Recommendations to Support Nurses and Improve the Delivery of Oncology and Palliative Care in India

Virginia T LeBaron; Gayatri Palat; Sudha Sinha; Sanjeeva Kumari Chinta; Beaulah John Battula Jamima; Usha Lakshmi Pilla; Nireekshana Podduturi; Yadamma Shapuram; Padma Vennela; Vineela Rapelli; Zahra Lalani; Susan L Beck

doi:10.4103/IJPC.IJPC_153_16

Recommendations to Support Nurses and Improve the Delivery of Oncology and Palliative Care in India

Indian J Palliat Care. 2017 Apr-Jun;23(2):188-198. doi: 10.4103/IJPC.IJPC_153_16.

Authors

Affiliations

¹ Department of Acute and Specialty Care, University of Virginia School of Nursing, Charlottesville, VA, USA.
² Palliative Access Programme, Two Worlds Cancer Collaboration-INCTR, Canada.
³ Department of Pain and Palliative Care, South Indian Cancer Hospital, India.
⁴ Department of Medical Oncology, South Indian Cancer Hospital, India.
⁵ Department of Pediatrics, South Indian Cancer Hospital, India.
⁶ Department of Radiation Oncology, South Indian Cancer Hospital, India.
⁷ Department of Nursing, South Indian Cancer Hospital, India.
⁸ Vancouver Hospice Society, British Columbia Cancer Agency, Canada.
⁹ Division of Acute and Chronic Care, University of Utah College of Nursing, Salt Lake City, Utah, USA.

Abstract

Context: Nurses in India often practice in resource-constrained settings and care for cancer patients with high symptom burden yet receive little oncology or palliative care training.

Aim: The aim of this study is to explore challenges encountered by nurses in India and offer recommendations to improve the delivery of oncology and palliative care.

Methods: Qualitative ethnography.

Setting: The study was conducted at a government cancer hospital in urban South India.

Sample: Thirty-seven oncology/palliative care nurses and 22 others (physicians, social workers, pharmacists, patients/family members) who interact closely with nurses were included in the study.

Data collection: Data were collected over 9 months (September 2011- June 2012). Key data sources included over 400 hours of participant observation and 54 audio-recorded semi-structured interviews.

Analysis: Systematic qualitative analysis of field notes and interview transcripts identified key themes and patterns.

Results: Key concerns of nurses included safety related to chemotherapy administration, workload and clerical responsibilities, patients who died on the wards, monitoring family attendants, and lack of supplies. Many participants verbalized distress that they received no formal oncology training.

Conclusions: Recommendations to support nurses in India include: prioritize safety, optimize role of the nurse and explore innovative models of care delivery, empower staff nurses, strengthen nurse leadership, offer relevant educational programs, enhance teamwork, improve cancer pain management, and engage in research and quality improvement projects. Strong institutional commitment and leadership are required to implement interventions to support nurses. Successful interventions must account for existing cultural and professional norms and first address safety needs of nurses. Positive aspects from existing models of care delivery can be adapted and integrated into general nursing practice.

Keywords: Chemotherapy; India; nurses; oncology; palliative care; recommendations.