Clinical Nurse (R/N) Exp - Oncology

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The Professional Nurse/Clinical Nurse is a professional who remains responsible for the assessment, planning and implementation of individualised, holistic and person centered nursing care of a patient, their families or the community, either performed directly or indirectly.

The incumbent ultimately coordinates patient care within the concept of the multi-disciplinary health team, also fulfils the role by the use of scientifically based nursing theories and processes, treating the patients as a physical, social and spiritual individual, and by use of educational and technical means applicable to health care practice.

NATURE OF SPECIALIZATION

Oncology and Palliative Nursing is a speciality, whereby nurses care for people who are at risk for developing cancer, patients diagnosed with cancer, patients receiving treatment for cancer, patients in need of supportive and palliative care, serious illness, cancer survivors and their families/caregivers.

Oncology and palliative nursing occurs throughout the lifespan and includes individuals from all ages and cultures along a continuum of care and across service delivery systems. Oncology and palliative nursing occurs at primary, secondary and tertiary care levels and include hospices and homes.

The role of the Oncology and Palliative Nurse is underpinned by holism and encompasses direct care to patients and families/caregivers in cancer care settings as part of the multidisciplinary team. The role is expanded to include cancer prevention and health promotion in communities, and caring for patients for whom cure is no longer possible and their families/caregivers for improved quality care. Caring for the cancer survivor forms part of her/his role.

The core concepts and interventions specific to oncology and palliative nursing include:

• Prevention and detection of cancer through immunization and screening.
• Management of patients who are treated for cancer by means of surgery, radiotherapy, chemotherapy, hematopoietic stem cell transplantations and immunotherapy.
• Management of acute and chronic cancer and treatment related complications and side effects as well as patient problems and issues, including those of the family/caregiver. These include managing pain and other distressing symptoms and optimizing quality of life for the sick person and the family/caregiver throughout the disease trajectory, in a holistic manner.
• Management of the patient experiencing an oncology emergency.
• Management of the patient for whom cure is no longer possible and the families/caregivers.
• Care for cancer survivors and people with serious illness in their family setting.

The Oncology and Palliative Nurse requires specific evidence-based knowledge and demonstrates excellent clinical competencies in cancer and palliative care, beyond that acquired through a basic nursing education programme.

2. OVERLAP OF COMPETENCIES

While each of the study areas below may yield a stand-alone qualification, there is shared knowledge and skills, creating an overlap of some competencies. This might have educational implications where some modules could be shared by the different specialities. It is possible that some of the names disciplines may not become full qualifications, depending on educational requirements and the percentage of core content.

The overlapping qualifications are:

• Child nursing
• Nephrology nursing
• Intensive care nursing
• Primary care nursing
• Orthopaedic nursing

3. SUMMARY OF CORE COMPETENCIES

DOMAIN 1: PROFESSIONAL, ETHICAL AND LEGAL PRACTICE

1.1 Professional practice

• 1.1.1 Accept accountability for increased responsibility in respect of own professional judgment, actions, outcomes of care and continued competence, in accordance with legislation and competency frameworks.
• 1.1.2 Recognize and practise within the professional, ethical and legal parameters of a specialist nurse.
• 1.1.3 Recognize own level of competence and limitations in the field of oncology and palliative nursing, and take remedial actions where required.
• 1.1.4 Consult with or refer to appropriate others when encountering situations beyond own experience.
• 1.1.5 Recognizes and respects different levels of accountability for the range of available health care professionals in cancer and palliative care.
• 1.1.6 Collaborate with the multidisciplinary team to ensure a team-based approached in the care of cancer patients and their families/caregivers, and towards collective learning and implementation of evidence-based practice.
• 1.1.7 Promote access to cancer and palliative care as a right for all South Africans, as stipulated by the Constitution of South Africa.

1.2 Ethical Practice

• 1.2.1 Deliver cancer and palliative care in a manner that preserves and protects the rights, autonomy, dignity, values, beliefs and preferences of patients and their families/caregivers and health care providers in the midst of challenging care settings.
• 1.2.2 Recognise that oncology and palliative care professionals have frequent encounters with ethical dilemmas due to the nature of their specialization, which are not limited to but include:
  • To treat or not to treat
  • Assisted death and euthanasia
  • Resuscitation
  • Collusion
• 1.2.3 Practice in a manner that conforms to the Code of Ethics for Nursing and the Employer’s Code of Ethics.
• 1.2.4 Engage in effective ethical decision-making with respect to oncology and palliative care.
• 1.2.5 Act in an advocacy role to protect Human Rights and challenges violations of the rights of the patient.
• 1.2.6 Maintain confidentiality and security of written, verbal and electronic information acquired in a professional capacity.
• 1.2.7 Respect the patient’s rights to privacy and dignity.
• 1.2.8 Demonstrate professional integrity and ethical conduct in response to health sector marketing strategies when procuring and utilizing drugs and other products for treating cancer and palliative patients.

1.3 Legal Practice

• 1.3.1 Practice in accordance with professional and other relevant international and national legislation, applicable to specialist nursing practice and the cancer and palliative population.
• 1.3.2 Practise in accordance with relevant policies, procedural guidelines and protocols in terms of oncology and palliative care.
• 1.3.3 Recognise and act upon laws relating to the professional role and/or Professional Code of Conduct.

DOMAIN 2: CLINICAL PRACTICE – CARE PROVISION AND MANAGEMENT

2.1 Health Promotion

• 2.1.1 Create awareness through collaboration and engagement with the community, to improve knowledge and awareness of cancer and palliative care.
• 2.1.2 Develop and use follow-up systems to ensure that cancer and palliative patients receive appropriate support and rehabilitation services, to optimize quality of life.
• 2.1.3 Empower the cancer and palliative patient and the family/caregiver with knowledge and skills, in order to assist them to plan and manage their own care effectively.
• 2.1.4 Recognise and utilise the resources and resilience that a person experiencing loss may have at his/her disposal.
• 2.1.5 Understanding pathological responses to bereavement and the ability to manage these responses appropriately to facilitate their grieving, in order to promote healthy adjustment in the context of bereavement.

2.2 Assessment

• 2.2.1 Gather accurate and relevant objective and subjective data required for oncology and palliative practice, through systematic health and nursing assessment.
• 2.2.2 Use validated instruments to assess disease and treatment-related symptoms/problems on a continuous basis, recognising that such symptoms may be physical, emotional, psychological, social or spiritual.
• 2.2.3 Request diagnostic tests and procedures in line with specialist oncology and palliative nursing standards/ competence.
• 2.2