Department of Nursing

Chie Asanuma

Introduction

The Department of Nursing of the National Cancer Center Hospital East (NCCHE), as a member of the cutting-edge cancer medical team and a core hospital for cancer nursing in Japan, strives hard to fulfill its responsibility to improve cancer nursing. Under this nursing philosophy, we perform our duties according to the following basic policies:

1)Respect the dignity and rights of patients'lives and value relationships with patients to provide palliative care.

2)Pursue essential nursing and conduct scientific and creative care.

3)Promote clinical studies and disseminate novel information on cancer nursing.

4)Train prospective leadership-position personnel.

The Department of Nursing also actively participates in planning hospital management by providing good medical and nursing services and pursuing operational efficiency in a harmonious way.

Routine activities

1. Nursing

The staff of the Department of Nursing shoulder responsibility as members of the NCCHE. Accordingly, we actively participate in planning hospital management under multidisciplinary coordination, collaboration, and cooperation to deliver the best, safe, robust care which meets the needs of patients and their families. Also, we engage in operational improvements, structure reorganization, team medicine, community-healthcare cooperation, personnel training, and staffing to provide good medical and nursing services.

In 2017, the construction of the Center of New Surgical and Endoscopic Development for Exploratory Technology (NEXT ward) will be completed. As a result, the functions of our operating theaters, endoscopy center, outpatient center, and outpatient laboratories are expected to expand.

To meet expectations, in 2016, we greatly increased staffing of nurses; strengthened the nursing system (gradual introduction of night shifts under a four-nurse system and stepwise strengthening of the nursing system at departments with expanded functions); established a training system for new recruits; provided financing to cover increasing costs for labor, facilities, and equipment; and, to improve patient services and the work environment, improved operational efficiency and safety through interprofessional cooperation and work sharing. Thus, we improved the medical performance in 2016 compared with 2015 in terms of the mean number of inpatients, bed utilization rate, bed occupancy rate, mean length of hospital stay, number of outpatients, and number of outpatients treated with anticancer agents.

2. Training

Our in-hospital training programs, the same as those of the National Cancer Center Hospital (NCCH), are characterized by two major types of training: Basic Training, which provides basic nursing knowledge and skills, and Special Training on Cancer Nursing, which provides cancer nursing practice.

The in-hospital training program aims to produce nurses who can mitigate patients'distress with basic nursing knowledge and skills, as well as excellent expertise and skills related to cancer, and who provide patient-oriented "palliative care" for patients and their families. Patients can thus receive treatment and care which patients and their families themselves select, while we can utilize our specialties in practice.

We support not only professional development as nurses by providing training but also opportunities for career enhancement by providing in-hospital training programs for nursing managers, researchers, and instructional leaders, and by actively helping aspiring nurses to participate in further education, overseas training, and out-of-hospital training.

For nurses working at other institutions, we held training including "Delirium Training Program", "Communication Training", and "Cancer Nursing Training" to improve nursing quality and to help the participants to enhance their careers at the NCCHE and other institutions.

3. Certified Nurse Specialists and Certified Nurses

In 2016, one certified nurse in palliative care and one certified nurse in infection control were newly qualified in the NCCHE. At present, nine certified nurse specialists in two areas and 33 certified nurses in eight areas serve as active role models who practice their specialized nursing in each department to which they are dispatched, and as members of medical teams including infection-control, palliative-care, and nutrition-support teams in a multidisciplinary manner.

We established credentialing systems for in-hospital nursing on anticancer agents IV and on radioactive intravenous injections. The two systems qualified a total of 86 in-hospital certified nurses, 79 of which are now playing active roles as practitioners to ensure the safe administration of anticancer agents and contrast agents.

For nurses working at other institutions, we held training including "Delirium Training Program", "Communication Training", and "Cancer Nursing Training", which attracted a large number of participants from around the country. Some of our in-hospital training programs were opened to five national hospitals in Chiba Prefecture and other hospitals in the country, leading to the improvement of the nursing quality both in and outside of the NCCHE. The progress also resulted in career enhancement.

4. Management of Nursing Training Programs for Credentialing and Nurturing Certified Nurses

In 1995, the Japanese Nursing Association inaugurated a Credentialing System, which aims to expand nursing care in practice and improve nursing quality.

The NCCHE receives a high evaluation from the system committee of the Japanese Nursing Association for our excellent medical and nursing track record, adequacy in the number of high-quality instructional leaders, and training contents in the field of palliative care and cancer chemotherapy. The same committee certified the NCCHE as an educational institution which has excellent conditions for offering education to become a certified nurse. We set up the Department of Certified Nurse Curriculum, then developed a Curriculum for Certified Nurses in Palliative Care in 2015, and a Curriculum for Certified Nurses in Cancer Chemotherapy in 2016. These curriculums are held every year, offering a 9-month curriculum in which students can learn while working. In 2016, the Palliative Care Course accepted 22 fourth-generation students and the Cancer Chemotherapy Course accepted 10 first-generation students. The two courses are currently in session.

A total of 47 first-, second-, and third-generation trainees who had completed the Palliative Care Course passed the Japanese Nursing Association Credentialing Examination Test, and they are now working as certified nurses at medical institutions throughout Japan. They are providing patients, their families, and communities with high-standard care using the advanced palliative-care nursing skills they have learned. At the same time, they are actively helping to improve the skills of care nurses by fulfilling the three duties of: providing high-standard care, giving instruction on practice, and offering advice to nurses.

Research activities

In 2016, we made conference presentations on 32 subjects including three subjects presented overseas. The number of researches increased largely thanks to stronger support from a research support team in our hospital and from a support system by our nursing-research support team comprising certified nurse specialists and certified nurses. We also tried to obtain research funding from external institutions to conduct high-quality nursing research as a cancer research center, and we received grants for three studies.

A total of 18 articles were published in journals. We are now working on the book "Cancer Chemotherapy Upskilling Test" in cooperation with the The Department of Nursing of the National Cancer Center Hospital (NCCH), with publication planned for February 2018.

Future prospects

Our challenges for 2017 are further growth as a research core base hospital and as an advanced treatment hospital, and reorganization of the hardware and software sides toward the completion of the NEXT ward. The Department of Nursing of the NCCHE, as a member of team medicine, will strive hard to provide high-quality pioneering medical care appropriate for a research core base hospital and an advanced treatment hospital with special functions, to promote clinical studies and trials, and to strengthen medical-safety systems. Meanwhile, to address evolving medical care, we will work to secure nursing staff resources and proper nurse staffing which are essential to improve nursing quality and to create novel nursing.

As a cancer research center, we share the view that we cannot achieve our philosophy and mission without stable operation. Accordingly, the Department of Nursing of the NCCHE will continue to improve management by working closely with other departments.