Rationale and Development of an Institutional Pediatric Chemotherapy Certification Course Mary Alice Alley Stam, RN, BSN, MS In a large pediatric teaching hospital located in the southwestern part of the United States, few nurses had participated in a formal program that taught the knowledge and skills required for the nurse to care for the patient receiving chemotherapy. In order to enhance the necessary clinical competency of the nursing staff, a Chemotherapy Certification Course was developed for this institution. In reviewing the literature there was minimal information on how to develop such a program. The purpose of this article is to describe the development of this course with the intent that it can serve as a guide in facilitating and implementing such a course in other institutions. As more hospitals adopt institutional certification as a form of continuing education in cancer nursing, perhaps the gap between knowledge and practice will decrease. The institutional certification course will be a significant step toward improving the level of practice of nurses caring for patients receiving chemotherapy. The goal of promoting professional competence will benefit the nurse, the institution, and patients and their families. © 1990 by Association of Pediatric Oncology Nurses.
THE LAST DECADE there were 6.5 million diagnosed and more than 10 million people were under medical care for
TOM
new cancer cases
cancer.’
For a significant number of these medical care involves some form of checases, motherapy. Although the range of treatment modalities for cancer patients is expanding, chemotherapy continues to pfay a significant role. Since chemotherapeutic agents are generally nonselective, affecting many types of rapidly dividing cells other than cancer cells, there is a narrow range between therapeutic and toxic doses. Therefore, it is essential that nurses caring for these patients be especially careful in calculating drug dosages for these agents, and be alert to the initial signs of toxicity as well as expected side effects. With early detection and intervention, unavoidable side effects can be
From Carousel Clinic PA, Ft. Worth, TX Address correspondence to Mary Alice Alley Stam, RN, BSN, MS, 610 Green Meadow N, Colleyville 7X 76034. © 1990 by Association of Pediatric Oncology Nurses.
1043-4542/90/0703-0003$03.00/0
minimized and the toxic effects of chemotherapy can oftentimes be avoided. A survey in 1983 showed significant gaps in cancer nursing education in basic professional schools of nursing? An average of only 14.5 hours was allotted to the study of cancer nursing in these basic programs. The assessment by Croytor et al3 of learning needs in nurses caring for patients with cancer demonstrated that most nurses desired information on current cancer therapy and interventions to assist the patient in
tolerating Staff
treatment.
nurses are
often
responsible
for veni-
puncture, reconstitution of drugs, administration of chemotherapy drugs, and the management of
chemotherapy-related side effects. Because few nurses have participated in formal programs that teach the necessary knowledge and skills required for managing individuals receiving chemotherapy, an institutional chemotherapy certification course would be a useful method for decreasing this knowledge and practice gap.4 Current state laws regarding nursing responsibility vis a vis intravenous chemotherapy are 109
Downloaded from jpo.sagepub.com at INDIANA UNIV on March 18, 2015
110
TABLE- 1. Course Outline Guidelines
Downloaded from jpo.sagepub.com at INDIANA UNIV on March 18, 2015
111
TABLE 1. Course Outline Guidelines
Abbreviations: ALL, acute
rarely explicit
At least
(Cont’d)
lymphocytic leukemia; AML, one
state
(Alabama)
acute
dards of
course
institution that determines the stan-
practice. 5,6
However, institutional certification should not be confused with institutional licensure of the past. As cited in fickeissen,1 certification is a
_
process that validates the nurse’s knowledge and expertise in a defined functional or clinical area of nursing. For the registered nurse who meets predetermined standards, institutional certification represents a level of professional competence that exceeds the minimum required by the R.N. licensure.
Institutional certification programs may vary in degree of quality and lack standardization, but these programs can provide a significant step toward improving standards for safe nursing
practice. As more hospitals adopt institutional certification as a form of continuing education in cancer nursing, clinical competency will improve promoting the level of patient care as set forth in the Scope of Practice and Outcome Standards of Practice for Pediatric Oncology lYursing.8 The certification course will decrease the knowledge and practice gap, improve patient care, and minimize complications, 4 thus leading to shorter hospital stays. The Chemotherapy Certification Course (CCC) will provide the nurse with competence and increase the nurse’s
of the patient care standards~4 The will also decrease the potential for litigation toward the institution as well as the nurse. An alternate choice to institutional certification would be national certification through the Oncology Nurse Society (ONS). This level of certification, however, is contingent upon completion of a minimum of 3 years experience in oncology nursing, 1,000 hours of experience within the previous year, and receiving a passing score on the certification exam.9 Because this national certification course is not specific to pediatrics, and is based upon generalized knowledge, an institutional certification course may be a more feasible alternative to certifying a sufficient number of pediatric staff nurses. At the present time there is not a national certification process or course available for the pediatric oncology nurse. Hopefully, the Association of Pediatric Oncology Nurses will develop a program for national certification for the pediatric oncology nurse as the ONS has done for the nurse caring for the adult oncology patient awareness
re-
quires certification, but for the most part it is the
employing
myeloblastic leukemia; CML, chronic myelocytic leukemia.
_
Content To
develop
an
institutional certification
course, a planning committee should be formed to do the initial problem assessment as well as meet with nursing administration to formulate
policy. After approval tion
a
from
task force should be
Downloaded from jpo.sagepub.com at INDIANA UNIV on March 18, 2015
nursing administraappointed to formu-
112
late the program. A minimum of 8 to 10 weeks should be allowed for the planning once the task force has been appointed. This time frame will also allow enough time to contact and receive responses from faculty speakers. Curriculum content for certification includes both a didactic and a clinical component delivered over a 2-day period. The didactic component is designed to cover the major aspects of nursing care related to the patient receiving chemotherapy. The clinical component is designed to include instruction and evaluation of the nurse’s technical competence in administering chemotherapy. This component is to be completed following the didactic portion. The course is designed to facilitate safe preparation and Administration of antineoplastic drugs. Administration techniques include intravenous (IV) infusion, intrathecal, IV bolus, implantable devices, central venous catheters, oral, and intramuscular. An appropriate amount of time is allotted to cover the risks and procedures for handling chemotherapeutic agents. Following a review of normal and malignant cellular physiology, general pharmacology of antineoplastic drugs is introduced. The content focuses on drug calculation as well as the administration of these agents. Detailed explanations of chemotherapy protocols and orders are also addressed. The didactic content also includes nursing care for chemotherapy induced side effects such as nausea, vomiting, stomatitis, alopecia, bone marrow depression, and infection. Essential components of patient education are delineated, and include normal and abnormal blood counts. The final hour is devoted to the topic of care of the caregiver and addresses the origins of stress and burn-out in the oncology professional nurse. It is suggested that the CCC be offered as follows:
Downloaded from jpo.sagepub.com at INDIANA UNIV on March 18, 2015
113
During the proposed clinical component each
.
demonstrates clinical competency in the administration of an N push and a continuous infusion. Completion of the clinical component is accomplished within 30 days of completing the didactic component. The written test is to be taken 30 days after completion of the course. The CCC should be coordinated by the Department of Nursing Education or nurse educator. The recommended multidisciplinary faculty should be directed by the oncology CNS and/or the nurse educator. To ensure that other disciplines cover the course content that nursing considers vital, the course director writes and/or approves specific course objectives for each discipline. The faculty recommended for participation includes pharmacist, chaplain, physician, dietitian and/or nutritional support team, social worker, and the experienced oncology nurse. As a general guideline, this 2-day course can be offered every 3 months to certify as many nurse
TABLE 2. Clinical
Preceptor Checklist
registered nurses as possible. The initial precepcomprised of two experienced as designated by the course nurses oncology
tor group will be
director. These preceptors should meet modified criteria based on their expertise in the oncology field. They must participate and complete the initial program at the designated institution. If needed the group can be expanded to meet the future needs of the institution.
Project Schedule
and
Management Plan .
phase includes 2 months of iniby the course director and a planning committee composed of at least two experienced oncology nurses. The planning committee is responsible for problem assessment, obtaining approval from department heads, obtaining approval for a budget to develop the program, and appointing a task force. The planning
tial
problem
assessment
The task force assists with the program development and implementation by writing the specific course content for the suggested chemo-
therapy course topics.
Responsibilities
NOTE.
and Time Frame for the
by the or
Task Force The responsibilities and time frame for the task force include: (1) set the projected date to offer the first class; (2) identify faculty and speakers (10 weeks before the projected class date); (3) commitment from speakers (6 to 8
Completed checklist should be signed and dated preceptor and mode of drug infusion, ie, push
nurse
continuous, should be noted.
weeks before course starts); (4) assign persons responsible for presenting and assembling syllabus and handouts (8 weeks before course); (5) specific objectives assigned for each topic (10
Downloaded from jpo.sagepub.com at INDIANA UNIV on March 18, 2015
114
weeks before first class); (6) objectives due back to be reviewed (8 weeks before class) and approved by course director and an appointed assistant ; (7) compile a pretest and posttest (5 weeks before class); (8) handouts approved and ready to be presented (4 weeks before class); (9) sponsors for the breaks (a pharmaceutical company) ; the same person will be responsible for planning and implementing the coffee and refreshment break (6 weeks before class); (10) apply for continuing education points (8 weeks before class); and (11) order certificates to be presented to the nurses who complete the course (4 weeks before class). It is suggested that one person be responsible for the following: (1) outline and present format for clinical preceptor responsibilities (4 weeks before class); (2) outline and present format for preceptor checklist; (3) format of communication sent to head nurse after staff is certified; (4) format of communication sent to students after completion of classroom, clinical, and test; (5) certificate to be sent after completion; and (6) registration for class with deadline no less than 1 week before the class.
References
This article described the development and suggested guidelines for an institutional pediatric chemotherapy certification program. Having established the need for such a program, a secwas devoted to preparatory tasks involving implementation of the suggested course. This included the formation and responsibilities of the planning committee as well as a suggested time frame within which the tasks should be tion
completed. The remainder of the article was devoted to discussion of the actual content of the proposed certification course. Broad course objectives as well as specific topic objectives were provided (Table 1 ). Sequence of time allocation and teaching strategies for each topic were also suggested. The need for a clinical and a didactic component of the course was discussed as well as the suggested qualifications for the multidisciplinary faculty. The criteria for’successful completion of the course and a plan for keeping knowledge and skills current were delineated (Table 1). Finally, a suggested clinical preceptor checklist was included in Table 2.
’
1. Rowland HS (ed): The Nurse’s Almanac (ed 2). Aspen, CO, Bowie, 1984 2. Brown JK, Johnson JL, Gorenwald SL Survey of cancer nursing education in U.S. schools of nursing. Oncol Nurs Forum 10:82-83, 1983 3. Croytor J, Brown JK, Morrow GR: Assessing learning
needs of nurses who care for persons with cancer. Cancer Nurs 1211-220, 1978 4. Welch-McCaffrey D: Rationale, development, and evaluation of a chemotherapy certification course for nurses. Cancer Nurs 8:255-262, 1985 5. Hughes CB: Giving cancer drugs I.V. Am J Nurs 86 :34-
38, 1986
Conclusion
6. Gaddy-Cohen D, Bums L, Wofford L. The development, implementation and evaluation of a chemotherapy certification course for pediatric nurses. J Assoc Pediatr Oncol Nurs 3:21, 1985
7. Fickeissen JL:
Getting
certified. Am J Nurs 85259-
263, 1985 8. Association of Pediatric Oncology Nurses: Scope of Practice and Outcome Standards of Practice for Pediatric
Oncology Nursing. Richmond, VA, APON, 1988 9. Oncology Nursing Certification Corp: Oncology Nursing Certification Bulletin, 1988. Pittsburgh, PA, Oncology Nursing Certification Corp, 1988
Downloaded from jpo.sagepub.com at INDIANA UNIV on March 18, 2015
THE LAST DECADE there were 6.5 million diagnosed and more than 10 million people were under medical care for
TOM
new cancer cases
cancer.’
For a significant number of these medical care involves some form of checases, motherapy. Although the range of treatment modalities for cancer patients is expanding, chemotherapy continues to pfay a significant role. Since chemotherapeutic agents are generally nonselective, affecting many types of rapidly dividing cells other than cancer cells, there is a narrow range between therapeutic and toxic doses. Therefore, it is essential that nurses caring for these patients be especially careful in calculating drug dosages for these agents, and be alert to the initial signs of toxicity as well as expected side effects. With early detection and intervention, unavoidable side effects can be
From Carousel Clinic PA, Ft. Worth, TX Address correspondence to Mary Alice Alley Stam, RN, BSN, MS, 610 Green Meadow N, Colleyville 7X 76034. © 1990 by Association of Pediatric Oncology Nurses.
1043-4542/90/0703-0003$03.00/0
minimized and the toxic effects of chemotherapy can oftentimes be avoided. A survey in 1983 showed significant gaps in cancer nursing education in basic professional schools of nursing? An average of only 14.5 hours was allotted to the study of cancer nursing in these basic programs. The assessment by Croytor et al3 of learning needs in nurses caring for patients with cancer demonstrated that most nurses desired information on current cancer therapy and interventions to assist the patient in
tolerating Staff
treatment.
nurses are
often
responsible
for veni-
puncture, reconstitution of drugs, administration of chemotherapy drugs, and the management of
chemotherapy-related side effects. Because few nurses have participated in formal programs that teach the necessary knowledge and skills required for managing individuals receiving chemotherapy, an institutional chemotherapy certification course would be a useful method for decreasing this knowledge and practice gap.4 Current state laws regarding nursing responsibility vis a vis intravenous chemotherapy are 109
Downloaded from jpo.sagepub.com at INDIANA UNIV on March 18, 2015
110
TABLE- 1. Course Outline Guidelines
Downloaded from jpo.sagepub.com at INDIANA UNIV on March 18, 2015
111
TABLE 1. Course Outline Guidelines
Abbreviations: ALL, acute
rarely explicit
At least
(Cont’d)
lymphocytic leukemia; AML, one
state
(Alabama)
acute
dards of
course
institution that determines the stan-
practice. 5,6
However, institutional certification should not be confused with institutional licensure of the past. As cited in fickeissen,1 certification is a
_
process that validates the nurse’s knowledge and expertise in a defined functional or clinical area of nursing. For the registered nurse who meets predetermined standards, institutional certification represents a level of professional competence that exceeds the minimum required by the R.N. licensure.
Institutional certification programs may vary in degree of quality and lack standardization, but these programs can provide a significant step toward improving standards for safe nursing
practice. As more hospitals adopt institutional certification as a form of continuing education in cancer nursing, clinical competency will improve promoting the level of patient care as set forth in the Scope of Practice and Outcome Standards of Practice for Pediatric Oncology lYursing.8 The certification course will decrease the knowledge and practice gap, improve patient care, and minimize complications, 4 thus leading to shorter hospital stays. The Chemotherapy Certification Course (CCC) will provide the nurse with competence and increase the nurse’s
of the patient care standards~4 The will also decrease the potential for litigation toward the institution as well as the nurse. An alternate choice to institutional certification would be national certification through the Oncology Nurse Society (ONS). This level of certification, however, is contingent upon completion of a minimum of 3 years experience in oncology nursing, 1,000 hours of experience within the previous year, and receiving a passing score on the certification exam.9 Because this national certification course is not specific to pediatrics, and is based upon generalized knowledge, an institutional certification course may be a more feasible alternative to certifying a sufficient number of pediatric staff nurses. At the present time there is not a national certification process or course available for the pediatric oncology nurse. Hopefully, the Association of Pediatric Oncology Nurses will develop a program for national certification for the pediatric oncology nurse as the ONS has done for the nurse caring for the adult oncology patient awareness
re-
quires certification, but for the most part it is the
employing
myeloblastic leukemia; CML, chronic myelocytic leukemia.
_
Content To
develop
an
institutional certification
course, a planning committee should be formed to do the initial problem assessment as well as meet with nursing administration to formulate
policy. After approval tion
a
from
task force should be
Downloaded from jpo.sagepub.com at INDIANA UNIV on March 18, 2015
nursing administraappointed to formu-
112
late the program. A minimum of 8 to 10 weeks should be allowed for the planning once the task force has been appointed. This time frame will also allow enough time to contact and receive responses from faculty speakers. Curriculum content for certification includes both a didactic and a clinical component delivered over a 2-day period. The didactic component is designed to cover the major aspects of nursing care related to the patient receiving chemotherapy. The clinical component is designed to include instruction and evaluation of the nurse’s technical competence in administering chemotherapy. This component is to be completed following the didactic portion. The course is designed to facilitate safe preparation and Administration of antineoplastic drugs. Administration techniques include intravenous (IV) infusion, intrathecal, IV bolus, implantable devices, central venous catheters, oral, and intramuscular. An appropriate amount of time is allotted to cover the risks and procedures for handling chemotherapeutic agents. Following a review of normal and malignant cellular physiology, general pharmacology of antineoplastic drugs is introduced. The content focuses on drug calculation as well as the administration of these agents. Detailed explanations of chemotherapy protocols and orders are also addressed. The didactic content also includes nursing care for chemotherapy induced side effects such as nausea, vomiting, stomatitis, alopecia, bone marrow depression, and infection. Essential components of patient education are delineated, and include normal and abnormal blood counts. The final hour is devoted to the topic of care of the caregiver and addresses the origins of stress and burn-out in the oncology professional nurse. It is suggested that the CCC be offered as follows:
Downloaded from jpo.sagepub.com at INDIANA UNIV on March 18, 2015
113
During the proposed clinical component each
.
demonstrates clinical competency in the administration of an N push and a continuous infusion. Completion of the clinical component is accomplished within 30 days of completing the didactic component. The written test is to be taken 30 days after completion of the course. The CCC should be coordinated by the Department of Nursing Education or nurse educator. The recommended multidisciplinary faculty should be directed by the oncology CNS and/or the nurse educator. To ensure that other disciplines cover the course content that nursing considers vital, the course director writes and/or approves specific course objectives for each discipline. The faculty recommended for participation includes pharmacist, chaplain, physician, dietitian and/or nutritional support team, social worker, and the experienced oncology nurse. As a general guideline, this 2-day course can be offered every 3 months to certify as many nurse
TABLE 2. Clinical
Preceptor Checklist
registered nurses as possible. The initial precepcomprised of two experienced as designated by the course nurses oncology
tor group will be
director. These preceptors should meet modified criteria based on their expertise in the oncology field. They must participate and complete the initial program at the designated institution. If needed the group can be expanded to meet the future needs of the institution.
Project Schedule
and
Management Plan .
phase includes 2 months of iniby the course director and a planning committee composed of at least two experienced oncology nurses. The planning committee is responsible for problem assessment, obtaining approval from department heads, obtaining approval for a budget to develop the program, and appointing a task force. The planning
tial
problem
assessment
The task force assists with the program development and implementation by writing the specific course content for the suggested chemo-
therapy course topics.
Responsibilities
NOTE.
and Time Frame for the
by the or
Task Force The responsibilities and time frame for the task force include: (1) set the projected date to offer the first class; (2) identify faculty and speakers (10 weeks before the projected class date); (3) commitment from speakers (6 to 8
Completed checklist should be signed and dated preceptor and mode of drug infusion, ie, push
nurse
continuous, should be noted.
weeks before course starts); (4) assign persons responsible for presenting and assembling syllabus and handouts (8 weeks before course); (5) specific objectives assigned for each topic (10
Downloaded from jpo.sagepub.com at INDIANA UNIV on March 18, 2015
114
weeks before first class); (6) objectives due back to be reviewed (8 weeks before class) and approved by course director and an appointed assistant ; (7) compile a pretest and posttest (5 weeks before class); (8) handouts approved and ready to be presented (4 weeks before class); (9) sponsors for the breaks (a pharmaceutical company) ; the same person will be responsible for planning and implementing the coffee and refreshment break (6 weeks before class); (10) apply for continuing education points (8 weeks before class); and (11) order certificates to be presented to the nurses who complete the course (4 weeks before class). It is suggested that one person be responsible for the following: (1) outline and present format for clinical preceptor responsibilities (4 weeks before class); (2) outline and present format for preceptor checklist; (3) format of communication sent to head nurse after staff is certified; (4) format of communication sent to students after completion of classroom, clinical, and test; (5) certificate to be sent after completion; and (6) registration for class with deadline no less than 1 week before the class.
References
This article described the development and suggested guidelines for an institutional pediatric chemotherapy certification program. Having established the need for such a program, a secwas devoted to preparatory tasks involving implementation of the suggested course. This included the formation and responsibilities of the planning committee as well as a suggested time frame within which the tasks should be tion
completed. The remainder of the article was devoted to discussion of the actual content of the proposed certification course. Broad course objectives as well as specific topic objectives were provided (Table 1 ). Sequence of time allocation and teaching strategies for each topic were also suggested. The need for a clinical and a didactic component of the course was discussed as well as the suggested qualifications for the multidisciplinary faculty. The criteria for’successful completion of the course and a plan for keeping knowledge and skills current were delineated (Table 1). Finally, a suggested clinical preceptor checklist was included in Table 2.
’
1. Rowland HS (ed): The Nurse’s Almanac (ed 2). Aspen, CO, Bowie, 1984 2. Brown JK, Johnson JL, Gorenwald SL Survey of cancer nursing education in U.S. schools of nursing. Oncol Nurs Forum 10:82-83, 1983 3. Croytor J, Brown JK, Morrow GR: Assessing learning
needs of nurses who care for persons with cancer. Cancer Nurs 1211-220, 1978 4. Welch-McCaffrey D: Rationale, development, and evaluation of a chemotherapy certification course for nurses. Cancer Nurs 8:255-262, 1985 5. Hughes CB: Giving cancer drugs I.V. Am J Nurs 86 :34-
38, 1986
Conclusion
6. Gaddy-Cohen D, Bums L, Wofford L. The development, implementation and evaluation of a chemotherapy certification course for pediatric nurses. J Assoc Pediatr Oncol Nurs 3:21, 1985
7. Fickeissen JL:
Getting
certified. Am J Nurs 85259-
263, 1985 8. Association of Pediatric Oncology Nurses: Scope of Practice and Outcome Standards of Practice for Pediatric
Oncology Nursing. Richmond, VA, APON, 1988 9. Oncology Nursing Certification Corp: Oncology Nursing Certification Bulletin, 1988. Pittsburgh, PA, Oncology Nursing Certification Corp, 1988
Downloaded from jpo.sagepub.com at INDIANA UNIV on March 18, 2015
