CLINICAL

Downing J (1998) Radiotherapy nursing: understanding the nurse's role. Nursing Standard. 12,25,42-43.

Radiotherapy nursing:
understanding the nurse’s role
Radiotherapy nurses are integral members of the multidisciplinary team. In this article,
the author describes the role and makes recommendations for its future development.
Date of acceptance: October 22 1997.

Julia Downing,
BN(Hons), RGN, Dip
Cancer Nursing, MSc,
MMedSci. is Lecturer in
Cancer Nursing, Centre
for Cancer and Palliative
Care Studies, Institute of
Cancer Research,
London.

The role of the nurse in medical oncology is well
defined and accepted, particularly in relation to the
administration of chemotherapy. However, radio­
therapy nurses have not received equal recognition
(Bruner 1990). The role of nurses within radiotherapy
departments is perceived as being limited to obser­
vations, sorting charts and showing patients into
clinic rooms, but this misunderstands the contribution
to patient care made by the radiotherapy nurse.

Box 1. Common facets of oncology and
radiotherapy nursing
■ Assessment and education
■ Knowledge and prevention of side effects
■ Psychosocial support
■ Liaison with other healthcare professionals
■ Rehabilitation

HOLE OF THE RADIOTHERAPY NURSE

KEY
WORDS
RADIOTHERAPY
PATIENTS
RADIOTHERAPY
UNITS
NURSING
SPECIALISTS
These key words are based
upon work undertaken by
the RCN Library.

This article has
been subject to
double-blind review.

Traditionally, radiotherapy nurses have been isolated
in the department from other nursing staff, managed
by radiographers or doctors. However, nurses aim to
provide care based on practice that has evolved from
a nursing philosophy, therefore, nursing should be
defined and directed by nurses and not other health­
care professionals (Rosenal 1985).
Although there is no evidence that nursing
support in radiation oncology affects tumour response
to treatment, a patient and his or her family's response
to living with cancer is critical. Nurses are central to
this process (Strohl 1988). Radiotherapy nurses can
offer much of the supportive care needed to cope with
the emotional and physical effects of treatment
(Hilderley 1992), and are able to provide and co­
ordinate many aspects of patient care.
Bruner (1990) described nursing care in radiation
oncology as: The biophysical care required to ensure
that the patient and his or her family are able to cope
with, and adapt to, the diagnosis and treatments of
cancer and the side-effects of radiotherapy. Succinctly,
the role of the radiotherapy nurse is to enhance quality
of life for patients and their families.’
The nursing role in radiotherapy, however, has
lacked definition, clinical standards and nursing
research. A single description is impossible due to the
diversity of care given within departments. However,
important aspects of the nursing role in both oncolo­
gy and departmental radiotherapy nursing are the
same (Box 1).
Assessment and education Assessment is the
first step in planning care and focuses on the
patient's total cancer experience, not just radio­
therapy. It is important to ascertain how the patient

■ Clinical nursing research

is coping with the diagnosis of cancer and where
the radiotherapy treatment fits into his or her expe­
rience of the disease. The nurse must ascertain
the educational needs of both patient and family,
their understanding and misconceptions of radio­
therapy, and what they think is the goal of treat­
ment - radical or palliative. The nurse can then
introduce new information and reinforce what the
patient has already been told (Rosenal 1985).
This is a continuous process. Patients' needs
change as treatment progresses (Hilderley 1992).
Benner (1984) stated that a nurse is like a coach, pro­
viding the patient with information and care and
encouraging him or her to master skills and develop
inner strengths. The nurse takes what is foreign and
fearful to the patient and makes it familiar and, con­
sequently, less frightening.

Knowledge and minimising side effects
Radiotherapy nurses should know about treatment
sites, what side effects are expected and mea­
sures to alleviate them. Pre-treatment discussion
with the patient about his or her expectations can
help to decrease anxiety and might reassure the
patient that certain reactions are not indicative of
treatment failure or disease recurrence (Sitton
1992).
The nurse can help the patient to develop
strategies for coping with the treatment and its effects.
For example, the nurse should discuss the need for
extra rest and a decrease in normal activity to combat
fatigue, and prophylaxis and treatment for skin
reactions.

42 NURSING STANDARD MARCH ll/VOLUME 12/NUMBER 25/1 998
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Symptom management of acute and chronic reactions. Hilderley LJ (1992) Radiotherapy. For personal use only. so patients might need assistance with trans­ port or fares. such as radiotherapy clinical nurse specialists and nurse-led clinics. but there is a lack of published studies into the role (Grant 1992). the late effects of radiotherapy. 4. each patient will need the support of the nurse to persevere with the treatment. Nursing care must. Chapman & Hall. Strohl RA (1988) The nursing role in radiation oncology. In Dow KH. Hilderley LJ (Eds) Nursing Care in Radiation Oncology. nurses can be seen as a threat to radiographers. Hilderley LJ (Eds) Nursing Care in Radiation Oncology. therefore liaison and good communi­ cation are vital (Sitton 1992). about the care of patients receiving radiotherapy and the treatment of any side-effects. London. there­ fore. Philadelphia PA. partic­ ipation in research by nurses has changed from involvement primarily with medical research to increased involvement in nursing research. It is important to remember that rehabilitation is not only for patients who are recovering. and patients' emotional response to radiotherapy and the nurse’s role in this. its recommendations included the state­ ment that: The individual having radiotherapy receives safe and effective nursing care which ensures that information appropriate to his or her fam­ ily’s needs is provided and that actual and potential side-effects are minimised. Boston MA. therefore. 2017. Liaison in the hospital and community More skilled radiotherapy nurses are needed with the education required for assessment. 81. patients may feel apathetic. Philadelphia PA. Oncology Nursing Forum. in order to raise the profile of departmental radiotherapy nursing MARCH l l/VOLUME 12/NUMBER 25/1 998 NURSING STANDARD 43 Downloaded from RCNi. Radiotherapy nurses are collaborative care givers within the multidisciplinary team. not competitive (Rosenal 1985).rehabilitation. Webb P (1992) Oncology for Nurses and Health Care Professionals. enabling them to participate in their own recovery. The future of nursing within these depart­ ments is exciting due to the potential for nursing care created by developments in radiotherapy treatments and the continuing emphasis on outpatient care. Nurses provide a pivotal point through which a patient’s experience in radiotherapy can be commu­ nicated to other caregivers. 6. making appointments.and short-term side-effects and measures to prevent and minimise them. Sitton ET (1992) Clinical practice. because they see little or no obvious change in their disease and might. skin and wound care. a team of professionals is needed to com­ bine a range of knowledge and skills. self-esteem and quality of life are important to the end of life. In Groenwald SL. Treatment varies from a few days to several weeks and usually involves daily visits to the depart­ ment. specialist cancer nurses need to value the role and educate colleagues about it. Menlo Park CA. 13. All rights reserved. who fear that their role is being invaded or taken over (Rosenal 1985). . it is important to focus on sustaining quali­ ty of life for the patient and his or her family. but also for those who are dying . Cancer Nursing. Frogge MH. Second Edition.REFERENCES Benner P (1984) From Novice to Expert. In Dow KH. Copyright © 2017 RCNi Ltd. Scutari Press. that it is all a waste of time. Much work is needed in the area of nursing research so care can be properly validated. so holistic care should consider them also. 2123. and the ultimate goal is for patients to have control over their lives and be able to function at maximum potential (Stumm 1992). 335-338. the nurse should know about common long. Grant M (1992) Research. Bruner DW (1990) Model quality assurance program for radia­ tion oncology nursing. But the knowledge and skills of each care giver are important and should be complementary. The needs of patients receiving radiotherapy are too complex to be met by a single healthcare professional. Psychosocial support The patient with a diag­ nosis of cancer has a wide range of needs and problems (Hilderley 1992). liaison between mem­ bers of the multidisciplinary team is vital. Within the department itself. Royal College of Nursing (1991) Standards of Care tor Cancer Nursing. 9. In Tiffany R. 429-434. Working in isolation can­ not provide the optimum care needed by the patient and his or her family. so it is important for the patient’s self-esteem to emphasise what he or she can. Stumm D (1992) Living with cancer . Yarbro CH (Eds) Cancer Nursing: Principles and Practice. As the treatment progress­ es. Goodman M. rather than cannot. The departmental nurse also has a liaison and education role with other nurses. How­ ever. and be pre­ pared to provide written resources relating to radio­ therapy for patients and relatives.com by ${individualUser. in fact feel. be able to give emotional support. ordering X-rays or taking blood. London.control. be seen to be a clerical one. Link nurses between the radiotherapy department and other areas of oncology could help to raise the pro­ file of radiotherapy nursing and colleagues’ under­ standing of their role. The RCN (1991) recognised the importance of the nurse’s role in the prophylaxis and treatment of side-effects. WB Saunders Company. Psychosocial support must extend beyond radio­ therapy to follow-up care. The Canadian Nurse. in both hospital and the community. Nurses provide and co-ordinate many aspects of patient care. However a person reacts. Rehabilitation The concept of rehabilitation is relatively new in cancer care. It is important to remember that treatment as an outpatient invariably involves family and friends.displayName} on Jan 03. 15. Areas in which research is needed include the impact of nurses on the care and treatment of radiotherapy patients. No other uses without permission. therefore. Jones and Bartlett. the quality of life of patients having radiotherapy. The nurse’s role can. opportunity to guide and support patients. Often family and friends inadvertently encourage physical dependence. and because approximately 50 per cent of radio­ therapy treatment is palliative in nature (Bruner 1990). Rosenal L (1985) Radiotherapy nurse: developing a new role. do. Clinical nursing research In oncology.’ To achieve this. along with research-based stan­ dards of care. There is also scope for developing more specialised areas of care. worse. intervention and the development of the role. Addison-Wesley Publishing Company. but their role. therefore. Second Edition. Radiotherapy nurses have the THE FUTURE CONCLUSION Nurses have a definite place within radiotherapy departments. must be developed (Bruner 1990) to ensure consistency of practice and high quality patient care. WB Saunders Company. The specialty of radiotherapy nursing has devel­ oped over the past ten to 15 years. be individualised and holistic.