PCa specialist nursing workforce under threat
With a diminishing nurse:patient ratio and no consistent approach for training a new workforce, Professor Sara Faithfull worries that patients in Europe might face a future without the expertise these nurses offer
According to new research commissioned by Prostate Cancer UK prostate cancer specialist nursing workforce is currently facing an uncertain future if immediate steps are not taken for training a new workforce. Among the 300 specialist nurses surveyed by Prostate Cancer UK, nearly 49 per cent reported that they were approaching retirement or have considered leaving nursing within the next ten years. The findings of the study are highly disturbing and imply that we might be letting down men with prostate cancer, not just in the UK, but across the European Union.
Men with prostate cancer need support from specially trained nurses to have optimal outcomes. More men are surviving prostate cancer diagnosis and treatment and living into older age. This good news story is because prostate cancer is being detected earlier and as a consequence men are living longer. Evidence shows that many cancer survivors have some unmet supportive care needs including psychological, sexual and health system and information needs and are living with the adverse effects of treatment.
Despite improvements in therapies, problems such as urinary continence and urinary frequency, sexual and bowel problems, fatigue and body changes can occur not just during treatment but for many months to years after treatment. Improving patient outcomes is not just about cure but enhancing quality of life, preventing and minimising complications and where possible promoting healthier lifestyle.
Population based studies show that men with prostate cancer have significant chronic illness and psychological ill health compared to men of a similar age group. Men with prostate cancer have more hospital admissions after cancer treatment than men of a similar age and are often less physically active and more obese than men of a similar age. The quality and provision of nursing support has a significant impact on cancer survivors’ needs and subsequent outcomes. Nurses can address many of these needs for men by providing holistic assessment, symptom management and psychological support as well as signposting men to services and support at home. In a large European study of seven countries, improved health was directly associated with receiving nursing.
The greatest areas of need in 80 per cent of men across all these European countries were the need for help with psychological health, sexual dysfunction, and access to health services and information support. These are all areas where nursing can play a significant role in addressing.
Although cancer care requires a multi-disciplinary team (MDT) approach to service delivery, nurses should be included as they are in an ideal position to lead and provide specialist prostate cancer services. A foundation for effective support for men in living with and beyond a cancer diagnosis is care. The delivery of appropriate and effective nursing management of treatment, side effects men experience not just during therapy but long term all contributes to men’s experience and satisfaction.
Raising awareness for primary care team’s that men also continue to have needs when they return home in the community is part of future family nursing care. Education for nurses to help inform management of men’s diagnosis, treatment, rehabilitation, survival and advanced disease is important to develop the level of skills required in managing men’s health and psychological needs.
In Europe training for specialist nurses is mandated in only a few countries and there is no consistent approach to advanced practice across Europe. The European Oncology Nursing Society provides core curricula for oncology nurses in general oncology practice and in specialist areas such as elderly care, lung and breast cancer and this provides an educational standard that has been adopted across many countries within Europe and beyond.
At present there is no curriculum for training nurses in prostate cancer. Education for specialist nurses is gained through study days or workshops and many nurses need support to attend these sessions. We need a standard to base future nurse competencies and job roles upon. Recognising the value of clinical leadership provided by nurses and how this enhances patient safety, quality and effectiveness is essential. Education and training help nurses provide patient centred care and improve the effectiveness of treatment as well as aid men’s recovery
Professor Sara Faithfull is Director of Health Science Innovation and Enterprise, School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Stag Hill Guildford, UK.