Partnering with oncology nursing leaders in Latin therapies in cancer

482 Volume 25, Issue 4, Fall 2015 • CanadIan onCology nursIng Journal
reVue CanadIenne de soIns InFIrmIers en onCologIe
FEATURES/RUbRiqUES
internAtionAl PersPectiVes
Partnering with oncology nursing leaders in Latin
America to deliver an education program on oral
therapies in cancer
by Tracy Truant, Esther Green and Luz Esperanza Ayala de Calvo
Global initiatives and partnerships
among nurses between and across
countries are important strategies to
begin to address global inequities in
cancer care (Sheldon, 2010). Cancer
nurse leaders in Latin America, spe-
cically Argentina, Brazil, Colombia,
and Mexico, recently advocated for
enhanced access to high-quality oral
therapies (OT) nursing education and
resources, as well as improved direct
nursing care of people receiving OTs
(Ayala de Calvo, 2010, 2014). Despite
increasing numbers of cancer patients
receiving OTs in those countries, few
receive care by knowledgeable nurses
who can eectively prevent and/or man-
age the associated toxicities and sup-
port patients to maintain adherence
to the treatment plan (Barton, 2011;
Schneider, Hess & Gosselin, 2011). This
gap in OT nursing care may negatively
impact patients’ quality and length of
life (CANO/ACIO, 2010; Neuss et al.,
2013; Oakley, Crowe & Johnson, 2010;
Weingart et al., 2011).
Over the past three years, these
Latin American nursing leaders have
partnered with a Canadian work-
ing group under the auspices of
ISNCC’s Philanthropic and Corporate
Committee. Co-led by Esther Green
(Canada) and Luz Esperanza Ayala
de Calvo (Colombia), and supported
by the Executive Director of ISNCC
(Sarah McCarthy), the Canadian work-
ing group (Donalda MacDonald, Komal
Patel, Janice Stewart, Tracy Truant) was
tasked with developing a culturally sen-
sitive train-the-trainer OT education
program for nurses in Latin America.
Using a participatory collaborative
approach, the working group met via
web-based technology for more than
a year to understand the OT learning
needs in Latin America and create the
train–the-trainer program, which was
contextualized for the dierent practice
environments and health care systems
among the four countries. In addition
to a review of the literature for OT nurs-
ing care best practices, permission was
obtained to contextualize the de Souza
Institute’s (de Souza Institute, 2015)
OT learning modules for the unique
needs in Latin America. Canadian nurse
educators Simonne Simon and Diana
Incekol were involved in completing
the nal pilot version of the OT educa-
tion program, which included modules
on 1) introduction to OTs, 2) nurse’s
role and responsibilities, 3) teaching
and learning principles of OTs, 4) oral
therapies for cancer therapy, 5) toxicity
assessment and management, and
6) safe handling and disposal of oral
hazardous drugs. Given the minimal
development of nursing roles in OT
care in Latin America, another key doc-
ument developed by the working group
outlined the role, standards and com-
petencies of the registered nurse in the
care of people receiving oral therapy
and their families. This document was
deemed essential to advocate for OT
nursing resources, revisions to models
of care that align nursing resources to
patients’ OT needs and develop policies
to support professional nursing practice
related to OT care.
To ensure the OT train-the-trainer
program was complete and eective for
the Latin American context, the pro-
gram was pilot tested in December 2013.
Nurse champions were identied in
each of the four countries to receive and
contextualize the education materials
further and oer the pilot OT program
in their country. With support from the
working group members, nurse cham-
pions Silvina Estrella de Ellis, Victoria
Brunelli and Clara Cullen (Argentina),
Patricia Salles and Lailah Nunes (Brazil),
and Luz Esperanza Ayala de Calvo
(Colombia and Mexico) delivered the
one-day educational program to nurses
in each of those countries in a face-to
face format. Seventy-six oncology nurses
from a variety of practice settings, some
travelling more than 1,000 km, attended
one of the four pilot workshops.
Evaluations were conducted at each pilot
workshop, which aided in further revi-
sion and renement of the program.
A nal workshop held in May 2014
used the rened program and was deliv-
ered in both Spanish and Portuguese.
It was conducted in Bogota, Colombia
with 42 nurses from all four countries,
About tHe AutHors
*Tracy Truant, RN, MSN, PhD(c),
Doctoral Candidate, University
of British Columbia School of
Nursing, T201-2211 Wesbrook Mall,
Vancouver, BC V6S 1R6
604-230-2001
T[email protected]
Esther Green, RN, BScN,
MSc(T), Director, Person Centred
Perspective, Canadian Partnership
Against Cancer, 1 University Avenue,
Toronto, ON M5J 2P1
Esther.green@
partnershipagainstcancer.ca
Luz Esperanza Ayala de Calvo,
MEd, ONS, RN, Especialista
en Enfermería Oncológica- Mg.
Educación e Investigación, Consultora
Independiente de educación en
cáncer, Vicepresidenta Asociación de
Enfermería Oncológica Colombiana
(AEOC), Magistrada Tribunal
Nacional Ético de Enfermería (TNEE
[email protected]
*Preferred author for correspondence

483
Canadian OnCOlOgy nursing JOurnal • VOlume 25, issue 4, Fall 2015
reVue Canadienne de sOins inFirmiers en OnCOlOgie
FEATURES/RUbRiqUES
and was facilitated by the nurse champi-
ons who conducted the pilot workshops.
These nal workshop participants were
invited based on their potential to teach
the OT program to other nurses in their
country and/or inuence the revision of
models of care and allocation of nurs-
ing resources to provide OT nursing
care. At the end of the nal workshop
in Bogota, participants returned to their
countries and practice settings with the
expectation that they would use this
new knowledge in their own practice,
as well as teach the OT program to their
peers. Nurse champions who taught the
pilot and nal workshops were available
to provide ongoing support and coach-
ing to these nurses, as they taught the
OT program in their own countries and
practice settings.
Evaluation of the pilot and nal
workshop revealed high satisfaction and
improved knowledge about the nursing
care of people receiving OTs for their
cancer. Participants felt the face-to-face
format was eective to collaboratively
problem solve issues unique to their
settings, such as, for example, how to
maintain safety with minimal personal
and protective equipment, or how to
advocate for nursing roles and resources
to meet the standards of practice for OT
nursing care.
An additional evaluation was admin-
istered nine months after the comple-
tion of the nal workshop to determine
the uptake of the OT education pro-
gram in each of the settings. The nal
evaluation results are under review, but
preliminary analysis shows the addi-
tional value that the nurses experienced
through the education program, and the
support they experienced to apply the
knowledge in their clinical settings.
This international collaborative ini-
tiative has had far-reaching benets
beyond that of its intended goals. In
addition to sharing expertise to address
a gap in oncology nursing care in Latin
American countries, we have been able
to develop a template for the develop-
ment, implementation, evaluation and
ongoing monitoring of future collabo-
rative international initiatives. We have
had the good fortune to learn from our
Latin American colleagues about main-
taining a passion for oncology nursing
and patient care, despite signicant
obstacles. Perhaps most importantly, we
have come to a shared understanding
of what it means to be a global citizen
and to embrace nursing’s social justice
imperative to promote equity in health
for all.
Currently, the OT education pro-
gram—modular PowerPoint presenta-
tions and other resources (e.g., MASCC
oral agent teaching tool; NCIC tox-
icity assessment tool)—is available
online in Spanish and Portuguese on
the ISNCC website (http://www.isncc.
org/?page=OralChemo) for all to access
for future teaching and/or review.
English versions of the program will be
available on the ISNCC website by the
end of 2015, and available for all to use.
This project was supported by an
unrestricted grant from Pzer.
reFerences
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