The History Of Chemotherapy Nursing Essay

This chapter presents the summary, conclusion, implications, recommendations and limitations of the study.

SUMMARY

Chemotherapy is the treatment of cancer with one or more cytotoxic antineoplastic drugs ("chemotherapeutic agents") as part of a standardized regimen. Chemotherapy may be given with a curative intent or it may aim to prolong life or to palliate symptoms. It is often used in conjunction with other cancer treatments, such as radiation therapy or surgery. Certain chemotherapeutic agents also have a role in the treatment of other conditions, including ankylosing spondylitis, multiplesclerosis, psoriasis, rheumatoid arthritis, and scleroderma.

Traditional chemotherapeutic agents act by killing cells that divide rapidly, one of the main properties of most cancer cells. This means that chemotherapy also harms cells that divide rapidly under normal circumstances: cells in the bone marrow, digestive tract, and hair follicles. This results in the most common side-effects of chemotherapy: myelosuppression (decreased production of blood cells), mucositis (inflammation of the lining of the digestive tract), and alopecia (hair loss).

Some newer anticancer drugs (for example, various monoclonal antibodies) are not indiscriminately cytotoxic, but rather target proteins that are abnormally expressed in cancer cells and that are essential for their growth. Such treatments are often referred to as targeted therapy (as distinct from classic chemotherapy) and are often used alongside traditional chemotherapeutic agents in antineoplastic treatment regimens.

Healthcare workers exposed to antineoplastic agents take precautions to keep their exposure to a minimum. There is a limitation in cytotoxics dissolution in Australia and the United States to 20 dissolutions per pharmacist/nurse, since pharmacists who prepare these drugs or nurses who may prepare or administer them are the two occupational groups with the highest potential exposure to antineoplastic agents. In addition, physicians and operating room personnel may also be exposed through the treatment of patients. Hospital staff such as receiving personnel, custodial workers, laundry workers, and waste handlers, all have potential exposure to these drugs during the course of their work. The increased use of antineoplastic agents in veterinary oncology also puts these workers at risk for exposure to these drugs.

Safety standard protocol for chemotherapy administration helps the health care providers to monitor and evaluate the care which is crucial for the success of preventive measures. Educating and training of health care providers who prepare and administer chemotherapy is essential for preventing medication error, thereby increasing patient outcomes and decreasing health care hazards. When protocols are used by everyone it is easy to analyze whether the approaches laid down are scientifically and statistically effective.

The purpose of the study was to assess the effectiveness of safety standard protocol for chemotherapy administration on knowledge and practice among nurses.

The objectives of the study were

To assess the level of need for safety standard protocol for chemotherapy administration among nurses in experimental and control group.

To assess and compare the post test level of knowledge and practice regarding safety standard protocol for chemotherapy administration among the experimental and control group.

To correlate the post test level of knowledge regarding safety standard protocol for chemotherapy administration with practice among experimental and control group.

To associate the post test level of knowledge and practice regarding safety standard protocol for chemotherapy administration with selected demographic variables of nurses in the experimental and control group.

The study was based on the assumptions that

Nurses may have some knowledge on safety standard protocol for chemotherapy administration.

Providing information on safety standard protocol for chemotherapy administration may enhance the knowledge and practice regarding safety during chemotherapy administration among nurses.

The null hypotheses formulated were

NH1 : There is no significant difference in the post test level of knowledge on safety standard protocol for chemotherapy administration between the experimental and control group at p < 0.05 level.

NH2 : There is no significant difference in the post test level of practice on safety standard protocol for chemotherapy administration between the experimental and control group at p < 0.05 level.

NH3 : There is no significant relationship in the post test level of knowledge with practice on safety standard protocol for chemotherapy administration among nurses in the experimental and control group at p < 0.05 level.

NH4 : There is no significant association of the post test mean knowledge score on safety standard protocol for chemotherapy administration with selected demographic variables of experimental and control group at p < 0.05 level.

NH5 : There is no significant association of the post test mean practice score on safety level protocol for chemotherapy administration with selected demographic variables of experimental and control group at p < 0.05 level.

The review of literature, professional experience and expert’s guidance from the field of Medical and Surgical Nursing provided a strong foundation for the study. It also strengthened the ideas for conceptual framework, aided to design the methodology and develop the tool for the data collection.

In view of explaining and relating various aspects of the study, the investigator had adopted an Integrated Stuffle Beam’s model and Von Berttalannfy’s General system theory.

The researcher adopted a quasi experimental between group post test only design to assess the effectiveness of safety standard protocol for chemotherapy administration on knowledge and practice among nurses. 60 nurses were selected using non probability convenient sampling technique.

The tool for data collection had 4 sections. Section A: Personal Data Sheet to collect the demographic characteristics of nurses which includes Age (in yrs), Gender, Designation, Professional educational status, Total year of experience, any previous in-service education on chemotherapy administration protocol. Section B: Need Assessment Scale used to identify the need for safety standard protocol for chemotherapy administration. In this section 5 dichotomous questions were formulated. Section C: structured questionnaire to assess the knowledge of nurses about safety standards to follow chemotherapy administration. Section D: observational checklist to assess Post test level of Practice. Section E: Safety Standard Protocol. It comprises of 3 parts: I. Resource Material on chemotherapy, types of chemotherapeutic agents II. Self Instructional guidelines on General Chemotherapy Practice Standards, Chemotherapy Order Standards, Patient consent and education, Drug preparation, Drug administration and post chemotherapy care III. Demonstration of intravenous Chemotherapy Administration.

The Medical and Nursing experts validated the tool. The pilot study was conducted at V.S. Hospital, Chetpet, Chennai and it was found practicable and feasible to proceed with the main study.

The ethical aspect of research was maintained throughout the study by obtaining ethical committee clearance from the ICCR, formal permission from the authorities and written consent from the nurses who participated in the study.

The study was conducted for a period of 4 weeks. A brief introduction of self and explanation on the purpose of the study was given. The written consent from the nurses for data collection was obtained.

The investigator selected 60 nurses who fulfilled the sample selection criteria using the non probability convenience sampling technique from the medical, surgical, and pediatric oncology department of Cancer Institute, Adyar. The participants were assigned an identification number to maintain confidentiality. Initially, demographic detail was elicited using structured profile, and then the need assessment was done by using positive worded questionnaire. 25 (41.7%) nurses had high level of need, 19 (31.6%) nurses had moderate level of need, and 16 (26.7%) nurses had low level of need.

In the control group, the investigator administered structured questionnaire to assess their knowledge regarding safety standard protocol for chemotherapy administration. Each sample took 30-35minutes to answer the questions and their practice was assessed by using observational checklist. The self instructional protocols were given to the nurses in the control group at the end of the study.

Similarly, for the experimental group self introduction about the investigator and information about the nature of the study was explained. Resource material and self instructional safety standard protocol for chemotherapy was administered following that demonstration on chemotherapy administration was also done to the samples. Chemotherapy administration practice was assessed for the following 7 days. After 7 days, the nurses were gathered in batches based on their availability and were seated comfortably within the wards. Post test questionnaire was administered. Each sample took 30-35 minutes to answer the questions.

The major findings of the study

The overall post test mean of knowledge in experimental group was 19.87 with S.D of 4.77 and the overall post test mean score of knowledge in control group was 17.10 with S.D of 4.57. The mean differed knowledge score between experimental and control group was 2.27. It showed that after the administration of chemotherapy administration safety standard protocol, there was a significant improvement in the knowledge level of nurses with a‘t’ value of 2.292 at p<0.05 level.

Hence the NH1 stated earlier that ‘there is no significant difference in the post test level of knowledge on safety standard protocol for chemotherapy administration between the experimental and control group at p < 0.05 level was rejected.

The overall post test mean of practice in experimental group was 11.57 with S.D of 3.34 and the overall post test mean of practice in control group was 9.50 with S.D of 3.12. The mean differed practice was 2.07. It showed that after the administration of chemotherapy administration safety standard protocol, there was a significant improvement in the practice level of nurses with a‘t’ value of 2.481 at p<0.05 level.

Hence the NH2 stated earlier that ‘There is no significant difference in the post test level of practice on safety standard protocol for chemotherapy administration between the experimental and control group at p < 0.05 level was rejected.

With regard to the post test level of knowledge in the experimental group, the mean score was 19.87 with S.D of 4.77. In the post test level of practice, the mean score was 11.50 with S.D of 3.34. The calculated Karl Pearson ‘r’ value was 0.482 with significance at p<0.01 level. It showed that after the administration of chemotherapy administration safety standard protocol, there was a moderate positive correlation between post test level of knowledge and practice in the experimental group.

With regard to the post test level of knowledge in the control group, the mean score was 17.10 with S.D of 4.57. In the post test level of practice, the mean score was 9.50 with S.D of 3.12. The calculated Karl Pearson ‘r’ value was 0.69 with moderate level of significance at p<0.01 level. It showed that after the administration of chemotherapy administration safety standard protocol, there was a moderate positive correlation between post test level of knowledge and practice in the control group.

Hence the NH3 stated earlier that ‘There is no significant relationship in the post test level of knowledge with practice on safety standard protocol for chemotherapy administration among the experimental and control group at p < 0.05 level was rejected.

The analysis using chi square test, showed that there was a low significant association of the post test level of knowledge with educational status and total years of experience of nurses in the experimental group and with the total years of experience of nurses in the control group in dealing with chemotherapy administration at p<0.05 level

.

The educational qualification which is generally an assumed variable to have an association with the posttest level of knowledge score did not show any association. Professional seniority and years of experience provides more opportunity to the nurses for sharing of knowledge from other members of the health team, self instruction by utilization of books, internet, etc.

Hence the NH4 stated earlier that "There is no significant association of the post test mean knowledge score on safety standard protocol for chemotherapy administration with selected demographic variables of experimental and control group at p < 0.05 level was rejected for the educational status and total years of experience in experimental group and total years of experience in control group and was accepted for the other demographic variables such as age, designation and gender.

The analysis using chi square test, showed that there was a low significant association of the post test level of practice with educational status of nurses in experimental group at p<0.05 level.

There was no significant association between the post test level of practice with selected demographic variables of nurses in control group at p<0.05 level.

Hence the NH5 stated earlier that "There is no significant association of the post test mean practice score on safety standard protocol for chemotherapy administration with selected demographic variables of experimental and control group at p < 0.05 level was rejected for the educational status in experimental group and was accepted for other demographic variables such as age, gender and total years of experience whereas it is accepted for all the demographic variables for control group such as age, gender, designation and total years of experience.

CONCLUSION

The present study assessed the effectiveness of safety standard protocol for chemotherapy administration on knowledge and practice among nurses. On the basis of the above study findings, it can be said that by enhancing the nurse’s knowledge we can ensure sound practice and this should be a major concern in the present day health scenario. Hence, safety standard protocol for chemotherapy administration can be utilized by the nurses to provide effective care to cancer clients.

IMPLICATIONS

The investigator had drawn the following implications from this study which is of vital concern to the field of Nursing education, Nursing practice, Nursing administration and Nursing research.

Nursing Education

Nursing education is the foundation on which the nursing practice is built. Sound knowledge creates and ensures delivery of sound practice. Hence the prevention guidelines and protocols should be included in nurse’s education curriculum as well as in continuing refresher nursing education program.

Evidence based guidelines should be integrated into nursing practice to render effective and quality care.

Skill development is an essential component of professional life. The present study emphasizes on enhancement of knowledge and practice by making students to observe and assist in chemotherapy preparation and administration with adherence to safety standard protocol for chemotherapy administration.

Education has a positive impact on retention of knowledge, attitude and practice in all staff. There is a need to develop a system of continuing education to reduce the incidence of errors during chemotherapy administration and to improve the compliance with the interventions.

In service education, refresher course and training programs on chemotherapy administration should be systematically planned and regularly conducted for staff nurses to keep them updated.

Nursing Practice

Nurses being in direct contact with the clients round the clock, play a vital role in chemotherapy administration and patient care during treatment plan. The need for high degree of awareness, knowledge and skill in nursing practice is essential to prevent medication error and in turn safeguard patient too.

Demonstration of chemotherapy preparation and administration by experts to nurses working in medical, surgical, and pediatric oncology unit and adequate supervision of their practice will enable improvement of their practices. Thus, the safety standard protocol for chemotherapy administration prepared by the investigator should be put into practice in order to reduce errors and in turn benefit the patient and staff.

Safety standard protocol for chemotherapy administration helps nurses to provide uniform and wholesome package for clients undergoing chemotherapy. This helps to boost the image of the nurses as an indispensable member of the health care team with their own scientific body of knowledge and scope of practice.

In this evidence based environment, localized research can be expanded to solve the immediate problems arises during nursing practice.

Root cause analysis of the factors hindering implementation of safety standard protocol can be performed to improve nursing practice

Nursing Administration

Nurse administrators should facilitate and encourage nurses to update their knowledge and practice chemotherapy administration strategies by organizing in-service education program.

Nurse administrators should remain updated about the treatment modalities in cancer by attending various workshops and conferences to introduce the needed changes coming up through ongoing scientific research.

Nurse managers are in a position to prepare policies, protocols in relation to safety standards for chemotherapy administration and enhance its use in the hospitals.

Nurse managers can strengthen interdisciplinary and multidisciplinary collaboration with researchers in the field of cancer chemotherapy.

Nursing leaders in the hospitals and accrediting bodies can implement policies to make sure that nurses in India practice uniform protocols and guidelines. They must support and commit the resources needed to implement and monitor evidence based prevention practices and to measure their progress.

Nursing Research

The essence of research is to build up a body of knowledge in nursing. The findings of the present study serve as basis for other professionals and the student nurses to conduct further studies and to find out the effectiveness of various methods of providing education.

In India, the research studies related to assessment of knowledge and practice of staff nurses on safety standard protocol for chemotherapy administration was very few. Student researchers can be motivated to conduct studies in this area.

The nurse researchers should encourage the staff nurses to implement the research findings in their daily care and bring out more techniques to promote health of the clients.

Expanded dissemination of the research findings to nurse practitioners and student nurses through internet, journals, literature helps to promote evidence based practice.

The findings of the study will help the professional nurses and nursing students to gain knowledge on safety standard protocol for chemotherapy administration.

The generalization of the study results can be made by further replication of the study in various settings and larger population.

Develop stronger evidence base for nursing practice by conducting multisite studies.

RECOMMENDATIONS

The researcher encourages the use of safety standard protocol for chemotherapy administration in Cancer Institute, Adyar and V.S hospital, Chetpet, Chennai.

The researcher recommends the utilization of safety standard protocol for chemotherapy administration by the student nurses of Omayal Achi College of Nursing and its affiliated hospitals.

Similar study can be replicated on a larger sample to increase validity and generalizability of findings.

A true experimental study can be conducted to assess the effectiveness of the safety standard protocol for chemotherapy administration.

An explorative study can be done at various settings to identify factors influencing the nurse’s practice on chemotherapy administration.

A study can be conducted to evaluate the quality of nursing care after implementation of safety standard protocol for chemotherapy administration.

LIMITATIONS

The study was limited to staff nurses who are working in the medical surgical and pediatric oncology unit.

Researcher found difficulty in getting Indian reviews related to safety standard protocol for chemotherapy administration.

The researcher found it very strenuous to get permission from the hospital, to conduct the study.