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Baseline standards for paediatric oncology nursing care in low to middle income countries: position statement of the SIOP PODC Nursing Working Group

In 2013, the SickKids-Caribbean Initiative (SCI) was formalised among The Hospital for Sick Children in Toronto, Canada, the University of the West Indies, and Ministries of Health in six Caribbean countries (Barbados, The Bahamas, Jamaica, St. Lucia, St. Vincent and the Grenadines, and Trinidad and Tobago). The aim was to improve the outcomes and quality of life of children (<18 years) with cancer and blood disorders in the partner countries. Core activities included filling a human resource gap by training paediatric haematologists/oncologists and specialised registered nurses; improving capacity to diagnose and treat diverse haematology/oncology cases; developing and maintaining paediatric oncology databases; creating ongoing advocacy activities with international agencies, decision makers, and civil society; and establishing an integrated administration, management, and funding structure. We describe core program components, successes, and challenges to inform others seeking to improve health service delivery in a multidisciplinary and complex partnership.

Despite health gains over the past 30 years, children and adolescents are not reaching their health potential in many low-income and middle-income countries (LMICs). In addition to health systems, social systems, such as schools, communities, families, and digital platforms, can be used to promote health. We did a targeted literature review of how well health and social systems are meeting the needs of children in LMICs using the framework of The Lancet Global Health Commission on high-quality health systems and we reviewed evidence for structural reforms in health and social sectors. We found that quality of services for children is substandard across both health and social systems. Health systems have deficits in care competence (eg, diagnosis and management), system competence (eg, timeliness, continuity, and referral), user experience (eg, respect and usability), service provision for common and serious conditions (eg, cancer, trauma, and mental health), and service offerings for adolescents. Education and social services for child health are limited by low funding and poor coordination with other sectors. Structural reforms are more likely to improve service quality substantially and at scale than are micro-level efforts. Promising approaches include governing for quality (eg, leadership, expert management, and learning systems), redesigning service delivery to maximise outcomes, and empowering families to better care for children and to demand quality care from health and social systems. Additional research is needed on health needs across the life course, health system performance for children and families, and large-scale evaluation of promising health and social programmes.

Highlight examples of pediatric oncology nursing's accomplishments during the past 2 decades with attention to specialized practice, patient/family education, research/evidence-based practice, and advocacy and how these efforts can be leveraged to reduce disparities in the cure and care of children and adolescents with cancer.

Review of currently published literature, guidelines, and websites documenting pediatric oncology nursing's contributions.

Over the past 20 years, the collective work of pediatric oncology nurses across the world has improved the care of children with cancer and their families and brought attention to areas of disparities.

Implications for Nursing Practice: Although work remains to reduce disparities, current evidence from nursing science and practice is available to address disparities and guide advocacy efforts for children and their families as well as the nurses who care for them.

This study examined the status of pediatric oncology nursing research in three low- and middle-income countries (LMICs) as examples across three World Health Organization regions: East Africa, Eastern Mediterranean region, and Latin America.

Published literature was identified from Google Scholar, PubMed, Scielo, Virtual Health Library, and reference lists of some articles.

The experiences of the three LMIC pediatric oncology nurses illustrate the situation of nurse research in their setting and identify relevant published literature. The authors highlight the challenges for nurses to conduct research (eg, lack of training, mentors, funding, and opportunities). Local evidence to inform nursing practice in LMICs is needed. Recommendations for ameliorating the situation include increased advanced practice nurse education, physician and hospital support, funding, and protected time.

Pediatric oncology nursing practice is culturally and context-driven and requires locally acquired evidence to support best practices. Only when sufficient, sustainable, and local nursing research training and education is available in LMICs, will this evidence be generated. Nursing research training (eg, master's and PhD programs), funding, and protected time are three key steps to guide and motivate staff nurses as well as academic nurses to participate in research that informs the care of children and adolescents with cancer across all countries and not only those with significant resources.

The designation of the year 2020 as the International Year of the Nurse provides time for reflection on the importance of nursing in meeting the needs of the under-served throughout the world. The purpose of this project was to implement an education network for nursing caring for children with cancer across sub-Saharan Africa.

The Extension for Community Health Outcomes (ECHO) model is used by Global HOPE Nursing to implement a real-time internet based learning platform that provides nurses in sub-Saharan Africa with access to nursing expertise in the care of children with cancer. Case-based learning strategies are used at monthly Project ECHO nursing seminars to provide access to nursing expertise in the care of children with cancer. Early career nurses specializing in pediatric oncology are mentored to serve as Global HOPE Nursing Project ECHO presenters.

During the first ten months, 321 participants from 12 countries attended an ECHO seminar with an average of 32 participants per seminar. Participants felt more confident in providing childhood cancer nursing care after the Project ECHO seminar and evaluations demonstrated a case-based approach to learning was extremely successful. by the number of participants that continue to attend.

A key focus of the Global HOPE Nursing Project ECHO is to build a knowledge network to increase capacity of pediatric oncology nursing experts in sub-Saharan Africa. This Project ECHO also enables early career nurses to develop skills and knowledge regarding how to mentor others. Innovative projects using learning platforms can be effective in promoting nursing specialization and fostering future nursing leaders in sub-Saharan Africa.