面向未来的癌症护理：以人为本的基础护理的重要性

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Nurses could be their “own worst enemies.” Resilient, adaptable, going the extra mile to fill gaps in the system and take on other roles when we see the need—although these qualities are commendable, if they start to become expected norms within a system or in an organization, then the consequences can be profoundly damaging. Compensating for system defects means that invariably our own jobs risk being compromised, and our priorities are at the mercy of other agendas that may or may not help us do the jobs we want or need to do. In the context of nursing workforce shortage and the ever-increasing demand of care due to the rising incidence of people diagnosed with cancer and prevalence of people living with cancer, protecting and strengthening nursing going into the future are of critical importance. As the first step, in this editorial, we call for actions from all cancer nurses to recommit ourselves to person-centered fundamental care (PCFC)—the core contribution we make to health, recovery, and care.1,2

Every nurse should know how to assess the needs for and deliver PCFC. Building on over a decade’s empirical work, Kitson and colleagues,3 along with International Learning Collaborative members globally,2,4 have been painstakingly describing what fundamental care is and why we need to be more explicit in embedding it into our health and care systems.5 Failures in fundamental care delivery are widely documented,2 yet there is (to date) less agreement and alignment from the nursing profession on how to turn these challenges into growth and opportunities. Effective PCFC delivery requires cancer nurses to be able to think in an integrated way about a person’s fundamental care needs.6 These include establishing a trusting relationship; integrating the physical, psychosocial, and relational needs of the patient; and being sensitive to the context or setting where the care is being experienced. The encounter between the nurse and the patient is dynamic, iterative, and negotiated in real time.

Challenges to having PCFC embedded as part of our day-to-day practice include the following: currently, fundamental care is so embedded in our undergraduate curricula that it becomes invisible7; delivering PCFC is perceived as “common sense” or a simple task and therefore not valued or reinforced in the nursing curriculum; new graduates talk about the lack of appreciation of fundamental care skills in the practice area,8 while paradoxically research on “missed care” and burnout in the nursing workforce identifies nurses’ inability to provide PCFC as examples of the key elements leading to leaving the profession.9,10 Although people with cancer articulate the need for all aspects of fundamental care, they do not necessarily expect their nurses to be able to address all needs because of their “lack of time.”11 Such findings highlight the need for the profession to examine and reexamine the following: (1) How do we ensure PCFC is not undermined in the nursing care? (2) What are the macrolevel, mesolevel, and microlevel barriers to PCFC, and how do we begin to overcome them? (3) How should PCFC manifest in day-to-day practice across all nursing and specialist nursing roles and all cancer care settings? (4) How do nurses partner with the “care networks” of people with cancer to ensure sustainable care delivery? These ongoing gaps in our conceptualization through debates and consensus of what constitutes cancer nurses’ responsibility to assess the needs for and deliver PCFC should be addressed if we’re going to future-proof cancer nursing moving forward.

Seizing the Future

The challenge and opportunity for nursing will be about how we can provide PCFC to all people with cancer, across all settings and the cancer care continuum. We call for actions from cancer nurse leaders to influence, lobby, and advocate for a more integrated approach to valuing PCFC assessment and delivery as a universal skill in nursing practice, which is protected and supported by skill mix, ratio, and resource policies. More research is required to explore how the myriad of nursing and specialist nursing roles exemplifies the core contribution of nursing to fulfill the fundamental needs of people with cancer. Our job in the future is not to take over care; but to hang on to our core contribution we make to health, recovery, and care.

Raymond Javan Chan, PhD, MAppSc (Research), BN, RN, FACN Alison Kitson, DPhil, BSc(Hons), RN, FRCN, FAAN, FAHMS Caring Futures Institute, College of Nursing and Health Sciences, Flinders University

全文翻译（仅供参考）

护士可能是他们“自己最大的敌人”。弹性、适应性强、加倍努力填补系统中的空白并在我们看到需要时承担其他角色——尽管这些品质值得称赞，但如果它们开始成为系统或组织内的预期规范，那么后果可能会造成严重破坏。补偿系统缺陷意味着我们自己的工作总是有受到损害的风险，我们的优先事项受制于其他议程，这些议程可能会或可能不会帮助我们完成我们想要或需要的工作去做。在护理人员短缺以及由于癌症诊断和癌症患者患病率上升导致护理需求不断增加的背景下，保护和加强未来的护理至关重要。作为第一步，在这篇社论中，我们呼吁所有癌症护士采取行动，重新致力于以人为本的基础护理 (PCFC)，这是我们对健康、康复和护理做出的核心贡献。1,2

每个护士都应该知道如何评估和交付 PCFC 的需求。基于十多年的实证研究，Kitson 及其同事3以及全球国际学习合作组织成员2,4一直在煞费苦心地描述什么是基本护理，以及为什么我们需要更明确地将其嵌入到我们的健康和护理系统中。5基础护理服务的失败已被广泛记录，2但（迄今为止）护理行业在如何将这些挑战转化为增长和机遇方面的共识和一致性较少。有效的 PCFC 交付要求癌症护士能够以综合方式思考一个人的基本护理需求。6其中包括建立信任关系；整合患者的身体、心理和人际关系需求；对接受护理的环境或环境敏感。护士和病人之间的接触是动态的、迭代的和实时协商的。

将 PCFC 纳入我们日常实践的挑战包括：目前，基础护理已深深嵌入我们的本科课程中，以至于它变得无形7；提供 PCFC 被认为是“常识”或简单的任务，因此在护理课程中没有得到重视或加强；新毕业生谈论在实践领域缺乏对基本护理技能的认识，8而对“错过护理”和护理人员职业倦怠的自相矛盾的研究表明，护士无法提供 PCFC 作为导致离开该行业的关键因素的例子. 9,10尽管癌症患者表达了对基础护理各个方面的需求，但他们并不一定希望他们的护士能够满足所有需求，因为他们“没有时间”。11这样的调查结果强调了该行业需要检查和重新检查以下内容：（1）我们如何确保 PCFC 在护理中不受损害？(2) PCFC 的宏观、中观和微观层面的障碍是什么，我们如何开始克服这些障碍？(3) PCFC 应如何体现在所有护理和专科护理角色以及所有癌症护理机构的日常实践中？(4) 护士如何与癌症患者的“护理网络”合作，以确保提供可持续的护理服务？通过辩论和共识，我们在概念化中持续存在的差距是什么如果我们要面向未来的癌症护理向前发展，那么癌症护士有责任评估和交付 PCFC 的需求应该得到解决。

把握未来

护理的挑战和机遇将是关于我们如何在所有环境和癌症护理连续体中为所有癌症患者提供 PCFC。我们呼吁癌症护士领导者采取行动，影响、游说和倡导一种更综合的方法，将 PCFC 评估和交付作为护理实践中的一项普遍技能进行评估，该技能受到技能组合、比例和资源政策的保护和支持。需要更多的研究来探索无数的护理和专科护理角色如何体现护理在满足癌症患者基本需求方面的核心贡献。我们未来的工作不是接管护理；但要坚持我们对健康、康复和护理所做的核心贡献。

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