Today we are delighted to bring you 2 special guest blogs for World Cancer Day. The first blog, from Kristen Maloney, discusses the art of cancer nursing while our second blog, from Professor Sarah Kagan, discusses cancer nursing and older people.
Beauty Within Precision: Reflecting on Nursing in Cancer Care for #WeCanICan
Kristen W. Maloney MSN, RN, AOCNS
February 4, 2016 is World Cancer Day. As nurses, we are surrounded by tremendous anticipation for scientific advances in cancer. The science that encompasses our daily practice is largely based on numbers. We aim to reduce global incidence of cancer so that the projection of 21.4 million people worldwide by 2030 overestimates reality. Changing survivability so that people diagnosed with lung cancer can expect something more hopeful than five year survival of about 10% globally. Click Here For Link
We examine President Obama’s Precision Medicine Initiative, developing new research to individualize treatments for patients.
In keeping with the World Health Organization, as nurses, we work to limit premature deaths from cancer. We do our part in the treatment aimed at curing or at least controlling cancer for every person in our care. Amidst all of this science, the journey taken as people live with cancer is often framed only in quantitative biomedical science and medical treatment. Emotions and relationships become the stuff of human interest stories, taking second place to what is viewed as true science.
As nurses, we find ourselves sharing moments with patients and their families during their most vulnerable moments within the cancer journey. We witness from diagnosis and sit with patients in the aftermath of hearing “you have cancer”. We guide them in making the transition from patient to person surviving cancer. We attend to those who will not survive and support them and their families at the end of life. How then do we treat these moments in the journey? Imagine the devastation when a young mother is hospitalized, all the while longing to be with her children? Bring to mind the possibilities when a proud man finds himself too weak to walk. Think about what a father feels when he talks about not making it to see his daughter get married? These moments are among the many that nurses witness, support, and guide in their care of people who have cancer.
The emotions and relationships that these stories call to mind are beyond science, lacking evidence that we so often adhere to, in order to provide the best “care “. Still, nurses are there, finding solutions to life’s moments in midst of cancer care. We might set up Skype, so that Mom can see her kids. We guide the weak man to the bathroom, preserving his dignity through humor, distraction, or some other personally meaningful tactic. We help that Dad to write his thoughts in a letter to be read on the occasion of his daughter’s marriage. We nurses are privileged to be a part of these precious events, no matter how grand or ordinary.
Invested in how a patient lives with cancer is truly an art. The beauty that contributes to the journey each patient takes. Too often we fail to recognize the extraordinary ability we possess as nurses when we act in these moments. We too easily miss the art and its evidence within our practice.
The evidence of our art comes not in a randomized controlled trial; it emerges in reflection. Since the 1970s, and even before, nurses around the world have benefitted from reflective practice. As an intellectual habit, a tool to refine care, a means to cope with the stress and distress of nursing those living with cancer, reflective practice allows us to contemplate our everyday actions and the effect we have on so many patients and their families.
A variety of strategies can be used to achieve reflective practice, including, guided reflection one-on-one, journaling or group discussions. In thinking about the moment that Mom began to cry when she couldn’t see her children each day, allowing yourself to feel the raw emotions. Consider the actions you took as her nurse. These actions are the art within your practice. In caring for the proud man too weak to walk, you were able to find a means to ensure his dignity. In reflecting, think about how you established your relationship with him, easing his distress with your presence. As you helped that tearful father write to his daughter words down to give to his daughter on her wedding day, imagine the rippling impact you had on this family.
As nurses, we must embrace these many opportunities to learn from our experiences with our patients. In reflecting on them, we shape our art for the well-being future. Our patients and their families should be recognized as our best teachers, partnering in our efforts to build the art of cancer nursing.
Daily, we hear emphasis on the science of cancer care. I challenge you to recognize the remarkable influence you have on patients’ lives, throughout their cancer journey in your reflective practice.
Together, through science and art, numbers and beauty, we continue in our quest to enhance the cure cancer by enriching the lives of those who live with it. #WeCanICan #WorldCancerDay
Confessions of a Card Carrying Gero-Oncology Nurse
#cardcarryinggerooncologynurse #IJOPN #gerionc
Sarah H. Kagan PhD, RN; Lucy Walker Honorary Term Professor of Gerontological Nursing, University of Pennsylvania; Editor in Chief, International Journal of Older People Nursing http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1748-3743
Full disclosure: I am a card carrying Gero-Oncology Nurse. OK, I admit I sort of defined the specialty, imagining that card for myself and any nurses whom I can engage in consideration of a refreshed social contract for our ageing populations(Kagan, 2016b). Seriously, I keep one metaphorical foot in each nursing specialty. Gerontological nursing and oncology nursing garner my equal attention as I maintain focus on my true interest: supporting older people living with cancer and other chronic conditions through evidence-based nursing.
I’ve been writing about Gero-Oncology Nursing for over a decade and have practiced it for far longer(Kagan, 2004). To be honest, I sort of stumbled into this unacknowledged specialty. I came to nursing with a profound interest in older people. My first position was on a medical-surgical oncology inpatient unit in a community teaching hospital on the West Coast of the United States. When I interviewed, the nurse manager said to me “well, if you are interested in older people, then come work here”. I did and she was right. Most of our patients were indeed older.
I’m glad I took that position and even happier I listened to my nurse manager. She reflected on evidence – the age demographic of her unit’s patient population – and I quickly learned to do the same. Thirty years on, I am a Gero-Oncology Nurse for reasons of evidence. Those reasons include an overwhelming preponderance of evidence in one case and a troubling lack of evidence in another. The preponderance is easy to see. Cancer is a disease of ageing. More properly, cancer in adults is an epigenetic disease, one that results from interaction between genome and environmental exposures(Tsai and Baylin, 2011, Clark et al., 2013). The numbers are compelling. More than half of all cancer diagnoses are made in people over age 65 and more than a third in people aged 75 and older(Siegel et al., 2015). Median age at cancer diagnosis is in the 7th decade of life across high income societies like the UK and the US. Leading Cancer diagnoses reveal the extent to which cancer is an age-related disease too. In high and middle income nations, cancers of the breast, colon and rectum, and lung are most common(Torre et al., 2015). These are epigenetic diagnoses, most peaking around the seventh decade of life.
Knowledge of the world’s most common cancers holds important clues about realities of cancer in the 21st century. Most are curable or controllable, but only with adequate access to appropriate screening and effective cancer treatment. In fact, today, colorectal cancer is even preventable through routine screening. Colonoscopy allows for removal of precancerous polyps – making the classic cancer disease trajectory outdated. Despite achievable aims of cure and control, cancer care is often disparate for people depending on who they are and where they live. Critically, ageism figures prominently in cancer care around the world(Lawler et al., 2014). Breast and colorectal cancers are frequently curable for midlife and older people alike. Nonetheless, diagnosed with one of these cancers, older people might be provided less than standard treatment just by virtue of chronological age What might be curable disease becomes a distressing experience for many older people.
When complete cure is not possible, cancer is often a chronic condition for older people. Chronicity is significant dimension in GeroOncology Nursing. While some elders do die of their cancers – especially with diagnoses like lung and pancreatic cancers – many millions survive to live even longer lives. Some may even be diagnosed with other cancers; two or three in a long life is increasingly common. With all the evidence that outlines cancer as a major chronic or even curable condition in later life, our evidence to provide optimal nursing care lacks scope and depth. For example, cancer survivors – as they are referred to in American health policy – are overwhelmingly an older group(Rowland and Bellizzi, 2014, Rowland and Ganz, 2011). Despite evidence of aged demographics and epidemiology, gerontological nursing generally considers cancer in only limited ways while oncology nursing views care of older people as an optional subspecialty.
I am encouraged by nursing science that increasingly addresses the needs of older people with cancer. However, our science still doesn’t match current needs for evidence-based nursing care of older people living with cancer.
Whether we identify as gerontological nurses or oncology nurses, why are we reticent to redefine ourselves in alignment with societal need? Granted, the social construction of nursing entails much more than evidence – just consider all the stereotypes about who we are and what we do. Nonetheless, conceiving of cancer as a condition central to gerontological nursing as we do dementia is an obvious advantage for us as scientists and as clinicians.
I believe reframing oncology nursing as GeroOncology Nursing is long overdue(Kagan, 2016a). Older people are the majority age group in that patient population. Relegating their care to an optional sub-specialty is counter-intuitive. Now is the time to move beyond divisions of our discipline, divisions drawn from 20th century demographics and epidemiology, into the 21st century. We must, if we are to achieve evidence-based nursing for older people with cancer.
Gerontological nurses, oncology nurses, I’ve got some readings for you. And can I get you to join me in declaring yourselves card carrying GeroOncology Nurses?
References
CLARK, A. E., ADAMIAN, M. & TAYLOR, J. Y. 2013. An Overview of Epigenetics in Nursing. Nursing Clinics of North America, 48, 649-659.
KAGAN, S. H. 2004. Gero-Oncology Nursing Research. Oncology Nursing Forum, 31, 293-299.
KAGAN, S. H. 2016a. The Future of Gero-Oncology Nursing. Seminars in Oncology Nursing.
KAGAN, S. H. 2016b. Introduction: Revisiting Gero-Oncology Nursing. Seminars in Oncology Nursing.
LAWLER, M., SELBY, P., AAPRO, M. S. & DUFFY, S. 2014. Ageism in cancer care. British Medical Journal, 348.
ROWLAND, J. H. & BELLIZZI, K. M. 2014. Cancer Survivorship Issues: Life After Treatment and Implications for an Aging Population. Journal of Clinical Oncology, 32, 2662-2668.
ROWLAND, J. H. & GANZ, P. A. 2011. Cancer Survivorship Plans: A Paradigm Shift in the Delivery of Quality Cancer Care. In: FEUERSTEIN, M. & GANZ, P. A. (eds.) Health Services for Cancer Survivors. Springer New York.
SIEGEL, R. L., MILLER, K. D. & JEMAL, A. 2015. Cancer statistics, 2015. CA: A Cancer Journal for Clinicians, 65, 5-29.
TORRE, L. A., BRAY, F., SIEGEL, R. L., FERLAY, J., LORTET-TIEULENT, J. & JEMAL, A. 2015. Global cancer statistics, 2012. CA: A Cancer Journal for Clinicians, 65, 87-108.
TSAI, H.-C. & BAYLIN, S. B. 2011. Cancer epigenetics: linking basic biology to clinical medicine. Cell Res, 21, 502-517.