International Cancer Nursing News
QUARTERLY NEWSLETTER VOLUME 26 NUMBER 1 2014
New ISNCC strategic plan
Strategy is usually defined as being the means used to achieve a specific goal, and achieving any specific goal requires confirmation of specific tactics specific tactics and/or actions. Applying this to ISNCC read more »
Don’t miss the opportunity to attend the 18th ICCN this year in Panama City
The 18th International Conference on Cancer Nursing will be held in Panama City, Panama from September 7 to 11, 2014 read more »
Assessing constipation risk in oncology
Constipation is the most common functional digestive disorder in oncology, yet is also the most under-assessed and undertreated read more »
New era of oncology nurses in Asia
The Asian Oncology Nursing Society held its first ever conference in November 2013 in Bangkok with 464 participants attending the conference from around the world read more »
A study of women’s intention to receive postoperative radiation therapy read more »
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New ISNCC strategic plan Strategy is usually defined as being the means used to achieve a specific goal, and achieving any specific goal requires confirmation of specific tactics and/or actions. Applying this to ISNCC, our collective success relies on a comprehensive and ongoing strategic planning process. In June 2013 the ISNCC board of directors participated in a one-day inperson facilitated strategic planning process. In this process, the ISNCC board was able to carefully evaluate its current status, review its mission and vision, and determine strategic goals and objectives for the future. This process has three potential major benefits: 1. buy-in and ownership of the future of ISNCC by relevant stakeholders, 2. update of the mission and vision of ISNCC to re-confirm ultimate goals, 3. financial success via evaluation of current status and opportunity evaluation for the future. The ISNCC strategic planning process included an environmental scan of
the global and regional cancer control efforts, including evaluation of political, economic, social, technological and demographic trends (PESTLE analysis) and the strengths, weaknesses, opportunities and threats to the organization (SWOT analysis). Further, the ISNCC board of directors reviewed data from our ISNCC membership via survey — including feedback from individual, association and full members. The results of the strategic planning day were a revised ISNCC mission as follows: “Maximize the influence of nursing to reduce the global burden of cancer.” Further to this, the vision was updated to: “Lead the global nursing community in cancer control.” This vision is accomplished by building on our strategic relationships and partnerships, and by operating through our core values: accountability, equity, excellence, inclusivity, integrity, respect.
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In order to achieve the mission and vision in the next three years, ISNCC is focusing its efforts on the following strategic directions: building and sustaining stakeholder relationships, influencing health policy, advancing and applying knowledge, developing and engaging cancer nurse leaders. Over the next year, the presidents’ message will focus on detailed review of each of these exciting strategic directions. As always, we invite your comments, suggestions and offers to participate! Greta Cummings, ISNCC president
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Advertise in the ISNCC newsletter International Cancer Nursing News is distributed to over 11,000 cancer nurses worldwide. Advertising in ICNN will allow you to market directly to your target demographic. For further information on this exciting opportunity, please contact the ISNCC Head Office at email@example.com or by phone on +1 604 630 5516.
WHO report reveals increasing cancer rates A report published by the World Health Organization’s International Agency for Research on Cancer has revealed that cancer rates are continuing to grow at a rapid pace. The World Cancer Report 2014 found that in 2012 the global incidence of cancer rose to an estimated 14 million new cases, a figure expected to
rise to an annual 19.3 million by 2025. Most cancers occur in the less developed regions of the world, with 60% of cancers and 70% of cancer deaths from cancer in Africa, Asia, and Central and South America. Part of this is because of high population numbers but lack of early detection and access to treatment are significant factors.
The report’s authors emphasise that treatment alone would not be a sufficient response and that a greater focus is needed on prevention. Half of all cancers could be prevented, with tobacco causing 20% of cases, and infections such as hepatitis B and human papillomavirus as major causative factors.
Board of directors President, International Society of Nurses in Cancer Care Greta Cummings Canada President elect Brenda Nevidjon US Secretary/Treasurer Janice Stewart Canada Chair of the Editorial Committee Winnie So Hong Kong, China
Trustees Yael Ben Gal, Israel Esther Green, Canada Catherine Johnson, Australia Linda Krebs, US Tish Lancaster, Australia ISNCC Secretariat email: firstname.lastname@example.org tel: +1 604 630 5516, fax: +1 604 874 4378 375 West 5th Avenue, Suite 201 Vancouver, BC V5Y 1J6 Canada
Editor Kathryn Godfrey 11 Chesholm Road, London N16 0DP, United Kingdom email: email@example.com All correspondence should be addressed to the editor. http://www. isncc.org Published on behalf of the International Society of Nurses in Cancer Care by: Malachite Management Inc. 375 West 5th Avenue, Suite 201 Vancouver, BC V5Y 1J6 Canada ISSN 09565175
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Don’t miss the opportunity to attend the 18th ICCN this year in Panama City The 18th International Conference on Cancer Nursing will be held in Panama City, Panama from September 7 to 11, 2014 The Conference Management (CMC) and Scientific Planning Committees (SPC) have been working very hard to plan an exciting, evidence-based conference that provides opportunities for new knowledge, networking, and collaboration among participants. For this conference, several new features have been added to increase opportunities to meet and share experiences and best practices with oncology nursing colleagues from across the world.
The theme of the conference is “Strengthening Leadership, Unity and Compassion in Cancer Care,” with a primary focus on addressing disparities in cancer care worldwide. Co-chairs for the conference are Iveta Nohavova (Czech Republic) and Myrna McLaughlin de Anderson (Panama). The conference will have a variety of sessions to meet your educational needs: pre-conference workshops, plenary sessions, concurrent sessions, poster sessions, corporate workshops and tutorials official opening and closing ceremonies.
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You will also have the opportunity to hear the Robert Tiffany Lecture and a presentation by the winner of the Distinguished Merit Award, ISNCC’s highest awards. The keynote speaker is Dr Zoe Wainer, deputy director of medical services at the Peter MacCallum Cancer Centre, Melbourne, Australia. She will be speaking on the subject of “Cancer and Sex Differences, Personalised Medicine and Global Economics”. There will be daily plenary sessions on topics such as “Cancer Issues in Latin America and Global Implications” and “Genetics and Genomics” as well as collaborative sessions between ISNCC and the Oncology Nursing Society and the European Oncology Nursing Society. Corporate tutorials and symposia will be held daily during lunch and dinner. Many of these require pre-registration. Please visit www.isncc.org or contact the ISNCC Head Office at firstname.lastname@example.org for more information.
There will be poster sessions on days one, two and three of the conference. Posters will be available for viewing throughout each day and authors will have assigned times during the breaks
The Panama Canal — one of the many attractions of Panama.
to discuss their posters with delegates. Poster awards will be given for the top poster in the Clinical Practice, Education, Leadership and Research categories each day. Delegates will also have the opportunity to vote for the People’s Choice Award for the best poster of each day. A new element is being added for this 18th ICCN, during conference day three we will highlight the expertise of our Spanish-speaking colleagues with three concurrent sessions presented in Spanish as well as a public session, also presented in Spanish, for the Panama City Community.
Opportunities for networking
The CMC and SPC listened to the evaluations of previous ICCNs requesting more opportunities for networking. As a result for the 18th ICCN, there will be two opportunities to meet colleagues: the welcome reception on Sunday, September 7th and a networking reception on Tuesday, September 9th. Both will give you the opportunity to network with other attendees, meet exhibitors and view posters. In addition, slightly later start times each day will allow for networking over breakfast without missing any sessions.
The venue for the conference will be the Hilton Panama, a brand new hotel in the midst of Panama City. We will be the only guests and will have ample conference space and amenities, restaurants, fitness facilities and internet access. The hotel is non-smoking and near to the Panama Canal, other tourist attractions and shopping. We believe we have created a wonderful opportunity for you to learn, share and get involved with your international colleagues. We hope you have submitted your abstract and made your arrangements to come to the 18th ICCN. See you in Panama! Linda Krebs Chair of the conference management committee
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Assessing constipation risk in oncology This article describes the impact of constipation in oncology and discusses the development and implementation of a risk assessment scale Constipation is the most common functional digestive disorder in oncology, yet is also the most underassessed and undertreated.
Impact of constipation
Constipation affects 63 million people in North America — 12% of the worldwide population suffers from constipation. The prevalence rates are 81% in Europe with incidence of 17% in Oceania. Constipation affects individuals throughout their lifespan, increasing above the age of 65 years and affecting
three times as many women as men. Between 50% and 90% of cancer patients are prescribed opioids for pain management. Opioid-induced constipation is the most common and distressing symptom affecting quality of life in 78% of those with terminal disease. A literature review revealed the lack of systematic constipation risk assessment tool use in oncology (Richmond and Wright, 2004). The aim of using such a tool would be to identify patients at risk of constipation and proactively prevent constipation
development among patients admitted to the cancer centre. A nursing shared governance body in a comprehensive cancer centre formed an inter- and intra-professional collaboration (2007). The committeeconducted reviews of literature on: constipation risk assessment tools, definition of constipation, evaluation of best practice to prevent constipation development. The committee, in collaboration with other members of the shared
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1. Does patient believe he is prone to constipation? 2. Has laxative been used for constipation before? If yes, how often? 3. Does change of environment affect toileting habits? 4. Does patient have difficulty having a bowel movement in hospital toilet? 5. Does patient anticipate problems using a bedside commode or bedpan?
Medications Antiemetics = 2 Calcium-channel blockers = 2 Iron supplements = 2 Anticonvulsants = 2 Antidepressants = 2 Anti-parkinsonism drugs = 2 Antispasmodics = 2 Non-opioid analgesics = 3 Continuous opioid therapy = 5 Constipating cancer treatments = 3 Vinca alkaloids = 5
No = 0 Yes=2 Gender Male = 1 Female = 2 Mobility Independent = 0 Dependent on assistive devices or assistance from others = 1 Restricted to bed or chair = 2 Bed bound = 3 Fibre intake/ fruits/ vegetables consumed per day 5 oz or more servings = 0 3–4 servings = 1 2 servings or less = 2 Bran products consumed daily? Yes = 0 No = 2
Yes/No Yes/No Yes/No Yes/No
Psychological Psychiatric (depression, anorexia nervosa, etc) = 2 Learning disabilities or dementia = 2 Physiologic disorders Metabolic disorders (hypokalemia, uraemia, hypercalcaemia) = 2 Pelvic disorders (rectal mass, ovarian tumour, pelvic surgery) = 3 Neuromuscular disorders = 3 (Multiple sclerosis, spinal cord compression, parkinsonism, CVA) Endocrine disorders = 3 (DM, hypothyroidism)
Fluid intake consumed per day 10 cups or glasses or more = 0 6–9 cups or glasses = 1 5 cups or glasses or less = 2
Colorectal /abdominal disorders = 3 (Abdominal carcinomatosis, IBS, Ileus, anorectal fissure, strictures, prolapsed haemorrhoids, hernias)
SUB-TOTAL SCORE Total CRAS SCORE Low risk for constipation 10 and less Moderate risk for constipation 11–15 High risk for constipation ≥ 16
Figure 1: constipation risk assessment scale (Modified with permission and approval of Janice Richmond, author, 2007)
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Symptom management governance body, developed and implemented policy on constipation risk assessment and led the implementation of practice change. The Constipation Risk Assessment Scale (Richmond, 2006) was selected because it was used in an oncology setting. The tool was modified after approval of the author Janice Richmond to fit the American language and culture.
The purposes of the (CRAS) project are: to identify patients at risk of constipation using a systematic tool to prevent constipation, to achieve strategic vision for excellence in patient care to promote safety, timely, effective, efficient, equitable and patient-centred care, to prevent serious and lifethreatening situations related to bowel dysfunction.
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80% of inpatient nurses to complete the educational sessions on Constipation Risk Assessment Policy implementation 85% of patients admitted to a comprehensive cancer centre to be assessed by nurses using the Modified Constipation Risk Assessment Scale (Richmond, 2007)
The quality improvement project used the PDCA model. The model includes the plan-do-act-check phases during the different cycle of the project. The plan phase included the implementation of Constipation Risk Assessment Policy, educational rollout of the policy through in-service sessions on March 1–31, 2010 and inclusion of the CRAS education in orientation classes. The do component included the use of the CRAS tool in inpatient units including ICU effective April 1, 2010. The chart audit on use of CRAS from July 2010 to March 2011 comprises the check component. Analgesic Anti-parkinsonism Anti-convulsant Antispasmodic Antiemetics Antidepressants Figure 2: constipating medications
The determination of barriers, evaluation of the result and modification of strategies of implementation were the components of the act phase.
The bowel management specialist of the cancer centre conducted the educational sessions in collaboration with the staff educator. The contents of the sessions included: 1. policy on constipation risk assessment, 2. overview of the normal bowel function and dysfunction, 3. Constipation Risk Assessment Scale Tool, 4. review of constipating medications and chemotherapy, 5. intervention and management of bowel dysfunction, 6. patient education and documentation. The policy on constipation risk assessment requires a mandatory assessment of risk for constipation using the Modified Constipation Risk Assessment Scale (Richmond, 2007) within 24 hours of admission. Constipation is defined according to the Rome III criteria (Longstreth et al, 2006) as having at least two of the following in 25% of defecation: straining, lumpy or hard stools, sensation of incomplete evacuation, sensation of anorectal obstruction/blockage, need for manual manoeuvres to facilitate, fewer than 3 defecations per week. Patients should rarely have loose stools without laxatives and be distinct from having irritable bowel syndrome.
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CRAS process flow
The CRAS process flow includes the following components: On admission, nurses perform CRAS, review medications, add the total CRAS scores and identify the risk score stratification as low
Calcium channel blocker Constipating cancer treatments: Vinca alkaloids, Thalidomide, Docetaxel, Gemcitabine.
risk, moderate risk, and high risk. The CRAS score is then documented in the GI assessment of the initial nursing assessment. Care plans and order sets are activated according to risk scores. The components of the CRAS are: personal beliefs, gender, mobility, fibre intake, fluid Intake, medications, physiological and psychological aspects with corresponding scores. (See Figure 1) The nursing care plans and order sets for bowel management are identified and activated by nurses according to the risk score stratification as shown below. The approved order sets were developed in collaboration with the bowel management specialist, gastroenterologist and the clinical effectiveness specialist. The order sets include strategies to maintain, normalise and bowel training as determined by the CRAS risk scores.
The aims of the CRAS project were achieved. Of 866 charts reviewed from July 1, 2010 to March 30, 2011 97% have CRAS score documentation, 852 (85%) nurses successfully completed a CRAS educational session during March 2010. The policy implementation was communicated to all physicians, nurse practitioners, physician assistants and associate directors in nursing through monthly policy and practice updates, educational meetings and electronic communication. Some barriers identified are fast turnover of nurses, incomplete CRAS forms, frequent reminders for the practice change and nurses’ perception of it as an “added form”.
The educational implementation of CRAS led to a marked awareness of, and improvement in, the constipation risk assessment documentation. The development and implementation of CRAS policy is a practice change in constipation management in a cancer centre. The practice change is a result of collaboration among different stakeholders in a complex comprehensive cancer centre. Nurses play a crucial role in the proactive constipation prevention and early detection of patients at high risk for constipation. Knowledge of factors associated with bowel functions and dysfunction are essential in individualised bowel management. Constipation risk assessment is important to prevent
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News constipation. In oncology, opioidinduced constipation can be distressing. Nurses play a critical role in patient education to prevent constipation.
There is a need to measure the impact of CRAS scores on the activation of care plans and to use approved order sets as previously described for moderate and high risk scores. Integrating the constipation risk assessment in the electronic medical record can facilitate increased efficient use of the tool. Further validation of the CRAS tool in oncology and general patient population is needed.
Cynthia Abarado, Advanced Practice Nurse, Department of Genitourinary Medical Oncology; Annette Bisanz, Bowel Management Specialist (retired); Mary Cline, Advanced Practice Nurse; Christella Whitcher, Senior Staff Educator; Josephine Bianty, Coordinator, Department of Physical Medicine and Rehabilitation; Patti Perron, Clinical Staff; Dhavinder Kaur, Advanced Practice Nurse, Department of Pain Management; Mary Lohmann, Advanced Practice Nurse; Geri LoBiondo-Wood, The University of Texas MD Anderson Cancer Center, Houston, Texas.
The authors acknowledge the support of The University of Texas MD Anderson Cancer Center, Division of Nursing, Nursing Practice Congress – MDACC, Constipation PACT Committee, Documentation and Forms Committee, Nursing Practice Policy Development Committee and Nursing Education for the implementation of the Constipation Risk Assessment practice change.
Longstreth GF et al (2006). Functional bowel disorders. Gastroenterology, 130, 1480-1491. Richmond, JP (Permission to modify constipation risk assessment scale. A personal communication, 2007) Richmond, JP & Wright M (2006). Development of a constipation risk assessment scale. Journal of Orthopaedic Nursing, 10, 186-197. Richmond, JP & Wright, M (2004). Review of the literature on constipation to enable development of a constipation risk assessment scale. Journal of Orthopaedic Nursing, 8, 192-207.
New era of oncology nurses in Asia The Asian Oncology Nursing Society held its first ever conference in November 2013 in Bangkok with 464 participants attending the conference from around the world. Delegates came from Australia, Canada, China, Hong Kong, India, Indonesia, Iran, Japan, Philippines, Singapore, South Korea, Thailand, Taiwan, Turkey and USA. The inaugural conference had 40 speakers at plenary sessions and accepted 157 poster and 30 oral presentations. The aim of the conference
ISNCC president Greta Cummings with conference delegates
was to provide opportunities for networking and collaboration for oncology nurses across Asia, and to provide a forum for an exchange of ideas. The theme of the conference was “New Era of Oncology Nurses in Asia”. The opening ceremony began with a spectacular traditional Thai performance. Professor Wichit Srisuphan, president of Thailand Nursing Council and Professor Prasit Watanappa, deputy dean and director of Siriraj Medical School Faculty of Medicine Siriaj Hospital, delivered a welcome speech and congratulated the Asian Oncology Nursing Society on its establishment and the launch of its first conference. Nurse leaders from the Asia-Pacific region supported the event and delivered topics in the plenary sessions. Nurse leaders from other regions attended including Greta Cummings, president of ISNCC. The presentations focused on: professional development,
• contemporary oncology nursing practice, • nursing leadership in health services, • models of care in cancer nursing and oncology nursing education, • innovations in cancer management, • roles of oncology nurses for
improving quality of care and advancing nursing practice. At the last plenary session nine presidents of oncology nursing societies in the region shared their views of future collaboration within Asian oncology nursing. As a finale Dr Kwang-sung Kim, vice-president of the Korean Oncology Nursing Society announced that the 2nd AONS conference will be held in South Korea in 2015. The first conference was a successful event and all those who attended will look forward to future AONS conferences. Winnie So, board member, ISNCC, and External secretary, Executive committee, AONS
Conference delegates on a hospital visit during the AONS conference
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Research RESEARCH COLUMN
Breast cancer: a study of women’s intention to receive postoperative radiation therapy Along with bowel cancer, breast cancer has increased markedly in Japan. The mortality rate for breast cancer was the fourth highest by site among women in 2011, accounting for 12,731 deaths (厚 生労働省, 2012). While the occurrence of breast cancer peaks after the menopause in Europe and the United States, it frequently occurs before the menopause in Japan, peaking between the ages of 40 and 49. This study adopted the Bandura’s self-efficacy model (see table 1) to examine the intentions of women to receive postoperative radiation therapy for breast cancer. This study used a qualitative-descriptive approach.
Participants and settings
Three women who were undergoing post-operative radiation therapy at a cancer treatment centre in Tokyo during the study period were recruited and underwent three semi-structured interviews. The first interview was conducted before radiation treatment, the second 10 days later, and the third at the
last day of treatment. The question in the first interview was “What have you in mind regarding radiation therapy?” The question for the second was “Have you changed your thoughts that you expressed in the previous interview?” The question in the third interview was, “what were the reasons for you to complete the therapy?” All interviews were recorded, and contents that are related to the individual’s will to continue radiation therapy was extracted and categorised according to the four patterns of behavioural and affective states in the Bandura’s selfefficacy model. The study was conducted between August and December 2007.
Participants’ mean age was 39 years, and all were employed and had a husband or partner. Based on the interview content, five categories were extracted from the first interview including “Good relationship with physician”. This refers to the rapport of the physician resulting in a sense of comfort with the
Table 1: Categorised patterns of Bandura’s self-efficacy model Pattern I OUTCOME EXPECTANCY (high) EFFICACY EXPECTANCY (high)
Pattern III OUTCOME EXPECTANCY (low) EFFICACY EXPECTANCY (high)
Pattern II OUTCOME EXPECTANCY (high) EFFICACY EXPECTANCY (low)
Pattern IV OUTCOME EXPECTANCY (low) EFFICACY EXPECTANCY (low)
Bandura (1997) classified efficacy expectancy and outcome expectancy into four patterns according to high and low levels of each type of expectancy, enabling an understanding of the states of behaviour and affect associated with each pattern. In pattern I, individuals expect to achieve a positive outcome through their own behaviour, and believe they are able to carry out this behaviour. In pattern II, individuals believe that they are likely to obtain a positive outcome if they carry out the behaviour, but they are in doubt about whether the expected outcome can be achieved by them without outside intervention. In pattern III, individuals believe that an undesirable outcome may occur if they engage in the recommended behaviour, and thus, they are reluctant to engage in it. However, they are confident in their own ability to carry out their own behaviour should they decide to do so. In pattern IV, individuals believe that engaging in the recommended behaviour will produce an undesirable outcome, and they are not confident in their own ability. Therefore, they give up and do not engage in any kind of behaviour.
therapy as a whole. It is associated with increased outcome expectancy and efficacy expectancy, which corresponds to pattern I. In the category of “Negative impression of radiation therapy”, participants linked radiation therapy with “an atomic bomb” though they expected the treatment to be effective. Thus, they were anxious about whether they could be cured after the treatment. This category is associated with high outcome expectancy and low efficacy expectancy, which corresponds to pattern II. “While I don’t have a good impression of radiation, if I don’t do this I won’t get better . . . terms like “atomic bomb victim” are often mentioned.” (Participant C) In the second interview, eight categories were extracted including “Sense of isolation during radiation therapy”, which indicated struggles in building trust relationships with medical staff in the radiological department. This is associated with positive outcome expectancy and low efficacy expectancy, which reflects discouragement about taking recommended action, and corresponds to pattern II. “As expected, I get the feeling that what I want to say doesn’t get through. If that causes me to lose trust in medical staff, I will lose my desire to come (for treatment).” (Participant A) In the third interview, five categories were identified and one of them was “finding a new sense of worth”. This category refers to a state of self-awareness as a survivor who overcomes suffering and struggles, and treatment is considered as a part of life. This indicates high outcome expectancy and high efficacy expectancy and corresponds to pattern I. “I think it probably causes problems for my company (that I’m absent), but I take my time going home and watch television. I think taking time to relax is important.” (Participant A) Thus, the categories obtained from the three interviews were classified only as patterns I and II; none of them were classified as pattern III or IV.
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The three study participants succeeded in carrying out the task behaviour — radiation therapy — to its completion. The results showed that with high or low efficacy expectancy, high outcome expectancy (ie that radiation therapy would effectively inhibit recurrence) was maintained. High outcome expectancy was an important characteristic that sustained individuals’ will to continue
undergoing radiation therapy following breast cancer surgery. In Japan, since radiation is associated with being “an atomic bomb victim”, it arouses women’s anxiety and fear when they are receiving radiation therapy. It is common for survivors who have undergone radiation therapy to have such negative impressions. Consequently, they may hesitate to share with peers about their
experience of receiving cancer treatment. Fumiko Schwarz, Educator, Kanagawa Cancer Center Mitsuko Inayoshi, Professor, Kitasato University References
厚生労働省（2012) 2011年人動態統計（確定数） の 概況. Retrieved from Ministry of Health, Labor, and Welfare website: http://www.mhlw.go.jp/ toukei/saikin/hw/jinkou/kakutei11. Bandura A (1997). Self-efficacy: the exercise of control. New York: Freeman
赴新加坡医院参观学习见闻 ISNCC is committed to spreading education about cancer nursing care around the world. To improve access to our materials, the education column will be in a different language in some issues of the newsletter. This issue of the education column is in Chinese.
天津医科大学附属肿瘤医院是中国肿 瘤学科的发祥地，是国内最大的肿瘤 防治研究基地之一，集医疗、教学、 科研、预防为一体规模最大的肿瘤专 科医院。医院共有床位1500张，年收 治病人量达5万余人。我院是卫生部 的肿瘤临床研究中心，2012年医院护 理部被中国卫生部批准为国家重点护 理专科建设项目。医院非常重视肿瘤 护理学科的发展及护理管理水平的提 升。近年来，不断派出护士到境外知 名医院参观学习，加强护理同行间的 学术交流。 通过香港中文大学那打素护理学院Dr Winnie So 与新加坡国立大学护理学院 Professor Sally Chan 、癌症中心的护 理部主任Ms Chua Gek Phin的积极联 系，2013年9月23日至10月2日，成行 了我院6名护士长去赴新加坡中央医院 和癌症中心进行为期10天的参观学习 的宝贵的机会。
新加坡中央医院是亚洲排名第一的综合 性医院，也是在亚洲第一个取得“磁性 认证”的医院，医院内学科齐全，设备 先进，信息化网络覆盖全院各个部门。 新加坡癌症中心是以门诊服务为主的一 家专科医院，对肿瘤患者的服务具有特 色。现将6位护士长在新加坡学习期间 的收获及体会总结如下： 1 新加坡的医院注重患者安全和风险管 理，对患者入院时的评估内容全面细 致，特别是医院将跌倒事件发生的情 况作为护理质控管理的重要指标。对 存在高危因素的患者，在其床头用醒 目的标识注明“防止跌倒”的图案， 落实预防患者跌倒的各项措施，有 效降低了跌患者倒事件的发生率。为 确保药品安全，工作人员进入治疗室 首先要刷卡，取常用的药品及毒麻药 品时必须再次键入密码或指纹，确认 后，药品柜才能打开。 2.重视肿瘤患者的心理支持，为患者 开辟了服务热线，解决患者的心理问 题。为化疗患者建立了假发库，帮助 需要的患者解决脱发所带来的困扰。 定时组织患者活动，提高患者回归社 会的自信度。 3 重视患者满意度调查结果，依此解 决临床中实际存在的问题。例如在 癌症中心的Ambulatory Treatment Unit(ATU)，针对化疗病人等候时间
长的问题，医院联合其他专业机构， 研发了预约系统-RAPIDE,分别代表实 时(R-real)，流动（A-ambulatory） ，病人（P-patient），信息 （I-information），资源配置 （D-distribution）， 能动性 （E-elastic), 降低了患者的等候时间， 为癌症患者的治疗提供了便利。 4．医院注重人性化的护理管理，为护 士提供学习和发展的空间，尊重关爱 护士，注重护理的价值，医院就如一 块磁铁，吸住了护士愿意留在这个医 院工作。 虽然时间短暂，但使我院护士长们开 阔了眼界，更新了观念，特别是在培 养思维，引领变革和如何创造卓越的 护理方面有了很多启示。在学习中我 们也深深体会到，护理的进步与发展 需要世界护士的共同努力，虽然各 国的文化不同但护理的理念、护理的 方向是一致的，改革、创新、研究、 发展，用我们护理发展的成果去帮助 成千上万的患者及家庭减轻疾病所带 来的的痛苦及压力，提升人类健康水 平，这是世界护理人的愿望。为此我 们要相互交流，共同学习。 李燕 天津医科大学附属肿瘤医院护士长
Prof Swee Hia LIM 在SGH为我们讲护理教育，从左至右：Yan LI, Dong Jun LIU, Prof LIM, Zheng LI, Qian SHI, Yan WEN, Jing CHEN
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