Table Of ContentCancer Nursing
A Revolution in Care
The publishers would like to express their thanks
to the organisers of the conference:
The Royal Marsden Hospital, London
Nursing Times
International Society of Nurses in Cancer Care
NT
Cancer Nursing
A Revolution in Care
Proceedings of the Fifth International Conference on
Cancer Nursing, London, 4th-9th September, 1988
Edited by
A. Phylip Pritchard
Royal Marsden Hospital, London
M
Macmillan Press
Scientific & Medical
©The Editorand the Contributors 1989
All rights reserved. No reproduction, copy or transmission
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First published 1989
Published by
THE MACMILLAN PRESS LTD
Houndmills, Basingstoke, Hampshire RG21 2XS
and London
Companies and representatives
throughout the world
ISBN978-0-333-48735-8 ISBN978-1-349-10714-8 (eBook)
DOI 10.1007/978-1-349-10714-8
Contents
Preface viii
Part 1. International Perspectives in Cancer Care
Cancer Nursing: A Revolution in Care Sally Sims 1
Europe Against Cancer: A Plan for Action Jerzy Einhorn 5
Part 2. Changing Patterns of Health Care and Their Impact on Cancer Nursing
Changing Patterns of Health Care and Their Impact on Cancer Nursing Joyce Yasko 7
The Influence of Power and Politics Ginette Rodger 10
Changing Patterns of Health Care and Their Impact on Cancer Nursing Trevor Clay 15
The Cancer Experience-A Patient's View Juliette Evans 17
Part 3. Ethical Dimensionsin Cancer Care
Ethics in Cancer Care: A Challenge for Nurses Cornelia Fleming 19
Approaches to Advocacy Constance Donovan 22
Euthanasia-Guidelines for Nursing Practice Cees de Ridder 25
Part 4. Cancer across the LifeSpan
Pain and Anxiety Management Programme for Paediatric Cancer Patients Cynthia Stutzer 27
What Does the Schoolteacher Know? Anne Charlton 29
Impact of Cancer on Adolescents Barbara Warren 32
Caring for Dying Adolescents Danai Papadatou 34
Meeting the Rehabilitative Needs of Young Adults with Cancer Lisa Schulmeister 37
FamilyCaregivers of Cancer Patients: Reactions and Assistance Barbara Given, Tim Dwyer
JanetVredevoogdand BillGiven 39
Geriatric Oncology: Nursing Concerns Deborah Welch-McCaffery 43
Cancer: A Family Disruption Judi Johnson 45
Part 5. Supportive Care and Symptom Control
Needs Assessment of People Living with Cancer in a Canadian Province Mary Vachon and
Brenda Conway 49
Developing an Education and Support Programme for Cancer Patients and Their Family Members
Gertrude Grahn 53
v
Introducing Individual Psychosocial Interventions in an Oncology Setting Robert Tunmore 56
Family Centred Intervention in Promoting Psychological Adjustment MargaretFitch 60
Urostomy Patients: Strategies for Caring and Rehabilitation Gun Nordstrom 63
Part 6. Contemporary Issues Relevant to Cancer Nursing
Decision-making in Oncology: The Role of Patients and Nurses Hanneke de Haes 65
Identifying the Major Stressors in Cancer Nursing Susie Wilkinson 68
Health Promotion in Ambulatory Cancer Patients: Focusing on Wellness Marilyn Frank-Stromborg 73
What Do Patients Think about Specialist Cancer Centres? Andrew Thompson 78
Part 7. Management of Cancer Services
Using Change to the Advantage of Nursing Sharon Krumm 82
Establishing Standards of Care in the Oncology Setting Moya Berli 84
The Development of a Quality Assurance Index for Oncology Nursing Jill David 86
What Do Cancer Nurses Really Do? - Results of a Comprehensive Activity Analysis Glynis Markham 93
Part 8. AIDS - Its Impact on Cancer Care
WHO Global Programme on AIDS Birgit Sylvest Hansen 96
The Challenge Facing Nursing: The HIV Infection in Central Africa Olive Kopolo 98
HIV Infection: Its Impact on Cancer Care Richard Wells 104
Community Out-reach Ann Smits 107
Part 9. Innovative and Alternative Strategies
Humour: A Therapeutic Approach Kathleen Smith 109
Music and its Influence on the Side-effects of Chemotherapy Eldri Steen 111
Therapeutic Touch: Its Place in Nursing Practice Pat Turton 114
Hope as a Critical Factor in the Cancer Experience Jane Clark 117
The Role of Traditional Chinese Medicine in the Supportive Care of Cancer Patients Wang Ying 119
Telecommunication-Implications in Cancer Nursing Susan Goddard 121
Informing Patients about Phase One Studies: A Two-year Experience Yvonne Willems 123
Part 10. Transcultural Aspects of Cancer Nursing
Cultural Aspects of Oesophageal Cancer Vivienne Pervan 125
A Western Nursing Concept in an Eastern Setting Won Hee Lee-Kim 127
Beliefs towards a Diagnosis of Cancer: A Transcultural Approach Beverley Nielsen 129
Cultural Perspectives on Cancer of the Breast Joyce Lehoka 133
Part 11. Community, Home and Self Care
The Role of Nurses in a Comprehensive Cancer Screening Programme for Women in Finland
Kaija Massingberd 135
Self-Care-The Cultural Barriers Miriam Hirschfeld 137
vi
Post-discharge Crises for Cancer Patients and Their Families Marilyn Oberst, Diane Scott and
Ruth James 139
The Art of Out-patient Oncology Nursing Magi Sque 143
An Experimental Hospital-based Oncology Home-care Nursing System Lu Shu-Chin 145
The Administration of Chemotherapy in the Patient's Home- A New Perspective Jane Richardson 146
An Understanding Voice: The Telephone as a Cancer Counselling Medium
Shane Dobbin and Louise Burton 150
A Study of Patients' Drug Self-administration Patterns in a Cancer Hospital Sue Davis 152
Part12. Debates
Debate 1: This house believes that nursing models provide a useful tool in the management
ofpatientcare Proposer:SteveWright 154
Opposer: Karen Luker 157
Debate 2: This house believes that the nurse is ideally placed to act as the patient's advocate
Proposer:DerrynBorley 160
Opposer:KathMelia 162
Part13. Reviews
'We're Different-We're Children': A Symposium on Paediatric Oncology Nursing-Review
Lecture Georgina Bru 164
Radiotherapy Symposium-Review Lecture Ann Cattell 166
Nutrition Review PatriciaCrooks 168
'Working Together' :A Symposium on Rehabilitation-Review Lecture Christine Dowding 170
Bone Marrow Transplantation Symposium-Review Lecture Jean Edwards 173
Symposium on Spiritual Issues-Review Lecture Rosette Poletti 175
Symposium on Palliative Care-Review Lecture Jeanne Quint Benoliel 179
Poster Review Lecture Kate Copp 181
Author Index
vii
Preface
Cancer nursing has come a long waysince the First Interna given to cancer nurses both by their nursing colleagues and
tional Conference on Cancer Nursing washeld in London in otherhealth-care professionals.
1978.Cancernurses nowhavetheirowninternationalsociety The range oftopicscovered inthese proceedingsisremark
(InternationalSocietyofNursesinCancer Care),internation able.Ways'toblowawaypain' (Cynthia Stutzer),euthanasia
al journal (Cancer Nursing) and international conference (Cees de Ridder), the WHO's response to AIDS (Birgit
(InternationalConferenceonCancerNursing) heldeverytwo Hansen), the telephone as a medium for cancer counselling
years. The firstconferencesin1978and 1980were dominated (Shane Dobbin and Louise Burton) and the debunking of
bythe UnitedKingdomand North America.In1984and1986 some of the myths surrounding cancer nurses (Glynis Mar
thistrend began to change and in1988over 2000nurses from kham) are but a fewof the issuesdiscussed. The papers are
66countriescame to London's Royal Festival Hall to extend published in the same sessions and order as they were
theirknowledge and share theirexperiencesofwhat itmeans presentedattheconferenceapartfromthetwodebatesandthe
to care for people with cancer. It was fitting that the Fifth symposiareviewswhichappearasseparatesectionsattheend.
InternationalConferenceonCancerNursingshould returnto Ihopetheseproceedingswillserveasauniquereminderofthe
Londonin1988tocelebrateitstenthanniversarychoosing as wealthofknowledgeandexperiencepossessedbynursesfrom
its theme 'Cancer Nursing-A Revolution in Care'. For a the international community working incancer care.
revolution has occurred but, as Sally Sims stressed in her Ithank the BoardofDirectorsofthe International Society
keynote address,fewrevolutionshavebeenmoresuccessfulin ofNurses inCancer Care forinvitingme to act aseditor, the
transforming human suffering than the one that has taken speakers for meeting their deadlines and puttingup with my
placeincancercare.Inthenottoodistantpast,cancerpatients often pedantic queries and the remarkable band of
were denied the right to know their diagnosis (a practice still secretaries--RubyRambaran,AudreyHooson,DavidProud
not unknown insome countries,unfortunately).Nurses have foot, Anne Dean and Patricia Binstead-for delivering the
played an important part in ensuring that this right has been impossible time and time again.
returnedto thepatientwithcancer. Paperafter paperinthese
proceedings reveal the consumate skillswhich cancer nurses A. Phylip Pritchard, BA, RGN, RMN
bring tocancercare and validate the rightful recognition now TheRoyal MarsdenHospital, London, October1988
viii
Cancer Nursing: A Revolution in
Care
Sally Sims
Lecturer, CatholicCollegeofEducation, Sydney, Australia
(1870), 'No system can endure that does not march .. . to
INTRODUCTION
standstillistogobackwards'. Wecannotafford tostandstill.
Madam Chairman, distinguished guests, ladies and gentle Progressincancercare hascreatednewchallengesfor nurses
men, it is an honour to have been invited to deliver this and although significant progress has been made, cancer
Opening Address, 'Cancer Nursing: A Revolution in Care', continues to be a universal health problem. Methods are
and a privilege to be able to attend the Fifth International available to prevent one-third of all cancers and, provided
Conference on Cancer Nursing. detectiontakes place early enoughand appropriatetreatment
IamnotsureifThe RoyalFestival Hallisafittingplacefora isgiven,one-thirdofallcancerscan now becured. Inspite of
revolutionarygatheringbutregardlessofwhetherornotthisis this,eachyearnearly 6millionnewcancercasesarediagnosed
so,itistrue tosaythat inone sense weare allrevolutionaries. and more than 4 million or one in ten deaths are caused by
Each one of us has a part to play in ensuring a continuing cancerworld-wide (WHO 1984).
revolution in cancer care. Through the pioneering work of the hospice movement,
Revolutions conjure up images of violence, conflict and methodsare availabletoalleviatedistressingsymptomsand to
forced political change asinthe American War of Independ provideappropriatepsychologicalsupportforindividualswith
ence (1775-1783) and the French Revolution (1789-1798) of progressive cancer and their families. In spite of this, it has
the 18thCentury.Althoughimagessuchastheseareportrayed been estimated that at least 3.5 million people suffer cancer
inpaintings and historical literature, let usnot forget that the pain every dayand thatasmany as50-80% ofcancerpatients
other side of revolution is the transformation of human do not have satisfactory pain relief (WHO 1986).
suffering, the sweeping away of oppression and accelerated These statistics indicate that the need for nurses to be
social progress.Therecan be few revolutions that have been knowledgeable about cancer prevention, treatment, rehabi
more successful in transforming human suffering than the litationand palliationhasneverbeen moreurgent.Wecannot
revolutionwhichhastakenplaceincancercare.Iwouldliketo afford tostandstillifweare tomeet thesechallengesand ifwe
begin by considering briefly the need for a continuing are to be adequately prepared to meet the challenges of the
revolution incancercare beforegoing on to discussourmost future.
powerful weapon inensuring an on-going revolution. I shall Ifpresenttrendscontinue,theincidenceofcancerwillrisein
then consider some of the revolutionary forces which are almostallpartsoftheworld,principallybecauseofincreasesin
shaping cancer nursing as we know it and will conclude by the mean age of the world population but also because of
reflecting upon three revolutionary ideals which have great lifestyle factors such as tobaccoconsumption. Between 1960
significance for ourown revolution. and 1980,the death rate from lung cancerrose 76% for men
and 135% for women, an unnecessary and preventable
increase (Stjernsward 1986). Although there isevidencethat
smokingbehaviourischanging,changeisslowandlungcancer
THE NEED FOR ACONTINUING REVOLUTION IN
remains a major health problem. The need for a continuing
CANCER CARE
revolutionincancercare isparamount.Thequestionwemust
The development ofcancernursing as a specialtyhas been a seek toanswer is:howcanweensureanon-goingrevolution?
significant factor behindthe revolutionthathastakenplacein
cancercare.Inhisbook TheAnatomyofRevolution,Brinton
ENSURING ANON-GOING REVOLUTION IN
(1965) asserts that, 'Revolutions are born of hope and their
CANCERCARE
philosophiesareformallyoptimistic'.The revolutionaryvision
ofcancernursing asaspecialistareaofcare wasborn ofhope The word 'revolution' was first used by the astronomer
and the philosophy of the early cancer nurses was one of Copernicus in his De Revolutionibus (1543), the theory that
optimism. the sun, not the earth, is the centre of the universe.
Thatoptimismcontinuestoday.Wedonotshare acommon 'Revolution'originallymeant'rotation'or'turn'anddescribed
languageor health care system but cancernurses throughout the regular revolving motion of the stars (Bullock and
theworldshareacommonoptimismthatcontinuedeffortwill Stallybrass 1977).
achieve newlevelsofexcellenceincancercare. Lookingback Just as education was a major factor behind the early
just10years,cancernursing hascomealongwaysincethefirst advances in cancercare,we must 'turn back to' and reinvest
international conference in London in 1978. We have seen ourenergy ineducation,asthesinglelargest factor inensuring
many ofthe seeds ofhope ofthe early cancernursing leaders acontinuingrevolutionincancercareandacceleratedprogress
come to fruition and will learn of new hopes for the future against cancer.
during the course of the coming week. Jan Stjernsward (1986), Chief of the World Health
Although we have seen rapid developments in cancer Organization's CancerUnit, has stated that, 'Nothing would
nursing over the past decade,hope must be the driving force have a greater impact on cancer today than acting on the
behind continued effort. To quote Florence Nightingale knowledge we have already accumulated'.
1
