1 FEATURE

A core curriculum for a post-basic course in cancer nursing* PREPARED BY THE EUROPEAN ONCOLOGY NURSING SOCIETY

Early in 1989 a workshop was held in Oxford, UK, to prepare a core curriculum for post-basic cancer nursing programmes in Europe. Workshop participants were experts in cancer-nursing education from all over Europe, and were working in response to one of several recommendations made in a report to the ad-koc Working Group on Training in Cancer of the Advisory Committee on Training in Nursing of the European Commission (ACTN). The core curriculum was published in 1989, and formed the basis for a Consensus Conference held in 1991, where some minor amendments led to this revised edition. This edition received endorsement from the ACTN in April 1991, and has now been translated by the European Commission for use throughout the member states. Several countries are already piloting programmes or courses based on this curriculum. Others are planning events for 1992 and beyond.

Cancer is one of the major health problems of our times. Individuals with cancer are not merely people with a diseased body, they are also people with thinking minds and stirring souls, who re- late to others, whether family or friends. They have attitudes and aptitudes, interests and in- stincts, hopes and dreams, which are all affected by their condition. A philosopy for cancer nurs- ing might be reflected, therefore, in the state- ments contained in the box below.

trained nurses to care for people of all ages with cancer by delivering planned care to individuals both inside and outside health-care institutions. This care will be available during initial diag- nosis, treatment, rehabilitation andor palliative and terminal care.

The nurse undertaking a course based on this curriculum also has a responsibility in health promotion and primary and secondary preven- tion of cancer, both as a professional and as a

The purpose of this curriculum is to prepare member of the wider comn&nity.

A philosophy for cancer nursing

1. We believe that people with cancer are, first and foremost, individuals with personal needs who have the right to live their life to the full and die with dignity. The recognition of the patient as an indi- vidual and the response to those personal needs is the primary goal of cancer nursing. 2. We believe that every patient with cancer has

the right to the best available treatment, care and support despite the differences in social., political and economic structures. Furthermore, we believe that, given current knowledge and experience, idenufying patient needs in consultation with them is the most effective way to ensure the delivery of highquality nursing care and retain the inde- pendence of the individual. 3. We believe that patients and their families

should be encouraged and, where appropriate, in- structed to be active participants in setting and achieving their own realistic goals. 4. We believe that nursing should initiate and

encourage a multidisciplinary approach to the care of the individual with cancer. 5. We believe that nurses should be aware of their

contribution to health promotion and the preven- tion of cancer. Much of this may be achieved in the primary health care setting with the well public.

Health promotion continues with actual cancer patients, in whatever setting. 6. We believe in the importance of research as a

basis for improving patient care, and recognize our responsibility to initiate research and support our colleagues in their efforts. 7. We believe that, as professionally qualified

practitioners, nurses are accountable for their actions.

8. We believe that available knowledge about cancer nursing should be accessible to all nurses in Europe. 9. We believe that educational opportunities

equip nurses to act as a resource to patients and their families. Informed nurses also have the re- sponsibility to provide information to the public about cancer, its prevention and its treatment. 10. We believe that education for cancer nursing:

values the student as an individual; encourages active participation of students in the learning process;

0 is based on clearly defined goals and objec- tives that can be achieved and evaluated; is based on a model of adult learning which builds on existing knowledge and skills; is facilitated by appropriately qualified teachers.

“This article was prepared by EONS for the Commission of the European Community’s ‘Europe Against Cancer’

I programme.

European Journal of Cancer Care 1 :2, I992 7

The model In establishing the core curriculum from the ini- tial philosophy of cancer nursing, a model was chosen that focused on the recipient of nursing care - the person with cancer or a member of the public needing information to help prevent cancer. Integration of theory and practice de- velops from this, by determining the care needed and the knowledge-base and competencies required to achieve that care. The theory can then be interlaced with the competencies at an appropriate level.

A basic model to implement a course based on this core curriculum is given in Fig. 1. The start- ing point (I) may be to design a first course, following an assessment of need, or it may be an opportunity for evaluation of an existing educa- tional programme. For the purpose of this docu- ment, the nurse's contribution to the care of the person with cancer has central components with additional threads interwoven throughout. The central components are:

Health promotion, prevention and early detection;

0 Treatment, care and rehabilitation.

To enable nurses to be effective in their care, the following personal and professional issues need to be addressed. These form the threads to be interwoven throughout the curriculum:

0 self awarenesslrole awareness e attitudes and values 0 professional development 0 stress management 0 problem-solving strategies 0 decision-making strategies 0 research awareness

~ i ~ . 1. A basic model to politics of health care implement a core- 0 ethical issues curriculum course. quality-of-life issues.

I. Assess needs

VI. Evaluate progress and achievement

f I

V. Identify learning opportunities

IV . Plan content and method of implementation

11. Generate

\ philosophy

J 111.' Determine course

purpose and goa Is 1

Health promotion, prevention and early detection Although the difficulties of providing experience in this area of care are recognized, nurses should be aware of their contribution to the promotion of health, prevention and early detection of cancer. Depending on the setting, practical experience should be offered whenever possible.

Primary prevention Primary prevention includes:

0 information giving 0 recommendations to the public for reducing their risk factors for cancer 0 participation in health-promotion programmes or activities.

Nursing activities in primary prevention include:

0 providing information encouraging and educating individuals to

enable them to adopt healthy lifestyles 0 being supportive to those individuals in the changing of their lifestyle.

Theoretical content includes:

0 identification of those cancers that are or may be preventable 0 study of the causes and aetiology of the relev- ant cancers 0 an understanding of the cultural and social practices that influence living habits 0 the study of relevant sociology and anthro- PObY 0 the acquisition of the skills of communicating information in a positive way 0 the study of the principles of teaching and learning 0 the study of the theories of attitudes and at- titude change 0 the identification of available local resources for cancer prevention.

Practical experience: it is envisaged that contact with the public in this context will vary. Depend- ing on the setting and available opportunities, practical experience should be offered whenever possible.

Secondary prevention and early detection

Secondary prevention and early detection include:

0 education in relation to early warning signs for cancer 0 screening programmes.

Nursing activities in secondary prevention and early detection include:

8 European Journal of Cancer Care 1 :2, I992

e providing information about screening Specific skills: facilities @ encouraging ‘at risk’ families to undertake screening 0 supporting patients who are awaiting the results of screening 0 caring for patients undergoing screening procedures 0 supporting patients who have been informed that they need treatment following screening.

0 technical 0 psycho-social: interpersonal, enhancement of coping strategies; teaching patients, families and colleagues 0 coordination of care 0 functioning as a member of a multidisciplinary team 0 collaboration with colleagues to establish an appropriate rehabilitation programme for the

Theoretical content includes:

0 understanding early warning signs and symptons of cancer, ‘at-risk’ groups and target populations

study of relevant cancers, including aetiology and signs and symptoms 0 understanding the epidemiology of relevant cancers

information about screening for ‘at-risk’ families 0 understanding the principies of screening, which cover social, moral, ethical and economic issues 0 knowledge about screening methods used 0 type of provision needed for those awaiting results of screening 0 study of aspects of health psychology, such as:

- beliefs about health - attitudes to cancer - the nature of anxiety and fear - coping strategies principles of teaching and learning (group and

individual).

Practical experience: depending on the setting and available opportunities, practical experience should be offered whenever possible.

Tertiary prevention This is directed at those with established disease and is encompassed, therefore, in the section below on treatment, care and rehabilitation.

Treatment, care and rehabilitation Having acquired the necessary theory and prac- tice, the nurse has specific knowledge and skills to deliver appropriate nursing care to the cancer patient.

Specific knowledge about:

8 cancer as a disease process and its effects upon the person

the promotion of rehabilitation and adjust- ment to existing disease

active treament modalities 0 palliative and terminal treatment and care.

patient.

Nursing activities include:

0 helping patients to express their feelings about the implications of cancer

enabling patients to cope with living with can- cer and adapting to their changed circumstances 0 preventing biological and psychological com- plications arising from cancer and its treatment

monitoring and controlling the effects of the symptoms arising from cancer and its treatment

promoting physiological and psychological integrity and sustaining those functions com- promised by cancer and its treatment 0 supporting those having surgery for cancer 0 administering anti-cancer drugs and being aware of the safety precautions required 0 participating in the management of treatments using internal and external radiation and being aware of the safety precautions required 0 providing information about cancer and its treatment within the limits of knowledge and expertise.

Theoretical content includes:

(a) The understanding of cancer, its invasive nature and approaches to treatment

(i) Disease process

epidemiology 0 aetiology

cell biology pathology

0 immunology systematic effects.

specific cancers

principles of staging 0 diagnostic tests.

(ii) Diagnostic and staging techniques of site-

(iii) Treatment

principles of treatment treatment modalities

0 surgery - principles of cancer surgery - care required before, during and after

- specific problems resulting from cancer surgery

surgery

EuropeanJournal of Cancer Care 1:2, 1992 9

0 radiotherapy - radiation physics - principles of radiotherapy - biological effects of radiotherapy - radiation protection - prevention and treatment of short- and

long-term side-effects of radiotherapy - care required before, during and after

radiotherapy 0 chemotherapy - principles of chemotherapy - pharmacology of cytotoxic drugs - biological effects of chemotherapy - safe handling and administration of

cytotoxic drugs - care required before, during and after

treatment - clinicaltrials - resuscitative and rescue measures

required following treatment - prevention and treatment of short- and

long-term side-effects of chemotherapy 0 other treatments

0 combined treatments - underlying principles and application

- underlying principles and application.

(b) To understand the major effects arising from cancer and its treatment (these will include physical, social, spiritual and psycho- logical effects)

0 acute and chronic pain 0 gastro-intestinal disturbances * soremouth * bone-marrow depression * dyspnoea * skin changes 0 alopecia 0 anorexia 0 weight losdgain * cachexia 0 fatigue 0 anxiety * uncertainty 0 social disruption.

(c) To facilitate the expression of feelings

* theories of perception * theories of communication 0 the nature of interpersonal interaction and car- ing relationships.

(d) To understand the nature and effects of cancer on self-image

0 concepts of self and sexuality * concepts of altered body image.

(e) To understand the principles of terminal care 6 symptom control * process of dying

theories of separation and loss 0 complicated and uncomplicated grief re- actions.

(f) Principles of informing, teaching and learn- ing about cancer

theories of adult learning strategies for information provision and

retention 0 the presentation of educational material re- lated to health and illness.

(g) To understand the moral issues and ethical dilemmas in the care of cancer patients

introduction to ethics consent to treatment clinical trials euthanasia

0 resuscitation 0 information control.

(h) Social aspects of chronic illness

* ethnic variations helping to cope with chronic illness and dis-

ability sociological analysis of disability family response to chronic illness.

Practical experience: it is envisaged that treat- ment of specific disease conditions will vary ac- cording to the setting in which patients are seen. There need to be opportunities under supervision to observe and practise the care of patients with the most prevalent cancers throughout all phases of the disease. Account needs to be taken of the nurse’s previous experience.

A course based on the curriculum A course-planning team should be formed locally to represent all components of the course. The team will plan, implement, evaluate, monitor and revise the course at appropriate times.

Regardless of the length of the course, there should be a balance between theory and practice; indeed the two should be directly related. The theory may occur in a classroom, clinical setting or by means of a distance-learning resource. Every student should have an individual course profile, which will include a minimum require- ment for practical experience, with the emphasis on the quality of that experience. The practice must be with patients or potential patients in order that most benefit may be gained from these equally important and interrelated aspects of learning. There needs to be a clear understanding and agreement that individuals undertaking an educational course receive every support and opportunity to pursue their studies.

10 EuropeanJouml of Cancer Care 1:2, 1992

Entry requirements Each nurse undertaking a course based on this core curriculum should have already achieved the first-level qualification of a nurse established in the EC directives (77/452 and 77/453 EEC) or equivalent in other countries. In addition, the nurse should have one year’s post-registration ex- perience in any nursing setting prior to under- taking a course based on this curriculum. A nurse who undertakes a course based on this cur- riculum should be competent to work as a pri- mary nurse in cancer in the general and specialist setting.

The setting It should be possible to undertake the course in any educational setting, providing the learners are able to have access to potential patients in a health-promotion context, and. actual patients undergoing diagnostic tests, surgery, ,radio- therapy, chemotherapy and palliative care.

The setting in which training is given may vary in accordance with the health and educational structures of the country or region in which the education and training take place. (National and regional circumstances may vary.) It is not prac- tical, therefore, to attempt to provide a blue-print for an ideal training environment. What is pos- sible in one area may be unattainable in another. Part-time, modular or distance learning should not be excluded from planning programmes based on this curriculum.

There are two important general principles which, nevertheless, need to be met:

0 The setting, both educational and practice- based, should be appropriate to the nature of the education and training to be provided, and should enable the objectives of the training to be met to the fullest extent. 0 Adequate resources must be available to achieve this. If these resources are not available locally or nationally, then they should be shared by those European colleagues who do have them.

Assessment and evaluation There needs to be assessment of student per- formance in relation to both the theoretical and practice components of the course, which must be clearly stated. Methods of assessment will vary across Europe. Assessments may include written examinations, individual or group essays or care- plans, oral presentations of the learner’s own work, assessment of practice and clinical skills, and self-assessment techniques. Assessment may be carried out by the teachers, clinical staff, peer group, and the learners themselves.

In addition to individual assignments, pro- gressive assessments of knowledge and skills

should be made throughout the length of the course. Formative and summative evaluation of the course may be achieved by involvement of all those concerned in its design, development and implementation, including the participants themselves. Clearly identifiable objectives need to be set for evaluation during course planning. These may relate to the theoretical content of the course, the practice or clinical setting, the personnel and the available resources. Again, all aspects of course design and planning may vary depending upon the setting in each European country, but each will need to be considered as part of the course-planning team’s remit.

Monitoring The course-planning team will be responsible for monitoring the quality of the course and its out- come, and for making revisions as necessary.

Outcomes In order to begin to look at the quality and standard of education achieved as a result of im- plementing this core curriculum, nursing out- comes for each of the main components of the curriculum are suggested below.

Health promotion, prima y and seconda y pre- vention of cancer. Expected outcomes include the ability of nurses to assess the health needs of a de- fined population together with other disciplines and to set standards to initiate prevention and early detection programmes.

Treatment for cancer. Expected outcomes include: - the competence of the nurses to provide

adequate care and life support during the implementation of treatment protocols for patients with cancer;

- the ability of nurses to acknowledge the current health status of patients and to work with them and their families to establish appropriate coping strategies to live with cancer.

Care and rehabilitation. Expected outcomes include: - the ability of nurses to assess requirements

for the care and rehabilitation of patients within their usual or current social context; the competence to deliver that care in collaboration with other professional colleagues; the recognition of the contribution of each member of the health-care team in the delivery of care; the ability to evaluate the effects of care and adapt care plans as necessary; the ability to acknowledge the involvement of patients and their families in each of the above.

EuropeanJournal of Cancer Care 1:2, 1992 11

Conclusion This curriculum has been prepared for use throughout Europe - an area where differences occur in the structure and management of educa- tion, nursing and nurse education. Throughout this document, therefore, there is an emphasis on flexibility and the need for national and local interpretation.

This is a core curriculum for cancer nursing, and is the first of a series of planned curricula. Subsequent curricula will address subspecialities such as paediatric cancer nursing and nursing the elderly with cancer. Other topics, such as sexuality and altered body image in patients having received treatment for cancer, will also be addressed. The European Oncology Nursing Society will promote the dissemination of these

curricula and other resources among nurses in Europe.

References Commission of the European Communities (1 986)

Europe Against Cancer Programme: Proposal for a plan of action 1987-1989. Commission of the Euro- pean Communities, Brussels (Com 861717 final).

Commission of the European Communities (1988) Advisory Committee on Training in Nursing. Report on Training in Cancer Nursing. Commission of the European Communities, Brussels (III/D/248/3/88).

Tiffany R., Webb P., Copp K. & Pritchard A.P. (1987) Report of the ad-hoc Working Group on Training in Cancer to the Advisory Committee on Training in Nursing. Commission of the European Communities, Brussels.

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