Chemotherapy Competency Curriculum for Inpatient Nurses

Introduction and Rationale

Though the vast majority of cancer cases in the American healthcare system are treated in cancer centers and other facilities specializing in cancer therapies, the permeation and diversity of the condition dictates that many supplementary, cooperative, peripheral, and long-term treatment needs must be met in general treatment facilities such as hospitals. This forms the rationale for the curriculum presented hereafter, which proceeds from the view that nursing skill sets in inpatient settings should include basic competencies related to chemotherapy. Because chemotherapy is an area of cancer treatment that itself produces an array of health needs, side effects, and medical realities, this discussion is underscored by the view that nursing professionals in most inpatient settings will require a full working knowledge of the cases in which chemotherapy is used; its likely physiological side effects; the emotional and psychological consequences of the treatment course; and the host of health experiences likely to accompany the treatment course.

The selected topic area of chemotherapy education is supported by findings indicating that patients undergoing chemotherapy are likely to require inpatient treatment at some point in the therapeutic process. Particularly, Bunce-Houston (2010) notes, "initial conditions leading to diagnosis, surgical recovery, long-term infusions, and treatment of side effects may occur in the inpatient setting. In addition, some patients may require hospitalization for treatment because of a nonexistent or unstable home environment or a lack of support services (e.g., home health nurse visits or a significant other to assist in the home)" (p. 1). In any of these contexts, the patient will require a nursing staff that is well-versed in the diagnostic, administering, and contraindicating qualities of the treatment course.

Bunce-Houston further notes that there is a particular need in the nursing education context to address this issue. With the larger focus of cancer treatment moving to specialist and outpatient settings, general registered nurses today are unlikely to have received the education and core competency training required to address chemotherapy-driven needs as they arise in the inpatient setting. This denotes a need to restore these core competencies as a measure of improving the quality of inpatient healthcare and of improving the flexibility of general nursing staffs, which must contend with high turnover and difficulty in the area of recruitment.

Nursing Topic Area and Core Competencies

Competencies in chemotherapy education and treatment are drawn primarily from the Oncology Nursing Society's (ONS) Chemotherapy and Biotherapy Guidelines and Recommendations for Practice, which offers basic recommendations for providing education and training in this area. The following four core competencies are verified by this set of guidelines and explicated in the article by Bunce-Houston.

1. Nurses must be educated in proper dosage calculations. Objectives include:

a. Recognition of contraindications
b. Understanding of side effects
c. Conceptual understanding of chemical reactions to dosage
d. Capacity to explain dosage to the patient
e. Ability to physically administer dosages

2. Nurses will be versed in the evaluation of laboratory data. Objectives include:

a. Ability to make relevant calculations
b. Ability to interpret data
c. Ability to use data to make meaningful medical evaluations
d. Ability to record relevant data to be read by others
e. Understanding of relevant symbols, abbreviations, and shorthand

3. Nurses will be able to educate and empathize with the patient, family, and support system about treatment realities. Objectives include:

a. Providing psychological support to the patient
b. Providing empathy to the patient
c. Remaining informative to family and the support system
d. Providing the patient with counsel on long-term lifestyle and behavior recommendations
e. Providing the patient and family with clear information on what to expect, what to prepare for, and what options are available at every step

Selected Competency and the Biopsychosocial Model

4. Nurses will have direct training in the handling, administration, and disposal of materials relating to the course of treatment. Objectives include:

a. Understanding of sanitary procedures
b. Awareness of possible risks
c. Knowledge to act in the event of unwanted treatment outcomes
d. Knowledge of best practices in the physical administering of treatment
e. Understanding of common side effects

In order to focus this discussion on a single actionable curriculum, the emphasis here will be on the third of the four competencies stated above. This competency calls for the nursing professional to possess a full understanding not just of the experiential and sensory realities of chemotherapy, but of how these are likely to impact the patient's emotional well-being and that of the family or general support system surrounding the patient. Accordingly, the curriculum below is designed to illuminate the theoretical and practical dimensions of this core competency. Instruction will be conducted according to two supplementary approaches: the GEM model and the practicum. The bulk of instruction will occur in a GEM setting so that active registered nurses can receive training and pedagogy through on-site terminals. This will help reduce the stress on each student's schedule in light of the already-noted nationwide nursing shortages. This element of the curriculum will pair shift groups "with mentors in nursing occupations via a website, email and special events. Group Electronic Mentoring in Nursing (GEM-Nursing) encourages students to pursue nursing careers through innovative group e-mentoring" (Chambers, p. 1).

According to available research on the subject, the experience and endurance of chemotherapy and related conditions resulting in inpatient status carry distinct emotional, psychological, social, and familial consequences. These consequences are the focus of the biopsychosocial perspective, a theoretical model based on the crossover of emotional and physiological conditions that can have real and tangible health outcomes. According to Plante (2010), "treatment for cancer . . . reflects the biopsychosocial perspective. In addition to medical treatments such as chemotherapy, radiation, and surgery, social support and psychotherapy have been found to enhance rehabilitation and sometimes even longevity" (p. 163).

This underscores the critical importance of the role played by nursing professionals in facilitating positive emotional, psychological, and social experiences throughout the course of treatment. The introduction of the biopsychosocial model to modern discussions on nursing competencies may be credited to American psychiatrist George Engel, who in 1977 published a theory integrating all aspects of an individual's health disposition into a treatment strategy (Pollin, pp. 5–6). This was a groundbreaking advance, promoting for the first time the idea that a treatment program could incorporate "interconnected spectrums, each as systems of the body. In fact, the model accompanied a dramatic shift in focus from disease to health, recognizing that psychosocial factors (e.g., beliefs, relationships, stress) greatly impact recovery from and recuperation from illness and disease" (Lakhan, p. 1). This is highly relevant to understanding the mental health implications for those enduring the inherently taxing experience of chemotherapy treatment.

Conclusion

The curriculum described above creates a foundation for the competency of educating and empathizing with the patient and his or her support system — first through instruction, then through simulated treatment scenarios, and finally through real treatment scenarios. The ambition is that registered nurses engaging this course of education will possess the basic competencies required to standardize inpatient treatment in relation to chemotherapy, improving both the quality of care delivered and the overall flexibility of general nursing staffs in meeting the evolving demands of inpatient oncology care.