TAKING STOCK - Taking Stock
EAPM Director Dialogues - Brigitte Grube
Brigitte Grube, of the Danish Oncology Nursing Society, is also Past President of EONS and chairs its advocacy group. In Vienna at the ECCO/ESMO congress, she was asked about the advances in personalised medicine in her field and the gaps and needs.
She focused straight away on education, saying: “We can see that the whole demography is changing, and we have more elderly people and that creates pressure for primary care. And many of the nurses in primary care in hospitals across Europe don’t have a specialist education. We can see that there is a need for specialist nurses in cancer care.
“And especially if you take personalised medicine – patient-centred care, not only about genomics and the body but also about the patients taking a decision and nurses informing them about (their condition and options). The nurses are often the ones who are there, and they know the patient, but there is a gap there for the nurses. They don’t have specialised knowledge.
Do they need it? Grube is clear on this: “Nurses do have to know something about all the pharmaceutical issues around the treatment and the side-effects, but they also have to interact with other disciplines. So they have to know that, if the patients have other diseases, what that will mean. And also the decision making to make patients more empowered to take decisions - that’s more a communication skill. That’s not just something you know, that’s something you have to learn.
“So we have been talking about how to build educational skills, and to have the EU and the politicians understand how important it is for the countries to have at least one year of (extra) education for the cancer nurses. That’s not the case at the moment. And that also concerns the content of the education, so not just to duplicate, because the whole healthcare systems are changing.
“Nurses also need to know how to analyse and be critical and also about evidence, and research and how to meet new things. Because, of course, nurses are sometimes not used to change, and would follow the line that they know. But if they have competences, when they meet new stuff… knowledge about how they should react. How they should be critical and analyse. Then they can learn.
“Reading new literature, finding new evidence-based methods – that’s a training process. And we’re trying to have that in the basic nursing training, not only the cancer training. Because it’s changing so fast so you have to have this way of learning new stuff all the time.”
So, how does it work? Grube says: “We have a core curriculum for basic cancer nursing training, which we run every year and we update it all the time. This is so it will reflect on the specialised demands for targeted therapy and personalised medicine – that’s a part of it. So we’re trying to hook up with ECCO, and they’ve said that that’s a priority. Quality nursing is a priority, to have it as a specialist area.”
She adds that: “Medical oncologists are recognised in the EU as specialists and ECCO say they will help us to get cancer nurses recognised. Because that way you can go back to your own nations and your politicians and say, hopefully, ‘this is an EU policy and it’s a directive, so you have to follow it’. You can’t treat cancer patients without some kind of an education – at least one year. We hope for that.
Grube was asked how far down the training process had travelled and replied: “In many of the areas we are trying to use e-learning as much as we can, so maybe just one day in two weeks will be the time when you meet and discuss face-to-face. Because we know that these nurses can’t leave their work. They are needed there. So to take them out for weeks? That’s not working.
“We have tried in the Nordic countries to have clinical nurse specialists as educators, so they are out there and they are taking care of the ones that are under education. So the nurses will still be at their ward but they will be having training, and this is to have them at their work as much as possible while learning.”
She adds: “We have worked with it in Denmark for four years now, and there is an increasing number of nurses taking this education. We’ve seen some of the outcomes for the patients, and done some surveys on follow-ups in breast and head and neck cancers.
“The thing is, the roles of the nurses are changing. There are not enough physicians and so many patients and they will be out there in the community, and in the primary care, so there has to be a shifting of roles. The WHO has mentioned this, these shifting roles. So has the OECD. We have to look at the workforce in general, look at what the demands are and not be so restricted in what was the past. So maybe we need to throw it up in the air and say ‘what are we going to do?’ because there will be so many cancer survivors and we’re all living longer.
The times-they-are-a-changing, but who is ready and who is not? Grube says: “What we see it that when the physicians work closely together with the advanced nurses they think it’s marvellous, because they have a great collaboration. They can be cautious at first but, in the end, they always support it. We must all think differently than we used to.”
And how could the European Commission and others help? She says: “In the next few years I really wish for recognition of cancer nursing as a specialty at EU level and also have one-year education starting to be implemented in some areas.”
When pushed she says: “It should be compulsory in every Member State - that is my wish. In the end, it has been shown that if you don’t have the right education for nurses, people will die.”