Oncology Nursing Care Standards

RESEARCH REPORT ONCOLOGY NURSING CARE STANDARDS Astrid M de Kleijn and Marie E Muller introduction medical diagnoses convey so dramatically and unambiguously the spectre of death as does Oncology is the study of malignant neoplastic Abstract cancer. From the moment of detection and diseases generally referred to as cancer Oncology nursing as a specialised diagnosis, the certainty of mortality influences (Baldonado & Stahl, 1982: 1). Oncology nursing discipline has no published the behaviour of both the patient and the medical nursing is the nursing of patients suffering from nursing care standards for South Africa. care team. Consequently it is important that some form of neoplastic pathology. As a The purpose o f this study was to formulate those involved in patient treatment and support disease, cancer has been known thoughout oncology nursing standards for a examine their own attitudes toward cancer and re^rded history. Hippocrates himself particular research hospital A specific death before attempting to care for others d^^ibed many types of neoplasm and he approach was used and the oncology (Portlock & Goffinet, 1986: 295). Oncology probably coined the term carcinoma (Kahn, nursing experts in the research hospital nursing care therefore requires special nurses. Love, Shermand & Chakravorty, 1983: 3). Until compiled and formulated the standards. the late 1950’s, because of the apparently Group discussions and critical debating The professional responsibilities of a registered incurable nature of the disease, a diagnosis of of the standards followed. The standards nurse are embodied in the South African cancer was viewed by both the patient and were ratified by means of verbal Nursing Council (1984) regulation relating to health care provider, as a death sentence. consensus between the experts and the scope of practice of persons who are However, advances in surgical techniques, professional nurses in the oncology unit. registered or enrolled under the Nursing Act radiation therapy, chemotherapy and These standards could serve as a guide to (RSA, 1978). immunotherapy have greatly altered prognoses ensure quality oncology nursing care. The registered nurse is responsible for for the better. Today it is estimated that 40% of National validation of the standards is scientifically based physical, chemical, diagnosed neoplasms are curable and 15% of the recommended remaining have a life expectancy greater than 15 psychological, social, educational and years (Dietz, 1981: 3). Uittreksel technological nursing care. This therefore requires specialised knowledge on the part of Therapy, however, may cause primary and/or Onkologiese verpleging, as 'n the nursing staff in an oncology nursing unit and secondary disabilities and the patient is exposed gespesialiseerde verpleegdissipline, het meeting the basic health needs of the oncology to many difficulties. Not only is his future geen formeel-gepubliseerde patient becomes a specialised area of nursing. unpredictable but the methods of treatment used verpleegstandaarde in Suid-Afrika nie. The professional responsibilities also include to alleviate his condition are often very toxicand Die doel van hierdie studie was om mav induce a variety of unpleasant side effects onkologiese verpleegstandaarde vir 'n preventive, promotive, curative and rehabilitative aspects of nursing care and the a^P^oblems. Most patients receive a course of spesifieke navorsingshospitaal te recognition of the patient as part of a family and chemotherapeutic drugs and/or radiation formuleer. ‘n Spesifieke benadering ten a community. The acts and interventions the therapy as part of their treatment regimen. opsigte van standaardformulering is nurse is expected to perform ensure that the Successful therapy depends upon meeting the gevolg. Kundiges in die hospitaal het patient is nursed in totality with his physical, individual needs and carrying out evaluation of standaarde saamgestel en geformuleer. the quality of care on an ongoing basis. This Groepbesprekings en kritiese social and psychological needs being met. The professional nurse is responsible too for the Valuation of the quality should take into debatvoering het gevolg. Die standaarde specific nursing care of patients at high risk, in consideration the potential course and outcome is by wyse van verbale i’consensus deur die this case the patient suffering from cancer. The of the disease (Dietz, 1981: 172-173). kundiges en professionele verpleegkundiges in die onkologie objective of the health team is the rehabilitation The oncology nurse plays an important role in verpleegeenheid bekragtig. Hierdie of the patient, back into family and community the multiprofessional treatment regimen and is standaarde behoort as riglyn te dien vir life. In order to maintain control of their lives, accountable for rendering quality nursing care. gehalteverpleging in hierdie verband. many cancer patients need to change their Nurses are, however, unable to objectively and Nasionale validering van die standaarde habits, modify their normative prescribed social formally evaluate the quality of oncology word aanbeveel. roles, redefine and reinterpret basic concepts nursing care due to a lack of standards and such as health and illness. Thus the nurse’s evaluation instruments in this regard. Standards objectives are to assist the patient to adjust to guide the nursing practice and will help to different ways of meeting his daily monitor the quality of nursing care rendered in LITERATURE REVIEW requirements, establishing new techniques of the oncological nursing unit. Oncology nursing care is a multifaceted self care, modifying self-image, revising his routine of daily living, and developing a new The purpose of this study is to formulate speciality which deals with patients who may be life-style compatible with the effects of any oncology nursing care standards for a particular at any point on the health-illness continuum disabilities (Dietz, 1981: 170). hospital. ranging from the high risk patient needing information about prevention to the patient On respecting the right of the patient to needing comfort and support duri ng dy i ng. Few self-determination, his involvement in the Curationis, Vol. 14, No. 2, August 1991 23 planning and implementation of a nursing care anxious to begin treatment, he will also be appropriately (Portlock & Goffinet, 1986: programme is of paramount importance. The reluctant to suffer its side effects. 254-263). patient has the right to give informed consent Communication, accessibility, and consistent Oncology nursing care is a specialised regarding all medical and nursing interactions support assist in lessening this ambivalence. discipline requiring very special nurses. (Given & Given, 1984: 146). For those patients who are cured, stress and Oncology patients receive quality nursing care anxiety do not end with the completion of In assessing the patient’s health needs and when the nurse rendering that care adheres to treatment but may be present continuously for problems, the nurse should take into the scientific principles of diagnosing the many years to come. For those whose disease consideration his lifestyle, history, cultural patients’ health needs and problems, recurs or who cannot be cured, there is a background and self-care performance. The formulating and implementing an appropriate persistent confrontation with mortality. patient’s abilities and disabilities which will nursing care plan and evaluating the Care-givers should bear in mind such determine the extent of his engagement in effectiveness of her nursing interactions. The fundamental features of human worth as respect self-care activities should also be assessed patient’s response to the treatment modality is for the individual, inclusion in a community, (Given & Given, 1984: 140). Problems most dependent upon such variables as the cancer concern for the physical body, and personal commonly experienced by the oncology patient diagnosis, the stage of the disease, health meaning beyond the self (Portlock & Goffmet, are nutritional, psychological and comfort history, socio-economic status and motivation. 1986: 295). (pain) status, potential for infection and injury, Malignant diseases prevail in all organs and knowledge of the disease process and the Main physical problems to be considered are systems of the body and therefore the oncology i mpl ications of the treatment modalities, as wel 1 pain, nutritional status, haemoptysis, pleural nurse needs to be a specialist in all the different as the ability to carry out activities necessary for effusion, pericardial effusion, hepatic types of cancer. daily living (Cox & Wark, 1980: 109-132). metastases, bowel obstruction, renal failure, bone metastases, and viral/fungal infections. DEFINITION OF TERMINOLOGY The progressive anorexia-cachexia Pain in a patient with cancer may be due to accompanying advanced malignancy may be a Oncology nursing care benign, unrelated causes, may be referred, and major source of morbidity. Cachectic patients may be very difficult to control. The patient also Oncology nursing care is the nursing of patients are often unable to tolerate the complications of needs to cope with fear, anxiety and depression suffering from cancer and may be curative, cancer therapy and are more susceptible to of chronic pain (Portlock & Goffinet, 1986:297; restorative, palliative or supportive, depending infections (Pruitt, 1983: 370; Smith, 1975: 53). Cox & Wark, 1980: 109-132; Hauck, 1986: upon the medical diagnosis of

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