Important issues in clinical practice: perspectives of oncology nurses.

As the 1990's draw to a close, the cancer care environment is undergoing rapid change. Many issues exist within the complex environment of cancer care that could create a challenge in providing quality nursing care to patients. This study examined the current challenges oncology nurses face in their daily practice. Surveys were mailed to members of the Canadian Association of Nurses in Oncology asking them to indicate on a list of 80 issues which were problems in their daily practice. From the responses of 249 oncology nurses, the following items were ranked as the top 10 problems: anxiety, coping/stress management, bereavement/death, fatigue, metastatic disease, comfort, pain control and management, quality of life, recurrence of primary cancer, and nurse burn-out. Principal component analysis was conducted to determine if patterns existed in the way problems had been rated. Five components explained 42% of the variance in the data set: comprehensive cancer care, communication, experience of loss, terminal illness, and signs and symptoms. Implications for nursing practice, education and research are highlighted.