Term Paper on "Curriculum Design and Evaluation"

Term Paper 8 pages (2267 words) Sources: 8

[EXCERPT] . . . .

Curriculum Design

Curriculum for Patient-Care Competency in Chemotherapy-Based Treatment

Though the vast majority of cancer cases submitted to the American healthcare system are treated in cancer centers and other facilities specializing in cancer therapies, the permeation and diversity of the condition dictates that many supplementary, cooperative, peripheral and long-term treatment needs must be met in general treatment facilities such as hospitals. This forms the rationale for the curriculum to be presented hereafter, which proceeds from the view that nursing skill sets in inpatient settings should include basic competencies related to chemotherapy. Because chemotherapy is an area of cancer treatment that itself produces an array of health needs, side effects and medical realities, the research here is underscored by the view that nursing professionals in most inpatient settings will require a full working knowledge of the cases in which chemotherapy is used; its likely physiological side-effects; the emotional and psychological consequences of the treatment course; and the host of health experiences which are likely to accompany the treatment course.

Nursing Topic Area:

The selected topic area of chemotherapy education is supported by findings denoting that patients undergoing chemotherapy are likely to require inpatient treatment at some point in the therapeutic process. Particularly, Bunce-Houston (2010) notes, "initial conditions leading to diagnosis, surgical recovery, long-term infusions, and treatment of side effects may occur in the inpatient setting. In addition, some patients may require hospitalization for treatment because of a nonexistent or unstable home environment or a lack of support services (eg, home health nurse visits or a significant other to assist in the home)." (p. 1) in any of these contexts, the patient will require a nursing staff which is well-versed in the diagnostic, administering and contraindicating qualities of the treatment course. The article by Bunce-Houston goes on to note that there is a particular need in the nursing education context to address this issue. With the larger focus of cancer treatment moving to specialist and outpatient settings, it is the case today that general registered nurses are unlikely to have received the education and core competency training required in order to address chemotherapy-driven needs as they arise in the inpatient setting. This denotes a need to restore these core competencies as a measure of improving the quality of inpatient healthcare and of improving the flexibility of general nursing staffs which must contend with high turnover and difficulty in the area of recruitment.

Competency Statements:

Competencies in chemotherapy education and treatment are drawn primarily from the Oncology Nursing Society's (ONS) Chemotherapy and Biotherapy Guidelines and Recommendations for Practice, which offers basic recommendations for providing education and training in this area. The following four core competencies are verified by this set of Guidelines and Recommendations and explicated in the article by Bunce-Houston.

1. Nurses must be educated in proper dosage calculations. Objectives include:

a. Recognition of contraindications

b. Understanding of side effects

c. Conceptual understanding of chemical reactions to dosage

d. Capacity to explain dosage to patient

e. Ability to physically mete out dosages

2. Nurses will be versed in the evaluation of laboratory data. Objectives include:

a. Ability to make relevant calculations

b. Ability to interpret data

c. Ability to use data to make meaningful medical evaluations

d. Ability to record relevant data to be read by others

e. Understanding of relevant symbols, abbreviations and shorthand

3. Nurses will be endowed with the ability to educate and empathize with the patient, family and support system about treatment realities. Objectives include:

a. Providing psychological support to patient

b. Providing empathy to patient

c. Remaining informative to family and support system

d. Providing patient with counsel on long-term lifestyle and behavior recommendations

e. Providing patient and family with clear information on what to expect, what to prepare for and what options are available at every step

4. Nurses will have direct training in the handling, administration and disposal of materials relating to the course of treatment. Objectives include:

a. Understanding of sanitary procedures

b. Awareness of possible risks

c. Knowledge to act in the event of unwanted treatment outcomes

d. Knowledge of best-practices in physical administering of treatment

e. Understanding of common side-effects

Course of Study for Selected Competency:

In order to whittle the focus of this discussion to a single actionable curriculum, the focus here will be on third of the four competencies stated above. This competency calls for the nursing professional to possess a full understanding not just of the experiential and sensory realities of chemotherapy but of how this are likely to impact the patient's emotional well-being and that of the family or general support system surrounding the patient. Accordingly, the curriculum below is designed to illuminate the theoretical and practical dimensions of this core competency. Instruction will be conducted according to two supplementary approaches: the GEM model and the practicum. The bulk of instruction will occur in a GEM setting so that active Registered Nurses can receive training and pedagogy through on-site terminals. This will help to reduce the stress on each student's schedule in light of already-noted nationwide nursing shortages. This element of the curriculum will pair shift-groups "with mentors in nursing occupations via a website, email and special events. Group Electronic Mentoring in Nursing (GEM-Nursing) encourages students to pursue nursing careers through innovation group e-mentoring." (Chambers, p. 1)

According to available research on the subject, the experience and endurance of chemotherapy and related conditions resulting in one's inpatient status carry distinct emotional, psychological, social and familial consequences. These consequences are the focus of the biopsychosocial perspective, which is a theoretical model based on the crossover of emotional and physiological conditions that can have real and tangible health outcomes. According to the text by Plante (2010), "treatment for cancer. . . reflects the biopsychosocial perspective. In addition to medical treatments such as chemotherapy, radiation, and surgery, social support and psychotherapy have been found to enhance rehabilitation and sometimes even longevity." (Plante, p. 163)

This underscores the critical importance of the role played by nursing professionals in facilitating positive emotional, psychological and social experiences through the course of treatment. The introduction of the biopsychosocial model to modern discussions on nursing competencies may be credited to the ingenuity of American Psychiatrist George Engel, who in 1977 would publish a theory integrating all aspects of an individual's health disposition into a treatment strategy. (Pollin, 5-6) This would be a groundbreaking liberality, promoting for the first time the idea that a treatment program could incorporate "interconnected spectrums, each as systems of the body. In fact, the model accompanied a dramatic shift in focus from disease to health, recognizing that psychosocial factors (e.g. beliefs, relationships, stress) greatly impact recovery from the progression of and recuperation from illness and disease." (Lakhan, 1) This is very useful to our understanding of the implications to mental health of those enduring the inherently taxing experience of chemotherapy treatment.

Engel's biopsychosocial perspective lends some insight on how best to provide emotional and psychological support to one suffering from the condition at the center of our discussion and serves as a basis for the curricular focus provided by this core competency. It also underscores the degree to which such a medical crisis will lead to permanent change in the lives of those around the afflicted individual.

First and foremost, those who considered themselves friends and family to the patient undergoing chemotheapy must orient themselves as a community of support, both for the afflicted and for his closest family members. This comports with Engels' assertion that his biopsychosocial model "places the person in a systems hierarchy with the following dimensions: two person dyads, the family, the community, the culture-subculture, the society-nation, and the biosphere. Engels points out that all of these dimensions has an influence on health, and all must be taken into consideration by the clinician." (Pollin, 5-6) Thus, for those who surround the patient, there should emerge a profound change in the way that they perceive responsibilities to the patient. Though most medical care such as the use of chemotherapy or surgical attention will require the attention and experience of qualified medical personnel, family and friends become part of a network attempting to find ways to bring emotional comfort and support to the individual facing treatment.

This also points to another major change in the treatment perspective for the subject over the course of his medical crisis. One of the core challenges inherent to the biopsychosocial framework for case management is the inherency of coping strategies for the realities of a condition, which differs from the prevailing emphasis simply on remission from physical pain and symptoms. Namely, "the emphasis on curing and heroic medicine has fostered a mindset that makes it difficult for some physicians to 'merely' care for those they cannot cure." (Pollin, 6) Engels' ideas promote an altogether different understanding of medical treatment that emerges as relevant in the management of conditions for those enduring chemotherapy. Indeed, this shows that once initial treatment procedures have begun, the strategy of care for a nursing professional should shift from attempting… READ MORE

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