I am writing this piece in the week of International Nurses Day (https://www.icn.ch/what-we-docampaigns/international-nurses-day). This was meant to be the start of many celebrations, Florence Nightingale at 200 and the first ever global Year of the Nurse and Midwife (https://www.who.int/news-room/campaigns/year-of-the-nurse-and-the-midwife-2020). Any plans for celebrations are, however, on hold. Nonetheless, nursing and nurses remain in the spotlight, like never before in my time as a nurse, as they have taken center stage in this unfolding pandemic. Nurses are on the front line and not only in intensive care units. They are present across the continuum of health and social care, with many deployed to clinical areas less familiar to them. However, nothing is as it was, everything feels unfamiliar, and uncertainty has become every nurse's constant companion.
These thoughts brought me to think about “presence” and what that might look like in cancer care currently. By presence, I mean a purposeful practice of awareness, focus, and attention with the intent to understand and connect with patients.1 Compassionate connected care is at the core of high-quality cancer care. Compassion goes beyond acts of basic care and likely involves kindness and giving a little more than you have to, attending to the little things, to connect with families who have unique needs and experiences of suffering.2,3 Presence is more often conveyed through tangible means, such as tactile contact, posture, eye contact, and body language, many of which are no longer available to cancer nurses as we social distance, wear personal protective equipment, and try to maintain family-centered care at a distance. As nurses, we can no longer rely on human contact to convey our feelings; indeed, unnecessary contact must be avoided to minimize cross-transmission. So, what does nurse presence look like, and how do we stay connected with our patients and deliver safe compassionate care in the current climate? The answer to this question is, I just don't know.
However, I feel it is an important question to ask. There are shared concerns about safeguarding cancer care (https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30243-6/fulltext). We are all well aware of the disruptions to the full spectrum of cancer care services, with screening, case identification, and referral in symptomatic cancer diagnosis all being affected by COVID-19.4,5 There are calls for research to study the impact of COVID-19 on cancer-related mortality, and there are also calls for research regarding pandemic preparedness. I would like to add to these calls to encourage nurses to gather evidence that will help us to understand how safe and compassionate care is being delivered during this crisis. Why? Because we need to know how cancer nurses are connecting with patients and how they are communicating emotionally charged information such as informing a family of a cancer diagnosis, or relapse, and offering end-of-life and bereavement care, as these are all being delivered at a distance, behind a mask, with no opportunity to reach out and offer physical comfort. If this is our “new normal,” we need to describe what nurse presence looks like and share what we learn widely so that, globally, patients with cancer will continue to benefit from nurse presence now and in the future.
1. Brown-Johnson C, Schwartz R, Maitra A, et al. What is clinician presence? A qualitative interview study comparing physician and non-physician insights about practices of human connection. BMJ Open
. 2019;9(11):e030831. http://dx.doi.org/10.1136/bmjopen-2019-030831
2. Balatt J, Campling P. Intelligent Kindness: Reforming the Culture of Healthcare
. London, England: RCPsych Publications; 2011.
3. Tierney S, Seers K, Reeve J, Tutton L. Appraising the situation: a framework for understanding compassionate care. J Compassionate Health Care
. 2017;4:1. doi:10.1186/s40639-016-0030-y.
4. Jones D, Neal RD, Duffy SRG, Scott SE, Whitaker KL, Brain K. Impact of the COVID-19 pandemic on the symptomatic diagnosis of cancer: the view from primary care. Lancet Oncol
. 2020; 21(6):748–750. Published online April 30, 2020. doi: https://doi.org/10.1016/ S1470–2045(20)30242–4.
5. Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Oncol
. 2020; 4(5):E10–11. doi:https://doi.org/10.1016/.