N Editorial

274 Volume 26, Issue 4, Fall 2016 • CanadIan onCology nursIng Journal
reVue CanadIenne de soIns InFIrmIers en onCologIe
Editorial
Never doubt for a moment that nurses make a dierence
in the lives of patients. They make that dierence by
working in so many dierent 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 che-
motherapy administration. So I am in a rather interesting
(and humbling) position of being able to observe the develop-
ments 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 pre-
pared 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 pre-
dominantly 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 loca-
tions. (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 man-
ager who attended our rst 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
the planning for the new cancer centre and they have a lovely
spacious, light-lled room for chemotherapy—with the right
airow.)
Other examples of Kenyan nurse-led initiatives making a
dierence 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 eect 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 nding is evi-
dent (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 escala-
tor was a new experience for one patient we saw recently’.
• A study of the needs of gynecological patients was under-
taken 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 lit-
erature about patient needs did not really help with under-
standing the needs of the women she saw in her practice;
their life experience, and living every day was so dierent
from that of women in North America.
I suspect this type of list could be generated from observa-
tions 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 sup-
port for implementing new ideas, however, is key and contin-
ues to be a challenge for African nurses.
In the next few months, CANO will be engaging in dia-
logue 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