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Developing cancer education at the Royal Marsden School

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VOL: 102, ISSUE: 15, PAGE NO: 42

Hilary Hollis, MSc, PGDip Nurse Ed, RN, RNT, is acting head, School of Cancer Nursing and Rehabilitation, The Royal Marsden NHS Foundation Trust, London

The NHS Cancer Plan (Department of Health, 2000a) recognised that it was critical to invest in NHS staff through ed...

The NHS Cancer Plan (Department of Health, 2000a) recognised that it was critical to invest in NHS staff through education and development in order to achieve improvements for cancer patients, while the DH (2000b) acknowledged that too few nurses had undertaken specialist training in cancer care. Four years later, NICE (2004) recognised that some cancer patients were being denied access to rehabilitation services owing to a lack of allied health professionals (AHPs) adequately educated in cancer care.

The Royal Marsden School of Cancer Nursing and Rehabilitation is the UK's only provider of cancer education based in an NHS trust. It was set up with the aim of addressing the shortage of specially trained healthcare professionals in the country by providing a unique service in relation to education in cancer care. This will better enable NHS services across the UK to meet the needs of people with cancer and their families. The school's close proximity to The Royal Marsden NHS Foundation Trust means that theory and practice can be brought more closely together, since both staff from within the school and those in clinical practice can teach in the classroom and work in practice.

Maintaining educationists' clinical skills

Gould et al (2004) suggest that nurse educationists in cancer and palliative care might be more effective if they spent more time working in the clinical setting. The school facilitates this through the lecturer practitioner role, which enables its academic staff to maintain their clinical competence by spending part of their time in clinical practice.

Equally, the school's access to world-renowned cancer specialists from The Royal Marsden, who teach and contribute to the development of its educational programmes, provides an opportunity to relate up-to-date evidence to clinical practice. A further important aspect of many programmes is the involvement of patients - a key learning point for many students.

Resources within the school

The school is based in a dedicated facility within the education and conference centre at The Royal Marsden's west London site. This accommodation incorporates a skills laboratory, teaching rooms and a 130-seat lecture theatre, all of which are equipped with a full range of audiovisual equipment.

The David Adams Library supports all students and staff in the school and contains one of the most up-to-date and extensive ranges of books and journals in the English language related to the care and treatment of people with cancer. The library's stock has been developed to meet the needs of both the school and the wider interests of staff working in the trust, thus enabling users to gain knowledge that will inform their practice, professional development and research.

Cancer care programmes

Since its establishment in 2002, the school has developed programmes with the aim not only of building up the specialist cancer nursing workforce of the future, but also of making programmes available for nurses and AHPs working with patients with cancer who are being cared for in more general settings in district general hospitals across the country. School staff have facilitated a three-day programme in over 12 NHS trusts - a formal evaluation study is being undertaken to assess its impact and will be presented and published later in the year. The school's programmes provide education to staff at all levels - from newly qualified nurses and AHPs to those leading cancer care at a national level.

The wide scope of educational provision developed by the school ensures a continuum of education, allowing cancer care professionals at all stages of their career to access a programme appropriate to their needs. We have already established a range of programmes, including:

- Cancer Care in General Settings;

- Diploma of Higher Education in Cancer Care/Nursing;

- BSc (Hons) in Cancer Care for Nurses and AHPs;

- Postgraduate Diploma/MSc in Cancer Care for AHPs;

- Postgraduate Diploma/MSc in Cancer Clinical Research;

- National Cancer Leadership Programme.

The school is the only educational facility in the UK that offers two unique programmes: master's-level cancer care education for AHPs began in January 2004, having been developed in response to the NICE (2004) guidelines, and in March 2006 the master's-level programme for professionals working in cancer clinical trials was introduced. The latter was developed in response to the new cancer research infrastructure that was set up following the recommendations made in The NHS Cancer Plan (DH, 2000a).

Most of the educational programmes provided at the school are made up of individual modules that can be taken on a stand-alone basis as well as part of a whole programme. In particular, the school offers a wide range of specialist and site-specific modules that cover a range of clinical subjects, including:

- Lung cancer;

- Breast cancer;

- Haemato-oncology.

In addition to providing formal educational programmes, The Royal Marsden Education and Conference Centre, which is situated within the school, offers study days and conferences aimed at a range of healthcare professionals.

New developments

The school is currently developing a number of new educational programmes, which should begin to take students in September 2006. A PG Dip/MSc Nurse Practitioner in Cancer Care is being developed in response to changes in service delivery in the field of cancer care. This programme is also being developed in recognition of the work undertaken by the NMC (2005) towards the registration of advanced nurse practitioners and the need to provide these nurses with master's-level education. It will follow an educational model proposed by King and Ackerman (1995) and will consist of three main areas:

- General core knowledge for all master's-prepared nurses;

- Core knowledge for advanced practice;

- Advanced knowledge and skills required for advanced practice in specific specialties.

The new programme will provide core modules for nurse practitioners working in paediatric, community and other acute settings; these will be followed by four cancer-specific modules. The programme will be led by one of our lecturer practitioners. In addition to developing students' physical assessment skills, the cancer-specific modules will explore cancer diagnosis and treatments, the complex clinical issues encountered by people with cancer and the critical thinking skills professionals need in order to manage issues and transform future practice in cancer care.

A new national module for speech and language therapists on surgical voice restoration will consolidate a series of study days funded by Macmillan Cancer Relief and the Department of Health into an accredited module. This will begin in the autumn of this year as we continue to develop and expand our provision of education on rehabilitation in cancer care. This is the first such comprehensive study programme in the UK that has been designed to meet the needs of speech and language therapists specialising in head and neck oncology.

Finally, the school's most recently appointed lecturer practitioner will be responsible for developing education and support in cancer critical care nursing for newly qualified nurses who wish to work in this specialist area. Research has found that many newly qualified nurses have pessimistic attitudes towards cancer, associating it with inevitable death. However, providing appropriate education and clinical support for these nurses has been found to correct and prevent such attitudes (Corner, 1993). The school already runs a successful programme for newly qualified nurses who want to work in cancer care and we hope to extend this to help The Royal Marsden to recruit newly qualified nurses to its critical care unit.

Critical care in general has faced major difficulties in recruiting and retaining nursing staff (DH, 2000c), and in cancer care, with its associated stigma, this has been even more challenging. Students on our general programme currently undertake a week's induction to the trust, attend a number of study days in their first six months and then undertake a module on foundations in cancer care. At the same time they work with clinical practice facilitators to develop a range of clinical competencies. Our newly qualified cancer critical care nurses will be provided with a similar level of education and support, but they will also undertake a module on caring for the acute/critically ill cancer patient and work closely with the lecturer practitioner, who will be based in the clinical setting for half of the working week.

Meeting patients' needs

The School of Cancer Nursing and Rehabilitation continues The Royal Marsden's strong educational tradition, which has produced many of the UK's key clinicians, researchers and educators who have gone on to lead and influence cancer nursing and rehabilitation at both a national and international level. Through its broad range of programmes we are able to meet the educational needs of healthcare professionals working in cancer care at all levels, including those just beginning their careers as nurses or AHPs to those at consultant level. We also aim to meet the needs of professionals working with cancer patients in non-specialist settings. In so doing we want to prepare healthcare professionals who can meet the needs of patients and carers at every stage of their cancer journey.

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