Editorial N ever doubt for a moment that nurses make a difference in the lives of patients. They make that difference by working in so many different ways. I have experienced a week where I observed example after example of the impact nurses have had. As I write this editorial, I am in Nairobi, Kenya, engaged in a project that involves assessing the needs for cancer nursing education. I was here with other Canadian colleagues (Sherrol Palmer-Wickham, Kathy Beattie and Angela Boudreau) in 2009 and 2010 to teach introductory cancer nursing and chemotherapy administration. So I am in a rather interesting (and humbling) position of being able to observe the developments that have occurred in patient care. Clearly there were creative, passionate nurses taking steps to improve cancer patient care. The project team with which I am working consists of 10 members. All are oncologists or surgeons other than me (the only nurse). All have commented on the vital role that nurses play. In the words of one member, ‘We just drop in and spend a few minutes with a patient, and then walk away; you are there all the time, picking up the pieces.’ In my opinion, nurses are the heart and soul of health care. I am convinced that the health care system would not work very well without us. In Kenya, nursing care of cancer patients is largely provided by generalist nurses who have had little opportunity to learn about specialist oncology care. The majority of nurses are prepared at the diploma level (three-year program). At present, 3% are degree prepared at the Bachelor level. Although 13% have an additional one-year preparation in a specialty, this is predominantly in midwifery. Cancer care has only recently been recognized as a specialty practice and an education program made available in the form of the one-year specialty higher diploma program. There are 26 nurses enrolled in two locations. (Of note, Princess Margaret Hospital was instrumental in supporting the development of this program and it was built on the basis of the Canadian Association of Nurses in Oncology Standards of Care.) But let me share a few observations from here. One of my favourite stories concerns a young nursing manager who attended our first chemotherapy workshop. He was exposed to in-depth information about personal protection and environmental concerns regarding chemotherapy. Upon his return home, he reorganized his chemotherapy unit—moving it from a small, enclosed, dark room to the hospital courtyard outside his unit. He erected a tent or awning, and purchased lawn chairs, and was able to provide a safer environment for patients and nurses. What a wonderful adaptation within his environment to achieve a better standard for chemotherapy delivery! (And, as a footnote, his ideas were incorporated into 274 the planning for the new cancer centre and they have a lovely spacious, light-filled room for chemotherapy—with the right airflow.) Other examples of Kenyan nurse-led initiatives making a difference in patient lives are: • A Breast Health Awareness Outreach Program held in local shopping centres (very popular places for the public) where nurses can teach women about breast health and perform clinical breast exams, as required. Recently, the program has extended to be held in church and other faith-based settings. • Creation of printed, simply worded, side effect management sheets for patients receiving chemotherapy and families in their own language. • Setting up a ‘one-stop’ breast health centre of excellence at the cancer centre where women can self-refer or be referred by their family doctor; not only is screening available, but all the necessary subsequent steps if a suspicious finding is evident (i.e., surgical consultation, psychosocial support, and treatment planning). • Development of a navigator program proposal for cancer patients coming from rural settings to the cancer centre for treatment. Many of the patients have not been to the ‘big city’ of Nairobi before; one nurse told me, ‘Seeing an escalator was a new experience for one patient we saw recently’. • A study of the needs of gynecological patients was undertaken by one of the nurses studying her Master’s. She had to travel to South Africa to complete her degree, but conducted her study with the women in Nairobi. She found that the literature about patient needs did not really help with understanding the needs of the women she saw in her practice; their life experience, and living every day was so different from that of women in North America. I suspect this type of list could be generated from observations in many other countries. Nurses are constantly working to improve care of patients and families in their own ways and in their own settings. In essence, they are being ‘leaders from where they stand’. Having access to current evidence and support for implementing new ideas, however, is key and continues to be a challenge for African nurses. In the next few months, CANO will be engaging in dialogue about its role in international arenas. I would encourage you to think about how Canadian oncology nurses can reach out and support nurses in other countries in their struggle to improve cancer care. Margaret Fitch, RN, PhD Editor in Chief, CONJ Volume 26, Issue 4, Fall 2016 • Canadian Oncology Nursing Journal Revue canadienne de soins infirmiers en oncologie