Nursing management of prostate cancer in Italy

Mon, 6 Jan 2014

Philippa Aslet, BAUN President, opened the two-day conference which focused on prostate cancer treatment during the first plenary sessions. Among the issues discussed were modernising diagnostic procedures, targeted HiFu, effects and treatment options of pelvic radiation, to name a few. Debates, poster viewings and a symposium were also part of the programme.

The European Association of Urology Nurses (EAUN) was well represented during the conference with Lawrence Drudge-Coates, uro-oncology clinical nurse specialist and lecturer at Kings College Hospital NHS Foundation Trust, speaking on the topic “Optimising the suspected prostate cancer referral pathway – The benefits of a nurse-led approach.” The author also participated in the conference with the Eileen O’ Hagan Lecture “Prostate Cancer: A European Nursing Approach,” presenting his views on prostate cancer management trends in Italy.

The Italian experienceItaly’s public healthcare system, founded in 1978, has no mandatory insurance for citizens. Prostate cancer is managed in both public and private hospitals and apart from urology and oncology units in generalpurpose hospitals, several centres dedicated to cancer patients can be found in the country.

According to records of the Italian National Institute for Statistics (ISTAT), there have been more than 42,000 hospital discharges in 2010 for activities related to prostate cancer management in Italy, with the northern regions accounting for about 50% of this figure.

Urological nursing education

A clear distinction exists between the activities performed by doctors and nurse with the former responsible for screening and diagnosing the disease, and prescribing appropriate medical or surgical therapies. Italian nurses do not perform activities such as prostate biopsy, compared with their mainland European colleagues (such as nurses in the UK), and are also prohibited by Italian law to prescribe drugs.

Italian nurses are responsible for perioperative nursing and are involved in pain assessment and rehabilitation following prostate cancer therapies. Treatments include pelvic floor muscle exercises, functional electrical stimulation, biofeedback and extracorporeal magnetic innervation to help patients recover after surgery (e.g. urinary incontinence after radical prostatectomy). They also train patients to perform intermittent catheterisation and manage their urinary diversions.

Research is another key activity in Italian nursing practice, such as conducting comparative studies on rehabilitation treatments and validating clinical nursing scales which are used in assessing the characteristics of the surgical site after operations. Currently, one of my colleagues is collaborating with the EAUN guidelines group regarding the update of recommendations in managing urinary incontinence. In Italy, academic nursing education was introduced in the early 90s and later underwent further upgrading with bachelor programmes (180 ECTS), master of science courses (120 ECTS), and doctorates (180 ECTS). Morover, post-bachelor specialised urology courses are being offered in some major universities particularly in pelvic floor rehabilitation. Such courses typically include 24 hours per week of theoretical classes and 60% of practical training, for a total of approximately 300 hours (there are variations in actual hours since programmes differ).

TrendsThere are few academic positions for nurses in Italy, but there is a good collaboration between the clinical and academic fields, with several bachelor and post-bachelor students writing their final dissertations on urological nursing topics Another trend is that more urology nurses are involved in projects such as “Slow Medicine” through professional associations like the Italian Association of Urology Nurses, and the National Federation of Nursing Colleges. Such projects involve both physicians and nurses and are aimed at reviewing healthcare procedures in various fields, including urology, based upon criteria of clinical evidence.

To reiterate, Italian nurses are closely involved in rehabilitation more than in other healthcare pathways when it comes to patients with prostate cancer. Although urological nursing research is still developing, recent trends are promising. Moreover, there is a need to strengthen evidence-based practice, which require the active participation of all nurse and the crucial role of professional associations. Another important point are future strategies to improve post-bachelor education, particularly addressing the need for a standardised programme for urological nurses, and which can be implemented at the national level. This issue could be an interesting discussion point in the session entitled "What is Nursing Urology" during the annual EAUN meeting in Stockholm in April 2014. This topic can be discussed from a European point of view, so dont miss the opportunity of participating in this important debate! Stefano Terzoni, EAUN board member, during the EAUN lecture.

Stefano TerzoniEAUN Board memberTutor NurseSan Paolo BachelorSchool of NursingMilan (IT)