[Doctors-nurses integration in paediatric onco-hematology: a cornerstone for quality of care. Report on a three years experience].

The rapid evolution of care and the constantly changing needs and expectations of patients and their families require flexibility and re-organisation of the caring and treatment activities. These include the increased need for high-specialised personal competence; communication and interpersonal skills; and a close collaboration and integration between doctors and nurses--the main professional groups in the health care team. An optimal integration is not always and easily achievable and requires personal motivation, active efforts, investments and the development of the effective operative models for providing the integrated high specialised daily care. It is not easy in the busy daily routine to find time, motivation and share common goals. This is why a support for the groups willing to implement projects for improving integration between doctors and nurses was provided through an action-research laboratory. The aims of the multi-step action-research laboratory were the following: to improve the integration of different professionals; to improve the exchange of knowledge and skills; to build the necessary bases for planning and running comprehensive, integrated clinical projects in the field of paediatric haematology-oncology. The ultimate goals of this effort was to improve the quality of the care and cure provided to children with cancer and their families. The project lasted three years, and consisted of yearly residential meetings alternating with experiences conducted in the working environments of the participants. The following steps were planned: Identification of the problem. Participants were asked to analyse the main problems of their units, that could be solved-improved with a better integration/collaboration between doctors and nurses and the main difficulties routinely encountered in working effectively together. Groups were asked to analyse the problem in their own practice, identify the possible solutions, main obstacles, strengths and weaknesses, plan the necessary of activities (short and medium term) for improving the problems. Sharing of projects. The projects were shared and common problems and solutions discussed. Final presentation of the projects with the aim of devising solutions and strategies for consolidation of the eventual changes obtained. Supervision, theoretical support and personalised feed-back from the scientific panel were guaranteed between the meetings and during the planning and implementation phases. Methods, instruments and techniques for improving collaboration and integration were discussed during the yearly meetings (i.e. how to work by objectives; how to plan and co-ordinate multidisciplinary meetings...) with lectures, workgroups, role-playing. Representatives from the 16 wards participated to the project: at least one nurse and one doctor from each centre, in the position to take decisions and implement changes. In spite of common problems related to the workload, difficulties in involving other colleagues, 13 projects were implemented. The need to discuss, plan together, organise interdisciplinary meetings improved the integration and communication between doctors and nurses.