The various roles of oncology nurse specialists: An international perspective

Ilana Kadmon, PhD, RN was for many years a nurse specialist in Breast Cancer at Hadassah Medical Center, Jerusalem, Israel. From 2016, she started the role of a nurse academic consultant at the nursing division at Hadassah. Her PhD is from The University of Edinburgh, UK. Her research involved psychosocial aspects of breast cancer, and the role of the breast care nurse (BCN). She was a pioneer in developing the post of the BCN in Israel. This position was initially developed by her at Hadassah and initiated by the Israel Cancer Association. Beyond her clinical expertise, at the Hadassah School of Nursing, she lectures and writes in many areas on breast cancer care in general. She served as a board member of the European Oncology Nursing Society, and was also a member of the Editorial Committee of the European Journal of Oncology Nursing. Moreover, she serves as a reviewer for many nursing journals. She was involved in a mutual international collaborative project with nurses in Tianjin, China. She was there for seminars and initiated some cross-cultural research in the area of partners of women with breast cancer, involving both countries. Moreover, she has been invited to Cyprus, Greece Russia, and Turkey to teach and give workshops. Ilana Kadmon, PhD, RN was for many years a nurse specialist in Breast Cancer at Hadassah Medical Center, Jerusalem, Israel. From 2016, she started the role of a nurse academic consultant at the nursing division at Hadassah. Her PhD is from The University of Edinburgh, UK. Her research involved psychosocial aspects of breast cancer, and the role of the breast care nurse (BCN). She was a pioneer in developing the post of the BCN in Israel. This position was initially developed by her at Hadassah and initiated by the Israel Cancer Association. Beyond her clinical expertise, at the Hadassah School of Nursing, she lectures and writes in many areas on breast cancer care in general. She served as a board member of the European Oncology Nursing Society, and was also a member of the Editorial Committee of the European Journal of Oncology Nursing. Moreover, she serves as a reviewer for many nursing journals. She was involved in a mutual international collaborative project with nurses in Tianjin, China. She was there for seminars and initiated some cross-cultural research in the area of partners of women with breast cancer, involving both countries. Moreover, she has been invited to Cyprus, Greece Russia, and Turkey to teach and give workshops. The role of nursing, by the end of the 20th century, changed and developed in the Western world. However, in many of the Asian countries as well as other countries in the less developed world, the process is still going on but has been advancing since the beginning of the 21st century. As an example, in the urban areas of China, nursing is widely recognized as an independent profession and is growing as an academic profession which can be seen by the number of graduate level courses for nurses. Israel is another good example of the academic process that has happened in nursing since the 1990s. One example is the development of the role of the oncology nurse. However, internationally, one of the major problems is the variation in definition of what generally can be meant by the term nurse specialist. As an example, breast cancer and the role of the specialist nurse varies greatly in role/responsibilities and academic preparation. Great Britain was the first country to introduce the role of the BCN 1Amir Z, Scully J, Borrill C. The professional role of breast cancer nurses in multi-disciplinary breast cancer care teams. Eur J Oncol Nurs 306–14.Google Scholar, 2Burnet K, Chapman D, Wishart G, Purushotham A. Nurse specialists in breast care: A developing role. Nurs Stand 38–42.Google Scholar, 3Watson M, Denton S, Baum M, Greer S. Counselling breast cancer patients: A specialist nurse service. Couns Psychol Q 25–34.Google Scholar and the BCN has since been introduced in other countries including Sweden, the Netherlands, the USA, and Australia, to name a few.4Liebert B, Furber S. Australian women's perceptions of a specialist breast nurse model. Aust Health Rev 88–93.Google Scholar, 5McArdle JM, George WD, McArdle CS, Smith DC, Moodie AK, Hughson AV, et al. Psychological support to patients undergoing breast cancer surgery: A randomised study. Br Med J 813–6.Google Scholar, 6White K, Wilkes L. Describing the role of the breast care nurse in Australia. Eur J Oncol Nurs 89–98.Google Scholar, 7Wilkes L, White K, Beale B, Cole R, Tracy S. Supportive care for women with breast cancer: Australian nurses' perspective. Nurs Health Sci 71–6.Google Scholar, 8Begley C, Elliott N, Lalor J, Coyne I, Higgins A, Comiskey CM. Differences between clinical specialist and advanced practitioner clinical practice, leadership, and research roles, responsibilities, and perceived outcomes (the SCAPE study). J Adv Nurs 1323–37.Google Scholar, 9Oncology Nursing Society Oncology Nurse Navigator, Role and Qualification. ONS, 2015Available from: https://wwwonsorg/advocacy-policy/positions/education/onnDate accessed: January 10, 2017Google Scholar Although some qualitative studies have been done on the role of the oncology nurse specialist,10Karlou CH, Vouzavali F, Lemonidou CH, Papathanassoglou E, Zafiropoulou-Koutroubas A, Katsaragakis S, et al. Qualitative study of care in oncology. Nurs Care Res 13.Google Scholar much information is still lacking as to the specific impact that the role and responsibilities of the nurse specialist has on women who require their care as well as on the specific role itself. Regarding breast cancer care, the development of the role of the nurse specialist began in the UK during the 1980s and became a model for other Western countries such as Sweden, the Netherlands, and Australia who wanted to establish a similar clinical nursing position. In North America, the role of the clinical nurse specialist (CNS) was developed, with less emphasis on follow-up for emotional support and counseling, and instead, there was more emphasis on clinical expertise. In part, as a result of these developments, a natural need arose to evaluate the role of the nurse specialist. In the 1980s, researchers in the UK conducted controlled studies to examine this particular issue. These studies showed that women who had met a BCN and received counseling, advice, and emotional support from such a professional showed lower levels of anxiety and depression, and a general better ability to cope with their disease.3Watson M, Denton S, Baum M, Greer S. Counselling breast cancer patients: A specialist nurse service. Couns Psychol Q 25–34.Google Scholar, 11Fallowfield LJ. Counselling for patients with cancer. BMJ 727–8.Google Scholar In Australia, some two decades later, nursing studies were done to examine the same issue but went one step further 12Campbell D, Khan A, Rankin N, Williams P, Redman S. Are specialist breast nurses available to Australian women with breast cancer. Cancer Nurs 43–8.Google Scholar, 13Eley RM, Rogers-Clark C, Murray K. The value of a breast care nurse in supporting rural and remote cancer patients in Queensland. Cancer Nurs E10–8.Google Scholar by looking at aspects of care in rural area women. They examined the unique contribution of the BCN in Australian women by employing both quantitative and qualitative research methodologies. Campbell et al.12Campbell D, Khan A, Rankin N, Williams P, Redman S. Are specialist breast nurses available to Australian women with breast cancer. Cancer Nurs 43–8.Google Scholar studied the availability and accessibility of Australian BCNs. They described a new concept of systematic care defined as at least three encounters with a BCN throughout their treatment. Their study focused on women living in rural areas and access to BCN care. They investigated various aspects of care provided by the BCN, such as coordination of care, provision of information, provision of emotional and practical support, and others. Their study provided relevant information regarding the importance of the role of the BCN in Australia, mainly to women living far from big medical centers. The issue of the multidisciplinary team is an important topic to further examine internationally. The recognition of the role of the specialist nurse comes not only from care to patients but also from the entire multidisciplinary team which includes the medical and psychosocial team and other health-care professionals. An example of this is seen in the report of a literature review done by Pillay et al.14Pillay B, Wootten AC, Crowe H, Corcoran N, Tran B, Bowden P, et al. The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: A systematic review of the literature. Cancer Treat Rev 56–72.Google Scholar about the multidisciplinary meetings in cancer care. To conclude, the role of the specialist nurse has a variety of definitions in different parts of the world. In the USA and Canada, it is defined more as the advance practice nurse, CNS, or the nurse practitioner. Some other countries, such as in Australia,15Monterosso L, Platt V, Krishnasamy M, Yates P, Bulsara C. The cancer nurse coordinator service in Western Australia: Perspectives of specialist cancer nurse coordinators. Aust J Adv Nurs 16–26.Google Scholar view the nurse navigator or coordinator as a specialist nurse. In European countries, the term, CNS, is more commonly used. The terms used in the South Pacific and other Asian-Pacific countries will also be discussed in this issue. I am delighted to introduce the reader to three articles written by nurses from my institution – the Hadassah Medical Organization located in Jerusalem, Israel. Other manuscripts we are privileged to present are from the USA, Australia, and a Taiwan oncology nurse scholar who currently lives in the USA.

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