estándares básicos de enfermería en oncológica pediátrica recomendados por siop para países de bajos y medios ingresos Linda Abramovitz, MSN, RN, CNS, BMTCN, FAAN Lisa Morrissey, MPH, RN, MSN Courtney Sullivan, MSN, RN, CPNP-AC, CPHON This presentation titled – “Overview of the SIOP Baseline Standards for pediatric nursing low and middle income countries” was created by members of the SIOP Pediatric Oncology in Developing Country (PODC) Nursing Working Group to facilitate the promotion and awareness of the Baseline Nursing Standards used with permission by SIOP Baseline Nursing Standards Taskforce

Esquema de la presentación Historia Descripción general Herramientas de abogacía During this presentation, I will cover the history of the baseline nursing standards, provide an overview of each of the six standards and discuss ways you can learn more about the standards using the advocacy toolkit. used with permission by SIOP Baseline Nursing Standards Taskforce

Brecha de sobrevida de cáncer infantil Países de altos ingresos Sobrevida libre de evento (%) Países de bajos ingresos Brecha de sobrevida Over the past 60 years event-free survival has increased from 10% to 83% in high income countries However, in low income countries survival remains around 10%. (Masera G Hematologica 2005; Siegel R Cancer Statistics 2018)

La calidad de atención de enfermería impacta los resultados del paciente Factores relacionados con la calidad de atención de enfermería se relacionan con la sobrevida del paciente y con complicaciones Educación Aumentar en10% número de enfermeras licenciadas  disminuye 5% la tasa de mortalidad de pacientes Dotación de personal Agregar un paciente más por enfermera  aumenta 7% la mortalidad y aumenta 7% las muertes prevenibles relacionadas a complicaciones (ej. shock, sepsis, embolismo pulmonar) Entorno laboral Buen entorno laboral  mejores resultados de los pacientes Factors related to the quality of nursing care are associated with patient survival and complications. Factors include: Education: 10% increase in baccalaureate-prepared nurses  associated with 5% decrease in mortality rates Staffing: Addition of one patient per nurse workload associated with 7% increase in mortality and 7% increase in preventable deaths related to complications (e.g. shock, sepsis, pulmonary embolus) Practice Environment: Supportive nursing work environments associated with better patient outcomes and decreased nurse burnout Supportive environments facilitate nursing care quality through nursing leadership, multidisciplinary teamwork and communication and nurses’ ability to address patient safety concerns and improve processes to improve patient outcomes (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002 Seminal work; Aiken, Clarke, Cheung, Sloane, & Silber, 2003 Seminal work; Aiken et al., 2011)

Enfermería oncológica pediátrica Las enfermeras desempeñan un rol fundamental en el cuidado de pacientes oncológicos pediátricos Las enfermeras oncológicas pediátricas necesitan: Conocimientos y habilidades especializadas Recursos adecuados Liderazgo apoyador No es posible contar con un programa de oncología pediátrica seguro y efectivo sin un cuidado de enfermería experto y de alta calidad Nursing plays a vital role in the provision of pediatric oncology care Pediatric oncology as a subspecialty requires a nursing workforce with specialized education and clinical skills to promote optimal patient outcomes. used with permission by SIOP Baseline Nursing Standards Taskforce

Historia de los estándares básicos de enfermería Taller pre conferencia de enfermería realizado en SIOP 2012 (Londres) Enfermeras de países de bajos y medios ingresos describieron barreras que enfrentan diariamente para proporcionar un cuidado de enfermería seguro Consenso sobre la necesidad de contar con estándares básicos de enfermería en oncología pediátrica The Baseline Nursing Standards for Pediatric Oncology in Low- and Middle-income countries were developed out of the 2012 London SIOP conference. The Pediatric Oncology in Developing Countries (PODC) Nursing Group held a 2 day workshop prior to SIOP 2012 conference in London The focus of the workshop was to identify pediatric oncology nurses educational needs. Nurses from Low, Middle, and High Income countries were represented. During the course of the workshop, it became clear that nurses in limited-resource settings faced barriers to providing quality care related to a lack of resources. And, that although addressing education was important, challenges faced in nurses’ work environments required a more comprehensive solution. The group agreed on the need to develop baseline standards for the delivering of quality nursing care to children and adolescents with cancer in limited-resource settings. used with permission by SIOP Baseline Nursing Standards Taskforce

used with permission by SIOP Baseline Nursing Standards Taskforce Los seis estándares básicos de enfermería en oncología pediátrica para países de bajos y medios ingresos 1. Dotación de personal según gravedad de los pacientes 2. Orientación estructurada para el personal nuevo 3. Educación continua 4. Equipo multidisciplinario 5. Recursos necesarios para un cuidado seguro 6. Práctica basada en evidencia The baseline nursing standards for pediatric oncology nursing in low and middle income countries were developed by a group of nurses who had attended the workshop. These are the 6 Baseline Standards Each of these standards are important individually; however, collectively, the Standards create a framework for quality pediatric oncology nursing programs. (Day et al., 2014; Day et al., 2015) used with permission by SIOP Baseline Nursing Standards Taskforce

used with permission by SIOP Baseline Nursing Standards Taskforce estándar 1 1. Dotación de personal según gravedad de los pacientes Índice Enfermera:Paciente 1:5 (Unidad oncología) Índice Enfermera:Paciente 1:2 (Unidades TMO/UCI) Enfermeros oncológicos especializados no deben rotar 2. Orientación estructurada para el personal nuevo 3. Educación continua The first standard focuses on staffing based on acuity A Nurse to Patient ratio of 1:5 is the recommendation for a pediatric oncology unit A Nurse to Patient ratio of 1:2 is the recommendation for a critical care unit or bone marrow transplant unit Retention of nurses on the pediatric oncology unit is an important. Nurses who have been trained and gained experience in oncology should remain within the pediatric oncology service and not rotated to other wards or specialties. 4. Equipo multidisciplinario 5. Recursos necesarios para un cuidado seguro 6. Práctica basada en evidencia (Day et al., 2014; Day et al., 2015) used with permission by SIOP Baseline Nursing Standards Taskforce

used with permission by SIOP Baseline Nursing Standards Taskforce estándar 2 1. Dotación de personal según gravedad de los pacientes 2. Orientación estructurada para el personal nuevo Mínimo 2 semanas de orientación formal 3 – 4 semanas de práctica clínica supervisada Validación de competencias 3. Educación continua Standard 2 states that a formal orientation program includes a minimum of 2 weeks of formal orientation followed by 3 – 4 weeks of supervised clinical care by an experienced pediatric oncology nurse. Observation by a preceptor at the bedside is a critical component of this standard and includes validation of clinical competency. You need specialized education and skills to provide safe and high quality pediatric oncology care. 4. Equipo multidisciplinario 5. Recursos necesarios para un cuidado seguro 6. Práctica basada en evidencia (Day et al., 2014; Day et al., 2015) used with permission by SIOP Baseline Nursing Standards Taskforce

used with permission by SIOP Baseline Nursing Standards Taskforce estándar 3 1. Dotación de personal según gravedad de los pacientes 2. Orientación estructurada para el personal nuevo 3. Educación continua Mínimo 10 horas/año Standard 3 states that pediatric oncology nurses must have a minimum of 10 hours of continuing education a year 4. Equipo multidisciplinario 5. Recursos necesarios para un cuidado seguro 6. Práctica basada en evidencia (Day et al., 2014; Day et al., 2015) used with permission by SIOP Baseline Nursing Standards Taskforce

used with permission by SIOP Baseline Nursing Standards Taskforce estándar 4 1. Dotación de personal según gravedad de los pacientes 2. Orientación estructurada para el personal nuevo 3. Educación continua 4. Equipo multidisciplinario Multidisciplinary Teamwork is the focus of Standard 4 which states that nurses must be acknowledged as core members of the pediatric oncology team As key members of the patient care team, nurses must be included on daily patient rounds and patient conferences. Reconocimiento de los enfermeros como miembros importantes del equipo de oncología pediátrica 5. Recursos necesarios para un cuidado seguro 6. Práctica basada en evidencia used with permission by SIOP Baseline Nursing Standards Taskforce (Day et al., 2014; Day et al., 2015)

used with permission by SIOP Baseline Nursing Standards Taskforce estándar 5 1. Dotación de personal según gravedad de los pacientes 2. Orientación estructurada para el personal nuevo 3. Educación continua 4. Equipo multidisciplinario Standard 5 focuses on Resources for Safe Care Safe care for staff, patient and family It is recommended that a pharmacist prepares chemotherapy. When unavailable, nurses responsible for preparing chemotherapy should be provided with chemotherapy Personal Protective Equipment (PPE and biosafety level cabinet 2A or higher. Protection against hazards and infections for hand hygiene and isolation supplies 5. Recursos necesarios para un cuidado seguro Seguridad para el personal, el paciente y la familia EPP para la manipulación de quimioterapia Protección contra riesgos e infecciones 6. Práctica basada en evidencia (Day et al., 2014; Day et al., 2015) used with permission by SIOP Baseline Nursing Standards Taskforce

used with permission by SIOP Baseline Nursing Standards Taskforce estándar 6 1. Dotación de personal según gravedad de los pacientes 2. Orientación estructurada para el personal nuevo 3. Educación continua 4. Equipo multidisciplinario Standard 6 addresses Evidence Based Practice and the need to establish nursing policies and procedures to guide the delivery of quality nursing care. Evidence-based paediatric oncology nursing policies and procedures should be available to guide the delivery of quality nursing care Nursing policies and procedures should be based on research and clinical expertise 5. Recursos necesarios para un cuidado seguro 6. Práctica basada en evidencia Políticas y procedimientos de enfermería para guiar una atención de enfermería de calidad (Day et al., 2014; Day et al., 2015) used with permission by SIOP Baseline Nursing Standards Taskforce

used with permission by SIOP Baseline Nursing Standards Taskforce Publicaciones: difundir la “declaración de posición” del grupo de trabajo de enfermeras del siop podc Lancet Oncology (2014) Cancer Control (2015) The Baseline Nursing Standards were published as a ‘Position Statement’ in 2014 by nurses who attended the workshop with a more comprehensive overview published in 2015. (Day et al., 2014; Day et al., 2015) used with permission by SIOP Baseline Nursing Standards Taskforce

respaldan los estándares básicos The standards have been well received by the international pediatric oncology community and endorsed by key academic pediatric cancer institutions, professional and parent groups, and non-governmental organizations. We are continuing this endorsement campaign. A ‘Task Force’ was set up to look at dissemination and implementation of the standards. A further workshop was planned prior to SIOP 2017 (Washington) used with permission by SIOP Baseline Nursing Standards Taskforce

In October 2017, A Leadership and Advocacy Workshop - Disseminating the Baseline Nursing Standards was held in Washington, DC prior SIOP Annual Conference. The group (many who are members of the SIOP PODC Nursing Working Group) focused on developing strategies and setting priorities to advocate and disseminate the standards. Taller de liderazgo y abogacía: Diseminación de los estándares básicos de enfermería

herramientas para abogar y promover los estándares Introducción a los estándares Descripción general de la presentación en PowerPoint de los estándares básicos de enfermería Introducción a la presentación general Documento resumen de los estándares Publicaciones Discurso de elevador (Elevator pitch) Descripción general de los Discursos de elevador: Presentación en PowerPoint Ejemplos escritos de Discursos de elevador Video de Discursos de elevador One of the outcomes of this workshop was the development of an ‘Advocacy Toolkit’ for the Baseline Nursing Standards Let’s review what is in the Advocacy Toolkit. Note to the presenter – You can review this slide with workshop participants to explore what is in the the Advocacy Toolkit Respaldo Ejemplo carta de respaldo Plantilla carta respaldo Lista de los estándares básicos respaldados https://siop-online.org/baseline-nursing-standards-advocacy-toolkit used with permission by SIOP Baseline Nursing Standards Taskforce

Para saber más de los estándares básicos de enfermería https://siop-online.org/baseline-nursing-standards To learn more about the 6 Baseline Nursing Standards please visit the SIOP Nursing Website. Thank you for your attention and allowing me to share these important standards with you. As an integral member of the multidisciplinary health care team, nurses will continue to impact the delivery of high quality care to children with cancer and their families. @nusbaselinestds used with permission by SIOP Baseline Nursing Standards Taskforce

agradecimientos Equipo de desarrollo de presentaciones en PowerPoint Linda Abramovitz, MSN, RN, CNS, BMTCN, FAAN (United States) Lisa Morrissey, MPH, RN, MSN (United States) Courtney Sullivan, MSN, RN, CPNP-AC, CPHON (United States) Equipo revisor de presentaciones Sara Day, PhD, RN, FAAN (United States) Rachel Hollis, FRCN, RGN, RSCN, MHsc (United Kingdom) Pearl Semetsa, RN (Botswana) Liz Sniderman MSN, APRN, CPNP-AC, CPHON (United States) Rima Saad, MSN, RN, CPHON (Lebanon) Please acknowledge the work of the PowerPoint Presentation Development Team and Presentation Reviewers and the generous donations of the Workshop Sponsors Patrocinadores del taller: Children’s National Health Systems, Association of Pediatric Hematology/Oncology Nursing (APHON), Dana-Farber Boston Children’s Cancer and Blood Disorders Center, St Jude Children’s Research Hospital, International Society of Pediatric Oncology (SIOP), The Aslan Project and UCSF Global Cancer Program used with permission by SIOP Baseline Nursing Standards Taskforce

Comité de planificación del taller y participantes Comité de Planificación del Taller de Liderazgo y Abogacía SIOP PODC Linda Abramovitz, MSN, RN, CNS, BMTCN, FAAN and Rehana Punjwani, BSN, RN (Co-Chairs) Courtney Sullivan, MSN, RN, CPNP-AC, CPHON, Glenn Mbah, MPH, BSN, RN & Rachel Hollis, FRCN, RGN, RSCN, MHsc Participantes del taller de liderazgo y abogacía SIOP PODC: Linda Abramovitz (US), Carmen Auste (PH), Sara Day (US), Marie-Solange Doucot (FR), Yuliana Hanaratri (ID), Kathy Houlahan (US), Scott Howard (US), Sun Jiwen (CN), Kathy Kelly (US), Paola Viveros Lamas (CH), Asha Mahajan (IN), Glenn Mbah (CM), Lisa Morrissey (US), Rehana Punjwani (PAK), Xiumei Qi (CN), Paul Rogers (CA), Rima Saad (LB), Pearl Semetsa (BT), Beth Siever (US), Louise Soanes (UK), Liz Sniderman (US), Courtney Sullivan (US), Rose Szeles (US), Belinda Tieku-Ward (GH), Lorena Segovia Weber (CH) and Jordan Wildermuth (US)

Referencias Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2011). The effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Medical care, 49(12), 1047. Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Jama, 288(16), 1987-1993. Aiken, L. H., Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational levels of hospital nurses and surgical patient mortality. Jama, 290(12), 1617-1623. Day S, Hollis R, Challinor J, Bevilacqua G, Bosomprah E. (2014). Baseline standards for paediatric oncology nursing care in low to middle income countries: position statement of the SIOP PODC Nursing Working Group. The Lancet Oncology, Volume 15, Issue 7, 681 – 682. Day S, Challinor J, Hollis R, Abramovitz L, Hanaratri Y, Punjwani R. (2015). Paediatric oncology nursing care in low- and middle- income countries: a need for baseline standards. Cancer Control, 111-115. used with permission by SIOP Baseline Nursing Standards Taskforce