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 G lobal 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, specifically 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 effectively prevent and/or manage the associated toxicities and support patients to maintain adherence 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 [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 482 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 working 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 working group (Donalda MacDonald, Komal Patel, Janice Stewart, Tracy Truant) was tasked with developing a culturally sensitive 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 different practice environments and health care systems among the four countries. In addition to a review of the literature for OT nursing 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 final pilot version of the OT education 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 document developed by the working group outlined the role, standards and competencies 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 effective for the Latin American context, the program was pilot tested in December 2013. Nurse champions were identified in each of the four countries to receive and contextualize the education materials further and offer the pilot OT program in their country. With support from the working group members, nurse champions 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 revision and refinement of the program. A final workshop held in May 2014 used the refined program and was delivered in both Spanish and Portuguese. It was conducted in Bogota, Colombia with 42 nurses from all four countries, Volume 25, Issue 4, Fall 2015 • Canadian Oncology Nursing Journal Revue canadienne de soins infirmiers en oncologie REFERENCES Ayala de Calvo, L.E. (2010). Working conditions and professional education in oncology nursing in countries of Central and South America. Oral presentation at the 16th Annual International Conference in Cancer Nursing, Atlanta, Georgia, USA. Retrieved from http://storage.googleapis. com/16th_iccn/Documents/16th_iccn_ abstract_book.pdf Ayala de Calvo, L.E. (2014, September). Cancer issues in Latin America and global implications: Challenges for oncology nursing in Latin America. Plenary presentation at the 18th Annual International Conference in Cancer Nursing, Panama City, Panama. Retrieved from http://storage.googleapis. com/18th_iccn/ICCN_Final_Program_ WEBSITE.pdf Barton, D. (2011). Oral agents in cancer treatment: The context for adherence. Seminars in Oncology Nursing, 27(2), 104–115. 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 administered nine months after the completion of the final workshop to determine the uptake of the OT education program in each of the settings. The final evaluation results are under review, but preliminary analysis shows the additional 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 initiative has had far-reaching benefits 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 development, implementation, evaluation and ongoing monitoring of future collaborative international initiatives. We have had the good fortune to learn from our Latin American colleagues about maintaining a passion for oncology nursing and patient care, despite significant 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 program—modular PowerPoint presentations and other resources (e.g., MASCC oral agent teaching tool; NCIC toxicity 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 Pfizer. Canadian Association of Nurses in Oncology (CANO/ACIO) (2010). CANO/ ACIO position statement on cancer chemotherapy administration and care: Oral chemotherapy supplement. CANO/ ACIO: Vancouver, BC. Retrieved from http://www.cano- acio.ca/~ASSETS/ DOCUMENT/CANO-Position-statementSupplement-On-Oral-ChemotherapyFinal%20July%202013-D2.pdf de Souza Institute (2015). About de Souza. Retrieved from http://www. desouzainstitute.com/ Neuss, M.N., Polovich, M., McNiff, K., Esper, P., Gilmore, T.R., LeFebvre, K.B., Schulmeister, L., & Jacobson, J.O. (2013). 2013 Updated American Society of Clinical Onclogy/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. Journal of Oncology Practice, 9(2s), 5s–13s. Oakley, C., Crowe, M., & Johnson, M. (2010). Introducing the United Kingdom Oncology Nursing Society’s (UKONS) position statement on oral chemotherapy. European Journal of Cancer Care, 19, 1–4. doi:10.1111/j.1365-2354.2010.01194.x Schneider, S.M., Hess, K., & Gosselin, T. (2001). Interventions to promote adherence with oral agents. Seminars in Oncology Nursing, 27(2), 133–141. Sheldon, L.K. (2010). International cancer care: What is the role of oncology nursing? Clinical Journal of Oncology Nursing, 14(5), 539–541. doi:10.1188/10. CJON.539-541 Weingart, S.N., Spencer, J., Buia, S., Duncombe, D., Singh, P., Gadkari, M. & Connor, M. (2011). Medication safety of five oral chemotherapies: A proactive risk assessment. Journal of Oncology Practice, 7(1), 2–6. Canadian Oncology Nursing Journal • Volume 25, Issue 4, Fall 2015 Revue canadienne de soins infirmiers en oncologie 483 FEATURES/Rubriques and was facilitated by the nurse champions who conducted the pilot workshops. These final workshop participants were invited based on their potential to teach the OT program to other nurses in their country and/or influence the revision of models of care and allocation of nursing resources to provide OT nursing care. At the end of the final 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 final workshops were available to provide ongoing support and coaching to these nurses, as they taught the OT program in their own countries and practice settings. Evaluation of the pilot and final 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 effective to collaboratively