Purpose: This article will describe the outcomes associated with restructuring clinical nurse specialists (CNSs) into a centralized model with dedicated efforts focused on team and individual development. Methods: A multiphase journey was undertaken to rebuild a team of CNSs after years of open vacancies and role confusion. After restructuring to a centralized model, a multiphase approach was taken that included innovative recruitment strategies, development of a talent pipeline through enhancement of student clinical placements, team and individual development activities, and value identification. Description of methods used for individual and team development is discussed in depth within this article, including achieving role standardization and optimization. Outcomes: Numerous outcomes were associated with this effort and are described within this article. Among them were the hiring of 21 CNSs, increased representation on hospital-wide committees and councils, quantification of the work contribution of CNSs within the organization, and a $1 568 229.36 cost avoidance associated with CNS work efforts, all in the first 24 months. Conclusion: As challenges facing the role put it at risk and healthcare becomes increasingly value based, the need for expert clinicians who can demonstrate their value becomes essential. Clinical nurse specialists and hospital leadership can benefit from exploring successful interventions to rebuild CNS teams to achieve these goals.

No abstract

The December 2014 issue of the European Journal of Oncology Nursing published an article by Näppä, Rasmussen, Axelsson, and Lindqvist that reported on a qualitative study of the challenges experienced by Swedish nurses when administering palliative cancer treatment at the end of life. The study identified the various clinical scenarios that create dilemmas among nurses. The authors described why chemotherapy at the end of life has become so prevalent and offered strategies to minimize or prevent the moral distress that can occur. Research from the United States identified similar trends in end-of-life treatment and supportive recommendations for multidisciplinary palliative care team collaboration as a solution.

No abstract

A R e v ie w o f " F a m ily C a re g iv e rs o f W o m e n W it h B re a s t C a n c e r in Ira n R e p o r t H ig h P s y c h o lo g ic a l Im p a c t Six M o n th s A fte r D ia g n o s is "Nancy G. Houlihan, MA, RN, AOCN® T he F o reig n E xch an g e co lu m n launches a new approach to ex panding the global u n d erstan d ing of oncology n u rsin g ch allenges and concerns. Each issue will include a review of an article that appeared in the most recent issue of the European journal of Oncology Nursing that is relevant to a shared, unique, or conflicting oncology issue or practice in the U nited States. This colum n review s an article about the shared dilem m a of distress caused by caregiver burden in the ever complex and shifting setting of care delivery. Family C aregivers o f W om en W ith Breast C ancer in IranAn article by Khanjari, Langius-Eklof, Oskouie, and Sundberg (2014) report ed on a stu d y of fam ily caregivers of women w ith breast cancer in Iran. The purpose of the study was to explore how family caregivers describe the areas of life that are important to their quality of life (QOL) and are influenced by having a fam ily m em ber w ith breast cancer. This article was chosen because of the methodology used to capture caregiver individual responses; the well-described influence of Iranian cultural, societal, and spiritual norms on cancer care; and the parallels to the American experience.According to the authors, breast cancer is the most common cancer in women in Iran. Like in Western countries, earlier diagnosis has led to a decline in mortality, but an increase has occurred in women diagnosed with breast cancer from ages 40-49 years. No national screening pro gram exists, so mammography is less ac cessible to women with lower incomes. In keeping with other Western trends, a shift has occurred from institutional to home care, creating more demand on the entire family. Societal changes described in the article include a drift in family structure from trad itio n al extended to nuclear fam ilies and an increase in the age at marriage, the age of parents at birth of the first child, and the overall numbers of unmarried men and women. Women have higher levels of education and em ployment rates and more often contribute to family income than previously. These changes in trends in society and family life are thought to negatively influence the situation of a family caregiver. M eth od s and Instrum entsThis longitudinal study was descrip tive and prospective at two time points (i.e., 2-3 weeks and six m onths after a family m em ber's breast cancer diagno sis). A previous study of the same popu lation in Iran using a standardized QOL instrument, the Caregiver Quality of Life Index-Cancer, showed that half of family caregivers had stable QOL at six months, w ith some showing im provem ent and smaller num bers showing decreases in QOL. These findings conflicted w ith other Western studies that reported nega tive impact on QOL over time.To further validate the experience of fam ily caregivers in Iran...