Oncology nursing training: A blended teaching approach in resource-limited countries

Mehrunnissa Taj
Benish Lalani
Nurani Madhani
Cornelia Ouma
Lydia Njumwa
Hafiza Ukani
Mildred Oluoch
Saleem Sayani, Aga Khan University
Fabiha Zaidi
Zeenat Sulaiman


Although cancer is a global health concern, resource-limited countries (RLCs) experience higher mortality and morbidity compared with high-income countries. Knowledge gaps and inadequate training are some of the many barriers to safe and effective patient care in RLCs. Oncology nursing as a subspecialty does not readily exist in many RLCs, such as Kenya and Tanzania; many of the nursing staff learn essential clinical skills on the job with no structured training. Advanced practitioners are critical in identifying knowledge deficits and elevating oncology nurses’ clinical skills for positive patient outcomes.

We used a blended teaching approach (a combination of computer-led sessions and face-to-face interactions) to impart cancer education to the nursing staff working in the oncology departments at four hospitals in Kenya and Tanzania. The training focused on cancer biology, epidemiology, pharmacology, safe chemotherapy administration, side effect management, and patient education. Computer-based modules and face-to-face skills training on chemotherapy administration were conducted over a four-month period. Pre- and post-assessments were held for each training session, and clinical skills were evaluated in-person at the completion of the course. Finally, a comprehensive post-assessment was conducted immediately after the training, and again at 3- and 6-month intervals to evaluate knowledge gain and retention over time.

Of 21 participants across four sites, the mean scores for the first pre- and post-test were 71.43% and 90.48%, respectively (p = .01), showing a significant improvement in knowledge. The post-tests after course completion and again at the 6-month interval showed mean values of 88.28% and 89.30%, respectively (p = .36), indicating a sustained effect of our intervention and no diminution of knowledge at 6 months. The initial face-to-face skills’ training was followed by 3- and 6-month sessions via video chat. At the final 12-month face-to-face visit, we confirmed recommended policy and clinical practice changes in effect and developed a plan for sustainability measures.

Blended teaching is an effective tool in improving knowledge, skills, and self-efficacy for clinicians practicing in RLCs. Advanced oncology practitioners can play an important role in assessing, designing, and implementing similar training courses in other areas of oncology, such as survivorship, and palliative care. The corresponding improvement in knowledge and skillsets could ultimately improve patient outcomes.