List of Contributors xiv

Foreword xvi

Introduction xviii

About the Companion Website xxi

1 Evolvement of Advanced Nursing Practice 1
Helen Kerr

1.1 Introduction 1

1.2 Evolvement of Nursing as a Profession 1

1.3 Advanced Nursing Practice 3

1.3.1 Criteria Associated with Advanced Nursing Practice 4

1.3.2 Advanced Practice Nurse Roles 6

1.3.3 Regulation 8

1.3.4 Components of Advanced Practice Nurse Roles 8

1.3.5 Education Requirements 8

1.3.6 Outcomes Associated with Advanced Practice Nurse Roles 9

1.3.7 Barriers to Advanced Practice Nursing Roles 9

1.3.8 Recommendations for Advanced Practice Nurse Roles 10

1.4 Conclusion 10

References 11

2 Emergence and Evolvement of the Clinical Nurse Specialist Role in Cancer Care 15
Helen Kerr

2.1 Introduction 15

2.2 Advanced Nursing Practice 15

2.3 Historical Context 16

2.4 Specialists vs. Generalists 17

2.5 Definition of a CNS 18

2.5.1 Role Blurring 18

2.6 Components of the Clinical Nurse Specialist Role 19

2.6.1 Direct Patient Care 20

2.6.2 Indirect Care 20

2.7 Professional Standards 21

2.8 Education Requirements 22

2.8.1 Impact of a Master's Qualification 22

2.9 Outcomes of the Clinical Nurse Specialist Role 23

2.9.1 Outcomes Associated with the Clinical Nurse Specialist in Cancer Services 24

2.10 Specialist Practice in Cancer Care 25

2.11 Future Direction of the CNS 25

2.12 Conclusion 25

References 26

3 Patient Perspective 31
Johanna McMullan

References 40

4 Carer's Perspective 43
Trevor Wightman

5 Key Worker Role 49
Karen Armstrong and Helen Kerr

5.1 Introduction 49

5.2 The Key Worker 50

5.2.1 Provision of Information 52

5.2.2 Provision of Emotional and Supportive Care 52

5.2.3 Coordination of Services 53

5.3 Key Worker/Clinical Nurse Specialist Impact on Direct and Indirect Patient Care 54

5.4 Challenges in Practice 55

5.5 'First Impressions Count' 57

5.6 Example of Change in Practice 58

5.7 Conclusion 59

References 59

6 Psychological Support 63
Caroline McCaughey, Edel Aughey, and Susan Smyth

6.1 Introduction 63

6.2 Part One: The Impact of a Cancer Diagnosis 64

6.2.1 Time Point One: Breaking Significant News 66

6.2.2 Time Point Two: Treatment Decision-Making 70

6.2.3 Time Point Three: Survivorship and Resilience 71

6.2.4 Fear of Recurrence 73

6.3 Part Two: Self-Care and the Clinical Nurse Specialist 74

6.4 Conclusion 77

References 78

7 Integrating Research and Evidence-Based Practice 84
Adrina O'Donnell, Ruth Boyd, and Clare McVeigh

7.1 Introduction 84

7.2 Evidence-Based Practice 85

7.3 Barriers to the Implementation of Evidence-Based Practice in the Clinical Setting 86

7.4 Role of Evidence-Based Practice in Caring for Patients with Cancer and Their Carers 87

7.5 Providing Evidence-Based Care as a Clinical Nurse Specialist 87

7.6 Clinical Application of Evidence-Based Practice by Clinical Nurse Specialists 88

7.7 Cancer Research and Clinical Trials 89

7.8 Cancer Clinical Trials, Research Nurses and the Role of the Clinical Nurse Specialist 91

7.9 The Role of the Clinical Nurse Specialist Along the Cancer Clinical Trial Patient Pathway 92

7.10 Con