Abstract
Background: As systemic anti-cancer therapies have shifted from inpatient to nurse-led outpatient settings, SACT nurses face mounting workload challenges, raising concerns about patient safety, care quality, and workforce sustainability. While the Registered Nursing Forecasting (RN4CAST) survey has been instrumental in evaluating workforce changes in acute and geriatric inpatient care, it has yet to be applied to oncology settings.
Aim: To further adapt and test the RN4CAST nurse survey so it is appropriate for use in systemic anti-cancer therapy (SACT) day units.
Methods: An exploratory sequential design was selected for this study. The first phase of the study involved qualitative interviews. Cognitive interviews were then conducted at Phase 2. Phase 3 is a convergent design mixed methods study. Mixed data were integrated into joint display tables.
Results:
Phase 1: 15 SACT day unit nurses were recruited. Two key themes emerged from the analysis: 'SACT day unit nurses’ roles' and 'Factors affecting SACT day unit nurses' roles'. The draft RN4CAST-SACT-D survey was ready for further testing.
Phase 2: 12 interviews were conducted within two rounds, 48 items remained unchanged, 20 items underwent rephrasing for enhanced clarity, 20 new items were incorporated to address test content gaps, and adjustments were made to the provided answers to 5 questions. The RN4CAST-SACT-D survey was ready for the feasibility study.
Phase 3: A total of 43 nurses completed the RN4CAST-SACT-D survey, yielding a response rate of 69.3%. Of these, 12 nurses participated in semi-structured interviews. Additionally, 172 patients completed the PR-CISE survey, with a response rate of 50%. The study identified key challenges and provided recommendations to refine the survey methodology.
Conclusion: This thesis introduces both a workforce forecasting tool and a methodological approach tailored to the SACT day unit setting, emphasising the importance of accurately assessing nursing workload within this specialised environment. The evidence presented in this thesis has the potential to inform policy and practice, offering actionable recommendations that can contribute to a better working environment for nurses.