This material is protected by U.S. copyright law. Unauthorized reproduction is prohibited. To purchase quantity reprints, please e-mail reprints@ons.org or to request permission to reproduce multiple copies, please e-mail pubpermissions@ons.org.

 

September 2010, Volume 37, Number 5

 

Article

What Does It Mean to Be an Oncology Nurse? Reexamining the Life Cycle Concepts

Marlene Z. Cohen, PhD, RN, FAAN, Betty R. Ferrell, RN, PhD, FAAN, Mark Vrabel, MLS, AHIP, ELS, Constance Visovsky, PhD, RN, ACNP-BC, and Brandi Schaefer, MSN, APRN, NP-C

 

Purpose/Objectives: To summarize the current research pertaining to the concepts initially examined by the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force and related projects completed in 1994.

Data Sources: Published articles on the 21 concepts from the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force work. Research published in English from 1995–2009 was obtained from PubMed, CINAHL®, PsycINFO, ISI Science, and EBSCO Health Source®: Nursing/Academic Edition databases.

Data Synthesis: Most of the concepts identified from the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force have been examined in the literature. Relationships and witnessing suffering were common concepts among studies of the meaning of oncology nursing. Nurses provide holistic care, and not surprisingly, holistic interventions have been found useful to support nurses. Interventions included storytelling, clinical support of nurses, workshops to find balance in lives, and dream work. Additional support comes from mentoring.

Conclusions: The research identified was primarily descriptive, with very few interventions reported. Findings have been consistent over time in diverse countries.

Implications for Nursing: This review indicates that although the healthcare system has changed significantly in 15 years, nurses’ experiences of providing care to patients with cancer have remained consistent. The need for interventions to support nurses remains.

 

The Oncology Nursing Society (ONS) Life Cycle of the Oncology Nurse Task Force began its work in 1989 and was summarized in the Oncology Nursing Forum (ONF) (McDonnell & Ferrell, 1992). The “Life Cycle” work began based on interest in recruitment and retention of oncology nurses. This interest led to a pilot study and a multisite study of the meaning of oncology nursing.

 

The pilot study described the “essence of oncology nursing” (Cohen & Sarter, 1992) as

 

. . . being on the front lines of a war against death, disfigurement, and intense human suffering. It requires the performance, prioritization, and coordination of multiple complex tasks. It involves handling frequent unexpected crises, both physiologic and psychological. It carries the rewards of reversing a fatal illness, balanced by the ever-present reality of death. Working with patients with cancer requires constant vigilance in monitoring for sudden problems and life-threatening errors. The cancer nurse’s empathy is sharpened by the awareness that “this could be me or my loved one.” Finally, working with patients with cancer means “being there” for people in their most private moments of suffering and responding to the heights and depths of their responses to this suffering (p. 1485).

 

The multisite study resulted in several papers published as a supplement to ONF (Cohen, Haberman, & Steeves, 1994). Haberman, Germino, Maliski, Stafford-Fox, and Rice (1994) provided greater insight into the experiences of individual oncology nurses. Large macro issues of the profession, ONS, roles, and global themes were discussed by the Life Cycle Task Force. Reports from the Life Cycle Task Force and publications of the two studies were reviewed, and 21 key concepts were identified (see Figure 1).

 

Methods

 

Since the Life Cycle study publications in 1994, many changes have occurred in cancer care and oncology nursing. ONS was interested in evaluating research done to examine these concepts and convened a task force to re-examine them. This task force had several conference calls, and the authors of this article proceeded with a literature search and the writing of this article. PubMed, CINAHL®, PsycINFO, ISI Science, and the EBSCO Health Source®: Nursing/Academic Edition databases were searched to identify research published in English from 1995–2009. Searches used keywords that were combinations of the 21 concepts identified from the original Life Cycle articles. Several concepts overlapped, and although all concepts had a great deal written about them, no research was located for six concepts. These concepts are described at the end of the findings section.

 

Findings

 

Experience or Meaning of Oncology Nursing

 

The meaning of oncology nursing is the most global concept, and studies that examined this topic also included other concepts. Studies were conducted in Johannesburg, South Africa; London, England; Ireland; and the United States. Common themes concerned the unique nurse-patient relationship and challenging interpersonal relationships with members of the multiprofessional team and management (Berterö, 1999; Dowling, 2008; Quinn, 2003; van Rooyen, le Roux, & Kotze, 2008). Perry (2008) described oncology nurses’ experiences as having moments of connection, making moments matter, and having energizing moments.

 

Research in the United States included a study with pediatric oncology nurses (Olson et al., 1998). Positive experiences dealt with nurses’ experiences with patients dying or recovering or with the close relationships that develop between nurses and patients. Nurses identified changes in values and behaviors related to providing more empathic care and in perspective (accepting limitations of care). In negative experiences, nurses regretted perceived inadequacy in handling situations, witnessed patient suffering that they felt unable to relieve, and had guilt, anger, or dread. Categories in these data included relating to others, experiencing life, death and dying, being aware of self as nurse, and experiencing diminishing qualities about the nursing situation, such as betraying trust, patient suffering, and grief and loss (Clarke-Steffen, 1998).

 

These studies focused on nurses’ perspectives and were all qualitative except for one tool development article (Steen, Burghen, Hinds, Srivastava, & Tong, 2003). Findings were similar despite that studies were conducted in several countries. Common themes included dealing with dying patients, developing close relationships, caring, and witnessing suffering.

 

Nature of Work, Cancer, Outcomes, Patient Acuity, and Workload

 

Closely related to the meaning of oncology nursing is the nature of the work. Studies conducted in several countries found that oncology nursing involved varied activities. Nurses in New South Wales, Australia, perceived themselves to have a major influence on the positive attitudes of patients with cancer and felt obligated to provide support and encouragement to patients based on patients’ values and beliefs (O’Baugh, Wilkes, Luke, & George, 2008).

 

Studies have examined nurses’ experiences administering chemotherapy. Nurses in the United Kingdom reported initially being frightened and anxious and were more confident with support from knowledgeable role models and after chemotherapy education (Verity, Wiseman, Ream, Teasdale, & Richardson, 2008). Administering chemotherapy resulted in “damage” from seeing patients’ suffering and being involved in dilemmas regarding administering chemotherapy (Saltmarsh & De Vries, 2008). Additional studies in Northern Ireland and in the United States found that nurses had both positive—enhancing autonomy and skills—and negative experiences that resulted in a perceived decrease in their caring roles (Fall-Dickson & Rose, 1999; McIlfatrick, Sullivan, & McKenna, 2006).

 

Palliative and end-of-life care has been found to be rewarding and challenging. Nurses who reported spending more time with terminally ill or dying patients reported more positive attitudes (Dunn, Otten, & Stephens, 2005). Nurses’ attitudes toward death were not related to their attitudes about caring for dying patients.

 

Phenomenologic studies of nurses caring for dying patients have found that nurses experience closeness with patients that has great meaning or their relationships may not include an intense engagement (Perry, 2009; Rittman, Paige, Rivera, Sutphin, & Godown, 1997). Modulating involvement helped manage emotional demands of practice. High standards of practice included preserving hope, easing the struggle, providing for a peaceful death, and providing privacy. Similar findings were reported in palliative care nurses in New South Wales (Wilke, Boxer, & White, 2003). Some nurses reported suffering personal distress as a consequence and found patient isolation and altered body image challenging. Physical illness and the emotional issues of patients, their families, and fellow palliative care workers have been found to saturate nurses (Jones, 1999). To protect themselves, nurses might assimilate the emotional traumas of others into physical symptoms. An environment conducive to making sense of illness experiences and integrating them into a meaningful life continuum was recommended.

 

Oncology nurses described the healthcare context in which palliative care occurs as having limited time for addressing complex issues, emphasizing prolonging life, and challenging care coordination (Ferrell, 2006; Pavlish & Ceronsky, 2007). Although nurses expressed a desire to help patients exercise choice, few felt able to discuss resuscitation or to act as advocates with physicians (Bass, 2003).

 

Oncology nurses who provided excellent care and made strong connections with patients were usually very satisfied with their careers (Perry, 2006). They also felt they were making a difference when they “see patients through” the care trajectory. Nurses accomplish this, in part, by helping people live on, individualizing care, enabling hope, and helping individuals find meaning.

 

Diverse Roles

 

A part of the experience of oncology nursing is that nurses have multiple responsibilities and roles in cancer-related care. Nurses were educators, counselors, patient advocates, compassionate caregivers, care coordinators, managers, listeners, navigators, and members of a multiprofessional team (Fillion et al., 2006; Hoelz, Sladek, & Michaelson, 2007; Willard & Luker, 2007). Additional roles include physical care, emotional support, patient and family education, consultation to address psychological issues, assessment and triage, symptom management, administrative responsibilities, and research (Shepard & Kelvin, 1999; Skott & Eriksson, 2005). Nurses collaborate to give patient-centered care and support to patients and their families (Willard & Luker, 2007). Competencies in oncology include holistically assessing patients and families; having knowledge of health promotion and family therapy; developing skills in communication, relationship building, teamwork, and problem-solving; and being mature as professional leaders (Fillion et al., 2006).

 

The nurse navigator, a relatively new role in oncology nursing, provides access to healthcare services, coordinates care, and decreases barriers to care in complex healthcare systems, particularly for medically underserved populations (Freeman, Muth, & Kerner, 1995). Nurse navigator roles vary by institution, have differing foci such as distress reduction or disease-specific issues, and provide support and guidance as patient advocates in multidisciplinary teams (Fillion et al., 2006; Palmieri et al., 2009).

 

As members of multiprofessional teams, oncology nurse specialists cite challenges related to acceptance by physician colleagues and insufficient organizational support for their roles. These challenges may impair nurses’ abilities to provide supportive care to clients. Building relationships and establishing role boundaries are used to overcome barriers (Willard & Luker, 2007).

 

Stressors

 

Stressors identified by oncology nurses have been examined in several countries. Nurses in the United Kingdom were found to thrive in a stressful occupation when caring for others in a multidisciplinary team (Gambles, Wilkinson, & Dissanayake, 2003). McNeal (1997) found that oncology nurses had low levels of stress and both high hope and perceived social support.

 

Members of the Canadian Association of Nurses in Oncology identified the top problems in their practice to be anxiety, coping and stress management, bereavement and death, fatigue, metastatic disease, comfort, pain management, quality of life, cancer recurrence, and nurse burnout (Fitch, Bakker, & Conlon, 1999). Oncology nurses from London, England, described their work as stressful, developed boundaries or “detachment,” found some people difficult, and felt both good about themselves and also at times felt a sense of failure (Pearce, 1998). In addition, because this study was conducted during the winter, working during the holidays stirred emotions. Nurses also saw time as a resource, and lack of time was a stressor because cancer involves “situations where people haven’t got a second chance” (Pearce, 1998, p. 236).

 

These nurses felt they were not valued by colleagues, managers, the organization, or society. They felt the study provided a chance to reflect and make sense of their experiences.

 

Nurses in Taiwan caring for patients who were dying in intensive care units felt fear, guilt, compassion, grief, and an opportunity for growth (Yang & McIlfatrick, 2001). Stressors included relationships with physicians or families, concealing prognoses from patients, and resuscitation orders. Coping strategies included religion and providing good nursing care.

 

Stress was related to individual, group, institutional, and cultural levels and included existential dimensions in Sweden (Ekedahl & Wengström, 2007). Primary coping strategies among these Swedish nurses included general boundary demarcation and support strategies. Other strategies were periodically changing activity, emotional outlets, and focusing on the here and now (Ekedahl & Wengström, 2006). The strategies can be functional or dysfunctional.

 

Pålsson and Norberg (1995) identified several stressors, including coming too close to patients and their families; keeping and restoring patients’ hope; conflicting opinions; feeling powerless; meeting unrealistic demands; patients’ trust in alternative medicine; feeling disgust, shame, and guilt; relationships to patients’ families; communication gaps; and problems in the home care of seriously ill patients. Dutch nurses caring for patients with cancer in pain experienced powerlessness, dilemmas concerning physical care and opiates, and discrepancy between pain relief goals and feasibility. Sharing feelings of powerlessness and standing back from a situation were identified as effective coping strategies (de Schepper, Francke, & Abu-Saad, 1997).

 

Oncology nurses perceive staff relationships and emotional demands, system demands, pathologic processes affecting patients and families, care restrictions, ethical concerns, suffering, and the death and dying process as stressful (de Carvalho, Muller, de Carvalho, & de Souza Melo, 2005; Florio, 1997). Coping included positive involvement in cancer treatment, instrumental and emotional support from coworkers, positive reappraisal, developing a growth perspective, affective regulation, balancing work stress, negative coping, apathy, withdrawal, and catharsis.

 

Nurses caring for children with cancer identified diagnosis, parents, shortage of nursing staff, deaths, and relapse as stressors (Harding, 1996; McCarron, 1995). Suggested solutions were mentoring, co-counseling, peer supervision, staff training, stress monitoring, group work, debriefing, regular liaison for staff, and outside interests.

 

Burnout

 

Burnout has been investigated in relation to occupational stress, difficult situations, perceived determinants of risks, and perceived support factors. Blomberg and Sahlberg-Blom (2007) found that team members handled difficult situations through daily reflection and balanced closeness with distancing themselves. Methods of relaxation found to decrease burnout were talking to friends, using humor, drinking coffee or eating, and watching television (Kash et al., 2000). This study also found that perception of oneself as religious lowered the risk of burnout. Quattrin et al. (2006) found high levels of emotional exhaustion among oncology nurses in Italy and recommended individual coping strategies and support groups to decrease burnout. Nurses identified disorganization as an important cause of stress. A study in Turkey found a negative impact on quality of life among oncology nurses when compared with similar studies of nursing in other specialties (Ergun, Oran, & Bender, 2005).

 

Emotional exhaustion has been found to be higher in older nurses (Quattrin et al., 2006), in younger nurses, and also among nurses with less education (Wu, Zhu, Wang, Wang, & Lan, 2007). Features found to be related to burnout included excessive workload (Barrett & Yates, 2002; Sherman, Edwards, Simonton, & Mehta, 2006; Wu et al., 2007) and dissatisfaction with pay (Barrett & Yates, 2002). Pålsson, Hallberg, Norberg, and Björvell (1996) found that burnout affects people in different ways as a result of individual personality traits, whereas Feldstein and Gemma (1995) found that confrontations with death and dying in oncology led to above-normal levels of despair, social isolation, and somatization. Self-transcendence was identified as finding meaning in life and death (Hunnibell, Reed, Quinn-Griffin, & Fitzpatrick, 2008). Differences in self-transcendence between hospice and oncology nurses were significant, and nurses who implemented self-transcendence were less likely to experience burnout.

 

Support Needs: Social and Instrumental

 

The meaning of oncology nursing and the stressors nurses experience indicate nurses need support doing this important work. Studies related to support needs of oncology nurses identified different support roles, needs, and instrumental tactics. Stressors, emotional exhaustion, and depersonalization were positively correlated in Australian nurses (Barnard, Street, & Love, 2006). A weak positive correlation also was found between peer support and personal accomplishment.

 

Several interventions have been found to be helpful. Macpherson (2008) found peer-supported storytelling among pediatric oncology nurses to be a valuable grieving tool. A clinical support nurse reduced work-related stress for pediatric oncology nurses, especially for those younger than age 40 (Chang, Kicis, & Sangha, 2007). Fitch, Matyas, and Robinette (2006) evaluated a workshop that helped caregivers balance their work and personal lives and assisted with coping strategies. Self-care, verbal expression of suffering and loss, and relaxation techniques were explored. Benefits were the values of connection, support, and stories. A final intervention dealt with nurses analyzing their dreams. Nurses were found to be more aware of their own feelings and those around them after participating in group dream work (Cohen & Bumbaugh, 2004).

 

Mentoring, Role Modeling, and Personal and Professional Development

 

Mentoring is another support for oncology nurses. Booth, Luker, Costello, and Dows (2003) found
substantial practice development needs, particularly in relation to organizational support and guidance,
educational support, resources, and access to evidence among specialist nurses working in cancer and palliative care in England, Scotland, and Wales. Oncology nurses reported that personal and collegial attitudes contribute to their development as professionals. The nursing team plays an integral role in the development of oncology nurses’ identities and fulfills a supportive function by providing caring and demonstrating respect for each other (Wengström & Ekedahl, 2006).

 

Wyatt (2007) found that an oncology nursing course was perceived to have a positive impact, especially on knowledge, communication skills, patient care, and attitudes toward cancer, symptom management, and emotional support. Although organizations such as ONS have offered mentoring opportunities for professional growth, to date, no studies have examined interventions to meet mentoring needs of oncology nurses.

 

Work-Life Balance and Competing Demands With Healthcare Reform

 

Although a great deal has been written about these topics, only indirectly related research was found. One study related work demand with healthcare reform. Canadian nurses described changes in oncology nursing over the past decade (Bakker, Fitch, Green, Butler, & Olson, 2006). More patients had increased acuity; were more knowledgeable, effective consumers of health care; were aware of cutbacks and shortages; and vocalized their concerns. Expectations of nurses also increased, including both nursing and non-nursing tasks, as positions were cut. In addition, cultural norms of nursing practice and social forces often were not compatible. Finally, nurses described “finding the way” as a behavior used to manage the changing healthcare environment and make meaning out of their work in cancer care. Overall, the findings portray Canadian oncology nurses in “survival mode” and “juggling” to balance the demands of clinical settings with the care they provide.

 

Another study described lead cancer nurses, a role created as part of the reform of the National Health Service in the United Kingdom (Kirshbaum, Booth, & Luker, 2004). Lead cancer nurses are senior nurses who take on the new role with continuing clinical responsibilities. Enhancing factors were the ability to use decision-making power, build alliances, and accommodate to changing environments. Factors hindering nurses were major changes in service and policy, restricted resources, and the cancer site-specific structure of health service provisions. Partnerships with local healthcare organizations and wider audiences were recommended to further contributions of lead cancer nurses. Both studies illustrate challenges and opportunities for oncology nurses when healthcare systems change.

 

Family and Patient Involvement

 

Nurses value family support. A phenomenologic study in Cyprus (Charalambous, Papadopoulous, & Beadsmoore, 2008) interpreted quality nursing care as “easily accessible care delivered by clinically competent nurses and supported by the family which considers the patients’ need for spiritual or religious care, communication, emotional support, and information giving” (p. 441).

 

Oncology nurses identified the emotional burden of the supportive care role as a key challenge, along with healthcare systems that are not responsive to needs of families (Turner et al., 2007). Adamsen and Rasmussen (2003) found that nurses function as social networkers in self-help groups and use their contextual competence by consciously encouraging relationships between fellow patients.

 

Technology and Treatment

 

Several articles have addressed updated cancer treatments and modern technology for cancer-related care. Dickerson, Boehmke, Ogle, and Brown (2005) described experiences of oncology nurses using the Internet in their practice—varying degrees of Internet integration in practice environments, changing schools of thought, developing Internet use for professional practice, redefining relationships, and new nursing skills.

 

Computer technology has been studied. Im and Chee (2006a) developed an online decision support computer program to support assessment of cancer pain. Most nurses evaluated the program as appropriate, accurate, and useful. User satisfaction differed based on gender, religion, ethnicity, job title, and specialization (Im & Chee, 2006b). Nurses’ and patients’ evaluations on the use of a computer-based multidimensional measure of symptoms, quality of life, and treatment of side effects agreed (Fortner, Baldwin, Schwartzberg, & Houts, 2006). Kim et al. (2006) found that computerized order entry reduced chemotherapy errors.

 

Telephone technology also has been used in monitoring and providing aid to patients (Downe-Wamboldt et al., 2007; Kaunonen, Aalto, Tarkka, & Paunonen, 2000; Maguire, McCann, Miller, & Kearney, 2008; Overend et al., 2008; Wilkinson & Sloan, 2009; Young et al., 2008). Patient satisfaction also was high in these studies.

 

Current technologies used in cancer treatment continuously are evolving. These studies indicated that computer technology could be an efficient method for collecting information and reducing errors in
cancer-related care. The suggestion that technology may redefine relationships is important to explore because relationships are key to oncology nursing.

 

Advanced Practice Nursing

 

The number and role of advanced practice nurses (APNs) continue to evolve. Three studies described advanced practice oncology nursing roles, barriers, and practice issues (Bryant-Lukosius et al., 2007; Kinney, Hawkins, & Hudmon, 1997; Lynch, Cope, & Murphy-Ende, 2001).

 

Numerous APN issues continue to be unresolved. Cunningham (2006) studied oncology APN use of Agency for Healthcare Policy and Research clinical practice guidelines (CPGs). Consistency between CPGs and interventions for pain, incontinence, and depression were 91%, 80%, and 69%, respectively. Consistency did not predict outcomes; however, the levels of consistency suggested that oncology APNs were aware of some CPGs more than others.

 

Case management with women with breast cancer also has been studied. Carroll (1998) found that 40% of clinical nurse specialist (CNS) roles were spent facilitating patient treatment choice. Facilitation occurred in different stages and was influenced by structural and contextual factors. These CNSs found it stressful to strive for a neutral role and ascertain what patients really wanted. A randomized clinical trial found that APNs improved some aspects of quality of life but did not lower costs (Ritz et al., 2000).

 

Loftus and McDowell (2000) explored contributions of oncology clinical nurse specialists (OCNSs). Issues related to the developmental needs of these nurses included uncertain ground, boundaries, support, and reflective practice. OCNSs often provide support in difficult circumstances and lack clarity regarding their counseling roles. OCNSs believe aspects of their roles are unique, and a comparative study of CNSs in other specialties could be undertaken. Research is needed to determine cost-effectiveness, advantages, and disease-specific populations that would benefit from APN services.

 

Certification

 

The American Board of Nursing Specialties (ABNS) found that certified and noncertified nurses agreed with value statements on certified practice (Niebuhr & Biel, 2007). In an earlier survey by ABNS (Stromborg et al., 2005), nurse managers preferred hiring certified over noncertified nurses. Managers who were never certified were less likely to hire certified over noncertified nurses. Only 30% of managers reported greater satisfaction among patients and families with the care they received from a certified nurse.

 

In a survey of ONS members, certification was correlated weakly with cohesion, commitment, and satisfaction (Hughes et al., 2001). Work setting, rather than certification, accounted for differences in job perceptions.


Job perceptions were most positive in settings with a high percentage of patients with cancer, a high percentage of RNs, and monetary support for continuing education. Oncology nurses’ certification was not associated with job perceptions that employers valued. Another study found that the primary reasons oncology nurses obtain and retain certification include the desire for personal achievement, professional growth, and development. Oncology certified nurses® (OCN®s) were more likely to work in settings in which employers supported professional development through continuing nursing education (Coleman et al., 1999). Certification also has been associated with high levels of professionalism and empowerment (Gaberson, Schroeter, Killen, & Valentine, 2003; Wynd, 2003).

 

McMillan, Heusinkveld, Chai, Miller-Murphy, and Huang (2002) conducted a role delineation study of basic oncology nursing practice. The highest ranking items for both frequency and importance pertained to professional performance, patient and family education, comfort, protective mechanisms, and coping. The lowest ranked activities pertained to research, prevention, detection, and sexuality.

 

Patients cared for by OCN®s did not have superior outcomes compared to those cared for by noncertified nurses (Frank-Stromborg et al., 2002). No differences were found with respect to pain assessments, assessment of fatigue at admission, unplanned visits or admissions to care facilities, and unscheduled home visits. OCN®s documented more postadmission fatigue assessments; however, patients of OCN®s had more infections and less documented patient teaching regarding infection.

 

Specialization and Scope of Work

 

Position papers and standards have been written about specialty and scope of practice. Studies have examined the effects of specialized nurses on the treatment of patients with cancer (Garvican, Grimsey, Littlejohns, Lowndes, & Sacks, 1998; Goodwin, Satish, Anderson, Nattinger, & Freeman, 2003; Koinberg, Fridlund, Engholm, & Homberg, 2004; Liebert et al., 2003; McArdle et al., 1996; Ritz et al., 2000; Wengström, Häggmark, & Forsberg, 2001). Although these studies do not examine the process or experience of nurses, they demonstrate that specialization improved several patient outcomes, including physical and psychosocial well-being.

 

Case Management

 

Case management has been described from several perspectives. A survey of directors of cancer screening programs found that case management programs had either a task focus or a self-identity focus (Lillquist, 2008). Task-focus partnerships undertook a broader range of tasks but were less likely to report autonomy in making program changes. Self-identity partnerships were less likely to report difficulties with other agencies and scored high on innovation, involvement in work, and interest in client service. Nurse case managers (NCMs) described spending most time on activities such as tracking diagnostic test results, communicating with clients, assessing client needs, and educating clients (Fawcett, Schutt, Gall, Cruz, & Woodford, 2007). The most frequently performed activity was documenting services; the least was discharging clients. Strategies are needed that remove barriers to NCM practice activities.

 

Another study described and categorized NCM interventions—assessment, facilitation, coordination, advocacy, teaching, support, collaborative problem solving, and keeping track. NCMs tailored interventions by combining categories for each patient to meet his or her needs. This tailoring and execution of interventions depended on the knowledge, experience, and skill of each NCM (Maliski, Clerkin, & Litwin, 2004). Sherrod and Richardson (2003) used a case management model to implement a faith-based initiative to promote breast cancer screening in a rural African American population. In this study, volunteers encouraged their friends to have mammograms. Faith-based initiatives can help identify strategies to provide cost-effective, quality, and accessible care across the continuum of health care in many settings. Careful planning and collaboration of case managers with community resources and other disciplines can strengthen partnerships, eliminate disparities, and improve outcomes for vulnerable populations.

 

In a randomized prospective trial, Jennings-Sanders, Kuo, Anderson, Freeman, and Goodwin (2005) found that older women living alone required more NCM contacts, and NCMs helped these women achieve positive health outcomes. Another study found that a nurse-managed smoking cessation program was effective, inexpensive, and acceptable for hospitalized smokers (Smith, Reilly, Houston-Miller, DeBusk, & Taylor, 2002).

 

Concepts for Which No Research Was Found

 

No research was found about recruitment and retention; environment, setting, and workplace issues; and career trajectory (life cycle). No specific research was found on recognition and rewards; however, this topic was described in work on the meaning of oncology nursing. In examining research related to volunteer organizations such as ONS, two studies addressed volunteerism in nursing, but neither was specific to oncology nurses (Alotaibi, 2007; Deleskey, 2003). Perceptions and motivations for volunteerism by oncology nurses, especially with regard to participation in oncology professional organizations, have not been studied. In addition, although a great deal has been written about generational differences, no research specifically addressed age. Several articles compared novice to experienced nurses, but these may not represent different generations. Ages were either not reported or had a wide range; for example, one study reported on a sample of nursing students with ages ranging from 18 – 48 years (Cunningham, Copp, Collins, & Bater, 2006).

 

Discussion

 

This review indicates that although the healthcare system has changed in 15 years, nurses’ experiences of providing care to patients with cancer have remained consistent. Research has examined most of the concepts from the Life Cycle Task Force. Findings have been consistent over time and across different countries. Relationships, caring, and witnessing suffering were common among studies of the meaning of oncology nursing. Nurses continue to see oncology nursing as both stressful and rewarding. Nurses provide holistic care, and, not surprisingly, holistic interventions have been found useful to support nurses. Interventions include storytelling, clinical support nurses, workshops for finding balance in lives, and dream work. The research found was primarily descriptive, with very small samples and few interventions reported. In addition, as roles change and evolve, studies of the effectiveness on costs and other outcomes are needed. Technology has changed, and it may alter relationships. Because this is a key aspect of oncology nursing, evaluating this change would be useful.

 

The authors gratefully acknowledge the work of the ONS Task Force. Task force members were Marlene Z. Cohen, PhD, RN, FAAN, Emma L. Dann, MS, RN, OCN®, CNA-BC, Betty R. Ferrell, RN, PhD, FAAN, Gail Mallory, PhD, RN, NEA-BC, Marlon Garzo Saria, MSN, RN, AOCNS®, Janet A. Sirilla, RN, MSN, OCN®, Anne Snively, BS, CAE, Sharon Steingass, RN, MSN, AOCN®, and Mark Vrabel, MLS, AHIP, ELS.

 

References                                                                

 

Adamsen, L., & Rasmussen, J.M. (2003). Exploring and encouraging through social interaction: A qualitative study of nurses’ participation in self-help groups for cancer patients. Cancer Nursing, 26, 28–36. http://dx.doi.org/10.1097/00002820-200302000-00004

 

Alotaibi, M. (2007). Factors affecting nurses’ decisions to join their professional association. International Nursing Review, 54, 160–165. http://dx.doi.org/10.1111/j.1466-7657.2007.00555.x

 

Bakker, D., Fitch, M.I., Green, E., Butler, L., & Olson, K. (2006). Oncology nursing: Finding the balance in a changing health care system. Canadian Oncology Nursing Journal, 16, 79–98.

 

Barnard, D., Street, A., & Love, A.W. (2006). Relationships between stressors, work supports, and burnout among cancer nurses. Cancer Nursing, 29, 338–345. http://dx.doi.org/10.1097/00002820-200607000-00013

 

Barrett, L., & Yates, P. (2002). Oncology/haematology nurses: A study of job satisfaction, burnout, and intention to leave the specialty. Australian Health Review, 25, 109–121. http://dx.doi.org/10.1071/AH020109

 

Bass, M. (2003). Oncology nurses’ perceptions of their role in resuscitation decisions. Professional Nursing, 18, 710–713.

 

Berterö, C. (1999). Caring for and about cancer patients: Identifying the meaning of the phenomenon “caring” through narratives. Cancer Nursing, 22, 414–420. http://dx.doi.org/10.1097/00002820-199912000-00003

 

Blomberg, K., & Sahlberg-Blom, E. (2007). Closeness and distance: A way of handling difficult situations in daily care. Journal of Clinical Nursing, 16, 244–254. http://dx.doi.org/10.1111/j.1365-2702.2005.01503.x

 

Booth, K., Luker, K.A., Costello, J., & Dows, K. (2003). Macmillan cancer and palliative care specialists: Their practice development support needs. International Journal of Palliative Nursing, 9, 73–79.

 

Bryant-Lukosius, D., Green, E., Fitch, M., Macartney, G., Robb-Blenderman, L., McFarlan, S., . . . Milne, H. (2007). A survey of oncology advanced practice nurses in Ontario: Profile and predictors of job satisfaction. Nurse Leadership, 20, 50–68.

 

Carroll, S. (1998). Role of the breast care clinical nurse specialist in facilitating decision-making for treatment choice: A practice profile. European Journal of Oncology Nursing, 2, 34–42. http://dx.doi.org/10.1016/S1462-3889(98)81259-3

 

Chang, A., Kicis, J., & Sangha, G. (2007). Effect of the clinical support nurse role on work-related stress for nurses on an inpatient pediatric oncology unit. Journal of Pediatric Oncology Nursing, 24, 340–349. http://dx.doi.org/10.1177/1043454207308065

 

Charalambous, A., Papadopoulous, I., & Beadsmoore, A. (2008). Listening to the voices of patients with cancer, their advocates and their nurses: A hermeneutic-phenomenological study of quality nursing care. European Journal of Oncology Nursing, 12, 436–442. http://dx.doi.org/10.1016/j.ejon.2008.05.008  

 

Clarke-Steffen, L. (1998). The meaning of peak and nadir experiences of pediatric oncology nurses: Secondary analysis. Journal of Pediatric Oncology Nursing, 15, 25–33. http://dx.doi.org/10.1177/104345429801500104

 

Cohen, M.Z., & Bumbaugh, M. (2004). Group dream work: A holistic resource for oncology nurses. Oncology Nursing Forum, 31, 817–824. http://dx.doi.org/10.1188/04.ONF.817-824

 

Cohen, M.Z., Haberman, M.R., & Steeves, R. (1994). The meaning of oncology nursing: A phenomenological investigation. Oncology Nursing Forum, 21(Suppl. 8), 5–8.

 

Cohen, M.Z., & Sarter, B. (1992). Love and work: Oncology nurses’ view of the meaning of their work. Oncology Nursing Forum, 19, 1481–1486.

 

Coleman, E.A., Frank-Stromborg, M., Hughes, L.C., Grindel, C.G., Ward, S., Berry, D., . . . Murphy, C.M. (1999). A national survey of certified, recertified, and noncertified oncology nurses: Comparisons and contrasts. Oncology Nursing Forum, 26, 839–849.

 

Cunningham, R.S. (2006). Clinical practice guideline use by oncology advanced practice nurses. Applied Nursing Research, 19, 126–133. http://dx.doi.org/10.1016/j.apnr.2005.06.003

 

Cunningham, S.M., Copp, G., Collins, B., & Bater, M. (2006). Preregistration nursing students’ experience of caring for cancer patients. European Journal of Oncology Nursing, 10, 59–67. http://dx.doi.org/10.1016/j.ejon.2005.05.004

 

de Carvalho, E.C., Muller, M., de Carvalho, P.B., & de Souza Melo, A. (2005). Stress in the professional practice of oncology nurses. Cancer Nursing, 28, 187–192. http://dx.doi.org/10.1097/00002820-200505000-00004

 

Deleskey, K. (2003). Factors affecting nurses’ decisions to join and maintain membership in professional associations. Journal of Peri-Anesthesia Nursing, 18, 8–17. http://dx.doi.org/10.1053/jpan.2003.18030008

 

de Schepper, A.M., Francke, A.L., & Abu-Saad, H.H. (1997). Feelings of powerlessness in relation to pain: Ascribed causes and reported strategies. A qualitative study among Dutch community nurses caring for cancer patients with pain. Cancer Nursing, 20, 422–429. http://dx.doi.org/10.1097/00002820-199712000-00006

 

Dickerson, S.S., Boehmke, M., Ogle, C., & Brown, J.K. (2005). Out of necessity: Oncology nurses’ experiences integrating the Internet into practice. Oncology Nursing Forum, 32, 355–362. http://dx.doi.org/10.1188/05.ONF.355-362

 

Dowling, M. (2008). The meaning of nurse-patient intimacy in oncology care settings: From the nurse and patient perspective. European Journal of Oncology Nursing, 12, 319–328. http://dx.doi.org/10.1016/j.ejon.2008.04.006

 

Downe-Wamboldt, B.L., Butler, L.J., Melanson, P.M., Coulter, L.A., Singleton, J.F., Keefe, J.M., & Bell, D.G. (2007). The effects and expense of augmenting usual cancer clinic care with telephone problem-solving counseling. Cancer Nursing, 30, 441–453. http://dx.doi.org/10.1097/01.NCC.0000300164.90768.ec

 

Dunn, K.S., Otten, C., & Stephens, E. (2005). Nursing experience and the care of dying patients. Oncology Nursing Forum, 32, 97–104. http://dx.doi.org/10.1188/05.ONF.97-104

 

Ekedahl, M., & Wengström, Y. (2006). Nurses in cancer care—Coping strategies when encountering existential issues. European Journal of Oncology Nursing, 10, 128–139. http://dx.doi.org/10.1016/j.ejon.2005.05.003

 

Ekedahl, M., & Wengström, Y. (2007). Nurses in cancer care—Stress when encountering existential issues. European Journal of Oncology Nursing, 11, 228–237. http://dx.doi.org/10.1016/j.ejon.2006.09.005

 

Ergun, F.S., Oran, N.T., & Bender, C.M. (2005). Quality of life of oncology nurses. Cancer Nursing, 28, 193–199.

 

Fall-Dickson, J., & Rose, L. (1999). Caring for patients who experience chemotherapy-induced side effects: The meaning for oncology nurses. Oncology Nursing Forum, 26, 901–907.

 

Fawcett, J., Schutt, R., Gall, G., Cruz, E., & Woodford, M. (2007). The work of nurse case managers in a cancer and cardiovascular disease risk screening program. Professional Case Management, 12, 93–105.

 

Feldstein, M.A., & Gemma, P.B. (1995). Oncology nurses and chronic compounded grief. Cancer Nursing, 18, 228–236. http://dx.doi.org/10.1097/00002820-199506000-00008

 

Ferrell, B.R. (2006). Understanding the moral distress of nurses witnessing medically futile care. Oncology Nursing Forum, 33, 922–930. http://dx.doi.org/10.1188/06.ONF.922-930

 

Fillion, L., de Serres, M., Lapointe-Goupil, R., Bairati, I., Gagnon, P., Deschamps, M., . . . Demers, G. (2006). Implementing the role of patient-navigator nurse at a university hospital centre. Cancer Oncology Nursing Journal, 16, 11–17.

 

Fitch, M.I., Bakker, D., & Conlon, M. (1999). Important issues in clinical practice: Perspectives of oncology nurses. Cancer Oncology Nursing Journal, 9, 151–164.

 

Fitch, M.I., Matyas, Y., & Robinette, M. (2006). Caring for the caregivers: Innovative program for oncology nurses. Canadian Oncology Nursing Journal, 16, 110–115.

 

Florio, G.A. (1997). The structure of work-related stress and coping among oncology nurses on high-stress units: A transactional analysis (Doctoral dissertation, State University of New York at Buffalo, 1997). Retrieved from UNI Microfilms (UNI Microfilms No. 9807292).

 

Fortner, B., Baldwin, S., Schwartzberg, L., & Houts, A.C. (2006). Validation of the Cancer Care Monitor items for physical symptoms and treatment side effects using expert oncology nurse evaluation. Journal of Pain and Symptom Management, 31, 207–214. http://dx.doi.org/10.1016/j.jpainsymman.2005.07.009

 

Frank-Stromborg, M., Ward, S., Hughes, L., Brown, K., Coleman, A., Grindel, C.G., & Miller Murphy, C. (2002). Does certification status of oncology nurses make a difference in patient outcomes? Oncology Nursing Forum, 29, 665–672. http://dx.doi.org/10.1188/02.ONF.665-672

 

Freeman, H.P., Muth, B.J., & Kerner, J.F. (1995). Expanding access to cancer screening and clinical follow-up among the medically underserved. Cancer Practice, 3, 19–30.

 

Gaberson, K.B., Schroeter, K., Killen, A.R., & Valentine, W.A. (2003). The perceived value of certification by perioperative nurses. Nursing Outlook, 51, 272–276. http://dx.doi.org/10.1016/j.outlook.2003.09.003

 

Gambles, M., Wilkinson, S.M., & Dissanayake, C. (2003). What are you like? A personality profile of cancer and palliative care nurses in the United Kingdom. Cancer Nursing, 26, 97–104. http://dx.doi.org/10.1097/00002820-200304000-00002

 

Garvican, L., Grimsey, E., Littlejohns, P., Lowndes, S., & Sacks, N. (1998). Satisfaction with clinical nurse specialists in a breast care clinic: Questionnaire survey. BMJ, 316, 967–977.

 

Goodwin, J.S., Satish, S., Anderson, E.T., Nattinger, A.B., & Freeman, J.L. (2003). Effect of nurse case management on the treatment of older women with breast cancer. Journal of the American Geriatrics Society, 51, 1252–1259. http://dx.doi.org/10.1046/j.1532-5415.2003.51409.x

 

Haberman, M., Germino, B., Maliski, S., Stafford-Fox, V., & Rice, K. (1994). What makes oncology nursing special? Walking the road together. Oncology Nursing Forum, 21(Suppl. 8), 41–47.

 

Harding, R. (1996). Children with cancer: Managing stress in staff. Part 2. Paediatric Nursing, 8, 28–31.

 

Hoelz, T.M., Sladek, M.L., & Michaelson, P.L. (2007). Blending nursing roles in oncology and imaging: An innovative strategy. Oncology Nursing Forum, 34, 27–31. http://dx.doi.org/10.1188/07.ONF.27-31

 

Hughes, L.C., Ward, S., Grindel, C.G., Coleman, E.A., Berry, D.L., Hinds, P.S., . . . Frank-Stromborg, M. (2001). Relationships between certification and job perceptions of oncology nurses. Oncology Nursing Forum, 28, 99–106.

 

Hunnibell, L.S., Reed, P.G., Quinn-Griffin, M., & Fitzpatrick, J.J. (2008). Self-transcendence and burnout in hospice and oncology nurses. Journal of Hospice and Palliative Nursing, 10, 172–179. http://dx.doi.org/10.1097/01.NJH.0000306742.95388.80

 

Im, E., & Chee, W. (2006a). Evaluation of the decision support computer program for cancer pain management. Oncology Nursing Forum, 33, 977–982. http://dx.doi.org/10.1188/06.ONF.977-982

 

Im, E., & Chee, W. (2006b). Nurses’ acceptance of the decision support computer program for cancer pain management. CIN: Computers, Informatics, Nursing, 24, 95–104.

 

Jennings-Sanders, A., Kuo, Y., Anderson, E.T., Freeman, J.L., & Goodwin, J.S. (2005). How do nurse case managers care for older women with breast cancer? Oncology Nursing Forum, 32, 625–632. http://dx.doi.org/10.1188/05.ONF.625-632

 

Jones, A. (1999). A heavy and blessed experience: A psychoanalytic study of community Macmillan nurses and their roles in serious illness and palliative care. Journal of Advanced Nursing, 30, 1297–1303. http://dx.doi.org/10.1046/j.1365-2648.1999.01223.x

 

Kash, K.M., Holland, J.C., Breitbart, W., Berenson, S., Dougherty, J., Ouellette-Kobasa, S., & Lesko, L. (2000). Stress and burnout in oncology. Oncology, 14, 1621–1637.

 

Kaunonen, M., Aalto, P., Tarkka, M., & Paunonen, M. (2000). Oncology ward nurses’ perspectives of family grief and a supportive telephone call after the death of a significant other. Cancer Nursing, 23, 314–324. http://dx.doi.org/10.1097/00002820-200008000-00010

 

Kim, G., Chen, A.R., Arceci, R., Mitchell, S.H., Kokoszka, K.M., Daniel, D., & Lehmann, C. (2006). Error reduction in pediatric chemotherapy: Computerized order entry and failure modes and effects analysis. Archives of Pediatrics and Adolescent Medicine, 160, 495–498. http://dx.doi.org/10.1001/archpedi.160.5.495  

 

Kinney, A.Y., Hawkins, R., & Hudmon, K.S. (1997). A descriptive study of the role of the oncology nurse practitioner. Oncology Nursing Forum, 24, 811–820.

 

Kirshbaum, M., Booth, K., & Luker, K. (2004). The changing face of cancer care in the UK: Can nurses help to structure new services? European Journal of Cancer Care, 13, 246–253. http://dx.doi.org/10.1111/j.1365-2354.2004.00476.x

 

Koinberg, I.L., Fridlund, B., Engholm, G.B., & Homberg, L. (2004). Nurse-led follow-up on demand or by a physician after breast cancer surgery: A randomized study. European Journal of Oncology Nursing, 8, 109–117. http://dx.doi.org/10.1016/j.ejon.2003.12.005

 

Liebert, B., Parle, M., Roberts, C., Redman, S., Carrick, S., Gallagher, J., . . . Trotter, J. (2003). An evidence-based specialist breast nurse role in practice: A multicentre implementation study. European Journal of Cancer Care, 12, 91–97. http://dx.doi.org/10.1046/j.1365-2354.2003.00331.x

 

Lillquist, P.P. (2008). Implementing case management in New York State’s partnerships for publicly funded breast cancer screening. Preventing Chronic Disease, 5(2), A45.

 

Loftus, L.A., & McDowell, J. (2000). The lived experience of the oncology clinical nurse specialist. International Journal of Nursing Studies, 37, 513–521. http://dx.doi.org/10.1016/S0020-7489(00)00028-6

 

Lynch, M.P., Cope, D.G., & Murphy-Ende, K. (2001). Advanced practice issues: Results of the ONS advanced practice nursing survey. Oncology Nursing Forum, 28, 1521–1530.

 

Macpherson, C.F. (2008). Peer-supported storytelling for grieving pediatric oncology nurses. Journal of Pediatric Oncology Nursing, 25, 148–163. http://dx.doi.org/10.1177/1043454208317236

 

Maguire, R., McCann, L., Miller, M., & Kearney, N. (2008). Nurse’s perceptions and experiences of a mobile-phone-based advanced symptom management system (ASyMS) to monitor and manage chemotherapy-related toxicity. European Journal of Oncology Nursing, 12, 380–386. http://dx.doi.org/10.1016/j.ejon.2008.04.007

 

Maliski, S.L., Clerkin, B., & Litwin, M.S. (2004). Describing a nurse case manager intervention to empower low-income men with prostate cancer. Oncology Nursing Forum, 31, 57–64. http://dx.doi.org/10.1188/04.ONF.57-64

 

McArdle, J.M., George, W.D., McArdle, C.S., Smith, D.C., Moodie, A.R., Hughson, A.V.M., & Murray, G.D. (1996). Psychological support for patients undergoing breast cancer surgery: A randomized study. BMJ, 312, 813–816.

 

McCarron, A. (1995). Stress in cancer care and coping strategies. Nursing Times, 91, 11–12.

 

McDonnell, K., & Ferrell, B. (1992). Oncology Nursing Society Life Cycle Task Force report: The life cycle of the oncology nurse. Oncology Nursing Forum, 19, 1545–1550.

 

McIlfatrick, S., Sullivan, K., & McKenna, H. (2006). Nursing the clinic versus nursing the patient: Nurses’ experience of a day hospital chemotherapy service. Journal of Clinical Nursing, 15, 1170–1178. http://dx.doi.org/10.1111/j.1365-2702.2006.01495.x

 

McMillan, S.C., Heusinkveld, K., Chai, S., Miller Murphy, C., & Huang, C. (2002). Revising the blueprint for the oncology certified nurse® (OCN®) examination: A role delineation study [Online exclusive]. Oncology Nursing Forum, 29, E110–E117. http://dx.doi.org/10.1188/02.ONF.E110-E117  

 

McNeal, L.J. (1997). The effects of perceived nonwork social support and hope upon oncology nurses’ occupational stress (Doctoral dissertation, the University of North Carolina at Greensboro, 1997). Retrieved from UNI Microfilms (UNI Microfilms No. 9730012).

 

Niebuhr, B., & Biel, M. (2007). The value of specialty nursing certification. Nursing Outlook, 55, 176–181. http://dx.doi.org/10.1016/j.outlook.2007.02.002

 

O’Baugh, J., Wilkes, L.M., Luke, S., & George, A. (2008). Positive attitude in cancer: The nurse’s perspective. International Journal of Nursing Practice, 14, 109–114. http://dx.doi.org/10.1111/j.1440-172X.2008.00673.x

 

Olson, M.S., Hinds, P.S., Euell, K., Quargnenti, A., Milligan, M., Foppiano, P., & Powell, B. (1998). Peak and nadir experiences and their consequences described by pediatric oncology nurses. Journal of Pediatric Oncology Nursing, 15, 34–36.

 

Overend, A., Khoo, K., Delorme, M., Krause, V., Avanessian, A., & Saltman, D. (2008). Evaluation of a nurse-led telephone follow-up clinic for patients with indolent and chronic hematological malignancies: A pilot study. Canadian Oncology Nursing Journal, 18, 64–73.

 

Palmieri, F.M., DePeri, E.R., Mincey, B.A., Smith, J.A., Wen, L.K., Chewar, D.M., . . . Perez, E.A. (2009). Comprehensive diagnostic program for medically underserved women with abnormal breast screening evaluations in an urban population. Mayo Clinic Proceedings, 84, 317–322. http://dx.doi.org/10.4065/84.4.317

 

Pålsson, M.B., Hallberg, I.R., Norberg, A., & Björvell, H. (1996). Burnout, empathy and sense of coherence among Swedish district nurses before and after systematic clinical supervision. Scandinavian Journal of Caring Sciences, 10, 19–26.

 

Pålsson, M.B., & Norberg, A. (1995). District nurses’ stories of difficult care episodes narrated during systematic clinical supervision sessions. Scandinavian Journal of Caring Sciences, 9, 17–27.

 

Pavlish, C., & Ceronsky, L. (2007). Oncology nurses’ perceptions about palliative care. Oncology Nursing Forum, 34, 793–800. http://dx.doi.org/10.1188/07.ONF.793-800

 

Pearce, S. (1998). The experience of stress for cancer nurses: A Heideggerian phenomenological approach. European Journal of Oncology Nursing, 2, 235–237. http://dx.doi.org/10.1016/S1462-3889(98)80677-7

 

Perry, B. (2006). Touched by a nurse: The imprint of exemplary oncology nursing care. Canadian Oncology Nursing Journal, 16, 37–45.

 

Perry, B. (2008). Why exemplary oncology nurses seem to avoid compassion fatigue. Canadian Oncology Nursing Journal, 18, 87–99.

 

Perry, B. (2009). Achieving professional fulfillment as a palliative care nurse. Journal of Hospice and Palliative Nursing, 11, 109–118. http://dx.doi.org/10.1097/NJH.0b013e31819975de

 

Quattrin, R., Zanini, A., Nascig, E., Annunziata, M., Calligaris, L., & Brusaferro, S. (2006). Level of burnout among nurses working in oncology in an Italian region. Oncology Nursing Forum, 33, 815–820. http://dx.doi.org/10.1188/06.ONF.815-820

 

Quinn, B. (2003). Exploring nurses’ experiences of supporting a cancer patient in their search for meaning. European Journal of Oncology Nursing, 7, 164–171. http://dx.doi.org/10.1016/S1462-3889(03)00019-X

 

Rittman, M., Paige, P., Rivera, J., Sutphin, L., & Godown, I. (1997). Phenomenological study of nurses caring for dying patients. Cancer Nursing, 20, 115–119. http://dx.doi.org/10.1097/00002820-99704000-00006

 

Ritz, L.J., Nissen, M.J., Swenson, K.K., Farrell, J.B., Sperduto, P.W., Sladek, M.L., . . . Schroeder, L.M. (2000). Effects of advanced nursing care on quality of life and cost outcomes of women diagnosed with breast cancer. Oncology Nursing Forum, 27, 923–932.

 

Saltmarsh, K., & De Vries, K. (2008). The paradoxical image of chemotherapy: A phenomenological description of nurses’ experiences of administering chemotherapy. European Journal of Cancer Care, 17, 500–508. http://dx.doi.org/10.1111/j.1365-2354.2007.00909.x

 

Shepard, N., & Kelvin, J.F. (1999). The nursing role in radiation oncology. Seminars in Oncology Nursing, 15, 237–249. http://dx.doi.org/10.1016/S0749-2081(99)80053-9

 

Sherman, A.C., Edwards, D., Simonton, S., & Mehta, P. (2006). Caregiver stress and burnout in an oncology unit. Palliative and Supportive Care, 4, 65–80. http://dx.doi.org/10.1017/S1478951506060081

 

Sherrod, R.A., & Richardson, S. (2003). Using a case management model to implement a faith-based initiative: Addressing breast cancer in a rural African American population. Lippincott’s Case Management, 8, 241–245. http://dx.doi.org/10.1097/00129234-200311000-00005

 

Skott, C., & Eriksson, A. (2005). Clinical caring—The diary of a nurse. Journal of Clinical Nursing, 14, 916–921. http://dx.doi.org/10.1111/j.1365-2702.2005.01155.x

 

Smith, P.M, Reilly, K.R., Houston-Miller, N., DeBusk, R.F., & Taylor, C.B. (2002). Application of a nurse-managed inpatient smoking cessation program. Nicotine and Tobacco Research, 4, 211–222. http://dx.doi.org/10.1080/14622200210123590

 

Steen, B., Burghen, E., Hinds, P.S., Srivastava, D.K., & Tong, X. (2003). Development and testing of the Role-Related Meaning Scale for staff in pediatric oncology. Cancer Nursing, 26, 187–194. http://dx.doi.org/10.1097/00002820-200306000-00003

 

Stromborg, M.F., Niebuhr, B., Prevost, S., Fabrey, L., Muenzen, P., Spence, C., . . . Valentine, W. (2005). Specialty certification: More than a title. Nursing Management, 36, 36–40. http://dx.doi.org/10.1097/00006247-200505000-00012

 

Turner, J., Clavarino, A., Yates, P., Hargraves, M., Connors, V., & Hausmann, S. (2007). Oncology nurses’ perceptions of their supportive care for patients with advanced cancer: Challenges and educational needs. Psycho-Oncology, 16, 149–157. http://dx.doi.org/10.1002/pon.1106

 

van Rooyen, D., le Roux, L., & Kotze, W.J. (2008). The experiential world of the oncology nurse. Health SA Gesondheid, 13, 18–30.

 

Verity, R., Wiseman, T., Ream, E., Teasdale, E., & Richardson, A. (2008). Exploring the work of nurses who administer chemotherapy. European Journal of Oncology Nursing, 12, 244–252. http://dx.doi.org/10.1016/j.ejon.2008.02.001

 

Wengström, Y., & Ekedahl, M. (2006). The art of professional development and caring in cancer nursing. Nursing and Health Sciences, 8, 20–26. http://dx.doi.org/10.1111/j.1442-2018.2006.00263.x

 

Wengström, Y., Häggmark, C., & Forsberg, C. (2001). Coping with radiation therapy: Effects of a nursing intervention on coping ability for women with breast cancer. International Journal of Nursing Practice, 7, 8–15. http://dx.doi.org/10.1046/j.1440-172x.2001.00239.x

 

Wilke, L.M., Boxer, E., & White, K. (2003). The hidden side of nursing: Why caring for patients with malignant malodorous wounds is so difficult. Journal of Wound Care, 12, 76–80.

 

Wilkinson, S., & Sloan, K. (2009). Patient satisfaction with colorectal cancer follow-up system: An audit. British Journal of Nursing, 18, 40–44.

 

Willard, C., & Luker, K. (2007). Working with the team: Strategies employed by hospital cancer nurse specialists to implement their role. Journal of Clinical Nursing, 16, 716–724. http://dx.doi.org/10.1111/j.1365-2702.2006.01560.x

 

Wu, S., Zhu, W., Wang, Z., Wang, M., & Lan, Y. (2007). Relationship between burnout and occupational stress among nurses in China. Journal of Advanced Nursing, 59, 233–239. http://dx.doi.org/10.1111/j.1365-2648.2007.04301.x

 

Wyatt, D. (2007). How do participants of a post-registration oncology nursing course perceive that the course influences their practice? A descriptive survey. European Journal of Oncology Nursing, 11, 168–178. http://dx.doi.org/10.1016/j.ejon.2006.10.006

 

Wynd, C.A. (2003). Current factors contributing to professionalism in nursing. Journal of Professional Nursing, 19, 251–261. http://dx.doi.org/10.1016/S8755-7223(03)00104-2

 

Yang, M.H., & McIlfatrick, S. (2001). Intensive care nurses’ experiences of caring for dying patients: A phenomenological study. International Journal of Palliative Nursing, 7, 435–441.

 

Young, A., Tarassenko, L., Weaver, A., Waters, R., Smith, J., Rowantree, J., & Kerr, D. (2008). Mobile phone technology for managing chemotherapy-associated side-effects [Abstract 3125]. Oncology Nursing Forum, 35, 559.

 

Marlene Z. Cohen, PhD, RN, FAAN, is a professor, the Kenneth E. Morehead Endowed Chair in Nursing, and associate dean for research in the College of Nursing at the University of Nebraska Medical Center in Omaha; Betty R. Ferrell, RN, PhD, FAAN, is a professor in nursing research and education at City of Hope National Medical Center in Duarte, CA; Mark Vrabel, MLS, AHIP, ELS, is the information resources supervisor at ONS in Pittsburgh, PA; Constance Visovsky, PhD, RN, ACNP-BC, is an associate professor in the College of Nursing at the University of Nebraska Medical Center; and Brandi Schaefer, MSN, APRN, NP-C, is a family practice nurse practitioner at Alegent Health Memorial Hospital in Schuyler, NE, and was a master’s of nursing student at the time of writing in the College of Nursing at the University of Nebraska Medical Center. No financial relationships to disclose. Cohen can be reached at mzcohen@unmc.edu, with copy to editor at ONFEditor@ons.org. (Submitted February 2010. Accepted for publication March 11, 2010.)

 

Digital Object Identifier: 10.1188/10.ONF.561-570