Nurses Attitudes and Knowledge Towards Controlling Chemotherapy Side Effects - Literature review Example

Nurses Attitudes and Knowledge towards controlling Chemotherapy side effects among cancer patients Introduction Nurses are professionals who come across with a variety of patients daily during their professional lives. The needs of these patients could be different because of the different types of diseases they might be suffering from. It is difficult for the nurses to fulfill all the demands of the patients because of the inadequate training they are obtaining and the changing nature of diseases and the demands of the patients. Kearney et al (2003) mentioned that despite advances the medical science that have led to effective treatments for cancer, myriad myths and biases related to cancer pervade both patients and professionals and act as hindrances to early detection, treatment and rehabilitation. Cancer is so much hyped disease among the general public that there is a belief that it is nearly impossible to diagnose it. Therefore it is necessary that healthcare professionals are aware of these misconceptions and are also aware of the facts about cancer. The present paper is a systematic review of previous findings pertaining to the attitudes of nurses towards chemotherapy and the knowledge of nurses towards side effects management among cancer patients. Attitudes of Nurses towards Chemotherapy in cancer and their knowledge on side effects of chemotherapy According to study “Exploring the work of nurses who administer chemotherapy”, published in the European Journal of Oncology Nursing by Veritya et al, (2008) nearly all nurses (95% from 26 London Hospitals) reported being frightened, scared and anxious when initially working with chemotherapy. Of these 86% stated they became more confident with experience, when supported by knowledgeable role models and following chemotherapy education. Over 80% (206) of the sample had received some form of education, whilst 241 nurses (94%) thought they could benefit from more. Nurses reported they were often or always worried about extravasations (44%), anaphylactic reactions (37%), and other nurses’ education and knowledge deficits (46%) (Veritya et al, 2008) As per the above study, nurses are not getting adequate training as desired on chemotherapy during their academic studies. It is important to note here that most of the nurses involved in the study were frightened and anxious which shows negative attitude towards chemotherapy in cancer. It is also revealed that nurses gain knowledge through experience and do not get adequate training on working with chemotherapy. Nausea, Vomiting, pain, fatigue etc are the major side effects of chemotherapy and the agony associated with these side effects are so severe that even a normal trained nurse cannot tolerate it. The patient who undergoes chemotherapy may complain so many things because of the severe discomforts and pain and in many cases; nurses may not have proper answer to these complaints. In a study “Oncology healthcare professionals’ attitude to cancer: a professional concern” by Kearney et al (2003), all the registered healthcare professionals from Regional Cancer Centre in Scotland were the population intended to survey which included medical, nursing and radiotherapy staff. Altogether 197 staffs were recruited for the purpose of survey. The study was to assess the attitude of oncology healthcare professionals towards cancer which was mostly dominated by females contributing to 91% of the respondents out of which 102 were registered nursing staff. A structured was carried out using Burns’ Cancer Brief Scales in view of its simplicity. The findings of the study revealed that despite working in Cancer Centre, nurses hold negative attitude towards cancer. The study supports the finding of Corner who found that professional experience reinforces negative attitude regarding chemotherapy in cancer which may lessen the effectiveness of support offered by nurses who fear cancer because staff holding negative attitude may be likely to take different decision than the one with positive attitude placing low value on the patient and psychological care. The study suggests educating the nurses and other healthcare professionals to alleviate fear and promote positive image. Slevin et al (1990) in a study “Attitudes to chemotherapy: Comparing views of patients with cancer with those doctors, nurses and general public”; 1000 nurses working on cancer were randomly chosen in London teaching hospital among other healthcare professionals along with patients to compare and assess the personal cost benefit of chemotherapy. Out of 1000 cancer nurses, only 303 (30%) responded to the questionnaire designed for the purpose of the study. The study reveals that patients were willing to accept intensive chemotherapy for a very small chance of benefit whereas nurses and healthcare professionals were less likely to accept radical treatment for minimal benefit with 10-50% leading to 12-24 months and 50-75% to treat for prolonging life, complete cure, and relief of symptoms respectively. (Slevin et al, 1990) The study reveals that the patients are much more willing to accept radical treatment as compared to nurses working on cancer. This shows their attitude towards cancer and level of fear that makes them to opt for less intense treatment of cancer through chemotherapy. Yildirim et al (2008) mentioned about the knowledge of nurses working in cancer care in “Knowledge and Attitudes of Turkish Oncology Nurses about Cancer Pain Management” It is further mentioned that effective pain management requires accurate knowledge along with correct attitude and assessing skills. The study, which included 68 oncology nurses from two university hospitals, uses the Nurses’ Knowledge and Attitudes Survey Regarding Pain was used measure the nurses knowledge and attitude which were later analyzed by descriptive statistics. The average correct response rate was 35.41% with rates ranging from 5.13% to 56.41%. The study reveals the most the correct answers were given by the nurses who were more experienced than the others which show that training courses offered in the courses do not fully equip the nurses on how to manage the cancer patients. The study suggests educating the nurses in order to improve the knowledge level regarding management of the side effects and other related issues of cancer. The findings of the study emphasize on training and educating the oncology nurses on how to deal with side effects cancer and manage the patients. Furstenberg et al (1998) in “Knowledge and Attitudes of Health Care Providers toward Cancer Pain Management: A Comparison of Physicians, Nurses, and Pharmacists in the State of New Hampshire” mentioned that barriers to optimal treatment of cancer pain exist at all levels of the healthcare system. This study was conducted as part of the New Hampshire State Cancer Pain Initiative so as to evaluate the knowledge and attitudes of all three types of provider’s viz. physicians, nurses and pharmacists. The sample size consisted of 1008 nurses including 189 Licensed Practical Nurse (LPN) and 819 Registered Nurses (RN apart from physicians and pharmacists. It was found that 74% nurses were comfortable managing cancer pains while only 3% reported poor adequacy training. However it is to mention that many respondents lacked knowledge of the fundamental facts of opioid pharmacology including choice of drug, routes and schedules. It is further revealed that 70% of the nurses agree that most of the patients enter health care system for relief of pain whereas 91% of the nurses strongly agree that physician should be contacted if the patient is not relieved of pain after receiving pain relieving medications while 9% of nurses somewhat agree with the decision. This shows that lack of knowledge, seriousness and awareness among nurses and it is necessary to impart training and education to nurses in managing various effects of cancer. Coleman et al (2009) in “Effect of Certification in Oncology Nursing on Nursing-Sensitive Outcomes” compared certified nurses with non certified nurses for knowledgeable and clinical behaviors related to symptom management of pain and chemother­apy-induced nausea and vomiting (CINV), patient satisfaction and nurse satisfaction. The study revealed that certified nurses participated in continuing education programmes and most of them were members of ONS as a result of which certified nurse’s scored more than non certified nurses. It is further revealed that nurses with more continuing educations had good knowledge on nausea while nurses in ONS had good knowledge on both pain and nausea. The findings of the study reveal that certification in oncology nursing improves patient care quality. PICO Analysis Article Population Intervention Outcome Coleman et al, (2009) Effect of Certification in Oncology Nursing on Nursing-Sensitive Outcomes Certified and non certified nurses To compare the knowledge and attitude of certified nurses and non certified nurses towards symptom management Certified nurses showed better knowledge level than the non certified nurses in the side effect management of Chemotherapy Veritya et al (2008) Exploring the work of nurses who administer chemotherapy Nurses, across 26 London hospitals providing cancer services The study was carried out to study the attitude of nurses while administering chemotherapy and the education level among the nurses. It was revealed that most of the nurses got frightened and didn’t have adequate knowledge due to lack of proper education during academic trainings. Kearney N, et al (2003) Oncology healthcare professionals’ attitude to cancer: a professional concern, 197 healthcare professionals of Regional Cancer Centre in Scotland out of which 102 were nurses To assess the attitude of oncology healthcare professionals towards cancer Despite working at Cancer centre, nurses held negative attitude towards cancer deterring them to take decisions in time of crisis as compared to those with positive attitude who were mostly experienced nurses Slevin et al (1990) Attitudes to chemotherapy: Comparing views of patients with cancer with those doctors, nurses and general public 1000 nurses working on cancer were randomly chosen from London teaching hospital. Out of which only 303 responded to the questionnaire To compare and assess the personal cost benefit of chemotherapy It was revealed that patients were willing to opt for radical care treatment in chemotherapy which was less likely accepted by the healthcare professionals due to low attitude towards cancer. Yildirim et al (2008) “Knowledge and Attitudes of Turkish Oncology Nurses about Cancer Pain Management” 68 Oncology nurses from two university hospitals To assess the knowledge of nurses for effective pain management It is found that more experienced nurses were comfortable in managing the patients and had good knowledge on pain management as compared to trained nurses Furstenberg et al (1998) “Knowledge and Attitudes of Health Care Providers toward Cancer Pain Management: A Comparison of Physicians, Nurses, and Pharmacists in the State of New Hampshire” 1008 nurses including 189 LPN and 819 RN To evaluate the knowledge and attitudes of all three types of provider’s viz. physicians, nurses and pharmacists. Though the nurses are aware of pain management and had good knowledge on cancer related issues, there is still some lack of know how among the professionals, and it is essential to impart training so as to make them aware of various serious and unknown treatments. References 1. Coleman E.A, Coon, S.K., Lockhart, K., Kennedy, R., Montgomerry, R. Copeland N, McNatt, Savell, and Stewart, C (2009) Effect of Certification in Oncology Nursing on Nursing-Sensitive Outcomes, Clinical Journal of Oncology Nursing • Volume 13, Number 2, 165-172 2. Furstenberg K, Ahles, T., Whedon, M.B, Pierce, K Dolan,M, Roberts, L, and Silberfarb P.M. (1998) Knowledge and Attitudes of Health-Care Providers Toward Cancer Pain Management: A Comparison of Physicians, Nurses, and Pharmacists in the State of New Hampshire, Journal of Pain and Symptom Management, Vol, 15, No. 6, 335-349 3. Kearney N, Miller M, Paul, J, Smith K, and Rice A.M (2003) Oncology healthcare professionals’ attitude to cancer: a professional concern, Annals of Oncology 14:57-61 4. Slevin L, Maurice, Linda Stubbs, Hilary J Plant, Peter Wilson, Walter M Gregory, P Joanne Armes, Susan M Downer (1990) Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public, BMJ, Volume 300:1458-60 5. Veritya,R., Wisemana, T., Reama,E., Teasdaleb, E. & Richardsona, A (2008), Exploring the work of nurses who administer chemotherapy, European Journal of Oncology Nursing, Volume 12, Issue 3. 6. Yildrim Y.K. and Cicek F (2008) Knowledge and Attitudes of Turkish Oncology Nurses about Cancer Pain Management, The American Society for Pain Management, Pain Management Nursing, Vol 9, No 1 pp 17-25 Read More