Prepared By:

Under The Supervision Of :

Professor / Abdullah Hujaily
Dr / Muhammed Osman
Dr / Nayef Altarawneh
Acknowledgment
To the light, our Professor, who guided us through the way. To Professor / Abdullah
Hujaily, Dr / Muhammed Osman, and Dr / Nayef Altarawneh, for their great efforts of
suer!ising and leading us, to a""omlish this fine wor#. To my friends and families, they
were a great sour"e of suort and en"ouragement, we than# them all and wish them all the
best in their li!es. To m mother and father, for their warm, #ind en"ourage, and lo!e. To
e!ery erson ga!e me something to light our athway, we than# them for belie!ing in us .
Than# you all$..
%%
Table of Contents
Contents Page
A"#nowledgement %%
Table of &ontents %%%
Abstra"t %'
The First Chapter: Background and Significance
(.(. %ntrodu"tion )
(.*. +esear"h roblem ,
(.-. The resear"h .uestions /
(.0. The role of on"ology nurses ((
The Second Chapter: Literature revie
*.(. literature re!iew (1
*.*. Design and method (/
*.-. Dis"ussion **
*.0. %mli"ations *2
The Third Chapter: The !ethodology
-.(. &ommuni"ation in "an"er nursing --
-.*. 3nowledge informing "an"er "are -)
-.-. The emotional nature of "an"er nursing -/
-.0. Dis"ussion 0*
-.2. &on"lusion 0)
"eferences 0/
#bstract
As "an"er is the leading "ause of death worldwide, e!ery nurse will be re.uired to
"are for atients with the "ondition at some oint in his/her "areer. Howe!er, non4se"iali5ed
on"ology nurses are often ill4reared to nurse atients suffering from "an"er. This literature
re!iew aims to ro!ide an o!er!iew of "urrent trends and de!eloments in "an"er "are
nursing in an attemt to identify the range of re!ious resear"h ertaining to "aring for
%%%
atients with "an"er on non4se"ialist wards. The re!iew finds that non4se"iali5ed "an"er
nurses reort a la"# of edu"ation and training with regard to "an"er "are and "an"er
treatments, whi"h a"ts as a barrier to ro!iding .uality nursing "are. 6motional and
"ommuni"ation issues with atients and their families "an also "ause non4se"ialist nurses
signifi"ant distress. %nternational resear"h has shown that se"ialist on"ology nurses ma#e a
"onsiderable differen"e to hysi"al and sy"hoso"ial atient "are. %t is therefore aramount
that non4se"iality nurses7 edu"ational needs are met to de!elo "lini"al "ometen"e and to
ro!ide suorti!e holisti" "are for both atients and their families.
On"ology nursing "ontinues to e!ol!e in resonse to ad!an"es in "an"er treatment,
information and biote"hnology. As new s"ientifi" and te"hnologi"al dis"o!eries are
integrated into "an"er "are, on"ology nurses need to lay a #ey role in the management of this
atient oulation. The role of the on"ology nurse has e8anded signifi"antly and "an differ
greatly a"ross "ultures. 9ohisti"ated treatments and the growth of targeted theraies will
"reate the "hallenge of ensuring that all nurses wor#ing in this arena are well4edu"ated,
indeendent thin#ers. Thus the future su""ess of on"ology nurses will fo"us on enhan"ement
of nursing ra"ti"e through ad!an"ed edu"ation. The in"reased globali5ation of health"are
offers e8"iting oortunities to a""omlish this goal by allowing for "ollaborati!e
relationshis among on"ology nurses a"ross the globe.
%'
The First Chapter:
Background and Significance
$%$% &ntroduction
A""ording to Arnold : ;oggs <(//2= and ;al5er4+iley <(//)=, "ommuni"ation is a
re"iro"al ro"ess of sending and re"ei!ing messages using a mi8ture of !erbal and
non!erbal "ommuni"ation s#ills. Howe!er, 9heard <(//-= suggests that, in the nurse>
atient relationshi, "ommuni"ation in!ol!es more than the transmission of information? it
also in!ol!es transmitting feelings, re"ogni5ing these feelings and letting the atient #now
that their feelings ha!e been re"ogni5ed. Pelau <(/11=, 9e!erston <(//@=, Aosbinder <(//0=,
Bil#inson <(///=, Attree <*@@(= and Thorsteinsson <*@@*= suort this !iew and indi"ate that
"ommuni"ation is a fundamental art of nursing and that the de!eloment of a ositi!e
nurse>atient relationshi is essential for the deli!ery of .uality nursing "are. Howe!er,
&rotty <(/12=, +eid <(/12= and Hodges et al. <(/1)= also highlight that nurses do not
"ommuni"ate well with atients and aroa"h atients only to deal with administrati!e or
fun"tional a"ti!ities. Morse <(//(=, ;ergen <(//*=, Haggman4 Caitila : Astedt43ur#i <(//0=,
Darman <(//2=, Hostutler et al. <(///= and Darrett : Payne <*@@@= suggest that this is be"ause
nurses are not aware of the meaning and signifi"an"e of the nurse>atient relationshi for
atients. This la"# of awareness by nurses results in them ma#ing assumtions about what
nursing "are a atient needs or wants be"ause they do not as# atients <;ergen, (//*? ;ooth
et al., (//)=. This tye of "ommuni"ation is not atient4"entered and "an ad!ersely affe"t the
de!eloment of a ositi!e nurse>atient relationshi that is essential for the ro!ision of
.uality atient "are. Patient4"entred "ommuni"ation is defined by Cangewit5 et al. <(//1, .
*-@= as E"ommuni"ation that in!ites and en"ourages the atient to arti"iate and negotiate in
de"ision4ma#ing regarding their own "are7.
)
$%'% "esearch Proble(
This aer is about to dei"t the fa"tors that ha!e influen"es on nurses while "ommuni"ating
with "an"er4 atients, and the fa"tors that manage this relation and "ommuni"ation ro"ess%
can"er is a signifi"ant "ause of morbidity and mortality worldwide <Borld Health
Organi5ation <BHO=, *@@/=, and e!ery nurse will, at some stage of their "areer, "are for a
atient diagnosed with "an"er <3endall, *@@,=. Nurses are "hallenged with meeting the needs
of atients and their families through all stages of the "an"er traje"tory? from diagnosis,
through treatment, otential re"urren"e, sur!i!orshi or ossible death <Bil#inson, (///=.
The nursing "are of atients with "an"er has been des"ribed as stressful, "hallenging and
emotionally demanding <&orner, *@@*=, re.uiring ad!an"ed "ommuni"ation s#ills,
"ounselling s#ills and se"ialist theoreti"al and ra"ti"al #nowledge. On"ology atients and
their families7 hysi"al and sy"hoso"ial needs are generally not being met in non4se"ialist
"lini"al settings.The s"oe of rofessional nursing ra"ti"e has e!ol!ed o!er the years with a
shift towards in"reased se"iali5ation. Aurthermore, the de!eloment of nurses7 s"oe of
ra"ti"e has been des"ribed by &astledine <(//*= in the "onte8t of general and se"ialist
ra"ti"e. Feneral ra"ti"e has been des"ribed as general e8erien"e a"ross traditional
se"ialist domains of nursing, while se"ialist ra"ti"e in"ludes se"ifi" e8ertise in
arti"ular fields of nursing <&astledine, (//* .<
On"ology nursing is one area that has de!eloed as a se"ialist domain. The role of the
"lini"al nurse se"ialist and ad!an"ed nurse se"ialist in "an"er "are has long been
established in the G3 and more re"ently in %reland, arti"ularly in breast "an"er, alliati!e
"are, and "hemotheray administration. One rationale for the de!eloment of the role was to
"urtail health"are "osts and meet the "omle8 hysi"al and sy"hoso"ial needs of atients
with "an"er and their families <Billard and Cu#er, *@@,=. The nurse se"ialist role is
fundamental to atient4"entred "are, and "an"er se"ialist nurses ma#e a signifi"ant
,
"ontribution to the hysi"al, sy"hologi"al and so"ial "are of atients with "an"er both in the
hosital and in the "ommunity <9#ilbe"# and Payne, *@@-=. The "ore "ometen"ies for the
nurse se"ialist, a""ording to the National &oun"il for the Professional De!eloment of
Nursing and Midwifery <*@@1=, in"lude H
Ha!ing a "lini"al fo"us
A"ting as atient ad!o"ate
Gnderta#ing resear"h and audit
Tea"hing and edu"ating "olleagues and atients
A"ting as a "onsultant for the se"ialty .
Aurthermore, the "an"er nurse se"ialist is also e8e"ted to fulfill a further range of a"ti!ities
su"h as information gi!ing, symtom "ontrol, sy"hologi"al "are and so"ial suort, and to
be a atient ad!o"ate and e8ert in the ro!ision of alliati!e "are <Billard and Cu#er, *@@,=.
%n essen"e, the nurse se"ialist in "an"er "are enhan"es atient "are in a holisti" manner .
The a"#nowledgement of the "omle8ity of the needs of indi!iduals diagnosed with "an"er
and their families has led to an in"reased awareness of the need for se"ially trained and
edu"ated nurses <Hen#e4Iarbro, (//)=. Ne!ertheless, many atients with "an"er are "ared for
by non4se"ialist nurses both in hosital and in the "ommunity <Bood and Bard, *@@@=. The
aim of this literature re!iew is to ro!ide an o!er!iew of "urrent trends and de!eloments in
"an"er "are nursing in an attemt to identify the range of re!ious resear"h and a!ailable
#nowledge ertaining to "aring for atients with "an"er on non4se"ialist wards.
1
$%)% "esearch *uestions
This aer attemts to answer a few .uestionsH
*. Bhat is the "urrent need for &lini"al Nurse 9e"ialists in "an"er "areJ
-. Bhy are &lini"al Nurse 9e"ialists re.uired by eole li!ing with "an"erJ
0. Bhy are there in"onsisten"ies in a""ess to &lini"al Nurse 9e"ialistsJ
2. Bhat ima"t do &lini"al Nurse 9e"ialists ha!e in "an"er "areJ
). Bhat is the imortan"e of &ommuni"ation in "an"er nursingJ
,. Bhat are the fields or #inds of "ommuni"ation gi!en to "an"er4atientsJ
/
$%+% The role of oncology nurses
Histori"ally, nurses ha!e layed a se"ial role in the "are of atients with "an"er, a
role that was ese"ially signifi"ant in those few institutions de!oted e8"lusi!ely to "an"er
"are before the Gnited 9tates of Ameri"a National &an"er A"t of (/,(. Howe!er, the
re"ognition of "an"er as a major Ameri"an health roblem and the subse.uent e8anded
resear"h and treatment rogram against "an"er, whi"h has o""urred during the ast .uarter4
"entury, has been a "atalyst for the de!eloment of on"ology nursing as a searate se"ialty.
At first many on"ology nurses wor#ed as nurses and data managers for "an"er resear"h
studies, but as the treatments in on"ology be"ame in"reasingly "omle8 so did the need for a
"ollaborati!e relationshi between the nurse and hysi"ian in order to ro!ide uni.ue
"omrehensi!e atient "are.
Today on"ology nurses in the Gnited 9tates ra"ti"e in a !ariety of settings, in"luding
a"ute4"are hositals, outatient "lini"s, ri!ate on"ologists7 offi"es, radiation theray
fa"ilities, home health"are agen"ies and "ommunity agen"ies. They may ra"ti"e in surgi"al
on"ology, gyne"ologi" on"ology, bone4marrow translantation, radiation on"ology, ediatri"
on"ology or medi"al on"ology. The majority are in!ol!ed in dire"t atient "are, with -2
er"ent wor#ing in a hosital/multihosital system, 0@ er"ent in the outatient/ambulatory
"are setting, *@ er"ent in radiation on"ology, and 2 er"ent in hosi"e or home "areK. The
roles of the on"ology nurse !ary from the intensi!e "are fo"us of bone marrow translantation
to the "ommunity fo"us of "an"er s"reening, dete"tion and re!ention. On"ology nurses in
the G.9. also tend to se"iali5e in "ertain "an"er lung "an"er "lini"s.
Nurses wor#ing in "an"er "are fo"us on atient assessment, edu"ation, symtom
management, and suorti!e "are. %n medi"al on"ology they lay an integral role in the
administration of antineolasti" agents and are resonsible for safe drug handling? e!aluation
of laboratory data? "al"ulation of drug dosages on the basis of body surfa"e area? insertion of
(@
intra!enous lines or a""essing "entral !enous de!i"es? "ontinuous and time intensi!e
monitoring to address otential ad!erse rea"tions or drug intera"tions? and s"reening atients
for in"lusion in a!ailable resear"h trials or roto"ols. %n the radiation on"ology arena the
nurses need to ha!e an understanding of radiobiology and radiation hysi"s. They are also
resonsible for e8tensi!e symtom management, atient edu"ation and the submission
ro"ess for "lini"al trials or resear"h roto"ols.
As more "omle8 treatment roto"ols are imlemented, nurses wor#ing in on"ology
will need to e8and their #nowledge base on new drugs, new te"hnologies, and biologi"
theraies. Aor e8amle, The National &an"er %nstitute <N&%= announ"ed in Danuary *@@) that
intraeritoneal <%P= "ombined with %' "hemotheray ostoerati!ely was the referred
treatment method for ad!an"ed o!arian "an"er. %P administration allows a high "on"entration
of "hemotheray to "ome into dire"t "onta"t with tumors and surrounding tissues and organs.
The announ"ement stimulated the need for on"ology nurses to be"ome familiar with %P
"hemotheray administration and atient management guidelines. These atients re.uire
"onstant monitoring of renal and "ardia" fun"tion through laboratory !alues as well as inta#e
and outut to re!ent fluid o!erload and ele"trolyte imbalan"es. The atients also need
ad!an"ed nursing assessment to re!ent any "omli"ations from the infusion.
Ad!an"es in mole"ular s"ien"e ha!e led to new biologi" theraies for atients with
"an"er. These biologi"al agents ha!e "reated a "hallenge and re.uire nurses to ha!e a
thorough understanding of their me"hanism of a"tions and side effe"t rofile. Patients may
"ontinue on these medi"ations at home thus re.uiring the nurse to do a "omlete assessment
of the #nowledge le!el of the atient and/or "aregi!ers regarding the rearation and
administration of the medi"ation at home, as well as management of ossible side effe"ts in
the home setting.
((
%n Asian "ountries the role of the on"ology nurse "ontinues to e8and as "an"er
be"omes a leading health "on"ern. Howe!er, a"ross Asia there is growing a"#nowledgement
of the need to "larify the role of nurses in order to ma8imi5e their "ontribution to "an"er "are.
Asia has many fa"es and is e8traordinary in its di!ersity of "ultures, habits, and health"are
systems. On"ology nurses in Asia fun"tion mainly in a "aregi!er role fo"using on treatment
deli!ery, edu"ation and symtom management. 9e"iali5ation is rarely seen. A study in *@@2
by Foal et al loo#ed at information needs of women with newly4diagnosed breast "an"er in
Malaysia and the Gnited 3ingdom. Malaysian women in this study emhasi5ed the
imortan"e of medi"al information on rognosis and sread of disease and the need for more
edu"ation. Although nurses se"iali5ing in breast "an"er are not features of the Malaysian
health"are system, the findings from this study suort the !iew that se"iali5ed nurses may
ha!e a !ital role to lay .
9tandards of ra"ti"e and "ometen"ies for on"ology nurses aear to be similar a"ross
"ontinents . On"ology nurses in an outatient medi"al on"ology "lini" in Thailand, just as in
the G.9., are resonsible for starting their own intra!enous lines, triaging atient hone "alls,
"al"ulating absolute neutrohil "ounts, administering "hemotheray and reorting all rele!ant
laboratory, athology and imaging studies. %n Thailand "hemotheray is generally mi8ed by
the harma"y e8"et in smaller hositals where the nurses are re.uired to mi8 their own.
Gnli#e the G.9., double4"he"#ing the dose of "hemotheray by "al"ulating the body surfa"e
area <;9A= is the resonsibility of the harma"ist. %n radiation on"ology the nurses on"e
again ha!e similar "ometen"ies to those nurses in the G.9. with a fo"us on symtom
management and atient edu"ation.
Gni!ersally the on"ology nurse has tremendous resonsibility in edu"ating the atient about
his or her "an"er treatment and often has better oortunities than any other member of the
health"are team to re!iew the treatment lan. Howe!er, for some Asian "ountries the
(*
"hallenges of edu"ation e8tend well beyond diagnosis and treatment. %n "ertain areas a
diagnosis of "an"er is taboo and rarely dis"ussed within the family and ne!er with outsiders.
Aor e8amle, breast "an"er literature in Malay languages, e!en in the offi"ial ;ahasa Melayu
language, did not e8ist largely be"ause of "ultural mores regarding ri!a"y about womenLs
bodies, la"# of edu"ation about the disease and the la"# of ubli" hositals to res"reen
women and ro!ide early diagnosis as well as treatment otions.
The use of alternati!e medi"ines is also a "ommon ra"ti"e in Asian "ountries and
on"ology nurses in these areas need to be familiar with the role su"h medi"ines lay in "an"er
treatment. A""ording to the Borld Health Organi5ation <BHO=, u to 1@ er"ent of
de!eloing "ountriesL oulations use traditional medi"ines as their rimary sour"e of health
"are . Those diagnosed with "an"er in 9outheast Asia will routinely find the lo"al do"torLs
"hoi"e of treatments something many medi"al insurers "onsider unusual. Outside major "ities
in la"es li#e &hina, for instan"e, herbal treatments are used regularly . Although alternati!e
theraies are be"oming more "ommon in the G9, the on"ology nurses in Asia must routinely
edu"ate atients regarding the use of su"h alternati!e treatments within the "onte8t of
different "ultural !alues. Aurthermore, it is not unusual for a atient to be offered treatment
with standard Besternstyle roto"ols with the addition of alternati!e theray.
FUTU", OF O-COLO./ -U"S&-.
%t has been estimated that there will be another *@ million new "an"er atients
worldwide in *@*@ . %n the de!eloing "ountries of Asia this oses a huge burden on an
already ta8ed health"are system. Bhen the rise in "an"er rates is "ouled with "on"urrent
theraies, targeted theraies and ad!an"ed treatment te"hnology, the need for ad!an"ed
ra"ti"e nurses be"omes e8tremely imortant. 6nhan"ing the on"ology nurse7s edu"ation is
(-
the main goal of the future and will allow nurses to ha!e a greater "ontribution to "an"er "are
in de!eloing "ountries.
As stated re!iously, throughout Asia there is great di!ersity of edu"ational
rearation. Nurses are, at best, gi!en a broad o!er!iew of "an"er "are in their basi"
edu"ational rograms, yet to ra"tise in on"ology, nurses must .ui"#ly learn the language of
this dis"iline. 6a"h tye of "an"er has a different etiology, athohysiology, natural history
and "ourse of treatment. The number of "hemotheraeuti" agents and drug "ombinations, as
well as targeted agents being added to treatment regimes is staggering. %n radiation on"ology,
ad!an"es in te"hnology ha!e led to more defined treatment and a greater need for atient
edu"ation.
A de"ade ago, an on"ology nurse "ould be"ome an e8ert in one treatment modality
su"h as surgi"al, medi"al or radiation on"ology. Now atients fre.uently re"ei!e "on"omitant
and se.uential theraies that re.uire assessment and management s#ills for all three
modalities. Nurses now ha!e subse"ialties su"h as breast "are nurses, alliati!e "are nurses,
stem4"ell translant nurses and so on. %n the larger "ities of Asia, nurses may be familiar with
newer te"hnology, but more edu"ation is needed for nurses wor#ing in remote, lessde!eloed
areas of the "ountry. As rele!ant health"are systems are ut in la"e to manage the raidly
in"reasing numbers of "an"er diagnosed in this art of the world, there will be a greater need
for edu"ation of on"ology nurses who ha!e ne!er been e8osed to managing s#in rashes from
targeted theraies or radiation theray e.uiment. Aor instan"e, the BHO estimates that the
Asia4Pa"ifi" region needs 0,@@@ radiotheray ma"hines to treat its atients, but has only (,*@@
. %f an in"rease in radiotheray "entres is the future of "an"er "are in this area, then many
more nurses will need to be"ome e8erts in radiation on"ology.
Although some "ountries re.uire their nurses to ha!e "ontinuing edu"ation "redits,
this is not the standard for all "ountries. Programs fo"using se"ifi"ally on on"ology are rare
(0
for nurses ra"tising outside a major "ity. This lea!es a la"# of further edu"ation on newer
treatment modalities.
On"ology nurses in Asia will also need to ta#e an a"ti!e role in de!eloing re!ention
rograms for "an"er. The raid rate of e"onomi" de!eloment in some Asian "ountries, along
with the a""omanying industriali5ation and urbanisation, are "ontributing to an e!er4
in"reasing ris# of "ommon "an"ers. %n Thailand 2, er"ent of boys begin smo#ing between
the ages of (2 and *@, and unfortunately most "ountries in Asia ha!e wea# oli"ies and
rograms for toba""o "ontrol .
Abundant e!iden"e in the G.9. has demonstrated the benefits of the ad!an"ed nursing
ra"ti"e . %n the de!eloing "ountries of Asia, ad!an"ed on"ology nurses "an also be
instrumental in "reating "an"er re!ention rograms. Aor e8amle, "er!i"al "an"er is the most
"ommon "ar"inomatous lesion in women in Thailand, a""ounting for (1.( er"ent of all
"an"ers found in Thai women . %n *@@*, the Allian"e for &er!i"al &an"er
Pre!ention and the Thai Ministry of Publi" Health <MOPH= e8amined an inno!ati!e aroa"h
to "er!i"al "an"er re!ention in Thailand . Twel!e nurses with ad!an"ed training used !isual
e8amination of the "er!i8 with a"eti" a"id <'%A= and "ryotheray to ro!ide testing and
treatment to women in a rural area of the "ountry. O!er , months, 2,/// women were tested
for "er!i"al "an"er or re4"an"er with '%A. %f they tested ositi!e, they were gi!en
"ounseling and offered "ryotheray and further "ounseling regarding its benefits. The results
of the roje"t indi"ated the '%A and "ryotheray erformed by ad!an"ed ra"ti"e nurses was
safe and feasible. Moreo!er it ro!ided a "ost4effe"ti!e aroa"h to ro!iding "an"er
s"reening and treatment to women in the rural areas of Thailand where a more traditional
aroa"h to "an"er re!ention is low .
(2
The Second Chapter:
Literature revie
()
'%$% Literature "evie
%n order to in!estigate trained nurses7 self4er"etion of their "ommuni"ation s#ills, ;urnard
: Morrison <(/11, (/1/, (//(= "ondu"ted studies using Heron7s si84"ategory inter!ention
analysis. The findings of these studies were "onsistent, in that the arti"iants generally
er"ei!ed themsel!es to be more s#ilful in the authoritati!e than fa"ilitati!e "ategories. The
authoritati!e inter!entions attemt to dire"t or "ontrol atient beha!iour while the fa"ilitati!e
inter!entions attemt to emower the atient. ;urnard : Morrison <(/11, (/1/, (//(=
roose that the findings of their studies be used as a basis for lanning and de!eloing
edu"ation rogrammes for training and resear"h into nurses7 interersonal "ommuni"ation
s#ills. Howe!er, the findings of these studies are limited by the use of Heron7s framewor#
be"ause it does not ta#e a""ount of how "onte8tual differen"es influen"e whi"h inter!ention
is used by nurses and it is imossible to #now to what degree nurses fo"used on their
intentions or a"tual beha!ior in nurse>atient intera"tions. Therefore, the rele!an"e of the
findings for "hanging or de!eloing nurses7 interersonal "ommuni"ation s#ills "an only be
!iewed tentati!ely. Ashmore : ;an#s <(//,= "on"ur with this !iew and re"ommend that
further e8loration of atients7 er"etions of nurses7 "ommuni"ation s#ills be "ondu"ted. %f,
as ;riggs <(/1*=, Ma"leod &lar# <(/12=, 9e!erston <(//@=, Aosbinder <(//0= and Oermann et
al. <*@@@= suggest, good "ommuni"ation is essential for .uality nursing "are, then it is
imerati!e that nursing resear"h eli"its atients e8erien"es of nurse>atient "ommuni"ation
and identifies what they !alue most in their intera"tions with nurses <Haggman4 Caitila :
Astedt43ur#i, (//0=. 9u"h information "an inform nursing theory and edu"ation and,
therefore, allow nurses to de!elo atient4"entred "ommuni"ation s#ills that are fundamental
to the deli!ery of .uality nursing "are.
Another !iew resented by Men5ies <(/)@, (/,@=, ;urton <(/12=, M"Mahon <(//@=, Telford
<(//*= and &hant et al. <*@@*= suggests that nurses do not "ommuni"ate well be"ause of the
(,
organi5ational "ulture. Traditionally nurses were not en"ouraged or suorted by ward or
hosital management to establish theraeuti" relationshis with atients. A""ording to
Men5ies <(/)@, (/,@= the reason for this is to rote"t nurses from diffi"ult emotional
situations, thereby re!enting stress. 9tudies by Bil#inson <(//(= and M"&oll et al. <(//)=
"ondu"ted *2 years later "on"ur with this. They found that nurses ha!e the ne"essary s#ills to
"ommuni"ate well with atients but "hoose not to be"ause of the la"# of organi5ational
suort and en"ouragement. %t aears that, o!er the last 0@ years, this organi5ational strategy
to re!ent stress has resulted in a so"iali5ation ro"ess that has eretuated the notion in
nursing that atient4"entred "ommuni"ation should be dis"ouraged and is unsuorted by
management <Bil#inson, (//(? Fraham, (//0? &ody, (//1? Billiams, (//1=. ;owles et al.
<*@@(= suorts this !iew and adds that "riti"ism of nurses7 "ommuni"ation may be
unrealisti" as no ben"hmar# for effe"ti!e nurse>atient "ommuni"ation "urrently e8ists.
Howe!er, in order to establish a ben"hmar# for effe"ti!e nurse>atient "ommuni"ation it is
essential to dis"o!er atients e8erien"es and !iews.
'%'% 0esign and (ethods
The urose of this study was to e8lore and rodu"e fa"tors relating influen"ing nurses
relation with "an"er atients and how nurses "ommuni"ate with them. A .ualitati!e
erse"ti!e using a Heideggarian/Fadamarian hermeneuti" henomenologi"al aroa"h was
"hosen for this study be"ause it is "on"erned with rea"hing a new understanding of the
meaning of the henomenon <nurse>atient "ommuni"ation= being studied as e8erien"ed by
the arti"iants <Co;iondo4Bood : Haber, (//1=. The site "hosen for this study was a
general hosital in the +eubli" of %reland and ethi"al aro!al was granted by the Hosital7s
ethi"s "ommittee.
(1
Sa(pling
Gsing uroseful samling, eight atients agreed to arti"iate in the study. Puroseful
samling is where the arti"iants are sele"ted rior to the study on the basis that they ha!e
e8erien"e of the henomenon being studied and "an arti"ulate this e8erien"e <Holloway :
Bheeler, (//)? Mays : Poe, (//)=. 6a"h arti"iant ro!ided written "onsent and "hose a
seudonym that was the only identifi"ation used on any do"umentation related to the study,
thus ensuring their anonymity. The arti"iants in"luded three males and fi!e females whose
ages ranged from the mid4*@7s to early ,@7s and who had been inatients for a minimum of 0
days. This meant that ea"h arti"iant would ha!e "ommuni"ated regularly with nurses
during their stay.
0ata collection
Data were "olle"ted using unstru"tured inter!iews that were tae re"orded and lasted -@
minutes on a!erage. 6a"h inter!iew began with me as#ing the arti"iant to tell me about
his/her e8erien"es of how nurses "ommuni"ated with her/him during their time as an
inatient. The arti"iants were as#ed to "larify and elaborate on "ertain issues as this heled
the resear"her to understand the meaning of the e8erien"e of how nurses "ommuni"ated for
indi!idual atients. At some stage during most of the inter!iews the arti"iants tal#ed about
issues unrelated to nurse>atient "ommuni"ation. Holloway : Bheeler <(//)= refer to this as
Edross7 and say that unstru"tured inter!iews will always "ontain a "ertain amount of irrele!ant
material. %n order to re4fo"us the arti"iants during inter!iews % as#ed the same .uestion E%f
you had to des"ribe the .ualities re.uired to be a good "ommuni"ator, what would you say
they were7J This was suffi"ient to re4fo"us the dire"tion of the inter!iew.
(/
0ata analysis
The aim of data analysis in henomenologi"al resear"h is to re!eal the meaning of the li!ed
e8erien"e of the henomenon being studied for the arti"iants. A""ording to ;ergum
<(//(= and +ay <(//0= data analysis in hermeneuti" henomenologi"al resear"h is a refle"ti!e
ro"ess. Data analysis in this study was a refle"ti!e ro"ess using the metahor of the
Ehermeneuti" "ir"le7 to e8lain the dynami" nature of gaining an understanding of a
henomenon <Annells, (//)= and referen"e to Fadamer7s Efusion of hori5ons7 to e8lain how
the resear"her "ame to a new understanding of the meaning for atients of nurse>atient
"ommuni"ation. This is resented through the des"rition and interretation of themes and
sub4themes. %n order to demonstrate trustworthiness in this study 9andelows#i7s <(/1)=
framewor# was used. This framewor# "omrises four fa"tors that are essential for
demonstrating trustworthiness. These fa"tors areH "redibility, fittingness, auditability and
"onfirmability. The "redibility of this study was a"hie!ed by in"luding an inter!iew trans"rit
and a thi"# des"rition of one of the themes in the final reort. As no ersonal information
was re"orded during the inter!iews, all audiotaes used to re"ord the inter!iews ha!e been
retained by the resear"her as a re"ord of data authenti"ity. Aittingness o""urs when the
findings of a study Efit7 into similar "onte8ts outside the study. The literature used to dis"uss
the findings demonstrates its fittingness. Auditability of this study was a"hie!ed by re"ording
details e8laining and justifying any de"isions made regarding the study in a refle"ti!e
journal and in"ororating this information into the final reort as a Ede"ision trail7. The
"onfirmability of this study arises from its "redibility, fittingness and auditability
<9andelows#i, (/1)=.
*@
'%)% 0iscussion
ECa"# of "ommuni"ation7 was the theme referred to most fre.uently by the
arti"iants in this study. They "ommented on how nurses were more "on"erned with
"omleting their Etas#s7 than tal#ing to them. 9ome of the arti"iants were frustrated by this
and felt that the nurses did not "are about them as indi!iduals. Other arti"iants
a"#nowledged that nurses were more "on"erned with their wor# and a""eted this as being
normal, although they did indi"ate that they would ha!e li#ed to be treated as an indi!idual.
Howe!er, regardless of how the arti"iants felt about how nurses "ommuni"ated, they did
not blame them. They all attributed the nurses7 oor "ommuni"ation s#ills to them being Etoo
busy7. Pontin : Bebb <(//2= and Attree <*@@(= suggest that atients are relu"tant oenly to
"riti"i5e nurses be"ause of a fear of retribution or the assi!e nature of the atient role or
a""etan"e of the national health "are deli!ery. They roose that instead atients Ewra u7
their "riti"isms in so"ially a""etable resonses <Pontin : Bebb, (//2=. This tye of
"ommuni"ation is arti"ularly e!ident in the resonses from the arti"iants in this study.
Howe!er, it remains !ery "lear from the arti"iants7 resonses that nurses do not always
"ommuni"ate in a atient4"entred way. A""ording to 9ines <(//2= atients be"ome
emowered by a atient4"entred aroa"h to "ommuni"ation. %t allows them to be a artner in
ma#ing de"isions about their own needs rather than the nurses ma#ing assumtions about
what their needs are <9ines, (//2=. Patient4"entred "ommuni"ation does not ta#e u more of
the nurses7 time or re.uire e8tra resour"es <Astedt43ur#i : Haggman4Caitila, (//*?
Billiams, (//1=, it is initiated by nurses in the words and body language that they "hoose to
use when aroa"hing atients.
A ossible reason why nurses do not always "ommuni"ate in a atient4"entred way is
that although they ha!e the ne"essary "ommuni"ation s#ills, they "hoose to use tas#"entred
*(
"ommuni"ation as a rote"tion me"hanism against emotional or ad!o"a"y ase"ts of their
wor# <9ines, (//2? 3ruij!er et al., *@@(=. This "ould be be"ause they feel unsuorted or
e!en dis"ouraged from "ommuni"ating in a atient4"entred way by management <M"Mahon,
(//@? Bil#inson, (//(? Telford, (//*=.
The se"ond theme that emerged from the data was Eattending7. Bhen the arti"iants
e8erien"ed some or all of these beha!iours they felt reassured, safe and "ared for as an
indi!idual. Attending beha!iours as e8erien"ed or !alued by the arti"iants in this study do
not re.uire e8tra time or resour"es. 3nowing that they "an trust the nurses to be oen/ honest,
understanding and be a!ailable if they needed them was the le!el of "ommitment re.uired by
the arti"iants. Howe!er, the effe"ti!e use of attending beha!iours by nurses re.uires that
they !alue atient4"entred "ommuni"ation
<Arnold : ;oggs, (//2= and ha!e a strong sense of selfawareness <;urnard, (//@=.
The third theme that emerged from the data is Eemathy7. 6mathy is defined by
+eynolds : 9"ott <*@@@=, . **)= asH
the ability to er"ei!e and reason as well as the ability to
"ommuni"ate understanding of the other erson7s feelings and their atta"hed meanings$
+eynolds : 9"ott <*@@@= des"ribe emathy as an essential rere.uisite for good nursing
ra"ti"e. %f nurses fail to emathi5e with their atients, then they "annot hel them to
understand or "oe effe"ti!ely as indi!iduals with their illness
<Morse et al., (//*? Pelau, (//,? +eynolds : 9"ott, *@@@=. Most of the arti"iants had
ositi!e e8erien"es of ematheti" "ommuni"ation by nurses. Howe!er, one arti"iant also
**
e8erien"ed non4ematheti" "ommuni"ation. This made her feel unhay, un"omfortable and
un"ared for. Although the issues that she refers to are hysi"al needs, it is imortant to note
that, by not meeting the arti"iants7 hysi"al needs, the nurses were failing to "ommuni"ate
to her that they understood her redi"ament or needs. This suorts the !iew that ematheti"
"ommuni"ation is an essential rere.uisite for the deli!ery of .uality nursing "are. ;e"ause of
the ositi!e influen"e that ematheti" "ommuni"ation and the negati!e influen"e non4
ematheti" "ommuni"ation has on atients, it is essential that nurses are aware of the ima"t
of the way they "hoose to "ommuni"ate has on their atients. The imli"ations are that nurses
who "hose to use nonematheti" "ommuni"ation fa!our tas#4"entred rather than atient4
"entred "ommuni"ation. A""ording to Fould <(//@= the rofessional so"iali5ation of nurses
en"ourages them to lose their indi!iduality and lose the natural ability to emathi5e. This
"on"urs with the literature <Men5ies, (/)@, (/,@? ;urton, (/12? M"Mahon, (//@? Telford,
(//*? Fraham, (//0? M"&oll et al., (//)= whi"h suggests that the rofessional so"iali5ation
of nurses results in tas#4"entred "ommuni"ation rather than atient4"entred "ommuni"ation.
The fourth theme that emerged from the data referred to Efriendly nurses7. All of the
arti"iants in the study raised the nurses for being friendly, "hatty and humorous. This
fulfilled an imortant so"ial fun"tion by rela8ing the arti"iants, assing the time and
heling them to forget their troubles. A ossible reason why all the nurses used humour and
were friendly and "hatty was that they er"ei!ed it as a suerfi"ial le!el of "ommuni"ation
that "reates an atmoshere that although rela8ed and so"iable, is unsuitable for dealing with
emotional or diffi"ult issues. The nurses, therefore, felt relati!ely safe "ommuni"ating this
way with all the arti"iants.%n "ontrast, although they "an be suerfi"ial, so"ial intera"tions
gi!e atients the oortunity to ste out of their si"# role and a""ording to 9umners <(//@=
and Astedt43ur#i<*@@(= humour in the nurse>atient relationshi hels to establish raort
*-
and trust, relie!es an8iety and tension and "on!eys unso#en emotional messages. This is
e!ident from the findings of this study. The arti"iants aeared to !alue highly the informal
humorous e8"hanges with the nurses. This tye of "ommuni"ation "an hel to ass the time
and defle"t from mundane, routine hosital life and atients are fre.uently instrumental in
"reating su"h intera"tions <Holloway et al., (//1? Darrett : Payne, *@@@=.
'%+% &(plications
The arti"iants in this study indi"ate that nurses do not always "ommuni"ate in a
atient4"entred way e!en when they ha!e the ability to do so and that nurse>atient
intera"tion is hea!ily influen"ed by the wor# and "ulture of the organi5ation <Darrett : Payne,
*@@@=. Howe!er, the literature <Pelau, (/11? 9e!erston, (//@? Aosbinder, (//0? +edfern :
Norman, (///? Thorsteinsson, *@@*= suggests that a ositi!e nurse> atient relationshi is
essential for .uality nursing "are and that this "an only be a"hie!ed through atient4"entred
"ommuni"ation. The imli"ations of this are that, if health "are management want to ensure
that atients re"ei!e .uality nursing "are, they will need to "onsider ositi!e nurse>atient
"ommuni"ation as essential and not an otional e8tra <Attree, *@@(? &hant et al., *@@*=.
9ending long eriods of time with atients does not always result in a ositi!e nurse>atient
relationshi. Astedt43ur#i : Haggman4Caitila <(//*= suggest that atient4"entred
"ommuni"ation does not re.uire additional resour"es. This imlies that staff shortages or
being Etoo busy7 "annot be used as an e8"use for oor nurse> atient "ommuni"ation. %t is the
.uality of the intera"tion that determines whether the relationshi is a ositi!e one or not and
it is the nurse who has the greatest influen"e on whether this haens <Milne : M"Billiam,
(//)=. &ommitment to ro!iding atient4"entred "are and a "hange in indi!idual,
rofessional and organi5ational !alues is suffi"ient <Attree, *@@(= in order to result in the
deli!ery of high .uality nursing "are.
*0
At an undergraduate and ostgraduate le!el, edu"ation relating to atient4"entred
"ommuni"ation should fo"us on illustrating that this tye of "ommuni"ation does not re.uire
a great deal of time. +ole4lay and the use of "riti"al in"iden"es is an ideal way of heling
students and staff nurses to "riti"ally refle"t on how they "ommuni"ate with atients <Muinn,
(//2=. This would also hel to de!elo their sense of self4awareness and subse.uently
in"rease their ability to "ommuni"ate using attending and ematheti" "ommuni"ation
beha!iours. The "onse.uen"e of this in "onjun"tion with other organi5ational fa"tors is the
deli!ery of high .uality nursing "are. This tye of tea"hing strategy would re.uire small
grou tea"hing and this has imli"ations for how large undergraduate grous of students are
organi5ed for the effe"ti!e use of su"h strategies. The findings of this study and similar
atient4fo"used studies "ould, howe!er, be used to inform e!en large grous of nursing
students about what atients !alue about nurse>atient "ommuni"ation.
There is a need to "ondu"t further resear"h that e8lores atients7 e8erien"es of how
nurses "ommuni"ate rather than "ondu"ting studies that e8amine nurses7 !iews of what they
er"ei!e good nurse>atient "ommuni"ation to be. Patient fo"used studies may identify
se"ifi" nursing beha!iours that atients !alue highly in terms of atient4"entred
"ommuni"ation. This #ind of information would allow nurses to demonstrate and de!elo
se"ifi" interersonal s#ills that are atient4"entred. A ossible limitation to this study is that
the small number of arti"iants means that the findings "annot be generali5e to a wider
"onte8t or oulation, howe!er, the findings are useful in that they "an be used to inform
undergraduate and ostgraduate nursing students about the ossible ima"t of their
"ommuni"ation beha!iour on the deli!ery of .uality nursing "are.
*2
0ealing ith the research 1uestions
(4 6a"h year just under *,@,@@@ eole are diagnosed with "an"er in 6ngland. There are
"urrently two million eole li!ing with "an"er and it is estimated that this will double
to four million eole by *@-@ as in"iden"e in"reases due to an ageing and growing
oulation and treatments imro!e. +esear"h shows that "urrent models of "are are
not identifying or meeting the needs of all atients li!ing with "an"er and the "urrent
"an"er wor#for"e needs to adat to imro!e "are and suort for "an"er atients. The
role of the #ey wor#er needs to be"ome embedded in ra"ti"e and the "urrent and
future wor#for"e need to be de!eloed with se"ifi" s#ills and se"ialist #nowledge in
"an"er, for e8amle understanding and suorting the management of "onse.uen"es
of "an"er treatment. The "an"er journey is "omle8 and disjointed and in!ol!es the
"are inter!entions from !arious multisite rofessionals su"h as on"ologists, surgeons
and "ounselors. The &N9 role ro!ides and reinfor"es rele!ant information and
aroriate liaison with other rofessionals and agen"ies to imro!e the "an"er "are
ro"ess for atients.
The main fun"tions of the se"ialist nurse role "an be des"ribed as te"hni"al, information
ro!ision, emotional suort and "oordination.
Emotional support should be accessible to all patients, as psychological wellbeing is
important when so much has to be faced. Often the psychological aspect of breast cancer is
not considered a high priority by health professionals. Although this is understandable when
their focus is on clinical issues, it should be an integral part of the overall care. The role of
CNs is crucial in this respect!
The suorti!e "are and information elements of the "an"er &N9 role in"lude%H
ro!iding suort at initial diagnosis
ro!iding indi!idualised information
*)
ro!iding suort with treatment de"ision ma#ing
ro!iding ad!i"e on management of symtoms and side effe"ts
ro!iding suort and assistan"e with ra"ti"al issues su"h as finan"e
ro!iding emotional and basi" sy"hologi"al suort
signosting to se"ialised suort ser!i"es
being a named and readily a!ailable "onta"t for the atient
running diagnosti" or follow4u "are "lini"s.
Desite this, only half of resondents of a *@@) sur!ey reorted that a nurse was in!ol!ed in
the management of their "ondition,. %n addition, ,2N of "an"er sur!i!ors in *@@/ did not
#now who to "onta"t for ad!i"e outside of offi"e hours and 0-N would ha!e li#ed more
information and ad!i"e.
*4 A *@@1 +oyal &ollege of Nursing <+&N= sur!ey re!ealed the s"ale of the otential loss of
&N9 e8ertise. More than a third of &N9s said their organisations had a !a"an"y free5e in
la"e, almost half reorting being at ris# of being downgraded and )1 er "ent had to see
more atients. The sur!ey also re!ealed that ( in 0 se"ialist nurses were at ris# from
redundan"y and 02N were as#ed to wor# outside their se"ialty to "o!er staff shortages.
A""ess to "an"er &N9s !aries both geograhi"ally and by tumour site, leading to ine.ualities
in atient e8erien"e. On a!erage, there is only one lung "an"er nurse in 6ngland for e!ery
()( eole diagnosed with lung "an"er, "omared to ((, eole er breast "an"er nurse.
Although there has been a small in"rease in &N9 osts sin"e *@@, in brain/"entral ner!ous
system, lung, uer gastrointestinal and haematologi"al "an"ers, the in"rease is insuffi"ient to
#ee a"e with the "urrent growth in "an"er re!alen"e.
*,
A *@@, sur!ey of breast "are nurses found that almost 2@N of nurses felt unable to ro!ide
the .uality of "are to all breast "an"er atients that they would li#e to. This was due to a
!ariety of reasons in"luding in"reased wor#load be"ause of new, additional duties, staff
shortages, and redeloyment to other areas, e.g. general wards. There is in"onsisten"y in job4
titles of roles that "an be "ategorised as a &N9. +e"ent resear"h found that almost 2@
different job titles are in use for nurse se"ialists wor#ing in the field of urologi"al "an"ers.
%n"onsisten"y in job titles has also been related to ambiguity in terms of the re.uirements and
duties of the &N9 role. %n addition the se"ifi" ser!i"es offered by &N9s may !ary a"ross the
"an"er "are athway as there is no minimum standard for the s#ills and #nowledge re.uired
to fun"tion in a nurse se"ialist role.
-4 &(proving 1uality and e2perience of care
The 6nglish go!ernment7s "an"er reform strategy <&+9= highlights that atients regularly
emhasise the role of the &N9 in imro!ing their "an"er e8erien"e The results of the
*@((/(* National &an"er Patient 68erien"e 9ur!ey suort this. 1,N of atients reorted
that they had been gi!en the name of a &N9. Of these o!er /(N reorted that the &N9 had
listened "arefully and that they got understandable answers from the &N9 all or most of the
time. Patients with a &N9 resonded far more ositi!ely than those without on a range of
items related to information, "hoi"e and "are. +e"ent resear"h into "omle8 treatment
de"isions for atients with ad!an"ed lung "an"er showed that &N9s lay a !aluable role in
suorting de"ision ma#ing and are seen as trusted sour"es of information.
The National Cung &an"er Audit *@(@ shows that in *@@/ )0.1N of atients seen by a lung
&N9 re"ei!ed "an"er treatment "omared to -@.0N of those who did not see a lung &N9, The
audit "olle"ted data on more than -,,@@@ atients in the G3 and Northern %reland,
reresenting aro8imately /2N of the e8e"ted number of new lung "an"er "ases. A G3
*1
sur!ey of the e8erien"es of men with rostate "an"er found that se"ialist nurses were
ran#ed the highest by men, in terms of health"are rofessionals and hel4lines, for the
ro!ision of emotional suort around the time of diagnosis and treatment de"ision4ma#ing.
+esear"h has shown that signifi"antly more atients who re"ei!ed nurse led follow u from
lung "an"er &N9s died at home rather than in a hosital or hosi"eH 0@N "omared to *-N
re"ei!ing "on!entional medi"al follow u. Additionally, in *@@/ )2N of eole with lung
"an"er seen by a lung &N9 re"ei!ed "an"er treatment "omared to -@N of those who did not
see a lung &N9. A *@@/ study of rheumatology "lini"al nurse se"ialists showed that almost a
.uarter of hysi"al "lini"al inter!entions in!ol!ed enhan"ing self4management rin"iles and
managing unresol!ed symtoms using se"ialist #nowledge and assessment.
&N9s hel imro!e atients e8erien"e and safety*1 be"ause they ha!e in deth #nowledge
of the hysi"al, sy"hologi"al and so"ial effe"ts of a se"ifi" "ondition and lay a #ey role in
the management of atient "are. They ha!e "onsiderable e8erien"e, are highly .ualified and
"arry out a range of fun"tions that ma#e them a #ey member of a multi dis"ilinary team
<MDT=. Patient safety and le!el of inade.uate staffing are often interlin#ed. ;etween Aril
*@@1 and Mar"h *@@/ more than --,@@@ atient safety in"idents were re"orded as relating to
the la"# of suitably trained or s#illed staff. &an"er &lini"al Nurse 9e"ialists "oordinate ward
admissions for atients who are unwell, e8edite outatient "lini" aointments, reorganise
re!iews to minimise "an"elled ro"edures or oerations and gi!e ad!i"e on managing
medi"ation throughout the "an"er journey. This enables atients to mo!e through the system
as smoothly as ossible and di!erts ressure away from other rofessionals su"h as do"tors
and the ward nursing team. A study in *@@/ to monitor the "omle8 wor#load of &N9s in
rheumatology "are re!ealed the imortan"e of &N9s in ro!iding safe ad!i"e on medi"ation,
showing that more than a .uarter of hysi"al "lini"al inter!entions in!ol!ed management of
*/
medi"ation in"luding dealing with to8i"ity and res"ue wor# asso"iated with the une8e"ted
ad!erse effe"ts of treatments.
A *@(@ Deartment of Health reort illustrates the ability for &N9 roles to influen"e, lead
and ad!an"e ra"ti"e and demonstrates the e8tent to whi"h ad!an"ed nursing ra"ti"e "an
suort ositi!e atient out"omes. 9e"ialist nurses ha!e a mu"h greater role in the deli!ery
of health"are than they had fi!e years ago. ;etween *@@2 and *@(@ the number of referrals to
a se"ialist nurse "lini" rose from ((2,@@@ to )2@,@@@a? an a!erage in"rease of aro8imately
(@,,@@@ a year. %t is therefore e!ident that FPs and "onsultants are a more li#ely now than
e!er to refer atients to se"ialist nurses. &an"er &N9s ha!e "learly demonstrated their
"ommitment to wor# "ollaborati!ely with their "olleagues to ensure that atients ha!e a""ess
to best ra"ti"e, e.uity of "are and "ontinuity of "are throughout the "an"er journey. &N9s
ro!ide suort to their "olleagues and "an be seen as e8erts by other members of the MDT,
ro!iding se"ialist ad!i"e and guidan"e to "olleagues on a range of issues in"luding
symtom "ontrol and atient "ommuni"ation. &N9 e8ertise is essential to the fun"tioning of
MDTs and they are often nominated as the E#ey wor#er7 within the team.
-@
The Third Chapter:
-ursing 3 Cancer
-(
)%$% Co((unication in cancer nursing
Food "ommuni"ation is a"#nowledged as the "ornerstone of nursing and is essential to the
deli!ery of effe"ti!e atient "are <Thorne, (///? Ceydon et al, *@@@=. Howe!er, many of the
studies re!iewed identified "ommuni"ation with atients with "an"er as a signifi"ant sour"e
of "on"ern and an8iety for both atients and nurses <Dunnie"e and 9le!in, *@@@? M"&aughan
and Parahoo, *@@@a? Bood and Bard, *@@@? Bil#inson et al, *@@*? Da!is et al, *@@-? Mohan
et al, *@@2? ;otti et al, *@@)? &unningham et al, *@@)? 3endall, *@@)=. Patients with "an"er
often fa"e un"ertainty, isolation and !ulnerability <Halldorsdottir and Hamrin, (//)=.
Aurthermore, atients often e8erien"e sy"hologi"al distress and ha!e many .uestions with
regard to their disease and the treatment otions a!ailable. A""ording to 3ruij!er et al <*@@@=,
the "ommuni"ati!e beha!iours of nurses "an hel atients who e8erien"e "onsiderable
distress after diagnosis to integrate the disease into their li!es. Gnfortunately, non4se"iali5ed
nurses are not always reared to manage distressed atients with "an"er owing to their la"#
of e8erien"e and se"iali5ed #nowledge.
%n a triangulated resear"h study on the e8erien"es and er"etions of (-0 re4registration
first4year student nurses, &unningham et al <*@@)= found that students e8ressed "on"erns,
fears and inade.ua"ies when "ommuni"ating with atients with "an"er. Howe!er, it is
imortant to reali5e that only half of the samle had any e8erien"e of "aring for atients
with "an"er, and only nine students attended the one4to4one inter!iews. Aurthermore, first4
year student nurses may ha!e !ery little e8erien"e of "ommuni"ating and "aring for atients
with "an"er in "omarison to final4year nursing students. Therefore, the samle "hosen for
in"lusion is a signifi"ant limitation of this resear"h study. 9amling final year nursing
students may ha!e resulted in more in4deth findings, "onsidering only nine first4year
-*
students arti"iated in the inter!iews and the .uestionnaire only too# (2 minutes to
"omlete.
Bood and Bard <*@@@= used a multidis"ilinary samle of se"iali5ed and non4se"iali5ed
staff and atients to e8lore the edu"ational needs of non4se"iali5ed staff when "aring for
atients with "an"er. The resear"hers used fo"us grous, and indi!idual and aired inter!iews
to gather information. Bood and Bard <*@@@= "laimed that non4se"iali5ed staff e8erien"ed
diffi"ulties with "ommuni"ation and often felt daunted and unsure of how to deal with
diffi"ult .uestions from atients or relati!es "on"erning diagnosis, treatment and rognosis.
The atients also e"hoed these findings, stating that non4se"iali5ed staff were fearful of the
disease and were unable to "ommuni"ate with them, dislaying a general la"# of "onfiden"e
o!erall. Dunnie"e and 9le!in <*@@@= agree, and further identified nurses7 feelings of
inade.ua"y and fear of Esaying the wrong thing7 when dealing with newly diagnosed atients
with "an"er. %n essen"e, feelings of fear and inade.ua"y relating to "ommuni"ating with
atients with "an"er emerged throughout many of the studies re!iewed, and related in art to
a la"# of #nowledge regarding "an"er as a disease and "an"er treatments <Dunnie"e and
9le!in, *@@@? Bood and Bard, *@@@? ;otti et al, *@@)? &unningham et al, *@@)=. Other issues
that ima"ted on nurse>atient "ommuni"ation in "an"er "are in"luded a la"# of time to
ro!ide indi!iduali5ed "are <Dunnie"e and 9le!in, *@@@? ;otti et al, *@@)= and a la"# of
training in "ommuni"ation s#ills <M"&aughan and Parahoo, *@@@a? Bood and Bard, *@@@=.
One of the main "oing strategies used by non4se"ialist nurses with regard to er"ei!ed
inade.ua"ies in "ommuni"ation s#ills was the use of blo"#ing te"hni.ues. ;lo"#ing
beha!iours were des"ribed by 3ruij!er et al <*@@@= as the use of a!oidan"e te"hni.ues or
distan"ing ta"ti"s in situations nurses er"ei!ed as stressful. Bil#inson <(//(= identified
fa"tors influen"ing how nurses "ommuni"ate with atients with "an"er and found that in more
than 2@N of "ases nurses used blo"#ing beha!iours. This finding was suorted by Mohan et
--
al <*@@2= and &unningham et al <*@@)=, who identified that nurses who felt unable to answer
atients7 .uestions de!eloed strategies for a!oiding Ediffi"ult moments7 by aearing too
busy to tal#, or by simly a!oiding these atients altogether. Many health rofessionals fear
that by as#ing atients Ehow they are7, un"ontrollable emotions su"h as anger or desair will
be unleashed, and it is often the "ase that non4se"ialist nurses are unreared to deal with
any "onse.uential emotional outbursts <Maguire and Pit"eathly, *@@-=. Aurthermore, Parle et
al <(//,= identified that without the aroriate assessment s#ills, health rofessionals may
find it easier to a!oid dis"ussing "an"er atients7 "on"erns altogether and inad!ertently
maintain a ersonal distan"e. Howe!er, the use of a!oidan"e beha!iours by nursing staff "an
ha!e a negati!e effe"t on atients. Aor e8amle, in a henomenologi"al study on the "aring
en"ounters of nine atients with "an"er <Halldorsdottir and Hamrin, (//)=, the atients
identified that a la"# of willingness to "ommuni"ate and "onne"t with them "ould be
er"ei!ed as reje"tion. +eje"tion was also reiterated by atients in Bood and Bard7s <*@@@=
study. Additionally, the maintenan"e of ersonal distan"e was identified by ;otti et al <*@@)=
as a strategy used by se"ialist "an"er nurses to a!oid being drawn into the atient7s
emotional world, thereby rote"ting nurses from be"oming too in!ol!ed with atients and
be"oming emotionally burnt4out and drained as a "onse.uen"es of "aring.
Arom the atient erse"ti!e, "ommuni"ation "an be the most imortant ase"t of treatment
<Thorne, (/11? Bood and Bard, *@@@=. Halldorsdottir and Hamrin <(//,= identified oen
"ommuni"ation as aramount to the "on"et of rofessional "aring in "an"er nursing.
Howe!er, "ommuni"ation with "an"er atients re.uires "omle8 and ad!an"ed s#ills,
in"luding the ability to "oe with stress and tension. This follows as "ommuni"ation with
indi!iduals li!ing with life4threatening illnesses is multifa"eted and emotionally demanding
<Aield and &o, (///=. Howe!er, ineffe"ti!e "ommuni"ation has been lin#ed to ad!erse
effe"ts on atient "omlian"e with treatment lans and furthermore, "an lead to atients
-0
feeling an8ious, un"ertain and dissatisfied with their "are <Audit &ommission, (//-=. Many
of the studies that fo"used on non4se"ialist nurses7 e8erien"es of "aring for atients with
"an"er identified "ommuni"ation as an area that "aused stress for ine8erien"ed nurses,
leading to a!oidan"e beha!iours and in"reased stress for atients with "an"er and their
families. This er"ei!ed stress is due, in art, to a la"# of edu"ation, but is also the result of a
la"# of theoreti"al and ra"ti"al #nowledge with regard to "an"er and "an"er treatments.
)%'% 4noledge infor(ing cancer care
A""ording to Arost et al <(//,=, a signifi"ant "hallenge for all nurses is meeting the so"ial,
"ultural, siritual and de!elomental needs arising from the atient7s resonse to their "an"er
diagnosis, the "omle8ities of treatment, and the ima"t of "an"er on the atient7s family. %n
order to fa"e these "hallenges, nurses should be aroriately e.uied with the #nowledge
and s#ills re.uired to manage and "are for atients re.uiring treatment and management of
"an"er <M"&aughan and Parahoo, *@@@a=.
%n Bood and Bard7s <*@@@= .ualitati!e study, one of the o!erar"hing themes identified was
the need for a better understanding of "an"er and how "an"er affe"ts the atient. Many staff
reorted instan"es when they felt they la"#ed the #nowledge and s#ills re.uired to ro!ide the
otimal "are. This feeling was also reiterated by atients in the study, who stressed the
imortan"e of being "ared for by staff who were well informed. A Northern %rish study was
"arried out by M"&aughan and Parahoo <*@@@a= using a .uantitati!e sur!ey design to assess
the self4reorted le!el of "ometen"e and edu"ational needs of ,- medi"al and surgi"al
nurses emloyed in a distri"t hosital, when "aring for atients with "an"er. The study too#
la"e in a distri"t hosital with 2,.2N of the samle emloyed in medi"al wards and 0(.(N
emloyed in surgi"al wards? one resondent did not suly this information. Two thirds of
the samle had o!er ten years7 nursing e8erien"e. The resear"hers reorted an identified la"#
-2
of #nowledge and s#ills regarding "an"er "are and treatment and in arti"ular, ain
management was identified as a sour"e of "on"ern for many of the nurses. 6thi"al dilemmas
su"h as withholding information and inade.uate sy"hologi"al "are also emerged. Howe!er,
the er"entage of re.uests for additional #nowledge in "an"er "are ranged from (-./>,@.1N,
with sy"hoso"ial #nowledge being the most re.uested edu"ational "on"ern. As a
"onse.uen"e of the study being based on nurses7 self4assessment of "ometen"e, the
reliability of the findings are .uestionable. %n a se"ond ubli"ation <M"&aughan and Parahoo,
*@@@b= using the same samle, the nursing attitudes to "aring for "an"er atients were
fa!ourable. The resear"hers suggest that the study should be reeated using a triangulation of
data "olle"tion methods to obtain a more detailed i"ture of non4se"ialist nurses7 needs,
attitudes and e8erien"es when "aring for atients with "an"er in Northern %reland.
Aurther studies, in"luding Mohan et al <*@@2= and &unningham et al <*@@)= identified
"on"erns about nurses7 #nowledge of "an"er and "an"er treatments. &unningham et al <*@@)=,
found that many student nurses held re"on"etions about "an"er as a disease, su"h as the
un"ertainty of whether "an"er is "urable or not, and the need to sea# in hushed tones when
mentioning the word E"an"er7. Mis"on"etions about "an"er and negati!e attitudes towards
the disease "an ha!e a detrimental effe"t on the atient, who is no doubt struggling to "ome to
terms with his/her diagnosis, treatment or re"urren"e. Ci#ewise, se"ialist on"ology staff in
Bood and Bard7s <*@@@= study highlighted that a la"# of understanding about some basi"
issues in "an"er only led to feelings of essimism about the disease and at the !ery least, was
not benefi"ial to atients.
Ciu et al <*@@)= "arried out a .ualitati!e des"riti!e study using semi4stru"tured inter!iews to
e8lain the meaning of E"aring7 from the erse"ti!es of *@ atients with "an"er. The
resear"hers7 analysis identified that atients er"ei!ed E"aring7 as nurses ha!ing .ualified
rofessional #nowledge, ematheti" attitudes and s#ills in "an"er "are in order to ro!ide
-)
information and edu"ation, and building and maintaining a trusting nurse>atient
relationshi. %n addition, &offey <*@@)= undertoo# a detailed "on"et analysis to gain an
understanding of the nurse>atient relationshi in "an"er "are. Data was "olle"ted from (),
arti"les and from two other sour"es? (* nurses arti"iated in two fo"us grou inter!iews, and
eight atients with an e8erien"e of "an"er arti"iated in a semi4stru"tured inter!iew. Arom
an analysis of the data the attributes of the nurse>atient relationshi in "an"er "are in"luded
Eenduring relationshi7, E"aring bene!olen"e7, and E"onte8tually negotiated re"iro"ity7. As
with any "on"et analysis, the findings "annot be generali5ed, as "on"ets are influen"ed by
signifi"an"e, use, "ulture, ersonal e8erien"es and "onte8t, and therefore "hange and alter
their meanings o!er time <M"6!oy and Duffy, *@@1=.
Throughout the nursing literature, non4se"ialist nurses identified a need for greater
understanding with regard to "an"er as a disease, and #nowledge relating to treatment.
Mis"on"etions about "an"er were also identified, arti"ularly in relation to the rognosis,
and were highlighted as ha!ing a otentially detrimental effe"t on the atient. The need for
edu"ation regarding the assessment and management of "an"er ain was also identified in
many studies <M"&aughan and Parahoo, *@@@a? Bood and Bard, *@@@? Mohan et al, *@@2=
with non4se"ialist staff reorting diffi"ulties in dealing with atients re.uiring alliati!e "are
and "aring for the atients7 families. %n essen"e, non4se"iali5ed nurses felt they needed a
better understanding of the role of the alliati!e "are team, other suort me"hanisms
a!ailable, and #nowledge with regard to the aroriate time to see# suort if re.uired
<Bood and Bard, *@@@? Mohan et al, *@@2=.
6!idently, the "are of atients with "an"er is "omle8 and en"omasses a wide range of
s#ills. Nurses "aring for atients with "an"er are "hallenged to ro!ide holisti" "are
en"omassing hysi"al, so"ial, siritual and sy"hologi"al "are, not only for the atient, but
also for his/her family. Patients who are newly diagnosed, atients with disease re"urren"e,
-,
atients re"ei!ing treatment, and atients in the final stages of illness all need the greatest
hel and suort that nurses "an ossibly ro!ide <+ustoen et al, *@@-=. The ro!ision of safe
"are is aramount and therefore ha!ing the ability to re"ogni5e the treatment side4effe"ts,
symtoms or "hanges in a atient7s o!erall health status is !ital for all nurses "aring for
atients with "an"er <Bood and Bard, *@@@=. %t would seem essential, therefore, that in order
to ro!ide "omrehensi!e holisti" "are that meets the needs of atients with "an"er, nurses
re.uire both ra"ti"al and theoreti"al #nowledge regarding the treatment and management of
"an"er from a holisti" erse"ti!e.
)%)% The e(otional nature of cancer nursing
A diagnosis of "an"er is a signifi"ant life e!ent that "auses disrution to the li!es of atients
and their families <3endall, *@@,=. Meeting the emotional and sy"hoso"ial needs of atients
with "an"er resents a "omelling "hallenge to health rofessionals and arti"ularly to those
who are not se"ialists in on"ology "are <M"&aughan and Parahoo, *@@@a=. Many of the
studies underta#en to e8lore the e8erien"es and edu"ational needs of non4se"ialist nursing
staff identified issues with regard to dealing with the sy"hologi"al needs of atients, the
emotional nature of "aring, and dealing with death and dying as diffi"ult to manage
<Dunnie"e and 9le!in, *@@@? M"&aughan and Parahoo, *@@@a? Bood and Bard, *@@@?
Mohan et al, *@@2=. A dominant feature in mu"h of the resear"h was the emotionally
demanding nature of "aring, with des"ritions of "an"er "are as emotionally draining,
"hallenging, sad and distressing <Mohan et al, *@@2=.
Dunnie"e and 9le!in <*@@@= undertoo# a des"riti!e henomenologi"al study to des"ribe the
e8erien"es of nurses who were resent with a atient re"ei!ing a diagnosis of "an"er. 9i8
.ualified nurses with o!er (1 months7 e8erien"e of "aring for atients with "an"er
arti"iated in the study. The arti"iants had all "omleted ost4registration study days and
-1
three of the si8 nurses had a degree .ualifi"ation. Data was "olle"ted using one4to4one semi4
stru"tured inter!iews and analysed using &olai55i7s <(/,1= data analysis framewor#. The
arti"iants identified a range of emotions, in"luding inade.ua"y, fear, distress and anger.
These feelings related to being unable to hel the atient, in art owing to a la"# of
#nowledge and diffi"ulties with "ommuni"ation. All arti"iants identified and emathi5ed
with atients their own age, and two arti"iants des"ribed how they la"ed themsel!es in the
atient7s osition when bad news was being deli!ered. Aurthermore, all arti"iants in the
study felt that Ebeing there7 was a "entral role of the on"ology nurse, and that this in"luded
ro!iding information, answering .uestions, listening and being silently resent. The more
e8erien"e nurses ha!e in "an"er "are, the more "omfortable they are with not ha!ing all the
answers <Muinn, *@@-=, and the more "omfortable nurses are with just Ebeing there7.
Dunnie"e and 9le!in <*@@@= also found that being resent with younger atients heightened
nurses7 awareness of their mortality and made the e8erien"e more diffi"ult to deal with.
3endell <*@@,= "laimed that when nurses were fa"ed with "aring for a youthful atient they
e8erien"ed "onsiderable emotional distress. Additionally, nurses in a study by ;otti et al
<*@@)= re"ogni5ed the need to distan"e themsel!es emotionally from atients with
haematologi"al malignan"ies. %nterestingly, the findings of ;otti et al7s <*@@)= .ualitati!e
e8loratory study identified that non4se"iali5ed and ine8erien"ed nurses were the most
!ulnerable and most li#ely to be"ome emotionally in!ol!ed and drawn into the li!es of
on"ology atients.
The "are of dying atients was a further emotional issue, raising many "on"erns for non4
se"ialist "an"er nurses. &aring for dying atients in an a"ute hosital setting may be
arti"ularly stressful and "hallenging for nursing staff, owing to the blend of "are re.uired in
an a"ute ward <Da!is et al, *@@-=, staffing and resour"e ressures, la"# of time, and la"# of
s#ills and the alliati!e "are #nowledge re.uired to ro!ide satisfa"tory nursing "are. ;rowne
-/
et al <*@@2= agree, and found that staff reorted regular stress when dealing with death and
dying. 9ome of this stress was thought to o""ur be"ause nursing staff often "ome to the job
with little or no e8erien"e in dealing with diffi"ult dying situations. The management of ain
and "ommuni"ation with dying atients and their families has also been identified as a
signifi"ant stressor when "aring for dying atients <M"&aughan and Parahoo, *@@@a? Mohan
et al, *@@2=. Dealing with atients7 families was highlighted in a number of studies as being
arti"ularly emotionally demanding for non4se"ialist nurses <M"&aughan and Parahoo,
*@@@a? Bood and Bard, *@@@? Da!is et al, *@@-? Mohan et al, *@@2=.
Mohan et al <*@@2= undertoo# a .ualitati!e des"riti!e study in Australia and found that
dealing with and suorting family members, e8laining issues su"h as end4of4life "are and
berea!ement, and withholding information were diffi"ult issues for non4se"ialist "an"er
nurses to manage. Only 2@ a"#ets "onsisting of se!en oen4ended sur!ey .uestions,
arti"iant information leaflets and return address en!eloes were distributed to four wards in
two hositals <0*@ beds and -* beds=. Twenty4fi!e sur!eys were returned and fi!e nurses
agreed to be inter!iewed in one4to4one inter!iews. %t is not "lear why the resear"hers
distributed only 2@ .uestionnaires, whi"h inter!iewed only fi!e nurses. The use of a larger
samle would ha!e in"reased the rigour of the study. Also, the use of the .uestionnaires,
albeit oen4ended, leads to methodologi"al "onfusion. Muestionnaires are not generally used
in .ualitati!e resear"h, but the use of the oen4ended .uestionnaire "ould ro!ide ri"h data in
terms of arti"iant narrati!es. Ne!ertheless, the resear"hers did not ro!ide a justifi"ation
for their use of .uestionnaires in this arti"ular study, and "ould otentially "ause "onfusion
for no!i"e resear"hers when attemting to interret the findings. Aundamentally, Mohan et al
<*@@2= "on"luded that non4se"iali5ed nurses re.uire edu"ation in "an"er "are, the
de!eloment of time management s#ills, "ounselling s#ills, and family4"entred "are in order
to ro!ide effe"ti!e holisti" nursing "are to atients with "an"er.
0@
6mbedded in the emotional nature of "aring for atients with "an"er is the notion of time.
Many studies a"#nowledged the imortan"e of time when ro!iding sy"hoso"ial "are for
atients and families <Dunnie"e and 9le!in, *@@@? M"&aughan and Parahoo, *@@@a? Mohan et
al, *@@2=. Howe!er, the nature of a"ute hosital "are is su"h that high wor#loads and a la"# of
time are tyi"al. Nurses emhasi5ed that the en!ironment of a busy ward is not "ondu"i!e to
ade.uate atient "are, and some nurses further belie!ed that atients would feel better "ared
for if they "ould share their e8erien"es with others in similar situations <Mohan et al, *@@2=.
)%+% 0iscussion
There ha!e been many issues raised in the nursing literature by non4se"ialist staff "aring for
atients with "an"er. %ssues relating to "ommuni"ating with atients and families were
identified in all studies, and staff reorted feeling ill4e.uied to deal with the information
needs of atients with "an"er throughout all stages of the "an"er traje"tory. Aurthermore, non4
se"iali5ed nursing staff reorted a la"# of edu"ation and training with regard to "an"er and
"an"er treatments as a signifi"ant obsta"le in the ro!ision of "omrehensi!e holisti" "are to
atients with "an"er and their families. The management of symtoms was also reorted as a
sour"e of an8iety and stress for non4se"ialist nurses <M"&aughan and Parahoo, *@@@a?
Bood and Bard, *@@@? Mohan et al, *@@2=. The emotional nature of "are and "are of dying
atients, the er"ei!ed la"# of #nowledge regarding symtom management and
"ommuni"ation, the en!ironment of "are and a la"# of time due to the inherent busyness of
a"ute medi"al and surgi"al wards, were also a"#nowledged as roblemati" for non4se"ialist
nurses. Many nurses held the !iew that atients with "an"er would feel better "ared for in a
se"ialist area, and while this is ideal, the "urrent state of health"are en!ironments and the
0(
roje"ted in"rease in the numbers of atients with "an"er suggests that this solution is a long
way from being reali5ed.
As a result of the in"reasing demand on the health ser!i"e and the e8anding need for
se"ialist "an"er nurses, there must be a "ommitment to ad!an"ing edu"ation in "an"er "are.
On"ology nurse edu"ation begins with student nurses in the "lassroom, and arti"ularly in the
"lini"al ra"ti"e area. Howe!er, student nurses are rarely reared to "are for atients with
"an"er <Aerguson, (//0=, and &loss et al <(//)= highlight that !ery few .ualified nurses
ursue ost4registration edu"ation in "an"er "are. The DH <*@@@b= re"ommends that re4
registration rogrammes should Ea""ommodate the initial and ongoing "are for eole
affe"ted by "an"ers7. Aurthermore, The +oyal &ollege of Nursing <*@@-= ublished a
Aramewor# for Adult &an"er Nursing identifying that nurses are #ey in the deli!ery of e8ert
effe"ti!e "are to eole with "an"erH
E...it is essential that the stru"ture, training and edu"ation of the nursing wor#for"e ro!ides
nurses with a sound #nowledge and understanding of the "are needs of "an"er atients, their
families, signifi"ant others and friends.7
&lini"al and theoreti"al edu"ation should therefore fo"us on toi"s related to understanding
the nature of "an"er, re!ention, diagnosis, treatment, interersonal "ommuni"ation,
sy"hoso"ial suort, death and dying, and the organi5ation and management of "an"er "are
<&unningham et al, *@@)=. %n addition, e8ert on"ology nurses "ould deli!er in4house
edu"ation to all hosital nurses and ro!ide ad!i"e to non4se"ialist nurses in times of need.
&lini"al nurses should be en"ouraged to de!elo both ra"ti"al and theoreti"al #nowledge in
"an"er "are, be"ause all nurses at some stage in their "areer will "are for atients with "an"er,
and therefore need to de!elo an understanding of the hysi"al, sy"hologi"al and so"ial
dimensions of this ase"t of nursing.
0*
)%5% -ursing &n Saudi #rabia
%n a""ordan"e with the 9audi "onstitution, the go!ernment ro!ides all "iti5ens and
e8atriates wor#ing within the ubli" se"tor with full and free a""ess to all ubli" health "are
ser!i"es. Fo!ernment e8enditure on the MOH in"reased from *.1N in (/,@ to )N in *@@2
and ).*N in *@@/ <figure, Table (= . A""ording to BHO the total e8enditure on ubli"
health during *@@/ was 2N of gross domesti" rodu"t . The MOH is resonsible for
managing, lanning and formulating health oli"ies and suer!ising health rogrammes, as
well as monitoring health ser!i"es in the ri!ate se"tor . %t is also resonsible for ad!ising
other go!ernment agen"ies and the ri!ate se"tor on ways to a"hie!e the go!ernment7s health
obje"ti!es .
The MOH suer!ises *@ regional dire"torates4general of health affairs in !arious arts of the
"ountry . 6a"h regional health dire"torate has a number of hositals and health se"tors and
e!ery health se"tor suer!ises a number of PH& "entres. The role of these *@ dire"torates
in"ludes imlementing the oli"ies, lans and rogrammes of the MOH? managing and
suorting MOH health ser!i"es? suer!ising and organi5ing ri!ate se"tor ser!i"es?
"oordinating with other go!ernment agen"ies? and "oordinating with other rele!ant bodies .
Aigure * illustrates the organi5ational stru"ture and the relationshi of deartments within the
9audi health "are system from the "ommunity to MOH le!el. OHealth friendsP is a sele"ti!e
"ommittee "onsisting of useful and influential "ommunity members, in"luding reresentati!es
from PH& "entres, who are #nowledgeable about "ommon so"ial norms and the otential of
the "ommunity. The essential role of this "ommittee is to liaise between PH& "entres and the
"ommunities they ser!e . %n re"ent years, the MOH has "ontinued to de!elo the number of
PH& "entres <Aigure *= and has initiated further roje"ts aimed at de!eloing health "are in
general and PH&s in arti"ular. Aor e8amle, the roje"t of the &ustodian of the Two Holy
0-
Mos.ues aims to establish *@@@ ad!an"ed PH& "entres, and to de!elo the e8isting ones in
terms of buildings, wor#for"e and ser!i"es.
AigureH(
AigureH *
00
)%5% Conclusion
The aer summari5ed the "urrent nursing literature with regard to "aring for atients
with "an"er on non4se"ialist wards. Throughout the analysis it be"ame e!ident that nursing
atients with "an"er and their families was an area that non4se"iality nurses wor#ing on
general medi"al and surgi"al wards found arti"ularly diffi"ult. Dealing with the emotional
resonses of atients, atient7s families and at times, the nurses7 own emotional resonses to
"aring for atients with "an"er, were identified as being stressful, usetting and frustrating.
These diffi"ulties were further "omounded by time "onstraints, la"# of e8erien"e, roblems
relating to "ommuni"ation, and the ro!ision of sy"hoso"ial "are .
Bhile it is referable that atients with "an"er are "ared for on se"ialist wards, the
dedi"ated "an"er ward may be unable to "oe with the !olume of admissions, and therefore
atients will "ontinue to be nursed on general medi"al and surgi"al wards. As a result, there is
an o!erwhelming need for sta#eholders to embra"e the needs of atients and nurses in the
organi5ation of "an"er "are nursing. These de!eloments are not only uni.ue to 6uroean
"ountries, but in #eeing with international trends, and ad!an"es in "an"er "are are re.uired
worldwide. +esear"h, although somewhat dated, has shown that edu"ated on"ology nurses
ma#e a signifi"ant differen"e to the atient7s hysi"al, sy"hologi"al and so"ial wellbeing
<M"&aughan and Parahoo, *@@@a? Mohan et al, *@@2=. &onse.uently it is aramount that the
edu"ational needs of non4se"iality nurses are met, so that all nurses are e.uied with the
"ometen"e and "onfiden"e to ro!ide "are for atients with "an"er.
02
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01