The cancer and palliative care placement

This chapter explains the varied roles that individuals, teams and departments have in providing services to patients and family members within the cancer and palliative care specialty. While you are on your practice placement, you will be working with some of these individuals and teams across a wide range of departments. Others may not be available at your local trust.

Although your own school of nursing/university and healthcare trust may organise your placements in different ways, many use the ‘hub and spoke’ model. Whether they do or not, this is a great way of identifying clinical learning opportunities. In addition to learning experiences in the hub placement, there are several spoke placements available as part of the learning experience. There are also potential opportunities to go on insight visits to work with multiprofessional team members, for example the community Macmillan nurse or escorting a patient for treatment in a different department.

These experiences are important to help you understand the role of each professional in the care environment and management of the patient and their family. Being familiar with the range of roles available and how they work in your clinical area can help in your assessment and care planning for a patient.

The ‘hub and spoke’ model in Figure 7.1 is supported by the NMC. It gives you the opportunity to be allocated to one clinical area for a period of time while also having the opportunity to be allocated to a spoke area and short insight visits.

Fig 7.1 Hub and spoke placement model

In this model, any area could be either a hub or a spoke placement. Some teams and departments may be accessed by an insight visit. Your placement will most likely be composed of one hub with several planned spoke opportunities and insight visits. Discussing the opportunities available with your mentor is important at the start of the placement.

The length of the placement may depend on the year of study as well as local arrangements between the university and clinical areas. Box 7.1 outlines a theoretical example of what a first year nursing student’s 18-week (‘year-long’) placement might look like. This sample placement demonstrates a wide range of learning opportunities that can stem from a core hub placement. It is important to remember that a cancer patient can be nursed in any clinical environment. Some placements will be much shorter than this, most ranging between 8 and 12 weeks. This is dependent on the school of nursing and your stage of training.

These placement experiences reflect the patient journey and will give you some insight into how teams can complement each other with the work they do to provide holistic patient care.

How each team/specialty works in the practice placement

The following individuals, teams and departments are potential spoke placements or insight visits within a hub placement. Some might be new to you while you may already have worked with others and understand their role.

Chaplain/chaplaincy

This could be a priest, pastor, rabbi, imam or another representative of a faith or belief serving a group of people who are unable to attend religious services or who need spiritual support and guidance. Chaplaincy is the term used to cover all these roles within a hospital environment. Chaplaincy teams can also offer support to professionals or teams working with complex or distressing situations.

Chemotherapy outpatients

This is a department which specialises in administering chemotherapy. It is staffed by trained chemotherapy nurses and is predominantly attend by outpatients. In some hospitals, inpatients will have chemotherapy in these departments.

Clinical trials team

Using evidence-based practice is important is all aspects of health care. Cancer treatments are complex and need to undergo rigid trails to test safety and efficacy. The clinical trials team are usually experienced nurses who will be working with patients and oncologists in the uptake of clinical trials and are responsible for the ethical and legal aspects of the trial.

Complementary therapist

This is a person who undertakes therapies such as hypnosis, homeopathy, acupuncture and massage (and many more) that complement conventional medicine. Complementary therapists are often assigned to a palliative care day unit or hospice. Currently not all complementary therapies are available to all patients and there is a lack of national professional regulation. There are numerous qualifications needed to practise as a complementary therapist.

Cytotoxic pharmacy

This is a specialist unit where cytotoxic drugs and infusions are prepared in an air flow cabinet. Some larger centres will have a specialist cytotoxic pharmacist to advise oncologists on prescribing and treatment protocols.

Counsellor

This is an experienced counsellor usually registered with the British Association for Counselling and Psychotherapy (BACP). Patients and relatives are usually referred to the counsellor for psychosocial support. In specialist clinical areas, there is usually a counsellor as part of the team who will be on ward rounds and in the case conference.

Dietician

This is a registered practitioner who will advise staff and patients on the nutritional requirements for a patient. Their role is important in all stages of the cancer pathway, including advice to patients who have loss of appetite and taste following chemotherapy, for patients with restricted swallowing or with severe nausea.

Discharge coordinator

Efficient and safe discharge of patients needs to be carefully coordinated. The person in this role might be a registered nurse or an experienced nursing assistant or receptionist. Their role is to act as the centre point for the liaison of the discharge and they will link in with a wide range of teams, for example the district nurse, GP, outpatient department, ambulance services and pharmacy.

End of life pathway coordinator

This is usually a registered nurse who will be experienced in palliative and end of life care working within a hospital to coordinate the use of the end of life care pathway. It is often referred to as the Liverpool Care Pathway (LCP). The role will include training staff how to use the pathway and picking up specific problems with symptom management and support of relatives. Sometimes this role is delivered by a member of the hospital Macmillan team.

Haematological transplant coordinator/unit

This unit is a specialist ward for patients with a haematological diagnosis. Many of these patients will be nursed in separate cubicle and there will be strict infection control policies in place. In some hospitals, patients will be on a mixed oncology/haematology ward.

Haematology day care

This is a specialised department for patients with a haematology diagnosis to come to hospital for treatment during the day.

Macmillan nurse or Macmillan team

Macmillan nurses are registered nurses with at least 5 years’ experience who have undertaken specialist courses in managing pain and other symptoms and in psychological support. They work in both NHS hospitals and community teams. The role might initially have been funded (or still may be) by the charity Macmillan Cancer Relief. Many posts are now funded by the NHS although the title ‘Macmillan’ remains.

Occupational therapist

This is a person who has undertaken a course of study to register as an occupational therapist to help patients develop, improve, sustain or restore the highest possible level of independence through the use of activities or intervention.

Oncologist

This is a consultant who specialises in the medical management of a particular type of cancer by treatment with chemotherapy and/or radiotherapy and/or endocrine therapy and/or biological treatments.

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1. Caring for the patient undergoing haemopoietic stem cell transplant
2. Caring for the patient undergoing radiotherapy
3. Principles of palliative care nursing
4. Transferable skills for future placements

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