Role of the Oncology Nurse

Oncology nurses practice in a variety of settings including acute-care hospitals,

ambulatory-care clinics, private oncologists' offices, radiation therapy facilities, home
health-care agencies, and community agencies. They practice in association with a
number of oncologic disciplines: surgical oncology, radiation oncology, gynecologic
oncology, pediatric oncology, and medical oncology. The majority of ONS members are
involved in direct patient care, with 44% working in a hospital/multi-hospital system,
21% in the outpatient/ambulatory-care setting, 9% in physician offices, and 5% in
hospice or home care.9 Positions in the outpatient and home care setting have increased
as more patients are being treated out of the hospital setting.21,28 The roles of the
oncology nurses vary from the intensive care focus of bone marrow transplantation to the
community focus of cancer screening, detection, and prevention. The advanced practice
of oncology nursing includes participation as principal investigators in nursing research
studies, serving as patient-care consultants, designing educational curricula, and
performing executive functions. In all these roles, there is emphasis on providing nursing
care to patients and families by efficient use of the nursing process, including assessment
and data collection, nursing diagnosis, planning, intervention, and evaluation. This
process permits an organized and systematic approach to nursing care.

The following discussion on the role of the oncology nurse focuses on patient assessment,
patient education, and coordination of care. This is followed by a specific discussion on
nursing care related to surgery, radiation therapy, chemotherapy, biotherapy, and
supportive care.

Patient Assessment

Nurses are expected to be expert in assessing patients' physical and emotional status, past
health history, health practices, and both patients' and families' knowledge of the disease
and its treatment. It is essential that a detailed nursing history and physical examination
be completed. An oncology nurse is expected to be aware of the results and general
implications of all relevant laboratory, pathology, and imaging studies.

Patient Education

The nurse often has a better opportunity than any other member of the health-care team to
spend the necessary time with patients and their families to develop the required rapport
for effective educational efforts. Such education includes structured and unstructured
experiences to assist patients cope with their diagnosis, long-term adjustments, and
symptoms; to gain information about prevention, diagnosis and care; and to develop
skills, knowledge, and attitudes to maintain or regain health status.29 This planned
education uses a combination of methods to best meet the needs, capabilities, and
learning style of the nurse scholar.30 The ONS has enhanced this definition by
recommending the following patient education outcome criteria:31 the patient and/or
family should be able to (1) describe the state of the disease and therapy at a level
consistent with his or her educational and emotional status; (2) participate in the decision-
making process pertaining to the plan of care and life activities; (3) identify appropriate
community resources that provide information and services; (4) describe appropriate
actions for highly predictable problems, oncologic emergencies, and major side effects of
the disease and/or therapy; and (5) describe the schedule when ongoing therapy is
predicted.

There are a variety of teaching tools and methods available, the choice of which is based
on individual patient needs and abilities. Printed, visual, and audiovisual educational
materials are used in conjunction with discussion and continued reinforcement.
Numerous patient educational materials also are available that relate to cancer, cancer
therapy, and the management of side effects.18,32–36 With the increased development of
the Internet, more and more cancer patients and family members are accessing the World
Wide Web (www) to gain information about cancer. Chat groups are serving as a source
of information as well as support. This method of communication will continue to be an
increasing source of knowledge for consumers.

Patients should be encouraged to keep personal, written, daily diaries that record
treatment dates, symptoms, test dates, and questions. A personal diary provides additional
written documentation of the onset of specific phenomena and accurate dates of therapy,
in case the patient's medical record is not available.

Coordination of Care

The oncology nurse plays a vital role in coordinating the multiple and complex
technologies now commonly employed in cancer diagnosis and treatment. This
coordination encompasses direct patient care, documentation in the medical record,
participation in therapy, symptom management, both patient and family education, as
well as counseling throughout diagnosis, therapy, and follow-up. The nurse should serve
as the patient's first line of communication. Ideally, the patient and family should feel
free to contact the oncology nurse by phone during the entire treatment program. Many
patients travel long distances, so the importance of communication by telephone must be
emphasized. It allows continuous patient communication, early recognition of
emergencies, and regular emotional support.

Camp-Sorrell37 noted that most patient problems can be managed without the patient
being seen in the office or emergency room. However, it is important for the nurse to
gather sufficient information to determine patient management. A telephone triage flow
sheet was developed (Figure 70.2) that provides the basic steps which are helpful in
identifying patient problems over the phone before consulting with the physician and
relaying specific instructions for follow-up care. This format can be used with complex
problem areas, and several specific examples are included below in the discussion on
chemotherapy.

Modern cancer care is performed at multiple sites by a variety of personnel at a pace that
is accelerated by a cost-conscious staff. Communication between personnel at different
facilities may be suboptimal, and the communication and coordination that the oncology
nurse can provide represents an invaluable service to patients who may be confused and
frightened.