Recommendations to support nurses and improve the delivery of oncology and palliative care in India

Abstract

Context:Nurses in India often practice in resource-constrained settings and care for cancer patients with high symptom burden yet receive little oncology or palliative care training.Aim:The aim of this study is to explore challenges encountered by nurses in India and offer recommendations to improve the delivery of oncology and palliative care.Methods:Qualitative ethnography.Setting:The study was conducted at a government cancer hospital in urban South India.Sample:Thirty-seven oncology/palliative care nurses and 22 others (physicians, social workers, pharmacists, patients/family members) who interact closely with nurses were included in the study.Data Collection:Data were collected over 9 months (September 2011– June 2012). Key data sources included over 400 hours of participant observation and 54 audio-recorded semi-structured interviews.Analysis:Systematic qualitative analysis of field notes and interview transcripts identified key themes and patterns.Results:Key concerns of nurses included safety related to chemotherapy administration, workload and clerical responsibilities, patients who died on the wards, monitoring family attendants, and lack of supplies. Many participants verbalized distress that they received no formal oncology training.Conclusions:Recommendations to support nurses in India include: prioritize safety, optimize role of the nurse and explore innovative models of care delivery, empower staff nurses, strengthen nurse leadership, offer relevant educational programs, enhance teamwork, improve cancer pain management, and engage in research and quality improvement projects. Strong institutional commitment and leadership are required to implement interventions to support nurses. Successful interventions must account for existing cultural and professional norms and first address safety needs of nurses. Positive aspects from existing models of care delivery can be adapted and integrated into general nursing practice.

An ethical imperative: Safety and specialization as nursing priorities of WHO Global Initiative for Childhood Cancer

“…There has been a strong focus on standards of accountability for health care in LMIC, but historically, a lack of prioritization, or even neglect, of protective measures for nurses and others has been evident. We must promote standards, identify incentives, and provide a solid rationale to institutions and governments to prioritize access to PPE for all those handling hazardous drugs, and, in parallel, advance specialized nursing roles and education to develop proficiency in pediatric oncology nursing care and optimize patient outcomes …”

“…We must promote standards, identify incentives, and provide a solid rationale to institutions and governments to prioritize access to PPE for all those handling hazardous drugs, and, in parallel, advance specialized nursing roles and education to develop proficiency in pediatric oncology nursing care and optimize patient outcomes. 42…”

Palliative Care in the Global Setting: ASCO Resource-Stratified Practice Guideline

“…Several other guidelines and authors have suggested particular subjects for education and training for health care personnel in palliative care. Examples 7 , 28 , 29 include providing education in assessing and managing patients’ pain and other symptoms, recognition of metastases, communication skills, leadership skills, cultural communication, 28 and basic oncology skills ( Table 3 for training resources from Maximal settings). 29 …”

“…The WHO Palliative Care Strategy states that policymakers should address “medicine availability, education, and government policy”; WHO also provides a model on access to opioids. According to LeBaron et al, 29 hospitals should have a first priority of making oral IR morphine available. “Institutions that have been successful in procuring morphine…could serve as role models and mentors to other institutions who wish to improve access to pain relief for their patients.…”

Challenges of using methadone in the Indian pain and palliative care practice

“…[ 1 ] Even more important is sensitizing the young medical and nursing graduates to the basics of palliative care. [ 47 ] Ongoing communication with the regulatory bodies like the Medical Council of India(MCI) is in progress. [ 1 ]…”