Applied nutritional investigationImproving oncology nurses’ knowledge, self-confidence, and self-efficacy in nutritional assessment and counseling for patients with cancer: A quasi-experimental design
Introduction
Cancer diagnosis and treatment modalities have a severe impact on patient nutritional status. They affect the metabolic process and cause loss of appetite. In addition, using different cancer treatment modalities, such as chemotherapy, surgery, and radiotherapy, causes a number of side effects, including anorexia, diarrhea, oral infection, vomiting, change in taste buds, and nausea, which affect eating habits and lead to poor nutritional status [1], [2]. Malnutrition and weight loss are common among cancer patients as a result of treatment options, particularly chemotherapy. Long periods of treatment cause nutrient loss, energy alteration, and decreased food intake [3], [4].
Importantly, there is an increased interest among heath researchers to examine the impact of nutrition on patients’ health status and disease prognosis. Different research studies, such as clinical trials, systematic reviews, and observational studies, have been conducted to evaluate patients’ nutritional status and the impact of nutrition on hospitalized patients with chronic illness. The results indicate that improving nutritional support leads to decreased morbidity and mortality, decreased length of hospital stay, and reduced cost of treatment [5], [6], [7].
Malnutrition is a serious and common problem among patients with cancer. It negatively affects their prognosis and reduces their quality of life. Statistics indicate that 15% to 40% of cancer patients experience weight loss during treatment. This percentage can increase up to 85% in patients with an advanced stage of cancer [8]. Accordingly, early intervention and patient education about nutritional supplements and habits can improve patients’ outcome and prevent such complications.
Multidisciplinary team collaboration is required for providing optimal nutrition care for patients with cancer. A qualified registered dietitian is an essential member of the heath team, but all physicians and nurses must be active participants in identifying patients at risk for malnutrition and follow-up the interventions. Bedside oncology nurse can perform initial screening, educate the patients, and develop a trust relationship to increase patients' compliance to the care plan. Dietitians perform complete and intensive assessment to develop the evidence-based interventions when required. The attending physician supervises the care plan and discus it with the team. This harmony of collaboration between multidisciplinary members allows for the provision of holistic care and helps identify patients with nutrition problems [9], [10].
Holistic care may include pharmacist, social workers, and physiotherapists. The ultimate goal of this collaboration is to identify patients with malnutrition and nutrition difficulties such as drug interaction, financial problems, and physical limitation. All health professionals must be knowledgeable according to their role. Nutrition care includes baseline screening, encouraging patients with cancer to eat, education about nutrition supplements, and tube feeding when needed. Different members participate in the treatment plan depending on the intention. The bedside oncology nurse is perfectly positioned and trained to perform the initial assessment and guidance [9], [10].
Cancer remains a leading cause of death worldwide; it is the second highest cause of mortality after cardiovascular disorders and one of the most common disorders among adults [11]. Accordingly, as the number of cancer patients increases, the need for qualified professionals, particularly nurses, increases as well. In general, nursing schools are preparing students to be general nurses with no specialized training in nutritional assessment and counseling for cancer patients.
Nurses play key roles in treatment plans for patients with cancer. Their ability to provide patients with nutritional support and advice depends on their knowledge about nutritional assessment and demands during this journey. Alarmingly, 43% of oncology nurses perceived themselves as having insufficient knowledge to provide advice on nutrition [12].
Increasing demand for nurses trained in proper nutrition practices in clinical settings has forced researchers to conduct experimental studies to assess the effectiveness of conducting educational programs on improving nurses’ knowledge, self-confidence, and self-efficacy. In addition, limited literature exists on the nutritional education of oncology nurses. Thus this study was conducted to assess the effectiveness of a nutritional education program on oncology nurses’ knowledge, self-confidence, and self-efficacy.
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Design, sampling, participants, and measures
A pretest and posttest quasi-experimental design was used to assess the effectiveness of an educational program on oncology nurses’ knowledge, self-confidence, and self-efficacy regarding nutritional assessment and caring for cancer patients. Ethical approval was obtained. Data were collected between April and June 2018. A power analysis for a t test was calculated to determine the estimated sample size [13]. A sample of 60 participants (30 participants per group) was estimated with an effect
Sample characteristics
Sixty oncology nurses participated in the study (26 female and 34 male). The mean age was 26.1 y for the experimental group (SD = 2.75) and 25.8 y (SD = 1.75) for the control group. The mean of experience was 2.9 y (SD = 0.79) for the experimental group and 3.2 y (SD = 0.81) for the control group. An independent t test was conducted to assess the homogeneity of the participants from both groups. The results indicated no significant differences in terms of age, gender, years of experience,
Discussion
Nutritional assessment and counseling are important elements in cancer care. They are defined as the advice and education given to change patients’ eating habits and behaviors. It is highly important to encourage optimal care and minimize nutritional complications and consequences on the treatment plan and patient outcomes [21].
Supportive nutritional care, including education and advice provided by nurses, is considered a pivotal factor in preventing or reducing the nutritional risk among
Conclusions
The educational program improved oncology nurses’ knowledge, self-confidence, and self-efficacy in relation to nutritional assessment and counseling. Improving nurses’ competencies will improve the quality of care provided to patients and patient health outcomes. The results of this study highlight the importance of continuing education for nurses to enable them to accomplish their roles. The sample size of the participants was considered a major limitation to generalizing the results, but the
Acknowledgments
The author would like to thank the participants for their efforts and time.
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