Development of AORTIC oncology nursing competencies in sub-Sahran Africa

Dr Naomi Oyoe Ohene Oti - National Radiotherapy Oncology and Nuclear Medicine Centre, Accra, Ghana

The cancer burden is also increasing, having over 19.3 million new cases. Over half of them die and it is said that over 70% are coming from the low- and middle-income countries, of which Africa also has a share. To be able to combat this burden we need competent nurses, a life-saving competent workforce to be able to deliver care to the cancer patients and their families. Looking at it in terms of our workforce, they are scarce, especially in oncology nursing.

Usually people come in with the short courses just to be able help people to be able to deliver quality of care to patients. But there has not been anything formal in terms of looking at the impact to the system. So in 2017 there was this nursing forum where we had a lot of nurses trying to comb through what are some of our challenges within our centre. We saw that we don’t have any standardisation in terms of practice. We have other people that have been making strides in oncology nursing. Some countries have started doing training and education in oncology nursing but there should be some form of standardisation across the board so that others could also look up and then help them to try to also develop their own curricula to be able to help equip the skills and knowledge of the nurses who deliver cancer care to a patient. So we thought why don’t we then develop competencies, have a standard across the board, where countries can then look at to be able to develop their own curricula. Because in developing curricula you need to look at the setting, contrast perspectives, you put all together with what is happening within the country.

So a group of nurses with international collaborators like the International Society of Nurses in Cancer Care, the Oncology Nursing Society from the US, came together with the AORTIC nursing group to be able to look at it and then be able to help and develop competencies.

So we then went out to adapt other existing curricula and competencies. By the way, we took that of the European Oncology Nursing Society, that of the Oncology Nursing Society from the US, the South African Oncology Nursing Society and that of the Canadian Association to be able to look at it and try to make a bridge to be able to adapt it to our system. Within there were nurses in Africa who were also involved in this competency development. It has taken a while, over four years, but we were able, after putting it all together, we sent it to the various members to be able to review. Then we sent it out to Africans, those who did the review were not without our group, they were in academia. Different countries, we had about 11 countries with 14 people who were either in academia or in practice to be able to look at it and review it. So the review was more whether you were… We had four steps – whether it is feasible and we also found if it’s not feasible, if it’s something that cannot be adapted to the system throughout. We had various areas of competencies, about 15 or 16 areas of competencies, and they had to go through. In looking through there were just a few comments, more of looking at the community health worker, what can we do to be able to upgrade the knowledge of the community health worker because they usually may be the first people a patient may encounter. We had to explain that it’s also taking care because the competencies we have someone who does not work in a cancer centre, like the first level, all nurses need some form of knowledge of cancer care. Then we have people who are specialised but in the specialisation we have levels. Maybe it was basic, after training as a Bachelor, some knowledge you need to know in cancer care if you are working in the cancer environment. Then we have an advanced level where there are added-on skills – they could maybe prescribe some chemo and do other added-on skills. So we had these three levels.

Throughout the review we only had about one or two who said in terms of ability to implement, they were saying in terms of resources were limited. There were two countries were saying they couldn’t have the resources to be able to implement it in terms of faculty. But in all we had good reviews from all our 14 reviewers. The reviewers were all across Africa – we had from North Africa, we had from West Africa, we had from South Africa, we had from Central Africa and East Africa. We tried to make sure that they were all part of the reviewers.

So at this point the next step is to make an endorsement by AORTIC and then we move on to other society bodies within countries, going to the various licensing or authorising from the various Ministries of Health, using the licensers, those who are able to license nurses, the various schools that do training to be able to look at it, to be able to help them to prepare their curricula according to what has been developed. Also then to the public, we will be able to have publications to allow others to replicate what we have done.

Is there potential to expand into more of Africa?

We did it more for Africa, not just sub-Saharan Africa because Egypt was also part of the review. They are also happy to have something like that, to be able to look at what they are doing now. Currently in Egypt it’s now doing a PhD in oncology nursing so they also need something like that to be able to help them standardise their training. Elsewhere now in Africa we are moving, we are having something that we have equivalent to the nurse practitioner in the US and others. So nursing in advance, having nurses who are going for advanced nursing skills. So we also need… It’s quite important that we need this so that it’s standardised. Any nurse that is in Ghana or in South Africa or in Egypt or in Kenya and trains as a nurse practitioner is a nurse specialist. You have ABC skills which should cut across all borders, irrespective of the cancers that you see.

Is there anything else you’d like to add?

What I want to put across is something that is for Africa and it’s Africans who developed it. I think it’s something that as it comes within country we are entreating all who matter to be able to take it up and help us standardise our practice for our patients to have quality cancer care which they deserve it and it’s their right to have it.