Competencias centrales para la formación del enfermero de práctica avanzada en oncología: un estudio Delphi

Schneider, Franciane; Giolo, Suely Ruiz; Kempfer, Silvana Silveira

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Sumário

ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (05) • 2022 • https://doi.org/10.1590/0034-7167-2021-0573 copiar

Competencias centrales para la formación del enfermero de práctica avanzada en oncología: un estudio Delphi

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Mapear y validar competencias centrales para la formación del enfermero de práctica avanzada en oncología.

Métodos:

Investigación exploratoria-descriptiva, de abordaje cuantitativo, con utilización de la técnica Delphi. Inicialmente, elaborado una matriz compuesta por seis dominios, con 112 competencias centrales del enfermero clínico especialista en oncología. Utilizado la escala de Likert para mensurar el grado de concordancia. La recolecta de datos ocurrió mediante la plataforma Google Forms^® de febrero a mayo de 2021. Los datos fueron compilados y analizados basados en las sugestiones de especialistas y la literatura.

Resultados:

100 competencias obtuvieron consenso (nivel de concordancia arriba de 85,7%) en la primera rodada; 13 nuevas competencias fueron propuestas por los miembros especialistas; y 125 fueron validadas en el transcurrir de la técnica Delphi.

Conclusión:

El mapeo y validación de competencias centrales permitirán la elaboración de nuevos modelos de formación vueltos a la práctica avanzada en oncología y harmonización educacional futura.

Descriptores:
Enfermería Oncológica; Enfermería de Práctica Avanzada; Enfermería Basada en la Evidencia; Competencia Clínica; Competencia Profesional

Characteristics	Round 1 (n = 23)	Round 2 (n = 21)	Round 3 (n = 15)
Sex
Female	21 (91.3%)	20 (95.2%)	15 (100%)
Male	2 (8.7%)	1 (4.8%)	0 (0%)
Regions of Brazil
North	1 (4.3%)	1 (4.8%)	0 (0%)
Northeast	2 (8.7%)	2 (9.5%%)	1 (6.7%)
Midwest	3 (13%)	3 (14.3%)	1 (6.7%)
Southeast	12 (52.2%)	11 (52.4%)	10 (66.7%)
South	4 (17.4%)	3 (14.3%)	2 (13.3%)
Portugal	1 (4.3%)	1 (4.8%)	1 (6.7%)
Academic degree
Specialization in oncology or onco-hematology	16 (69.6%)	15 (71.4%)	11 (73.3%)
Specialization in uni/multiprofessional residency in oncology or onco-hematology	4 (17.4%)	3 (14.3%)	2 (13.3%)
Master's (academic)	19 (82.6%)	17 (81%)	14 (93.3%)
Master's (professional)	3 (13%)	3 (14.3%)	1 (6.7%)
Doctorate (academic)	14 (60.9%)	13 (61.9%)	11 (73.3%)
Doctorate (professional)	0 (0%)	0 (0%)	0 (0%)
Post-doctoral	3 (13%)	3 (14.3%)	2 (13.3%)
Time of professional experience in oncology or onco hematology clinical practice
Up to 5 years	0 (0%)	0 (0%)	0 (0%)
From 6 to 8 years	3 (13%)	3 (14.3%)	1 (6.7%)
From 9 to 11 years	4 (17.4%)	3 (14.3%)	2 (13.3%)
From 12 to 14 years	1 (4.3%)	1 (4.8%)	1 (6.7%)
From 15 to 17 years	5 (21.7%)	5 (23.8%)	4 (26.7%)
From 18 to 20 years	3 (13%)	2 (9.5%)	0 (0%)
Over 20 years	7 (30.4%)	7 (33.3%)	7 (46.7%)
Time of experience with teaching and/or research in the field of oncology or onco hematology
Up to 5 years	4 (17.4%)	4 (19%)	2 (13.3%)
From 6 to 10 years	4 (17.4%)	3 (14.3%)	2 (13.3%)
From 11 to 15 years	6 (26.1%)	6 (28.6%)	4 (26.7%)
From 16 to 20 years	5 (21.7%)	4 (19%)	4 (26.7%)
Over 20 years	4 (17.4%)	4 (19%)	3 (20%)

Description	Consensus Level
Domain 1 - Care management A) Health promotion and cancer prevention
Acts towards health promotion and cancer prevention throughout the continuum of care, as well as carrying out screening and early detection of the disease, according to existing recommendations/protocols.	95.2%
B) Assessment of health/disease status
Evaluates and identifies the need for palliative and end-of-life care, considering: aspects related to the control and management of symptoms and pain; and improving cancer patients’quality of life.	100%
Evaluates adverse reactions/side effects related to the proposed treatment, as well as clinical manifestations related to the underlying disease (cancer).	100%
C) Diagnosis and care plan
Promotes/facilitates adaptations to orthoses, prostheses and/or other conditions resulting from the disease or cancer treatment (such as amputation, breast implants, stomas, drains/probes, among others).	95.2%
Contributes to a better understanding of the therapeutic plan and developing concepts for the self-management of symptoms by the patient, involving family, caregivers, and support networks.	95.2%
Plans/promotes meetings between cancer patients and those interested in specific topics, for the exchange of knowledge and experiences, patient reception, guidance, discussions, and support (e.g., group of patients with stomas, survivorship, group of patients undergoing chemotherapy, among others).	90.5%
D) Care plan evaluation
Plans and evaluates nursing care in line with other health team interventions, to improve the results of patients with a previous, current or potential diagnosis of cancer.	90.5%
Domain 2 - Ethics and professional commitment
Guides patients and family members/caregivers on the feasibility of access involving cancer therapy and informs them on rights related to the context of oncology.	100%
Domain 3 - Leadership
Evaluates barriers and facilitators of the patient’s family context and their support networks, considering the particularities, possibilities and limitations that exist, to achieve the best results.	100%
Encourages nurses in the development and implementation of innovative research focused on the care of patients with a previous, current, or potential diagnosis of cancer, allowing moments for debate and stimulation through investigative questions related to the practice of oncology nursing.	90.5%
Domain 4 - Interprofessional collaboration
Promotes a care plan incorporating actions linked to palliative care, in an increasing/progressive manner and in conjunction with the interprofessional team; seeking to provide therapeutic continuity to the cancer patient, their family/caregivers and the community in general, throughout the different stages of treatment.	90.5%
Domain 5 - Evidence-based practice
Implements interventions that improve the quality of and happiness/satisfaction with life of cancer patients and their families/caregivers, based on scientific evidence and existing/validated instruments.	95.2%
Domain 6 - Health education and research
Contributes to the health education process, which involves teams, managers, and the community in general —which needs to build their knowledge and increase their autonomy in individual and collective care, especially related to cancer.	95.2%

Description		Consensus Level
Domain 1 - Care management C) Diagnosis and care plan
Original: Builds distinct diagnoses related to cancer and risk factors for patients, focusing on clinical manifestations of the disease and its treatment.	Round 2 -Builds distinct nursing diagnoses related (…)	81%
	Round 3 -Developsnursing diagnoses related to the patient’shistory, considering their health/disease status, risk factors, clinical manifestations of cancer and current therapies.	100%
Original: Incorporates current and emerging genetic/genomic evidence in the delivery of nursing care, while considering patient values and advanced clinical judgment.	Round 2 -Competency did not reach consensus. Despite choosing the option “I am not decided”, there were no suggestions for changes. Participants were asked to reassess.	61.9%
	Round 3 -Incorporates genetics/genomics knowledge into clinical practice when planning patient and family care, considering their values and advanced clinical judgment.	93.3%
Domain 3 - Leadership
Original: Evaluates organizational policies, procedures, and/or protocols for their ability to support and improve the outcomes of cancer programs/treatments; using the results of these assessments to promote structural and/or process changes.	Round 2 -Competency did not reach consensus. Despite choosing the option “I am not decided”, there were no suggestions for changes. Participants were asked to reassess.	76.2%
	Round 3 -Actively participates in the construction and evaluation of institutional policies, procedures, and/or protocols, with the objective of supporting cancer programs/treatments and using the results of these evaluations to promote structural and/or process changes in health organizations.	86.7%
Original: Participates in legislative and regulatory initiatives to promote and improve population health care throughout the continuum of cancer.	Round 2 -Competency did not reach consensus. Despite choosing the option “I am not decided”, there were no suggestions for changes. Participants were asked to reassess.	76.2%
	Round 3 -Is aware of and seeks insertion in decision-making spaces, with the objective of promoting quality care to the population’s health throughout the continuum of cancer.	93.3%
Domain 5 - Evidence-based practice
Original: Develops innovative solutions and/or policies within the health system that can be generalized to different oncology units and/or environments, by populations, or specialized services.	Round 2 -Competency did not reach consensus. Despite choosing the option “I am not decided”, there were no suggestions for changes. Participants were asked to reassess.	76.2%
	Round 3 -Develops innovative solutions and/or participates in the construction of policies within the health system, which can be generalized to different oncology units and/or environments, by populations, or specialized services.	100%

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[1] Corresponding author: Franciane Schneider E-mail: franciane.s85@gmail.com