Role of the Clinical Nurse Specialist in Cancer Care

Helen Kerr, PhD, RN, is a Senior Lecturer at the School of Nursing and Midwifery, Queen’s University Belfast. She has a clinical background in cancer and palliative care nursing.

• List of Contributors xivForeword xviIntroduction xviiiAbout the Companion Website xxi1 Evolvement of Advanced Nursing Practice 1Helen Kerr1.1 Introduction 11.2 Evolvement of Nursing as a Profession 11.3 Advanced Nursing Practice 31.3.1 Criteria Associated with Advanced Nursing Practice 41.3.2 Advanced Practice Nurse Roles 61.3.3 Regulation 81.3.4 Components of Advanced Practice Nurse Roles 81.3.5 Education Requirements 81.3.6 Outcomes Associated with Advanced Practice Nurse Roles 91.3.7 Barriers to Advanced Practice Nursing Roles 91.3.8 Recommendations for Advanced Practice Nurse Roles 101.4 Conclusion 10References 112 Emergence and Evolvement of the Clinical Nurse Specialist Role in Cancer Care 15Helen Kerr2.1 Introduction 152.2 Advanced Nursing Practice 152.3 Historical Context 162.4 Specialists vs. Generalists 172.5 Definition of a CNS 182.5.1 Role Blurring 182.6 Components of the Clinical Nurse Specialist Role 192.6.1 Direct Patient Care 202.6.2 Indirect Care 202.7 Professional Standards 212.8 Education Requirements 222.8.1 Impact of a Master’s Qualification 222.9 Outcomes of the Clinical Nurse Specialist Role 232.9.1 Outcomes Associated with the Clinical Nurse Specialist in Cancer Services 242.10 Specialist Practice in Cancer Care 252.11 Future Direction of the CNS 252.12 Conclusion 25References 263 Patient Perspective 31Johanna McMullanReferences 404 Carer’s Perspective 43Trevor Wightman5 Key Worker Role 49Karen Armstrong and Helen Kerr5.1 Introduction 495.2 The Key Worker 505.2.1 Provision of Information 525.2.2 Provision of Emotional and Supportive Care 525.2.3 Coordination of Services 535.3 Key Worker/Clinical Nurse Specialist Impact on Direct and Indirect Patient Care 545.4 Challenges in Practice 555.5 ‘First Impressions Count’ 575.6 Example of Change in Practice 585.7 Conclusion 59References 596 Psychological Support 63Caroline McCaughey, Edel Aughey, and Susan Smyth6.1 Introduction 636.2 Part One: The Impact of a Cancer Diagnosis 646.2.1 Time Point One: Breaking Significant News 666.2.2 Time Point Two: Treatment Decision-Making 706.2.3 Time Point Three: Survivorship and Resilience 716.2.4 Fear of Recurrence 736.3 Part Two: Self-Care and the Clinical Nurse Specialist 746.4 Conclusion 77References 787 Integrating Research and Evidence-Based Practice 84Adrina O’Donnell, Ruth Boyd, and Clare McVeigh7.1 Introduction 847.2 Evidence-Based Practice 857.3 Barriers to the Implementation of Evidence-Based Practice in the Clinical Setting 867.4 Role of Evidence-Based Practice in Caring for Patients with Cancer and Their Carers 877.5 Providing Evidence-Based Care as a Clinical Nurse Specialist 877.6 Clinical Application of Evidence-Based Practice by Clinical Nurse Specialists 887.7 Cancer Research and Clinical Trials 897.8 Cancer Clinical Trials, Research Nurses and the Role of the Clinical Nurse Specialist 917.9 The Role of the Clinical Nurse Specialist Along the Cancer Clinical Trial Patient Pathway 927.10 Conclusion 97References 988 Symptom Management 104Michelle Keenan and Helen Kerr8.1 Introduction 1048.2 Pain 1058.2.1 Renal Impairment 1078.2.2 Hepatic Impairment 1088.2.3 Neuropathic Pain 1098.3 Breathlessness 1108.4 Nausea and Vomiting 1128.5 Constipation 1158.6 Conclusion 115References 1169 Multidisciplinary Teamworking 124Hinal Patel and Oonagh McSorley9.1 Introduction 1249.2 The Multidisciplinary Team 1259.2.1 Characteristics of an Effective Multidisciplinary Team 1269.2.1.1 The Team 1269.2.1.2 Multidisciplinary Meeting Organisational Logistics 1289.2.1.3 Infrastructure for the Multidisciplinary Meeting 1289.2.1.4 Person-Centred Clinical Decision-Making 1289.2.1.5 Team Governance 1299.3 The Role of the Clinical Nurse Specialist in Relation to the Multidisciplinary Team 1299.3.1 Challenges of the Clinical Nurse Specialist Working in a Team 1309.4 Conclusion 132References 13310 Leadership and the Clinical Nurse Specialist 136Ruth Thompson and Monica Donovan10.1 Introduction 13610.2 Leadership 13710.3 Self-Recognition of the Clinical Nurse Specialist as a Leader 13710.4 Leadership in the Context of the Clinical Nurse Specialist 13910.4.1 Clinical Leadership 14010.4.1.1 Clinical Expertise and Coordination of Care 14110.4.2 Professional Leadership 14210.4.2.1 Enhancing Practice 14310.4.2.2 Service Improvement and Innovation 14310.4.2.3 Collaborative Working 14410.5 Conclusion 144References 14411 Nurse-Led Clinics 149Shelley Mooney and Helen Kerr11.1 Introduction 14911.2 Nurse-Led Care and the Launch of Nurse-Led Clinics in Healthcare 15011.3 Components of a Nurse-Led Clinic 15111.4 Introducing a Nurse-Led Clinic 15211.5 Nursing Skills Required to Introduce and Establish a Nurse-Led Clinic 15411.6 Approaches to Delivering a Nurse-Led Clinic 15511.7 Patient Outcomes Related to Nurse-Led Clinics 15611.8 Benefits of Nurse-Led Clinics for the Registered Nurse 15711.9 Benefits of Nurse-Led Clinics for the Healthcare Organisation 15711.10 Challenges to Implementing Nurse-Led Clinics 15811.11 Nurse-Led Clinic Service Evaluation 15911.12 Future of Nurse-Led Clinics 15911.13 Reflection on the Role as a Uro-Oncology CNS Undertaking Nurse-Led Clinics 16011.14 Conclusion 161References 16212 Non-Medical Prescribing 166Laura Croan and Barry Quinn12.1 Introduction 16612.2 Background 16712.3 Developments in Nursing Practice and the Role of Prescribing 16812.3.1 Community Nurse Prescribing 16812.3.2 Clinical Management Plans 16912.3.3 Patient Group Directives 16912.3.4 The Growth of Independent Prescribing 17012.4 Preparing to Prescribe 17212.5 Benefits and Challenges of Non-Medical Prescribing 17212.6 Deciding to Become a Non-Medical Prescriber 17312.7 Conclusion 177References 17813 Cancer in the Adolescent and Young Adult 181Kerrie Sweeney and Helen Kerr13.1 Introduction 18113.2 Background to Adolescent and Young Adult Cancer Services 18213.3 Person-Centred Adolescent and Young Adult Care 18513.4 Support for Family and Significant Others 18513.5 Holistic Care 18613.6 Multidisciplinary Working 18713.7 Healthcare Professional Knowledge 18813.8 Adolescent and Young Adult Clinical Nurse Specialist Leadership Skills 18913.9 Communication with Adolescents and Young Adults 18913.10 Age-Appropriate Environments 19113.11 Adolescent and Young Adult Peer Support 19213.12 Adolescent and Young Adult Treatment Priorities 19213.13 Transitional Adolescent and Young Adult Care 19313.14 Living With and Beyond Cancer 19413.15 Late Effects of Cancer Treatment 19513.16 Palliative Adolescent and Young Adult Care 19513.17 Co-production 19613.18 Conclusion 196References 19714 COVID-19 and the Clinical Nurse Specialist 203Stephanie Todd and Helen Kerr14.1 Introduction 20314.2 Impact on Healthcare Services and Frontline Healthcare Workers 20414.3 Impact of COVID-19 on Cancer Services 20514.4 The Role of the Clinical Nurse Specialist Prior to the COVID- 19 Pandemic 20714.5 Devolvement of Staff over the COVID-19 Pandemic 20814.6 Impact of COVID-19 on the Clinical Nurse Specialist Role and Patient Care 20914.7 The Future of Healthcare Services Post–COVID-19 Pandemic 21214.8 Conclusion 213References 21415 Digital Health 218Amy Vercell and Sarah Hanbridge15.1 Introduction 21815.2 The Role of the Informatics Nurse/Chief Nursing Information Officer 22015.3 Electronic Observations 22015.4 Electronic Health Records 22115.5 Digitalisation of Blood Glucose Monitoring 22215.6 Electronic Nurse Prescribing 22315.7 Nurse Digitally Requesting Bloods 22415.8 Remote Consultations 22415.9 Virtual Wards 22515.10 Electronic Patient-Reported Outcome Measures 22615.11 Mobile Cancer Applications 22715.12 Home Blood Monitoring 22815.13 Artificial Intelligence 22915.14 Barriers to Digital Health 23015.15 Conclusion 230References 23116 Future Direction of the Clinical Nurse Specialist in Cancer Care 236Barry Quinn and Helen Kerr16.1 Introduction 23616.2 The Role of Caring and the Clinical Nurse Specialist 23816.3 Developing Skills for Today and the Future 23916.4 Leadership 24016.5 Equality, Diversity and Inclusion in the Role of the Clinical Nurse Specialist 24216.6 New Ways of Working 24416.7 Self-Reflection 24616.8 Conclusion 246References 247Index 250