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Abstract
Introduction Nurses comprise the largest group of health workers globally and are essential to the provision of care necessary for delivering curative therapy to children with cancer. In high-income countries, previous studies of the nurse workforce have shown an association between patient morbidity and mortality and nursing-related factors such as staffing, education and the nursing practice environment. There is currently limited evidence available to define the scope of essential core competencies for paediatric oncology nursing (PON) practice internationally and specifically in Latin America. Clearly defined essential core competencies contribute to establishing nurses’ scope of practice within clinical practice, education and research settings. Here, we aimed to map and synthesise the available evidence on the scope of PON practices in the context of clinical practice, educational training and research settings in Latin America.
Methods A scoping review (ScR) protocol is reported, adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement and guided by The Joanna Briggs Institute. MEDLINE/PubMed, Cochrane Library, Embase, CINAHL, Web of Science, Scopus, Science Direct and Latin American and Caribbean Health Sciences Literature, plus additional sources: The ProQuest Dissertation & Theses Global, The British Library, Google Scholar, medRXiv, ClinicalTrials.gov and WHO-ICTRP will be searched. No date or language restrictions will be employed. Two independent researchers will conduct all the steps of this ScR. The findings will be presented through tables, charts, narrative summaries and assessed based on the outcomes. The search strategy will be updated in May 2022. The expected completion date for this ScR is November 2022.
Ethics/dissemination This protocol does not require ethical approval. The dissemination plans comprise peer-reviewed publication and conference presentations, to be shared with International Oncology Societies/International Nursing Societies and advisory groups to inform discussions on future research. We expect that our results will be of interest to nurse professionals, especially, PON and nurse scholars concerned with this particular issue.
- Paediatric oncology
- Paediatric oncology
- MEDICAL EDUCATION & TRAINING
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Strengths and limitations of this study
To the best of our knowledge, this will be the first scoping review that will synthesise the scope of practice of paediatric oncology nurses in Latin America.
The review will adopt a rigorous approach, adhering to Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews guidelines, using a comprehensive and systematic search strategy, including all study designs, grey literature and preprints, with no time period or language restrictions.
This protocol includes clearly defined inclusion criteria aligned with the Population, Concept and Context strategy according to the updated Joanna Briggs Institute Manual for Evidence Synthesis, 2020.
The paucity of literature addressing the scope of practice of paediatric oncology nurses may limit findings, specifically factors associated with regulatory frameworks of the profession in different Latin American countries.
Introduction
As the battle against childhood and adolescent cancer continues to become a global concern, capacity-building initiatives to improve survival and outcomes in resource-constrained locations will be increasingly prioritised.1–3 As such, it is important to identify essential core competencies to ensure that paediatric oncology nurses have the knowledge, skills, attitudes and other characteristics deemed necessary for safe and effective professional practice. The identification of these competencies will help to determine the scope of subspecialty nursing practice, promote competent workforces, facilitate professional mobility and aid in comparative evaluation of the profession and professionals’ experiences at a regional level.
Nurses constitute the largest group of health professionals worldwide4–8 and are key to the provision of optimal care for children and adolescents with cancer. In high-income countries, previous studies9 10 on the nursing workforce have shown an association between patient morbidity and mortality and factors related to nursing, such as dimensioning nursing staff, education and specialised nursing practice. Although specialisation has been associated with better patient outcomes, in many countries, paediatric oncology is just now emerging as a recognised subspecialty. Available evidence on the scope of professional practice through essential competencies to support quality nursing practice in paediatric oncology internationally, especially in Latin America, is still incipient.11 To effectively build paediatric oncology nursing capacity, essential core competencies reflective of nurses’ scope of practice must be identified and incorporated into clinical practice, education and research.
Background
Nursing is the most numerous category of health human resources in most of countries.4 Recent estimates indicate that the total nursing workforce is 27.9 million professionals, with more than 80% in countries that represent half of the world’s population. The region of the Americas has 8.4 million professionals (approximately 30% of the global total), with 87% located in Brazil, Canada and the USA, which represent approximately 57% of the region’s population.4 Regarding the distribution of human resources in nursing, it is heterogeneous both within and between the countries of the region of the Americas. The proportion of nurses as well as nursing technicians/10 000 inhabitants varies from 3.5 in Haiti to 111.4 in the USA. In half of the countries, the ratio of nurses/10 thousand inhabitants is less than or equal to 10.4; however, there is variation, and it should be considered that Canada (106.2), the USA (111.4) and Cuba (81.3) have the highest proportions of nurses per 10 000 inhabitants.12 In one hand, the USA, Canada and some Caribbean Islands, there are four nurses/doctor. In the other hand, Guyana, Mexico and Suriname, this ratio is 1.1 to 1.8 nurses/doctor, while in Colombia, Chile, El Salvador, Guatemala, Honduras, Peru, Dominican Republic and Venezuela, the ratio can be less than one nurse per physician.12 13
One of the strategies proposed by the WHO to improve the delivery of health services and achieve the Sustainable Development Goals is to review the roles of professionals.14 Countries that have new roles for nurses improve access and coverage in certain areas where medical resources are limited.14–16
Nurses, in particular, those caring for patients with cancer had to quickly learn how to integrate new knowledge and new technologies into their daily work, often in a context where this population has multiple comorbidities.17 The improvement in the survival rate of children and adolescents with cancer since the 1970s is notorious, considering the differences between countries. The best indicators reflect advances in therapy, diagnostic tests, improvement in supportive care18–21 and nursing care.22 23 Hence, it is up to the nurse to act in prevention, disease control and quality of life actions. Therefore, they must have the skills to care for all stages of the therapeutic diagnostic process (diagnostic evaluation, treatment, rehabilitation and care for family members).24
Paediatric oncology is a highly specialised field that requires critical thinking and technical skills to safely deliver cancer-targeted treatment regimens, supportive care and monitor patient deterioration within the context of family-centred care.24 Still, the practice of paediatric oncology nurses requires extensive knowledge (art and science of nursing), strong critical thinking, problem-solving skills, decision making and a high degree of compassion and sensitivity towards children, adolescents, young adults, their families and their community.25
Accompanying this specificity of the care process, there is a growing need for nurses with specialised knowledge, skills and experience, in positions where they can develop and supervise clinical nursing practice, guide the education and training of the health team and patients and families and lead nursing research.26
Nursing in paediatric oncology and haematology transposes itself as a dynamic and evolving area of action, which is based on knowledge derived from theory, research and practice. It is not just the knowledge that the paediatric nurse acquires, but the application of this knowledge and the ability to apply it with art and science in the care of children, adolescents, young adults and their families.25
Based on this definition and the scope of practice, paediatric oncology nurses are professionals specialised in nursing care for children and adolescents with cancer and their families. For this practice, specialist nurses articulate compassionate, non-traumatic, complex, continuous, ethical, aesthetic and child-centred, adolescent-centred and family-centred care to meet the physical, emotional, psychosocial and cultural needs of those involved. In carrying out their work, they use evidence-based best practices and are guided by the best interests of their clients.
The work of the paediatric oncology nurse is organised from central constructs such as evidence-based practice, nursing theories, scientificity of care, autonomy, empowerment, management/management of the work process and education/literacy in health, which permeate the scope of its practice that must be aligned with the real health needs of patients and families involved in this process. Thus, the need to search for the development of professional competences to exercise a qualified and safe care is pivotal. The concept of competencies encompasses knowledge, skills and attitudes that support the provision of adequate and evidence-based care. It also encompasses, for a safe practice in any environment along the healthcare continuum, the principles of respect and preservation of dignity.27
Regarding the regulation of professional practice, in some countries its absence causes widespread dissatisfaction and abandonment of the profession. For this reason, it recommends that the regulation of the exercise of health professions be implemented and respected in line with the social, cultural and health system characteristics in each country.28 The need to discuss the regulatory frameworks of the profession in different countries is urgent. The International Council of Nurses has maintained a clear position on the importance of regulation to ensure safe and competent nursing practice to protect the public from receiving safe and ethical nursing care provided by competent nurses.29 Professional regulatory systems are influenced and shaped by the legislative, political, environmental, social, cultural and professional context in which they are developed and that some form of nursing regulation exists in much of the world, although not in all countries or regions. In some Latin American and Caribbean countries, there is no regulation of professional practice. However, in other countries, they have only minimal regulatory frameworks or are just beginning to create regulatory mechanisms. In addition, in some countries, there may be long standing regulatory systems but not all are up to date with contemporary practice and thinking.29
Research aim
To map and synthesise the available evidence on the scope of paediatric oncology nursing practices in the context of clinical practice, educational training and research settings in Latin America.
Methods
Study design
This scoping review will be reported following the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR)30 and is in line with the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis.31
There are a number of reasons why a scoping review might be conducted. Unlike other reviews that tend to address relatively precise questions (such as a systematic review of the effectiveness of an intervention assessed using a predefined set of outcomes), scoping reviews can be used to map the key concepts that underpin a field of research, as well as to clarify working definitions and/or the conceptual boundaries of a topic.32 A scoping review of scoping reviews found that the three most common reasons for conducting a scoping review were to explore the breadth or extent of the literature, map and summarise the evidence, and inform future research.33 The indications for scoping reviews includes: (A) as a precursor to a systematic review; (B) to identify the types of available evidence in a given field; (C) to identify and analyse knowledge gaps; (D) to clarify key concepts/ definitions in the literature; (E) to examine how research is conducted on a certain topic or field; and (F) to identify key characteristics or factors related to a concept.34
Steps of the scoping review include the: (1) definition and alignment of objectives and the research question; (2) elaboration of the inclusion criteria according to the objective(s) and the guiding question; (3) description of the planned approach to the evidence search, selection, data extraction and presentation of evidence; (4) search for evidence; (5) selection of evidence; (6) extraction of evidence; (7) analysis of evidence; (8) presentation of results; and (9) synthesis of evidence in relation to review, conclusions and implications of the results.31
To guarantee data reliability and methodological transparency of this review, the protocol was submitted for evaluation and registration in the Open Science Framework/Center for Open Science). Approval was obtained on 15 August 2021 (register ID: osf.io/24sv9). To formulate the review question, we have used the PCC strategy31 (P – Population; C – Concept; C – Context;), where P=population (certified paediatric oncology nurse), C=concept (essential core competencies in paediatric oncology) and C=context (clinical practice, education and research). This strategy facilitated structured critical reasoning on the topic and the formulation of the following review question: ‘What are the essential competencies for Paediatric Oncology Nursing in the context of clinical practice, educational training and research settings in Latin America?’.
Search strategy
The literature search will be carried out systematically in eight electronic databases: Medical Literature Analysis and Retrieval System Online (MEDLINE) through PubMed, Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Scopus, Science Direct and Latin American and Caribbean Health Sciences Literature. The search strategy for the studies will consist of a combination of controlled descriptors (indexers in the respective databases) and keywords, according to the indication offered in each electronic database. It is emphasised that there will be no date or language restriction in the search strategy to be carried out. In addition to the electronic databases mentioned previously, secondary searches will be carried out in a variety of other sources, such as in ProQuest Dissertations & Theses Global, The British Library and Google Scholar and Preprints for Health Sciences (medRXiv), ClinicalTrials.gov and WHO International Clinical Trials Registry Platform. Furthermore, the list of final references in the included primary studies will be manually analysed to find relevant studies to be added. Two researchers will perform the search strategy independently, according to the recommendations of the JBI guidelines.13 Initially, we will identify the existence of an index of specific subject titles in each database (such as MeSH terms, CINAHL Headings, Entree terms and the DeCS) and their synonyms (keywords). Subsequently, the search terms were combined using the Boolean operators ‘AND’ and ‘OR’.35–37 The search strategy that combines the controlled descriptors and keywords used in each database is depicted on the online supplemental file 1.
Supplemental material
In this phase of the search strategy, the EndNote reference manager will be used to store, organise and delete duplicates in order to ensure a systematic, comprehensive and manageable search.
Eligibility and study selection criteria
Inclusion criteria: primary studies, experience reports, guidelines, manuals, dissertations and theses related to the essential competencies to support quality nursing practice in paediatric oncology internationally, mainly in Latin America, will be included. No date or language restriction will be set for the study selection.
Exclusion criteria: studies focusing on oncology nursing practice involving adult and elderly populations will be excluded.
Two reviewers (LCL-J and EBSM) will also select the studies through an independent and blind manner. After this selection, a third reviewer (RAGL) will be responsible for analysing and deciding on the inclusion or exclusion of each article, especially in case of conflicting decisions. In this stage of inclusion and exclusion of the articles in the sample, the Rayyan38 application will support the archiving, organising and selecting articles.
Data collection
Two reviewers (LCL-J and RAGL) will independently extract data from each included study based on previously published extraction forms.31 35 39–42 The expected date of completion of this scoping review will be May 2022. Information to be extracted includes: (A) identification of the study and objectives; (B) study population and baseline characteristics; (C) study design; (D) recruitment methods; (E) sample size; (F) outcomes; (G) main findings; (H) clinical and epidemiological significance; (I) conclusions and (J) implications.31 35
Methodological appraisal of included studies
For the classification of the selected studies, we will use the hierarchy of evidence.43 This classification is divided in seven hierarchical levels, as described in table 1.
Hierarchy of evidence
Data analysis and presentation
A flow chart diagram (figure 1) will describe the entire study selection process.44
PRISMA flow chart. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Our findings will be presented through tables, charts and narrative summaries and will be assessed based on the type of data charted and the outcomes. To outline the networks of relationships between the keywords and the included references, a graphic map will be generated using VOSviewer, a useful software for visualising bibliometric networks. In addition, the significance of these findings will be considered insofar as they relate to the guiding question and consolidate the available evidence for the scope of practice in paediatric oncology nursing in Latin America, based on the essential competencies to be incorporated into clinical practice, education and research settings.
Limitations
The paucity of literature addressing the scope of practice of paediatric oncology nurses may limit findings, specifically factors associated with regulatory frameworks of the profession in different Latin American countries.
Ethics and dissemination
This study involves neither human participants nor unpublished primary data. As such, ethics approval from a human research ethics committee is not required. Plans for the dissemination of this study comprise peer-reviewed publication and conference presentations, to be shared with international oncology societies and international nursing societies and advisory groups to inform discussions on future research.
Authors are finalising/updating the search strategy in May 2022 and preparing to conduct the review. The aim is to complete the review by November 2022.
Patient and public involvement
This study protocol analyses existing research studies and therefore involves no patients or members of the public.
Data availability
Data are available on reasonable request.
Implications
To the best of our knowledge, this will be the first scoping review to look specifically at the essential core competences to support quality paediatric oncology nursing practice internationally, mainly in Latin America. We expect that our results will be of interest to nurse practitioners, nursing and oncology societies, especially, paediatric oncology nurses and paediatric hematology/oncology nurses and nurse scholars concerned with this particular issue in order to inform advisory group discussions on future research as well as to contributing to nursing education institutions, regulatory organisations and public health policies for the control of childhood cancer.
Ethics statements
Patient consent for publication
Acknowledgments
The authors gratefully acknowledge the strong support of the Pan American Health Organization and WHO for CureAll framework: WHO global initiative for childhood cancer.
References
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Contributors Conceptualisation: LCL-J and RAGL; methodology: LCL-J; resources: RAGL; acquisition/interpretation of data for the work: all authors; supervision: LCL-J and RAGL; writing – original draft: LCL-J, EBSM and RAGL; writing – review and editing, and approving the final version: all authors. All authors have approved and contributed to the final written manuscript. Guarantors: LCL-J and RAGL.
Funding The study is supported by National Council for Scientific and Technological Development (Process Number: 308292/2018-9).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.