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PAEDIATRIC CANCER

CANCER CONTROL 2015 113

advocacy role as part of their nursing practice, this can be

challenging in LMICs due to barriers such as hospital

regulations, administrators, paediatricians and even peer

groups, since nursing's scope of practice is not always well

defined. However, despite these barriers, LMIC nurses

caring for children with cancer can develop their role as a

patient advocate by carefully documenting their nursing

care, using effective communication with patients and

families, as well as working as a team member. The nurse's

ideas and suggestions will be better received if they speak

clearly with strong body language while advocating for the

child and family. The paediatric oncology nurse should know

the regulations and laws of the local health services to be a

more effective advocate.

Community and primary health-care providers' awareness

of early cancer symptoms is essential to address the

overwhelming numbers of children who arrive at the

hospital with advanced disease. Well-trained paediatric

nurses working in the community can help detect children

with cancer before their disease is so advanced that their

only option is end-of-life care.

The vision of the International Society of Paediatric

Oncology (SIOP) is that all children and young adults have

access to state-of-the-art cancer treatment and care (32). To

achieve this goal, nurses caring for children and young adults

must be well prepared and have adequate resources.

The IOP PODC Nursing Working Group was created in

2010 (with members from 23 countries) and joined existing

working groups under the SIOP Paediatric Oncology in

Developing Countries (PODC) Committee. The Nursing

Working Group "promotes the key role that nurses play in

cancer care for children and young people, and aims to both

support and learn from nurses working in developing

countries" (33).

A set of baseline standards for the provision of nursing

care was developed by the Nursing Group within SIOP in

order to highlight the fundamental role of nurses in

improving the care and survival of children with cancer.

Development of the standards was a priority for several

reasons. Nursing quality assessments from paediatric

oncology units in LMICs documented a consistent lack of

paediatric oncology nursing education, adequate staffing

and basic resources (34). Nursing Working Group members

from LMICs included experienced staff nurses from Ghana,

South Africa, Colombia, Argentina, India, Cameroon,

Pakistan and Ethiopia. They corroborated these findings and

described other challenges in their daily work when they

met together with HIC partners in a workshop designed to

address education and training needs of nurses working in

paediatric oncology. One of the outputs of this workshop,

held at the SIOP Congress in 2012, was an agreement to

initiate work on the development of a position statement by

the group. In December 2013, a final draft was completed.

"Baseline standards for paediatric oncology nursing care in

low- to middle-income countries: position statement of the

SIOP PODC Nursing Working Group", was submitted to

Lancet Oncology and published in June 2014 (35).

The Standards

‰ Standard 1: A staffing plan based on patient acuity levels

is utilized. A nurse to patient ratio of 1:5 for general

paediatric oncology units and 1:2 for critical care and

transplant units is recommended. Nurses who have been

trained and gained experience in oncology should remain

within the paediatric oncology service and not rotated to

other wards or specialities.

‰ Standard 2: All new nursing employees receive a

formalized paediatric oncology induction (orientation)

programme to include two weeks of theory and clinical

skills training followed by 3-4 weeks spent with an

experienced nurse preceptor. The induction programme

should include specific learning objectives. Evidence of

successful completion should be obtained before new

nurses provide direct patient care. Content should

include: review of paediatric cancers, administration of

chemotherapy and management of side effects,

management of venous access (central and peripheral),

control and prevention of infections, administration of

blood products, management of neutropenic sepsis,

early detection and treatment of oncology emergencies,

assessment and management of pain, nutritional

support, education for patients and families, palliative

care including death and dying and spiritual and

psychological issues.

‰ Standard 3: Nurses receive continuing education and

training to maintain and increase their paediatric

oncology clinical skills and knowledge. A minimum of 10

hours continuing education and training per year is

recommended.

‰ Standard 4: Nurses are recognized and acknowledged as

core members of the multidisciplinary paediatric

oncology team, as evidenced by inclusion in patient

rounds and all meetings with patients and

parents/caregivers when the diagnosis and treatment

plan are discussed.

‰ Standard 5: Nurses have the resources needed to

provide safe paediatric oncology care, to include:

Intravenous pumps, hand washing/sanitizing supplies

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