New models for elevating the practice and status of community-based nursing across the spectrum of cancer care in Central and Eastern Europe

摘要

Purpose: This supplement comprises an evaluation of Bridging Cancer Care, an initiative of the Bristol-Myers Squibb Foundation first conceived in 2007, addressing disparities in cancer care between Central and Eastern Europe and Western Europe. The strategic focus was refined in 2010 to put particular emphasis on capacity building of nurses in terms of education, training and empowerment. Methods: The evaluation was based on review of data and information from the program's monitoring and evaluation framework and from biannual reports submitted by grantees to the Bristol-Myers Squibb Foundation. Eleven of the grantees were selected to develop case studies, which illustrate a) the role of nurses in tobacco cessation, b) expansion of the scope of practice for general practice nurses in health promotion, prevention and early detection of cancer, c) capacity building for nurses in contemporary models of cancer care, care navigation and psychosocial support and d) establishment of nurse training programs in palliative care in Central and Eastern Europe.Results: Between 2010 and 2013,22 grants were awarded in Russia, Poland, Czech Republic, Hungary and Romania. The evaluation characterized the program's impact in terms of improved health equity, health outcomes, capacity building of nurses and public awareness about cancer. With regard to health equity, all projects targeted disproportionately affected populations (children, poor, rural, ethnic) among whom 35,493 individuals were reached either through cancer screening or community and clinical care. In relation to capacity building, overall 5724 healthcare workers, primarily nurses, received training in various aspects of cancer care, while more than 50,000 patients and more than 470,000 members of the general public were reached through educational initiatives. Most of the programs have been sustained beyond Bristol-Myers Squibb Foundation funding.Conclusion: The positive results were achieved predominantly through greater nurse empowerment, supported by the development of 17 different, customized and nurse-focused curricula. Such training can increase nurses' knowledge and skills as demonstrated by examination testing and evaluation of nurses in the workplace. Several projects also resulted in enhanced nurse leadership attributes and eleven lead to positive changes in models of clinical or community care involving nurses. In eight cases, these changes were subsequently embodied in new health policies.