Cancer Prevention and Control Workbooks Outcome Data
The evaluation of the workbooks provided a comprehensive picture of the impact of the information provided in the workbooks on program planning and implementation of programs. A complete description follows.
* Number of participants receiving the workbooks, 1996-2002 = 72
* Number of follow-up workbook evaluations returned = 57 (78% return)
* Translation into another language. Participants translated the entire workbook in some instances and, in others, translated the chapters most relevant to their needs (Fig 7).
* Nineteen languages have been documented: Armenian, Chinese, Czechoslovakian, Dhivehi, Georgian, Indonesian, Khasi, Latvian, Lithuanian, Persian, Portuguese, Romanian, Russian, Serbian, Slovene, Sotho, Spanish, Vietnamese, and Zulu.
* Translations in two additional languages are planned: Korean and Turkish
Workbook Chapters Most Often Used
The complete content of the workbooks was used in many instances but 9 of the topics were used more often: The Worldwide Overview; Breast, Cervical, and Lung Cancers; Nutrition; Pain Management; Risk Factors/Interventions; Psychosocial Support; and Palliative Care (Fig 8).
Application and Adaptation of Workbook Content for Multiple Uses
Multiple categories of content application were documented. Within each category, specific areas of use and application are noted. They are indicated in order of highest use (Fig 9).
Helpfulness of the Workbooks Overall
Fifty-four of the 57 participants rated the workbooks as very helpful and 3 found them somewhat helpful. The participants reported copies made for their libraries, given to teachers to integrate in their classes, used as a reference by staff in health departments, reproduced as files for health departments on cancer prevention, used as reference for talk on palliative care given at a National Nursing Conference, used for conducting workshops, seminars, and clinical assessment.
Participant Reports: Cultural Adaptations
Individual reports, as outlined in the "Evaluation" section, describe the multiple and various approaches used to address the cancer prevention and control issues in each country. The reports provide an overview of how each participant implemented programs and made changes in his or her personal health behaviors. They are the individual "stories or reports." The way, or how, they accomplished what they did, what they implemented, and why they chose a particular area for intervention is reported in relation to the culture and environment of the country. Categories of implementation strategies and issues emerged from the reports. They include identification of the facilitator-, educational approach-, learner-, common barrier-, and health behavior changes (Table 8).
Selected reports from the cancer workshop participants are presented to demonstrate the cultural diversity, the creativity in designing education programs, and the collaborative, collegial relationships the participants developed on return from the workshops.
Selected Reports (As submitted)
Brazil
Emilia Campos de Carvalho
Professor, Coordinator of Education
Activities developed since the workshop in Rio de Janeiro (August, 1998)
PROPOSAL
A research proposal "Nursing Care in Cancer Prevention, Early Detection, Treatment and Rehabilitation" to the Brazilian WHO Collaborating Centre for Nursing Research Development to work with partners on a study about nursing role in cancer prevention and control in Latin America.
PROGRAMS
School programs. The University of Sao Paulo at Ribeirao Petro College of Nursing offers its undergraduate nursing course since 1953. Since the beginning of the 1970's, the Oncology content was included in its curriculum. However, in 1999/2000 new topics such as nutrition and cancer, cancer pain and preventive interventions were introduced to the Nursing Undergraduate Program.
Community programs. Personal and group orientations to hospitalized patients and community members were intensified, especially regarding palliative care and psychosocial support.
Professional programs. Themes such as palliative care, psychosocial support and preventive interventions (life style and nutrition) were included in the Nursing Specialization Course (offered to clinical nurses who work in different areas, not only oncology).
REASONS TO SELECT THESE TOPICS
The above mentioned themes were selected because they were identified as necessary to nurses personal and professional formation as well as due to the interest of nurses and nursing undergraduate and graduate students.
PROGRAMS IMPLEMENTATION
The Chapters of the workbook Cancer Prevention contributed to the programs content. Also, some replicas of audiovisual materials as well as bibliographic references were used.
DIFFICULTIES
Strategies used to incorporate this content at the regular programs as well as in patients' orientation were not interrupted. However, we found some difficulties regarding the lack of demonstration tools (teaching models) for the orientation and training on physical examination.
RESULTS
1. Incorporation of knowledge and improvement of patients care through implementation of this clinical content in practice and in the review of work guidelines.
2. Consciousness about the need of preventive measures by patients, students and family members.
3. Understanding on cultural factors associated to cancer development and cancer pain by undergraduate students and nurses
4. Stimulus to create a Specialization Course on Oncology Nursing (400 hours) for nurses in Ribeirao Preto that will begin in February 2001.
5. Increase of research on nursing care in oncology, especially regarding psychosocial aspects.
6. Proposal to develop transcultural research on cancer nursing in the Americas, with the support of PAHO/Washington
7. Translation to Portuguese of some chapters of the workbook: Nutrition and Cancer, Program Evaluation, Cancer Pain, Palliative Care and Psychosocial Support (Annex 11).
CHANGES IN OWN BEHAVIOR
1. Personal incorporation of knowledge (alteration in dietary practices).
2. Personal implementation of preventive measures (breast self examination every three months, more attention regarding my skin and increase in physical activities.
Chile
Maria Aldunce
Nursing Consultant, PAHO
Home care services for palliative cancer care (PAHO)
WHY THIS PROGRAM
* Ever rising costs of health care has forced governmental and NGOs to consider home are as an alternative to hospital care.
* Goal of decreasing hospital length of stay
* PAHO, in work on palliative care, found home care to be relatively not developed in the region.
* In studies that have explored patient and family preferences regarding the site of care, home is the overwhelming preference, across country borders and disease and diagnostic states.
WHAT HELPED
Health Sector Reforms:
* Ever rising costs of health care has forced governmental and NGOs to consider home care as an alternative to hospital care.
* Goal of decreasing hospital length of stay.
TECHNOLOGICAL ADVANCES
* Ability to transfer some procedures from hospital to home.
DIFFICULTIES
* Differences on economical and technological development, medical and nursing education, and health problems among the Latin American and Caribbean countries.
RESULTS/OUTCOMES
* Final product was a draft for a PAHO Series document.
* A document that will be delivered to all the ministries of health of the region, with the goal of helping them implement home care programs (depending on their priorities) as part of the public health services and/or all the private provider institutions.
Contents of Cancer Prevention in a Physical Activity Course for nursing and medical students
WHY THIS PROGRAM
* Several studies have shown that physical activity may be one of the factors to decrease the risk of contracting colo-rectal and breast cancer (among other diseases).
* Professional advise regarding this issue, is very low in our country. Physical activity is not considered an important factor for reducing the risk of cancer.
WHAT HELPED
* Studies about the relationship between cancer prevention and physical activity.
* Authorities at the University are given more importance to health promotion and prevention programs.
* Objectives regarding this issues are present in all the subjects in our new nursing curriculum.
RESULTS AND OUTCOMES
* Increased awareness of physical activity of students and teachers within the nursing school.
Home Care Program for Cancer Patients at the School of Nursing
WHY THIS PROGRAM
* Patients, families and faculties identified the need to have a home-care program, in our Nursing Academic Center.
* Home care is a new area for research and professional development.
DIFFICULTIES
* Government financial difficulties
* Lack of well trained personnel.
WHAT HELPED
* The government (the payer) has developed new public policies and is starting to pay for this kind of nursing intervention.
* Our nursing school is a reference/testing center (for the government) to try out this kind of initiatives.
XI'AN, China
Yue Li
Head Nurse Cancer Department
Since attending the workshop in Oslo Norway in August 2000, I have grasped a lot of new knowledge, new method about cancer control and cancer care. I also have understood some great advances in cancer prevention, treatment and nursing. I think our work is very important and essential. More and more people in the world are suffering pain from cancer. We have to use more special knowledge continuously to improve ability and put it into practice in our daily work. This workshop gave us a good chance to study and communicate with our colleagues. I have done some work in three aspects since I returned.
The first, I translated some material about cancer control in to Chinese, such as A Course for Nurse Educator, Cancer Control, and Guide Booklet and other materials from international conference in Oslo Norway in August 20000.
The second, I gave a lecture to all nurses of our hospital about this workshop. I was also invited by other hospitals to give lecture.
The third, I wrote an article named International Cancer Control and Nursing Research Progress, which were adopted by a conference of National Nursing Thesis Exchange organized by Magazine "Present Age Nursing in China".
The purpose of my program is to introduce the knowledge to every nurse of our hospital and to improve cancer nursing in our hospital and in China. Cancer is becoming a serious disease of high morbidity and high mortality in China. But lots of people are still not yet aware of this risk. Many patients with cancer felt despair of their future. As a nurse, I think I have responsibility to tell everyone cancer can be prevented and cured, but we must grasp more professional knowledge and skills firstly if we want to do this work well.
Many cancer patients need help and answers from nurses who have a lot of experiences in cancer nursing. So, accumulating and renewing all of skills and experience in cancer control and cancer nursing are very important to every nurse. There is a professional lecture about cancer in our ward every Wednesday, which gives nurse a chance of exchange and study. I usually utilize this chance to introduce and spread information about cancer control and cancer nursing. Through these forms above, our work qualities and abilities can be improved gradually.
There are two aspects to help me carry out the programs.
The first is my job. I hope I can use my skills and experiences to help cancer patients who need help. I am very lucky to have an opportunity to learn the new knowledge in the workshop. I do my best to share it with my fellows. The second is leaders' support. During clinical practice, most leaders have realized the importance of nursing in China and the skills and qualities of nurse can directly impact the image of the hospital. So, the leaders expect the nurses to self-develop to learn more skill and knowledge.
There are two factors stopped me to implement the program including time and economic reasons. As a headnurse, I have a lot of professional and general work to do. Other nurses are busy dealing with various routine treatment and care. They have no surplus time to learn what they want. In most hospitals nurse are not enough. According to standard, ratio of the bed to nurse should be 1:2, in fact, it is 1:4-5. Most of us were overloaded. After finishing the work, we also have to do many other things, for example: housework, kids, and personal things. I often utilize my spare time to do these programs. So, I think if I have more enough time and economic ability, I can do it better.
Nursing fund shortage is another reason in our hospital. Most of income has to be used as staff salaries and nurses' cost of study and research is very little. I translated these materials and wanted to publish them in China to let more people to understand those knowledge and progress in cancer control and cancer nursing, but I still face lots of difficulties, I will try my best to completed this work.
During practicing palliative care, opioid drug still is limited to reduce pain.
Implementing the program, we can make many nurses know the development and progress in international cancer control and nursing. It can offer a good guidance to our cancer prevention and clinical nursing practice in our hospital. /we have developed psychosocial support and palliative care to those early stage patients with cancer and other cancer patients. We encourage them and their family to accept this diagnosis and operation or other treatments to make them confident as early as possible. We utilize various ways to help them, through telling them about some people who returned to social life and their family after treatments by radio, newspaper, television, and booklets. We built a record system for patients, including diagnosis, symptom, nursing goal, treatment, nursing measure and its effect evaluation. For the cancer patient who is dying, we applied various methods to reduce pain by use of opioid drug or other painkiller, tradition Chinese medical acupuncture analgesia, which satisfied their psychosocial requirements and helped them to achieve the best quality of life.
Nurses expect intensive nursing training because they meet different challenge everyday. They have to endure more pressure. Many nurses have some health problem. So, now breast self-examination, healthy life-style, keeping pleasurable mood are important to nurses.
My own behavior has changed in three aspects:
* Diet habit change. I liked to eat pickle vegetable and bacon before due to good taste, but now I realized it could lead to cancer risk. So, fresh meat, fish and fresh vegetable, fruits have often appeared in my family. I also enjoy it gradually.
* Breast self-examination and physical detection during a fixed time. I have slight proliferation of mammary gland, but work is very busy. I never paid any attention to my health before, but now, I always touch my breast and all around place when I take a bath every time. I receive a physical examination about half a year.
* Increase physical exercise and arrange my own work and life more reasonably. I like sports very much. Since I began to work, I have not had enough time to do it until now. I think regular exercise is very important to cancer prevention. Nowadays I play basketball or table tennis one time every week. I also take part in long-distance run race sometimes. All of these exercises made me full of vigor, happiness and confidence. I am enjoying my life.
Ghana
May Osae Addae
Principal Nursing Officer
Ministry of Health
Cancer prevention and early detection activities are little heard of in Ghana. Nurses and the general public have little knowledge about it. Facilities for early detection and treatment are lacking in the treatment centers in the regions. People who unfortunately get this disease are unaware of it initially and only get to the treatment centres in the terminal stages only to get surgery and palliative treatment.
The government is now taking considerable interest in this disease as people who get this condition and are enlightened always want to get treatment outside the country with the country's scarce foreign exchange.
I was fortunate to attend the 4th International Conference and the workshop in New York in 1986 with an award from the International Society of Nurses in Cancer Care which exposed me to the subject on cancer prevention and early detection and the modern techniques of its treatment. On my return to Atlanta, Georgia (Editors note: participant was attending another workshop the same time as this one and was selected by her country to attend both workshops) after the Workshop/Conference, I had the opportunity to give a 3 hour workshop with another nurse from Nigeria to the other 17 participants from other developing countries on the workshop we had what we extracted from the conference. We made available all the materials gathered from the workshop to them to read through. They were happy about the shared experience since it was a new information to almost all of them.
On my return home from the USA I wrote a two days' workshop for nurse educators to take place at the Midwifery Training School Lecture Theatre. This was to expose the nurse educators to the subject and also introduce the subject into the various nursing curricula. Though everything was written out on paper and I had discussions with some people at the headquarters, I had no funds to run the workshop.
In January, I gave a one day workshop to the 3rd year SRN's doing public health affiliation courses for 3 months and the public health students. The students were exposed to cancer prevention and early detection activities. It took the form of a lecture/discussion method and the feedback from them was very encouraging and showed that they had absorbed a lot.
In February, 1988, I had another discussion with the director of nursing services about the implementation of the workshop for the nurse educators. Her opinion was to hold the workshop for the nurses on the field first. This was further discussed with the director of manpower and training who agreed to it. The training strategy of training 30 nurses, 3 from each of the 10 regions to act as resource people to help in the training or other nurses in the region was agreed upon. I have therefore planned 3 day's workshop for nurses in Ghana to start in the 2nd week in December on paper and I am still exploring avenues to get funding for it.
I had an article published in the Weekly Spectator, a popular weekend paper in Ghana on cancer prevention and early detection and the warning signs to educate the general public on the disease. A lot of friends who met me after the publication said they learnt a lot from it and it was very educative.
At this juncture the Ministry of Health has now taken more interest in cancer prevention and had set up a Cancer Registry at the Korle-Bu Teaching Hospital. It is manned by 2 community health nurses.
For my Future Plans I want to develop a training manual for the training of nurses in the regions. This will make the training content material uniform for all the nurses. There is therefore the need to look for funding to print the manuals. The costing cannot be done now until I have finished with the Manual. I am waiting to include in the manual what we are going to cover from this present workshop.
New Delhi, India
Narender Nagpal
Principal and Dean, Faculty of Nursing
Hamdard University
The role of nurses in prevention and detection of cancer was the focus of deliberations in the Cancer Prevention and Detection Workshop held at London, England in 1996. It provided a focus on the incidence and prevalence of various types of cancer throughout the world, global strategies for cancer detection and prevention, its control and treatment. The information material on cancer prevention (a course for nurse educators) received during the Workshop provided ready reference material on global perspectives on cancer, most common types of cancer, their epidemiology, risk factors, methods of detection, guidelines on self-assessment, research findings on nutritional aspects and dietary risk factors. Some audio-visual material for teaching purposes was also included in the workbook. The participation updated my knowledge, giving me more confidence to communicate the gained knowledge with my teacher colleagues, and initiate other activities relating to cancer prevention and detection. The following programs were carried out:
1. Group discussions. About 6 hours were devoted to discussion on different types of cancer prevention, detection, control, nutritional aspects, treatment, palliative care/rehabilitation, etc. in the faculty meetings. Senior students were also included in the discussion.
2. Incorporation of cancer related information in the course curricula. Added focus was given to topics on risk factors, early detection and prevention and health education on this subject was incorporated in the curricula of the diploma and B.Sc. Nursing courses of the Faculty of Nursing, Hamdard University (Jamia Hamdard), New Delhi. The workbook proved to be a valuable source of reference material in carrying out this venture. The faculty members teaching medical & surgical nursing, and community health nursing made extensive use of the workbook to focus their teaching on various aspects of cancer care.
3. Sensitising nursing personnel in hospital setting. The knowledge about the role of nurses in screening, early detection and prevention of cancer was shared with nursing personnel of Majeedia Hospital (university hospital) in the form of two seminars (1/2 day).
4. Student participation in cancer awareness programmes: Four batches of students of both the general nursing and midwifery as B.Sc. Nursing programs doing their community health experience organized health talks and displayed posters on cancer prevention and detection. Teaching about self examination of breasts and referral for check ups to approachable concerned institutions was given a due emphasis.
5. Updating epidemiological data related to India: The statistics related to incidence and prevalence of cancer in India was updated from the data collected on National Cancer Control Programme in India. Some of the salient points were:
* The Cancer is one of the top ten causes of mortality and morbidity.
* It is estimated that at any given time, there are about 1.2 million persons suffering from various types of cancer at various stages.
* It is estimated that there are about 600,000 new cases every year in India; half of them die from this disease
* The estimated survival is 33 years after diagnosis. Nearly 1.5 million persons require facilities for diagnosis, treatment and follow up at any given time.
* The most common cancer in women is cervical cancer; it is lung cancer in men. Keep in view the immensity of the population and the above mentioned data - my efforts are just a drop in the ocean. (Population is estimated as 961 million, literacy 52%, life expectance 62 years, and the GNP 340 US $.)
The implementation of the above mentioned programs was mainly determined by feasibility, willingness of teaching staff of the Faculty of Nursing to update the teaching course curricula, and availability of institutional resources. We plan to prepare slides based on the audio-visual material provided in the work book as teaching aids from the grants received from the Ministry of Health and Family Welfare, Government of India. We are also seriously considering carrying out specific activities relating to cancer prevention and detection as a collaborative project.
Personally, I could break the barrier of embarrassment of getting a check up for cancer detection carried out. I could also counsel my colleagues and relations who had initial hesitation in getting themselves checked up.
Amman, Jordan
Hassan Al-Sharaya
Muna Al-kujuk
Oncology Clinical Nurse Specialists
We would like to take this opportunity to brief you about Al-Amal Cancer Center/Amman/Jordan. The idea of establishing Al-Amal Cancer Center matured as people who had suffered the loss of loved ones to cancer came together with physicians who had gone though the painful experience with many of their patients. The efforts of these two groups gave birth to the first comprehensive cancer center in Jordan, and in the region as a whole. a center that is specialized in providing cancer patients with different types of cancer treatment and care. The center which will be ready to open by the end of this year, will have (30) out-patient clinics, as well as one hundred and thirteen (113) beds. Additionally, the center will include special section for children and women, a complete radiotherapy facility, chemotherapy infusion center, and an up to standard rehabilitation facility. In addition to Al-Amal Center goals of providing full and comprehensive treatment (surgery, chemotherapy, bone marrow transplantation, and therapeutic radiology) and rehabilitation to cancer patients. the center plays an effective role in early detection and diagnosis, and provide preventive measures through creating public awareness and education. Al-Amal Center also aims at creating and organizing a cancer registry of statistics and studies on the different types of cancer in Jordan and their geographic distribution.
Now we would like to brief you about our activities in the last year. Since Al-Amal Center has not operate yet, we focused our cancer prevention and early detection activities on raising public awareness about cancer our activities included:
1. We organized (3) workshops about cancer screening, early detection, treatment, rehabilitation, and palliative care to (300) school teachers from the Ministry of Education. We launched those teachers with proper knowledge and modified their attitudes toward different cancers and their treatment. Our aim was to disseminate this information to the high school students.
2. We lectured at (50) high schools in Amman about cancer and its treatment where we focused on smoking cessation programs.
3. We have translated (25) booklets and brochures from the National Institute of Health in USA into Arabic language. Up to the present time, (11) booklets are printed and distributed throughout the Kingdom of Jordan. Additionally, we exchanged these booklets with neighboring countries like Egypt, and United Arab Emirates. The rest of these booklets will be ready by the end of this year.
4. Joining the world its celebration of the 1996 Nursing Day, the Nursing Department at Al-Amal Center organized a week long celebrations. These celebrations included:
* Open Scientific Day under the patronage of his Excellency the Minister of Health. Eighty (80) health care professionals attended this event. This scientific day included lectures about the role of the oncology clinical nurse specialist, psychosocial care of cancer patients, pain management, and smoking and cancer.
* Open Screening Day for breast, testicular, prostate, and skin cancers. (59) males and (76) females attended this clinic. Females participants wee taught about breast self exam, skin self exam, and vulvar exam. Male participants were taught about testicular self exam, and skin self exam. Additionally, Digital Rectal Exam was performed to all men over (60) years of age. All exams were free of charge.
* We received (25) calls from cancer patients about ways of prevention and early detection.
(10) calls from healthy people about ways of primary prevention.
(10) calls about social problems of cancer patients.
(5) calls about cancer treatment.
Thank you so much for your listening and this is an open invitation to all of you to come and visit Jordan with its gorgeous historical places.
Latvia
Inta Laze
Head Nurse
Latvian Oncology Center
CANCER CONTROL IN LATVIA
The Cancer has become a significant health problem in Latvia. Cancer is the second leading cause of death in Latvia, exceeded only by cardiovascular diseases. For 10 years cancer incidence and mortality rates has increase (incidence rate has increased about 12%, but mortality about 29% since 1988). In 1997 incidence rate was 340 per 100,000 population, mortality rate 210 per 100,000 population. The major cause of this increase has been lung and breast cancer. The 1-year relative survival rate has increased for all cancer. 45% of cancer patients who have diagnosed cancer (new cases) in this year will be dead in first year. It is indication to diagnostic and detection incompleteness. 5-year survival rate is 40%.
The reasons of late cancer detection are following:
* Latvian people social and economical problems, poverty and lifestyle (dietary patterns, smoking, alcohol use, etc.):
* late seeking medical care;
* lack of knowledge about cancer prevention, early detection and health promotion (population and medical professional);
* psychological barrier, fear of the cancer diagnose, fear of the death, grief, pain and suffering;
* self-treatment (urine therapy etc.), alternative treatment and quackery.
Latvian Government and Health Care Department must assume the responsibility for some of these reasons. The cancer care has financed by state budget, it is low to promote Latvian population health and provide for public education in cancer prevention and detection. Cancer care is not being a priority of health care system. More public educational activities, educational courses and informative booklets are sponsored by international organisations and volunteers.
Latvia will undergoing major transitional change in health care system and develop primary health care, including cancer prevention and early detection.
Prevention is better than cure!! Nurses are important people in the prevention and control of caner as well as in the nursing care of patients with cancer. The nurses have not access to educational materials in national language (no textbooks, nursing journals)
Cancer nurses education in Latvia has undergone several changes in recent years. The cancer prevention workshop in Brighton, England in 1996 has influenced some advanced educational programs in cancer nursing. That promote to prepare advance educational programs of cancer care accented cancer [prevention and detection and identify the health professional role in this process. The role of cancer nurses is providing general health education messages for cancer prevention will also be considered. They should know risk factors for specific cancer, the guidelines for cancer check-ups and how to perform self-examination techniques. Nurses are often in an advantageous position in their own families and in the community to teach lifestyle changes that can prevent cancer and increase the likelihood of early detection. In Latvia cancer nurses had not a strong traditions in cancer prevention and detection.
I have prepared and introduce in practice following comprehensive educational programs and use Cancer Prevention workbook:
* Postgraduate educational course for cancer nurses (continuing education). It is appropriated educational course including cancer prevention and early detection, identify risk factors and patient education to do breast self-examination and testicular self-exam and the other cancer detection activities, causes of cancer, signs and symptoms, treatment and cancer nursing management. The educational course consists of 240 training hours (217 theory and 23 practical). We use educational methods such as lectures, practical studies, discussions and audio-visual learning methods. After this education course cancer nurses acquire the special skills and knowledge in cancer care and cancer prevention which is necessary to practice in cancer care hospitals. This post-graduated education course with successful final examination provide cancer nurses to get certificate in oncology. In 1997 Oncology Nursing Certification was started. Nursing Certification is defined in Latvia as a voluntary process, but this special post-graduate course is obligatory for cancer nurses to practice in Latvian Oncology Center.
* The cancer care educational programme for Nursing School to educate student nurses as general nurse. After Nursing School general nurses can work on various hospitals and ambulatory care facilities. They can participate in cancer prevention and early detection activities at the community level and they must learn all about prevention and detection. The educational programme consists of 54 teaching hours (18 hours theory and 36 hours practice) and has divided into 3 parts: 1) cancer prevention and detection, 2) fundamentals of the cancer care, 3) palliative care.Finished this educational programme, nurses have a basic knowledge of cancer and have had the opportunity to provide cancer prevention and cancer nursing for this patient population. Nurses working in area of prevention are rewarded when someone makes lifestyle changes or choices that promote health. Identify the role of public education in the development of cancer control activities nurses have a major role in health education and health promotion.
* The cancer care educational course for social specialists (social workers). The aim is to improve access to cancer prevention and care services for this group by educating social service staff and support them with up to date information. This is 72 hours educational programme (40 theory and 32 practical). We are talking about health promotion, cancer risk factors and cancer prevention and detection. In this group cancer prevention will be of benefit not only to the individual, but also benefit to the friends and population of local area about health promotion, cancer prevention and detection, self-examination, etc.
These basic courses and programs of cancer care will improve nurse's and social worker's knowledge and skills to prevent and early detect the cancer. It is a step to public education.
In 1997 we had prepared and published public educational booklets "How to prevent a cancer" It consists of 3 parts:
1. Causes of cancer and risk factors
2. Breast-self examination skill
3. Testicular-self examination skill
In 1997 We had prepared and published woman calendars where they could note their physiological important days. The calendar contains information about breast-self examination (how and when to do it) and what is mammography screening.
At present the government screening programme for breast screening invites woman between 45-65 to attend mammography. It was started in 1997 and firstly in Latvia. Only 12% of woman from this breast screening programme group was healthy. One of every 12 women in Latvia after 20 years age has breast cancer incidence and mortality rates have been highest in Latvia.
Health education for the population has become very topical. The priority in cancer care is to educate nurse, physicians and the other health professionals about prevention. They can teach each other and the public about preventive health practices: smoking, alcohol use, safety rules at work place, dietary, sun protection activities, etc. and ask to do self-examinations, to attend mammography, clinical examination.
In 1998 in Latvian Oncology Center we started prostate-specific antigen blood testing. It should be performed on men aged 60 and older.
Lublin, Poland
Malgorzata E. Krasuska
Adjunct Professor
University Medical Academy
After attending the first part of the workshop in Brighton, I have developed following programs:
1. As an academic researcher teacher I have enlarged content of the curricula of oncology nursing for the graduate students in their master program. Enclosed here are the contents:
An overview of cancer and cancer prevention
Cancer epidemiology (worldwide & Poland)
Families and cancer (inheritance)
Cancer screening
Nutrition and cancer prevention
Tobacco, alcohol and cancer
Nursing role in cancer prevention as a common sense approachThe emphasis is placed on reducing the potential risk factors and especially diet, or harmful habits.
2. As a Head of the Department of Oncology Nursing I have started with the research project on: Role of the Master Prepared Nurse in Cancer Prevention which is realized within the university Medical Academy structure. The pilot project (stared 1st July 1998) is going to be finished in the end of September 1998, and after careful analysis the proper investigations should take place in the period of 2 years.
3. Another pilot project was initiated in the high school on Lublin, where graduate students of nursing have started with the health education and overview of cancer prevention, addressing the risk factors and advertising of the health life style including smoking cessation, diet modification. The important part of the content concerns the sexual life in regard to the cancer risk factors. The first year of that activity was successful and covered up to 70% of all the students (between 15 and 18 years old).
4. I have presented 2 papers on cancer prevention at the nursing conferences (congress of the Polish Oncology Nursing Society and the scientific conference of the Europa Donna movement.
I have chosen the presented topics in regard to the epidemiological and medical data as well as the fact of the great ignorance in the cancer prevention issues not only the public, but medical staff also.
It was not easy to develop those programs but being aware of all the factors as well as supported by the close links with US Oncology Nursing Society, attending the US NCI Cancer Prevention Academic Course (1st July-31 August 1997) and understanding the role of nurse in moving forward the goal of successful and cost effective cancer prevention, I was able to do it. In spite of some obstacles from the medical establishment, I have to underline the help and ongoing support of the university board and the staff from the Oncology chair at my University. However, I have to admit, that every step to take and every piece of work to do, is the only nurse's-responsibility. Than, after implementing of the pilot projects I was impressed by the very positive reaction of the public covered with our activity as well by the organizational support of the university.
Well, it cost an enormous amount of energy and it is very time consuming (doing that for the very first time) but my only message to my nurses' colleagues is: DO IT!!
Even now, far away from the end and without full spectrum (scientific analysis, results etc.) it is so rewarding and empowering.
Let me express my sincere thanks to the Cancer Control Workshop organizes, as well to the other US institution for helping me so much in my own professional development as well as for ongoing support, specially to American colleagues for showing me that: NURSES CAN DO.
South Africa
Nkinki Sophie Mahoko
Professor and Dean, School of Health Sciences
Two years have gone by since the last workshop in Oslo in August 2000. This report reflects the programme activities undertaken since the workshop attendance.
Programmes developed
SCHOOL PROGRAMME
One educational programme on the seven warning signs of cancer developed and implemented at 50 high schools. Education was conducted in the pupils mother language to ensure thorough understanding of the subject.
Second and third year students of nursing were used as educators. This was to effect peer education since the two groups were almost of the same age. It was thought that interaction would be more vibrant if students become trainers and educators. Each group of students was accompanied by one faculty when cancer education was carried out at schools.
COMMUNITY PROGRAMMES
Two programmes were put in place; and these are described in the following paragraphs.
Programme one: Seven signs of cancer. Traditional leaders (chiefs and headmen) and civic organizations were our first point of contact. This approach was used as a community entry process to ensure acceptability of the programme. The community was then called to a meeting by the community leaders.
The education programme was rolled out from schools to communities in 2001, and the school children conducted cancer prevention education in their villages in the presence of university students and faculty. This was used as an evaluation strategy to assess the effectiveness of our teaching strategy. Secondly, it was a way of empowering pupils to be assertive and to take education to their own people. Thirdly, it was a recruitment strategy into the nursing profession.
Programme two: Self-Breast examination. Education started in class of the students of nursing at the second year of learning. Two villages were adopted as sites for clinical practice. Community entry processes were used as outlined in the previous paragraph. At this point, the Limpopo Provincial, wing of the South African Cancer Association collaborated with the Department of Advanced Nursing Science of University of Venda for Science and Technology in implementing the self-breast examination in the communities. The first group of students trained was 60. Training period was two days and focused only on the structure of the breast and breast examination.
The second group of students who received training were 40. Training was conducted for one day only. Evaluation responses from students showed satisfaction and eagerness to start implementing the programme.
Education at Musekwa Village
The first self-breast examination started in April 2002 at Musekwa Village. Sixty five students were divided into groups of five to form thirteen teams. Each team had a settlement to attend to. Each group was expected to attend to six families with an average number of four women. A total number of people exposed to such education on one day was 112. Three people with suspected breast lumps were identified and referred to Siloam hospital for further examination and investigation.
Almost all people educated had no knowledge of self-breast examination. The community had a lot of question about cancer. There were indications that more information is needed about cancer, especially cancer of the cervix. A second visit was undertaken in May 2002. The purpose for the visit was to evaluate the extend to which the community has understood the education. Community members were asked to demonstrate how to do self-breast examination. They were found to have gained knowledge and skill. Those who were not sure were re-educated. Those who were not present during the first educational session were taught by their peers under the supervision of lectures and university students. This encounter revealed the need to teach communities about cancer.
Lectures and oncology nurses from Siloam Hospital paid the third visit to the community. The purpose was to involve the oncology nurse in the project, and to ask for his assistance regarding the diagnoses.
Education at Shigalo Village
The third group conducted its first self-breast examination education in April 2002. Seventy students were divided into groups of five to form fifteen teams. Like in the previous village, each team had a settlement to attend to. Each group was expected to attend to five families with an average number of five females. One hundred and seventy five (175) people received education in one day. Almost all people educated on that day had no knowledge of self-breast examination; and the information given was highly appreciated. There was a report of death due to breast cancer, and the family did not have any knowledge of cancer prevention. There was a lot of questions about cancer issues especially on cancer of the cervix. This was an indication that a lot of education has to be done, especially in the rural communities.
The second visit was paid on the 9th of May 2002. As a means of evaluation, the community members were asked to demonstrate how to perform self-breast examination. Those who were not sure were re-educated. Community members who were not present during the first educational visit were taught by their peers. The need to continue with community education about cancer was clearly identified.
Professional programme
A two day workshop was conducted on the workshop that was attended in Oslo. Over and above the sharing of ideas obtained at the Oslo workshop, we had to select aspects that were relevant to our situation and work towards implementing them. We also decided to involve students in whatever were done, from the planning to the implementation stages. This was to ensure that students own the programmes, and to ensure that they (the students) do the same in the communities they work with. The approach gave birth to the programmes described in the following paragraphs.
Individual education programmes were carried out through church groups by both students and staff. These mainly focused on the seven signs of cancer, self-breast examination awareness, prevention of cervical cancer and the importance of PAP smears.
Since communities live in the Tropic of Capricorn and it is very hot, people are encouraged to continue to use umbrellas (people here do not like wearing hats). The programmes and topics were chosen to meet the needs of local people. The community is rural, with no access to mammography. And cancer of the breast and cervix are rife. The most appropriate programmes were found to those on prevention.
What helped us to implement the programmes are students and other lectures who worked together as a team. The community also assisted because they were willing to learn.
Programme that could not be implemented
The other programme that could not be implanted was on the translation of nurse educators' manual to at least one African language. The reason was that the manual received in 2000 got lost in transit from Oslo. The one that was sent arrived a bit late. Translation was very difficult and slow due to unavailability of certain English word. The translation is continuing, and it is hoped that the translation will be completed by the end of 2002.
Changes in own behavior
The following behavioural changes as result of the last cancer control workshop:
* Cut down on fats
* Cut down of red meats
* Change of negative attitude towards cultural practices in the treatment and care of cancer patient. In fact I have started to refer some patients to these healers.
Turkey
Leman Birol
Instructor
After attending primary health care workshops and the Fifth International Conference on Cancer Nursing, being an instructor, I noticed the necessity of a more effective and more comprehensive training on cancer.
For this purpose, initially, I arranged a meeting with all instructors in my faculty, and I presented.
* the subjects discussed in the workshops and in fifth conference.
* the new developments in oncology nursing, and
* the documents that I had brought.
Then, the subject of cancer nursing and early detection of cancer was discussed, and it has concluded to invite senior instructors from each of the 6 different University School of Nursing to a meeting. The purpose of this meeting was to decide the framework of education,
1. in the training of nursing school students
2. in the training of graduate nurses
Afterwards all the attendants of this meeting discussed the same subject in their own faculties and they all agreed on the importance of early diagnosis of cancer.
And they arranged meetings with nurses in their regions who work in oncology hospitals or in medical-surgical services and they discussed the problems and the areas where further training was needed (Ankara, Istanbul, Izmir and Sivas).
As the result of these meetings the training requirements of the nurses came out to be as follows.
- early diagnosis and risk factors,
- prevention methods during application of chemotherapy
- care of terminally ill patients
- pain control
- communication with patients with oncological problems and with their families
- recent developments in cancer nursing
It was decided that it is necessary to be organized to carry out these activities.
Especially to reach graduate nurses working in this field, it was decided to establish oncology nurses association. After a long study, in October 13, 1989, Turkish Oncology Nurses Association was established and the existing associations and institutions for prevention of cancer in Turkey were all informed. The purpose of Oncology Nurses Association is to improve and disseminate the knowledge of oncology nursing. The association does not work on any subject (religion or politics) other that its' purpose.
In order To reach this purpose, the activities of the association are as follows:
a. to train nurses on oncology and to make them conscious of early diagnosis.
b. to make the society conscious about cancer.
c. to conduct and support surveys or research project about oncology nursing.
d. to cooperate with all the national or international associations, social institutions, hospitals dispensaries, etc. dealing with oncology.
e. to represent the oncology nurses in national or international meetings.
f. to arrange congress, conference, seminar, symposium or similar activities.
g. to publish about oncology nursing.
In this establishing stage, some of the attendants of the meeting, arranged seminars for the oncology nurses in their regions. For example, Ege University in Izmir arranged "Oncology Nursing Seminar" between 22-26 May 1989. Three of the nurses who attended this seminar organized a 5 days training program in their own hospitals.
Between 12-14 September 1990, Ege University School of Nursing will organize the Second Scientific Nursing Congress to which the nurses working in oncology field or in nursing education, there will be a panel meeting with 4 senior instructors during this Congress and Oncology Nursing will be discussed. I will be the chairman of this panel and the subjects will be;
- risk factors,
- gynecologic cancers and precautions,
- recent improvements in oncology nursing
- pain control
Some of the other activities related to nursing education are given below:
In the Medical Nursing Textbook, the risk factors of cancer, early diagnosis and oncology nursing were explained in details. The writing of this book continued in 1989 and the first edition was in 1989, second edition came out this month (August 1990).
The reconstruction studies of curriculum in schools of nursing continued in 1989-90. When these studies were completed, the way of presenting oncology nursing was discussed with the instructors in all subjects and it was decided to arrange a seminar at the beginning of this semester. In addition, graduate nurses were directed towards studying oncology nursing for their M.A. or Ph.D. degree. Four of them completed their dissertations in oncology nursing and a 5th one (from Izmir) started research about the role of a public health nurse in the early diagnosis of cancer. This research is basing on the adaptation of "Canscreen Questionnaire" form to our country's standards. (This adaptation is done because physical evaluation (assessment) is not included in the training program of nurses).
The "Our Leukemic Children Foundation" in Istanbul arranged a one week course for the nurses working in this field. I was, invited to this course as a president of Oncology Nursing Association. And I informed them about the objectives and training activities of Oncology Nurses Association.
Starting with October 1990, Turkish Oncology Association will arrange training programs in different regions in Turkey (Istanbul, Izmir, Trabzon, Sivas, Ankara) for nurses working in related fields about the subjects determined by Training Committee. The necessary financial support (2 million T.L.) for this activity is obtained.
Being an experienced instructor, I used to teach the importance of Oncology Nursing in my courses for years. However, after attending the 1988 Cancer Conference, I began teaching this subject more consciously.
I would like to thank to American and international cancer associations for giving me this opportunity on behalf of my country. Thank you.
Ho Chi Minh City, Vietnam
Tran Thi Thuan
Head, Nursing Department
Nursing Educator
Educational programs: We have three programs:
- Cancer nursing care materials for teaching in the B.S. curriculum
- A palliative care course for the R.N course and the B.S. course.
- A cancer prevention course in the health education programs for colleagues and nursing students and medical technology students, including: x ray technology, laboratory technology, physiotherapy and midwifery.
We have two cancer Prevention programs that are prevention and early detection
1. Prevention programs. 1. A no smoking program and 2. a program on vaccination against HBV. These are important programs, because lung cancer and liver cancer are both incurable but preventable. They are among the most common cancers.
2. We have one program For early detection of cancer. Cervical cancer mass screening is done in the hospital and the health stations. Breast cancer mass screening programs include B.S.W. and mammogram
Professional programs: We had 2 projects:
1. Nursing research. "A survey of the health of women of poor families in a district of HCMC, Vietnam"
2. A cancer nursing care workshop. Health education for prevention of the most important cancers in Vietnam: Cervical cancer,-breast cancer_liver cancer-lung cancer-gastric cancer. We discussed risk factors. -early signs and symptoms-early detection and primary prevention.
We also discussed the following topics:
- Health care and culture.
- Nutrition and cancer.
- Cancer pain control, management of other cancer signs and symptoms
- Palliative care. the nurse's role in palliative care.
- Home care and hospice care.