Implementing oncology nurse navigators or IPOs (which stands for “infirmière pivot en oncologie”) is a key element of the Quebec Cancer Control Program in order to improve the continuity of care. This qualitative study describes the process of implementing IPOs in teams working both in hospitals and in the community. Several groups of stakeholders (IPOs, physicians, nurses, various health workers, administrators, people with cancer and their families) described how they perceive the functions and effects related to this implementation. After putting results into perspective, we recommend developing measures promoting the dissemination of the role and integration of IPOs in formally defined health teams. We strongly advocate for the continuation of joint efforts in order to define and clarify this complex role. Key words: oncology nurse navigator, implementation, psychosocial adjustment, program evaluation
For many cancer control programs, cancer navigation has emerged as a specific strategy to improve access to supportive care and the patients' experience of cancer care. This study contributes to a better understanding of professional navigation by comparing two Canadian models: Quebec's Pivot Nurse in Oncology (PNO) and Nova Scotia's Cancer Patient Navigator (CPN). Qualitative interviews were conducted with professional navigators, patients and family members, front-line staff, physicians and health administrators (interviews: n=49; focus groups: n=10). The two models were analyzed using the professional navigation framework (Fillion et al., 2012). Although the models are different, results show that professional navigators in both programs perform similar functions and face similar challenges. This study highlights the complexity and the value of cancer navigation and recommends relevant actions to optimize its management within the health care system.
Abstract The objective of this exploratory study was to evaluate the impact of advanced parental cancer on adolescents' psychological status. A sample of 28 adolescents, having a parent with advanced cancer, was recruited and compared with a sample from the general population (N = 2,346). Late adolescents (age 15 to 18) experienced significantly more psychological distress than early adolescents (age 12 to 14). Moreover, late adolescents experienced significantly higher psychological distress than the general population for the same age group, which was not the case for early adolescents. Implications for adolescents living in families touched by advanced cancer are discussed. KEYWORDS: oncologycancerparental canceradvanced cancerpsychological distressadolescents Acknowledgments This study was part of a master's degree in social work obtained at Laval University. The student responsible for this study received funds from the Canadian Institute of Health Research Strategic Training Program in Palliative Care Research, Fonds Québécois de recherche sur la société et la culture, Centre de recherche de l'Hôtel-Dieu de Québec and Laval University Chair of Palliative Care.
Dans de nombreux programmes de lutte contre le cancer, la navigation en oncologie est devenue une stratégie ciblée visant à améliorer l’accès aux soins de soutien ainsi que l’expérience des patients qui reçoivent des soins en cancérologie. Cette étude vise à améliorer la compréhension de la navigation professionnelle par la comparaison de deux modèles canadiens du rôle associé à la navigation professionnelle en oncologie : l’infirmière pivot en oncologie (IPO) du Québec et l’infirmière responsable de la navigation professionnelle en oncologie (Cancer patient navigator—CPN) de la Nouvelle-Écosse. Nous avons mené des entrevues qualitatives auprès de d’IPO et de CPN, de patients et de membres de leur famille, de membres du personnel de première ligne, de médecins et d’administrateurs des soins de santé (entrevues : n = 49; groupes de discussion : n = 10). Les deux modèles ont été analysés au moyen du cadre conceptuel sur la navigation professionnelle (Fillion et al., 2012). Bien que les modèles soient différents, les résultats indiquent que les Intervenants pivots (IP) en oncologie des deux programmes ont des fonctions semblables et font face à des défis similaires. Cette étude met en relief la complexité et la valeur de la navigation en oncologie et recommande des mesures pertinentes qui visent à optimiser sa gestion au sein du système de soins.
<p>The world has entered an era of immense water-related threats due to climate warming and human actions.&#160; Changing precipitation patterns, reducing snowpack, accelerating glacial melt, intensifying floods and droughts have made the need for timely hydrometric information indispensable. Climate change thus introduced requirements for adaptive management and timely water resource information at the municipal, regional and national levels. Over the last 10 years, it became evident that demands from users had moved towards best available hydrometric data in near real-time.&#160; As with most hydrometric services around the world, the WSC was a legacy and archive-driven organization that published approved data on an annual basis.&#160; Real-time data was an after-thought simply equated with the application of rating curves onto telemetry water levels, while hydrographers remained focused on approving data months after the facts. To address this challenge, the Meteorological Service of Canada&#8216;s National Hydrological Services, and specifically the Water Survey of Canada (WSC) has developed a near real-time continuous data production system to meet the evolving needs of stakeholders.&#160; To meet this challenge, WSC developed solutions where data would be improved as field-measurements were being acquired. Corrections to data and rating curves are applied within hours of field discharge measurements, allowing for near-real time publication of corrected discharge information.&#160; Moreover, station conditions and performance are constantly monitored with &#8220;eyes-on-data&#8221; production tools that allow the program to optimize its field visits, costs and data publication. These tools were developed in-house to enable effective network time-management while communicating important information with partner agencies.&#160; This was made possible with a cloud-based hydrometric data production system and modern telecommunications tools.&#160; As a result of this work, the improved near real-time data became the catalyst to revamp a multi-decade approach to final data approval. This improved overall efficiency and is now leading to less delays in the approved data production cycle. &#160;This paper describes the design and implementation of the continuous data production system adopted at WSC and highlights some of the benefits noted since program implementation. This paper also identifies future investments that could help the sustainability of this new system in the long term.</p>
Purpose/Objectives: To elaborate, refine, and validate the professional navigation framework in a Canadian context. Research Approach: A two-step approach consisting of a qualitative evaluative design and formal consultations. Setting: Two applications of professional navigators in Quebec and Nova Scotia, Canada. Participants: Patient navigators, medical oncology specialists, nurses and oncology staff, administrators, family physicians, patients with cancer, and patients' families and significant others. Methods: Individual interviews (n = 49) and focus groups (n = 10) were conducted with professional navigators, patients and family members, front-line staff, family physicians, and health administrators. Formal consultations (n = 13) occurred with clinical experts, managers, and researchers from across Canada. Main Research Variables: The interview guide was based on an evaluative conceptual framework integrating questions related to the implementation process of the role of professional navigators and their organizational and clinical functions. Findings: Results support a bi-dimensional framework and define key role functions. The first dimension, health system-oriented, refers to continuity of care. The second dimension, patient-centered, corresponds to empowerment. For each dimension, related concepts were illustrated from data. Examples of outcomes also were suggested. Conclusions: The framework brings clarity to the role and functions of professional navigators and suggests relevant outcomes for program evaluations. Interpretation: With a clear definition of their role, professional navigators may be more efficient and less challenged in terms of setting priorities and making decisions while having to face demands from the health system and patients. The integrative framework could improve the effectiveness of cancer navigation programs.
Fillion et al. (2012) recently designed a conceptual framework for professional cancer navigators describing key functions of professional cancer navigation.Building on this framework, this study defines the core areas of practice and associated competencies for professional cancer navigators.The methods used in this study included: literature review, mapping of navigation functions against practice standards and competencies, and validation of this mapping process with professional navigators, their managers and nursing experts and comparison of roles in similar navigation programs.Associated competencies were linked to the three identified core areas of practice, which are: 1) providing information and education, 2) providing emotional and supportive care, and 3) facilitating coordination and continuity of care.Cancer navigators are in a key position to improve patient and family empowerment and continuity of care.This is an important step for advancing the role of oncology nurses in navigator positions and identifying areas for further research.
L’implantation d’infirmières pivots en oncologie (IPO) est un élément clé du Programme québécois de lutte contre le cancer pour améliorer la continuité des soins. Cette étude qualitative décrit le processus d’implantation d’IPO au sein d’équipes basées à la fois en centre hospitalier et dans la communauté. Plusieurs groupes d’acteurs (IPO, médecins, infirmières, divers intervenants, administrateurs, personnes atteintes du cancer et leurs proches) ont décrit leur perception des fonctions et des effets associés à cette implantation. La mise en perspective des résultats permet de recommander l’élaboration de mesures visant à favoriser la diffusion du rôle et l’intégration des IPO au sein d’équipes de travail formellement définies. La poursuite d’efforts concertés visant à définir et préciser la complexité de ce rôle est fortement recommandée.
Some healthcare organizations recommend adopting open visiting policies. These organisations are working towards the end goal of promoting the idea that patients and families can be true partners in care. An essential step in this culture shift involves openness to family presence and their engagement in the patient’s care. Among other things, their recommendations are based on data from studies that assessed the impacts of different types of visiting policies on patients, families and healthcare staff. In order to inform and guide an organizational reflection on possible changes to our hospital center’s visiting policies, our team undertook a systematic review that focussed on the advantages and disadvantages of open/flexible visiting policies, as perceived by patients, families and staff. Review articles and original articles were assessed and synthesized following a rigorous review process. Results of the reviewed studies suggest that flexible visiting policies lead to greater patient satisfaction with care and to positive impacts for both patients and families, and that these stakeholders have clear preferences for open/flexible policies. Nevertheless, policies including some guidelines to safeguard rest and sleep periods were deemed necessary by patients, rather than an unqualified open policy. Results also suggested that flexible visiting hours were not associated with an increased risk in hospital-acquired infections or septic complications in intensive care units (ICUs), where the majority of the reviewed studies were carried out. Authors recommended taking the specific context of care units into account when implementing new visiting policies, as needs may be different according to different health issues. Staff preferences over a model or the other were somewhat mixed. Some staff see the presence of families and visitors as an obstacle to the provision of care and a reason to fear increased workloads. In order to overcome this resistance, the importance of adequately preparing staff and supporting them throughout the policy change to ensure its success is highlighted.
