical contribution Oliver & Leary, 2012).