Helen Kerr, PhD, RN, is a Senior Lecturer at the School of Nursing and Midwifery, Queen's University Belfast. She has a clinical background in cancer and palliative care nursing.

List of Contributors xiv Foreword xvi Introduction xviii About the Companion Website xxi 1 Evolvement of Advanced Nursing Practice 1Helen 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 15Helen 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 31Johanna McMullan References 40 4 Carer's Perspective 43Trevor Wightman 5 Key Worker Role 49Karen 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 63Caroline 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 84Adrina 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 Conclusion 97 References 98 8 Symptom Management 104Michelle Keenan and Helen Kerr 8.1 Introduction 104 8.2 Pain 105 8.2.1 Renal Impairment 107 8.2.2 Hepatic Impairment 108 8.2.3 Neuropathic Pain 109 8.3 Breathlessness 110 8.4 Nausea and Vomiting 112 8.5 Constipation 115 8.6 Conclusion 115 References 116 9 Multidisciplinary Teamworking 124Hinal Patel and Oonagh McSorley 9.1 Introduction 124 9.2 The Multidisciplinary Team 125 9.2.1 Characteristics of an Effective Multidisciplinary Team 126 9.2.1.1 The Team 126 9.2.1.2 Multidisciplinary Meeting Organisational Logistics 128 9.2.1.3 Infrastructure for the Multidisciplinary Meeting 128 9.2.1.4 Person-Centred Clinical Decision-Making 128 9.2.1.5 Team Governance 129 9.3 The Role of the Clinical Nurse Specialist in Relation to the Multidisciplinary Team 129 9.3.1 Challenges of the Clinical Nurse Specialist Working in a Team 130 9.4 Conclusion 132 References 133 10 Leadership and the Clinical Nurse Specialist 136Ruth Thompson and Monica Donovan 10.1 Introduction 136 10.2 Leadership 137 10.3 Self-Recognition of the Clinical Nurse Specialist as a Leader 137 10.4 Leadership in the Context of the Clinical Nurse Specialist 139 10.4.1 Clinical Leadership 140 10.4.1.1 Clinical Expertise and Coordination of Care 141 10.4.2 Professional Leadership 142 10.4.2.1 Enhancing Practice 143 10.4.2.2 Service Improvement and Innovation 143 10.4.2.3 Collaborative Working 144 10.5 Conclusion 144 References 144 11 Nurse-Led Clinics 149Shelley Mooney and Helen Kerr 11.1 Introduction 149 11.2 Nurse-Led Care and the Launch of Nurse-Led Clinics in Healthcare 150 11.3 Components of a Nurse-Led Clinic 151 11.4 Introducing a Nurse-Led Clinic 152 11.5 Nursing Skills Required to Introduce and Establish a Nurse-Led Clinic 154 11.6 Approaches to Delivering a Nurse-Led Clinic 155 11.7 Patient Outcomes Related to Nurse-Led Clinics 156 11.8 Benefits of Nurse-Led Clinics for the Registered Nurse 157 11.9 Benefits of Nurse-Led Clinics for the Healthcare Organisation 157 11.10 Challenges to Implementing Nurse-Led Clinics 158 11.11 Nurse-Led Clinic Service Evaluation 159 11.12 Future of Nurse-Led Clinics 159 11.13 Reflection on the Role as a Uro-Oncology CNS Undertaking Nurse-Led Clinics 160 11.14 Conclusion 161 References 162 12 Non-Medical Prescribing 166Laura Croan and Barry Quinn 12.1 Introduction 166 12.2 Background 167 12.3 Developments in Nursing Practice and the Role of Prescribing 168 12.3.1 Community Nurse Prescribing 168 12.3.2 Clinical Management Plans 169 12.3.3 Patient Group Directives 169 12.3.4 The Growth of Independent Prescribing 170 12.4 Preparing to Prescribe 172 12.5 Benefits and Challenges of Non-Medical Prescribing 172 12.6 Deciding to Become a Non-Medical Prescriber 173 12.7 Conclusion 177 References 178 13 Cancer in the Adolescent and Young Adult 181Kerrie Sweeney and Helen Kerr 13.1 Introduction 181 13.2 Background to Adolescent and Young Adult Cancer Services 182 13.3 Person-Centred Adolescent and Young Adult Care 185 13.4 Support for Family and Significant Others 185 13.5 Holistic Care 186 13.6 Multidisciplinary Working 187 13.7 Healthcare Professional Knowledge 188 13.8 Adolescent and Young Adult Clinical Nurse Specialist Leadership Skills 189 13.9 Communication with Adolescents and Young Adults 189 13.10 Age-Appropriate Environments 191 13.11 Adolescent and Young Adult Peer Support 192 13.12 Adolescent and Young Adult Treatment Priorities 192 13.13 Transitional Adolescent and Young Adult Care 193 13.14 Living With and Beyond Cancer 194 13.15 Late Effects of Cancer Treatment 195 13.16 Palliative Adolescent and Young Adult Care 195 13.17 Co-production 196 13.18 Conclusion 196 References 197 14 COVID-19 and the Clinical Nurse Specialist 203Stephanie Todd and Helen Kerr 14.1 Introduction 203 14.2 Impact on Healthcare Services and Frontline Healthcare Workers 204 14.3 Impact of COVID-19 on Cancer Services 205 14.4 The Role of the Clinical Nurse Specialist Prior to the COVID- 19 Pandemic 207 14.5 Devolvement of Staff over the COVID-19 Pandemic 208 14.6 Impact of COVID-19 on the Clinical Nurse Specialist Role and Patient Care 209 14.7 The Future of Healthcare Services Post-COVID-19 Pandemic 212 14.8 Conclusion 213 References 214 15 Digital Health 218Amy Vercell and Sarah Hanbridge 15.1 Introduction 218 15.2 The Role of the Informatics Nurse/Chief Nursing Information Officer 220 15.3 Electronic Observations 220 15.4 Electronic Health Records 221 15.5 Digitalisation of Blood Glucose Monitoring 222 15.6 Electronic Nurse Prescribing 223 15.7 Nurse Digitally Requesting Bloods 224 15.8 Remote Consultations 224 15.9 Virtual Wards 225 15.10 Electronic Patient-Reported Outcome Measures 226 15.11 Mobile Cancer Applications 227 15.12 Home Blood Monitoring 228 15.13 Artificial Intelligence 229 15.14 Barriers to Digital Health 230 15.15 Conclusion 230 References 231 16 Future Direction of the Clinical Nurse Specialist in Cancer Care 236Barry Quinn and Helen Kerr 16.1 Introduction 236 16.2 The Role of Caring and the Clinical Nurse Specialist 238 16.3 Developing Skills for Today and the Future 239 16.4 Leadership 240 16.5 Equality, Diversity and Inclusion in the Role of the Clinical Nurse Specialist 242 16.6 New Ways of Working 244 16.7 Self-Reflection 246 16.8 Conclusion 246 References 247 Index 250