Downloaded by [New York University] at 09:34 13 September 2016 Advanced Nursing Practice and Nurse-led Clinics in Oncology Over the past ten years, there has been a dramatic increase in new nursing roles and nurse-led clinics within oncology. This unique handbook is a comprehensive companion for nurses studying and practising at an advanced level in this emerg- ing field. This text outlines and discusses roles, responsibilities and skills related to advanced practice in oncology nursing – including leadership, communication skills and prescribing – linking throughout to the implications for clinical prac- tice. It then provides a step-by-step guide to setting up and developing nurse-led clinics, looking in more detail at clinics focusing on surgery, chemotherapy, radio- therapy, clinical trials and follow-ups, and providing an in-depth case example of a clinic set up for adjuvant Herceptin use. Practical, relevant and underpinned by current legislation, Advanced Nursing Practice and Nurse-led Clinics in Oncology is an invaluable resource for oncol- ogy nurses. Carole Farrell is a Nurse and AHP Research Fellow at the School of Oncology, the Christie NHS Trust, Manchester, UK. She is Honorary Lecturer at the Univer- sity of Manchester, UK. Downloaded by [New York University] at 09:34 13 September 2016 This page intentionally left blank Downloaded by [New York University] at 09:34 13 September 2016 Advanced Nursing Practice and Nurse-led Clinics in Oncology Edited by Carole Farrell Downloaded by [New York University] at 09:34 13 September 2016 First published 2016 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 711 Third Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2016 C. Farrell The right of Carole Farrell to be identified as the author of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data Advanced nursing practice and nurse-led clinics in oncology / edited by Carole Farrell. p. ; cm. Includes bibliographical references and index. I. Farrell, Carole, editor. Downloaded by [New York University] at 09:34 13 September 2016 [DNLM: 1. Neoplasms—nursing. 2. Advanced Practice Nursing— methods. 3. Oncology Nursing—methods. WY 156] RC266 616.99'40231—dc23 2015007728 ISBN: 978-0-415-74649-6 (hbk) ISBN: 978-0-415-74650-2 (pbk) ISBN: 978-1-315-79750-2 (ebk) Typeset in Times by Apex CoVantage, LLC This book is dedicated to my family and friends for all their love and support Downloaded by [New York University] at 09:34 13 September 2016 This page intentionally left blank Downloaded by [New York University] at 09:34 13 September 2016 Contents Dedication v Table of contents vii List of tables and figures xi Preface xiii List of contributors xv Introduction 1 1 Nursing developments and policy influences 3 CAROLE FARRELL Defining nursing 3 Nursing models 4 Policy context and service demands 8 Policy influences on oncology nursing practice 10 Ensuring ‘value for money’ and quality of care 11 Summary 11 References 13 2 The changing face of oncology nursing 15 CAROLE FARRELL Scope of practice 15 Expanding nurses’ roles 16 Downloaded by [New York University] at 09:34 13 September 2016 Training 16 Alternative clinical nursing models 17 Clinical nursing models 18 Legislation and accountability for nurses’ roles 19 Types of law relevant to nursing 20 Summary 21 References 22 viii Contents 3 Advanced nursing practice and clinical leadership 25 CAROLE FARRELL Specialist practice 25 Advanced practice 25 Discrepancies with nursing titles 25 Defining advanced nursing practice 26 Exploring advanced nursing practice 27 Specialist and advanced nursing practice 27 UK frameworks for advanced nursing practice 28 The knowledge and skills framework (KSF) 29 The Scottish advanced practice toolkit 30 Clinical skills 31 Valuing nurses’ roles 32 From novice to expert practice 33 Influences on nurses’ olesr and advanced practice 35 Summary 35 References 36 4 Autonomy: implications for oncology nursing 40 CAROLE FARRELL What is autonomy? 40 Competence and autonomy 41 Determining mental capacity 42 Defining mental capacity 42 Autonomy and the role of the nurse 43 Professional accountability and autonomy 45 Autonomy and advanced nursing practice 45 Crossing boundaries in clinical practice 46 Support for role development and advanced practice 46 The importance of autonomy in advanced clinical practice 49 Independence and autonomy in nurse-led clinics 49 Uncertainties about autonomy and advanced practice 51 Downloaded by [New York University] at 09:34 13 September 2016 Summary 51 References 51 5 Non-medical prescribing 54 ELAINE LENNAN History of non-medical prescribing 54 Implementation of NMP 54 Literature review of NMP 56 Contents ix The nurses’ view 56 The doctors’ view 57 The patients’ view 59 Non-medical prescribing in the acute setting 60 NMP and cancer 61 Practice implications 63 Current legislation 64 National Prescribing Centre (NPC) 2012 65 Electronic prescribing 65 Training requirements 65 Audit and continuing professional development 66 Conclusion 67 References and further readings 67 6 Compassionate and effective communication: key skills and principles 72 ALISON FRANKLIN, CLAIRE GREEN, NICOLA SCHOFIELD Introduction 72 How well prepared are senior nurses to manage difficult or distressing conversations? 72 Topics for reflection 73 1. The importance of communication skills and the impact of communication on patients’ physical and emotional well-being 73 2. The challenge of working with patients’ emotions 76 3. Skills and strategies for effective communication 80 4. Distress can be catching – tips for personal survival 93 Conclusion 94 References 95 7 Developing and evaluating nurse-led clinics 99 CAROLE FARRELL Key policy influences 99 Development of nurse-led clinics in the UK 99 Downloaded by [New York University] at 09:34 13 September 2016 Nurse-led clinics in oncology 100 Ways of working in nurse-led clinics 101 Training 101 Types of nurse-led clinics in oncology 103 Value for money 103 Setting up nurse-led clinics 103 Clinical outcomes and nurse-led clinics 108 x Contents Evaluating nurse-led clinics 108 Summary 110 References 110 8 The nature of nurse-led clinics in oncology 115 CAROLE FARRELL Developing and expanding nurse-led clinics at the Christie 115 Developing protocol-led clinics 115 Developing nurse-led chemotherapy clinics 116 Developing nurse-led research clinics 116 Benefits of electronic prescribing in nurse-led clinics 117 Developing nurse-led radiotherapy clinics 117 Developing nurse-led Herceptin (Trastuzumab) clinics 117 Development of nurse-led follow-up clinics 118 Survey of nurse-led oncology clinics 119 Section 1: Chemotherapy nurse-led clinics 119 Section 2: Radiotherapy nurse-led clinics 128 Section 3: Surgical nurse-led clinics 133 Section 4: Nurse-led research clinics 135 Section 5: Nurse-led follow-up clinics 145 Summary 150 References 151 9 Nurse-led pathway for patients with HER2 positive breast cancer receiving Trastuzumab (Herceptin) 156 HELEN ROE Background information 156 The administration of Trastuzumab 157 Rationale for developing a nurse-led pathway 158 General pathway development 159 Development and implementation of the Trastuzumab pathway 160 The need to assess capacity and demand 163 Trastuzumab pathway six months after implementation 166 Downloaded by [New York University] at 09:34 13 September 2016 2010: Introduction of the first combined cardiology/oncology clinic in the UK 166 2012: Trastuzumab pathway evaluation from patients’ perspective 168 2014: Switching from intravenous to subcutaneous administration 171 2014: Auditing the switch for reported side effects 172 Current situation regarding the pathway 173 References 173 Index 177 Tables and figures TABLES 0.1 Operational definitions 2 1.1 Nursing theorists and nursing models 5 2.1 Types of laws relevant to nursing 20 3.1 Scottish framework for advanced practice 29 3.2 Incorporating KSF into advanced practice roles 30 4.1 Autonomy within nurse-led clinics 50 5.1 Timeline of recent changes to prescribing legislation 55 5.2 Number of nurse prescribers to date 56 5.3 The legal mechanisms for supplying medicines 64 6.1 Risk of developing an affective disorder (anxiety and/or depression) 73 6.2 Key communication tasks impacting on adjustment and coping 75 6.3 Example one: premature advice and information 78 6.4 Example two: moving away from the emotion 79 6.5 Example three: trying to ‘fix’ the distress 79 6.6 Facilitative communication skills and behaviours 83 6.7 Using facilitative skills to block or distance emotional cues 83 6.8 Using facilitative skills to facilitate disclosure of further cues and concerns 84 8.1 Nurse-patient consultations observed at each location 123 8.2 Clinical research