Provision of advanced uro-oncological nursing care – Part I

For several years, it is a trend in many countries to implement Advanced Nursing Practice (ANP) services. ANP is an ‘umbrella’ term for extended nursing  practice. These ANP services are intended to achieve an improvement in holistic patient care. 

Advanced Practice Nurse
The services are provided by Advanced Practice Nurses (APN) – usually by a Nurse Practitioner in the substitution model or a Clinical Nurse Specialist in the delegation model (1). The prerequisite for both roles is a Bachelor’s degree in Nursing, the subsequent completion of a Master’s degree and specialisation in a field with a focus on a specific patient group (2). However, the tasks and competences of the APN often vary, depending on the setting (outpatient or inpatient care), the patient population and national regulations (3).

“EAUN committed to supporting urology nurses in expertise development”

European Oncology Nursing Society
Based on the educational framework of the European Oncology Nursing Society (4), the scope of practice of the APN in oncology care includes parts of research, education, clinical practice and management. The APN has a high degree of professional autonomy and runs an independent clinical practice. In addition, the APN has independent case responsibility and the ability to assess health/disease and make informed decisions.

Diagnostic thinking skills
The basis of patient care is diagnostic thinking skills, which are part of the extended scope of practice. Furthermore, the APN advises health care providers, plans, implements and evaluates specific care programmes. This professional is the first point of contact for people with cancer and their relatives, e.g. in the follow-up of cancer survivors. Furthermore, the APN has the authority to diagnose, prescribe medication and treatment, refer people with cancer to specialists or admit them to hospital or other healthcare facilities (4).

EAUN is committed
The European Association of Urology Nurses (EAUN) is also committed to supporting urology nurses in the practice of their competences and the development of their expertise on different skill and grade level. Thus, competences are to be developed through various training courses (e.g. Webinars, ESUN courses) based on an educational framework concept. This educational framework concept is currently in the development phase (5). Furthermore, in the future, EAUN training courses might be creditable in the academic ECTS system. Further updates will be provided on the EAUN website (www.eaun.org/nurses/education-2/other-resources/).

Different settings and patient groups
Urological ANP care services are found internationally in different settings and are specialised for different patient groups. They range from inpatient to outpatient and from primary to secondary (hospital) care. In terms of uro-oncological patient groups, mostly people with prostate, bladder, kidney,  penile and testicular cancer are involved. In the case of people with prostate cancer, the prevention of the disease through genetic counselling is of particular interest (6). In addition, APNs support, for instance, informed decision-making on prostate-specific antigen (PSA) testing as part of the diagnostic process. They are also involved in assisting patients in coping with symptoms and therapeutic side effects (e.g. erectile dysfunction, incontinence, bone health) during the cancer survivorship phase. APNs are also trained to improve living conditions at home during the end-of-life phase and include relatives through the approach of Advance Care Planning.

Key people
It becomes clear that the care provided by an APN extends from the prevention of an oncological disease to the end of life phase. Various studies show that APNs can, among other things, improve healthrelated quality of life (7) and patients symptom management (8). In turn, the coordinative tasks of an APN can improve, e.g. interprofessional collaboration (9), reduce waiting time for diagnostic/treatment and the length of hospital stay (10).

In summary, APNs contribute to improve patient uro-oncological care in today’s world. Understanding APNs tasks and competencies will help implement this role in the interprofessional team and let patients, as well as health care professionals, benefit from their interventions. APNs broad expertise and problem analysis skills make them key people in identifying health care service gaps as well as in nursing practice development.

References
1. ICN-AANP. Definition and Regulation of Advanced Nursing Practice. 2019 [26.08.2019]; Available from: https://international.aanp.org/Practice/APNRoles.
2. Hamric, A.R., Spross, J.A., Hanson, C.M., Competencies of Advanced Practice Nursing., In Advanced Practice Nursing. An Integrative Approach. A.R. Hamric, Spross, J.A., Hanson, C.M., Editor. 2009, Saunders Elsevier: St. Louis.
3. CRNNS, Nurse Practitioner-Sensitive Outcomes. 2016 Summary Report. 2016, College of Registered Nurses of Nova Scotia.
4. EONS, European Oncology Nusing Society Cancer Nursing Education Framework. 2018, European Oncology NursingSociety.
5. Marley, J., et al., Developing an Educational Framework for Urological Nursing: Using a World Café approach to gain an emerging international understanding of issues, challenges and responses. International Journal of Urological Nursing, 2020. 14(1): p. 5-12.
6. Connors, L.M., Genomics to personalize care of prostate cancer. J Am Assoc Nurse Pract, 2020. 32(2): p. 106-108.
7. Bryant-Lukosius, D., et al., Evaluating health-related quality of life and priority health problems in patients with prostate cancer: a strategy for defining the role of the advanced practice nurse. Can Oncol Nurs J, 2010. 20(1): p. 5-14.
8. Spoelstra, S.L., et al., A trial examining an advanced practice nurse intervention to promote medication adherence and symptom management in adult cancer patients prescribed oral anti-cancer agents: study protocol. J Adv Nurs, 2016. 72(2): p. 409-20.
9. McCorkle, R., et al., An Advanced Practice Nurse Coordinated Multidisciplinary Intervention for Patients with Late-Stage Cancer: A Cluster Randomized Trial. J Palliat Med, 2015. 18(11): p. 962-9.
10. Drudge-Coates, L., Khati, V., Ballesteros, R., Martyn-Hemphill, C., Brown, Ch., Green, J., Challacombe, B., Muir, G., A nurse practitioner model for the assessment of suspected prostate cancer referrals is safe, cost and time efficient. ecancer, 2019. 13: p. 994.

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Franziska Geese, MScN, Research Associate, EAUN Board Member Elect, Berne (CH),  f.geese@eaun.org