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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