PEM says standardized teaching materials best

Educating nurses on best way to teach cancer patients

As manager of cancer services at Riverside Methodist Hospital, an 800-bed institution in Columbus, OH, Mary Szczepanik, MS, BSN, RN, oversees cancer research, cancer registry, and cancer education support and outreach.

"About 10 years ago, I went from being a patient education manager for the entire hospital to working just in cancer. A new department was created called cancer education support and outreach and I managed that department. The research and registry department started reporting to me in October 2006," says Szczepanik.

She now oversees about 20 employees. These include two research nurses who help select patients for one of about 140 trials available at the hospital and manage them.

"There is a huge patient education component to clinical research for cancer because those patients have to be extremely well informed and they have to understand even before they start the study what they are agreeing to, and then the education continues," says Szczepanik.

This area also has a person who assists the nurses and a person who tracks the regulatory requirements for all the trials.

Certified registrars collect data on each cancer patient that comes into the system for treatment at Riverside Methodist Hospital. Each year about 2,500 people are diagnosed with cancer at the institution.

In education support and outreach, Szczepanik supervises a nurse educator who provides orientation and continuing education to oncology nursing staff and other clinicians. These job duties include a monthly continuing education program, ethics discussions, weekly multi-disciplinary rounds on the oncology unit, and teaching core curriculum to new oncology nurses during their eight-week orientation.

Also in education is a lung health nurse who educates all lung cancer patients throughout their treatment and connects them and their family members to community resources. Two community education representatives staff the cancer hotline. They provide cancer information, coordinate referrals to support services, and also take requests for community presentations.

Other staff members include a licensed massage therapist, social worker, and a master's-prepared art therapist.

Hands-on work as well as oversight

The oversight of employees is just one aspect of Szczepanik's job. "I write all the policies and procedures for cancer patient education and I write the patient education materials, which we review on a regular basis. I teach a class on educating patients primarily to nurses, both on the two oncology units and throughout the hospital because our patients are on so many units," says Szczepanik.

As a manager on the cancer service line, Szczepanik reports to the director of operations for cancer services. She obtained her BSN from St. John College in Cleveland right after graduating from high school. She began her work as a nurse in pediatrics in 1971 and went to work for Riverside Methodist Hospital in 1979.

"I first worked in nursing education and then a patient education manager position was created and I took that," says Szczepanik.

In a recent interview, Szczepanik, who also sits on the editorial board for Patient Education Management, discussed her job, her philosophy on patient education, the challenges she has met, and the skills she has developed that help her do her job well. Following are the answers to the questions posed:

Q: What is your best success story?

A: It is the standardization of our teaching materials and the quality of our print materials followed by the education of the nursing staff on how to use them effectively and how to know when a patient is ready to learn.

Our standard is that for disease-specific information, we use the National Cancer Institute materials. If a person is diagnosed with lung cancer they get the NCI book on lung cancer. If they are to receive chemotherapy, they get the NCI booklet on chemotherapy and the Riverside drug sheet I write with the help of our clinical nurse specialist who works on the unit. Our sheets are all standardized and have the same type of information.

I wrote something called "Your Cancer Planner" that is a small three-ring binder divided into chapters and it is individualized by adding all the materials patients receive. The print shop puts holes in the NCI booklets so they fit, and the planner was designed to match the size of these booklets.

Q: What is your area of strength?

A: I am a good writer, a good problem solver, and I like developing new programs, taking new ideas and making them happen.

One program we developed ourselves is called "Kid Share." It is a monthly program where we meet with parents who have cancer to help them learn how to communicate and educate their children about their cancer. A few times a year we do a kid component of that which is an all-day retreat.

Q: What lesson did you learn the hard way?

A: As a nurse it was how to get organized, especially in terms of patient care and prioritizing what had to be done first.

The other lesson is that you can be a really good educator or manager, and it doesn't always mean the people under you or the patients will learn what they need to learn or do what they need to do.

As far as patients, I may be a really excellent patient educator but if the patient is too sick to learn, isn't willing to learn, or is willing but doesn't have the resources they need, you can fail because the patient is really the one who has to follow through.

So whether you are an educator or manager you can only provide a person with the tools they need and somewhat influence their motivation and then it is up to them.

Q: What is your weakest link or greatest challenge?

A: Having the resources I need, whether they are human resources or financial funding for programs and projects; that is the hardest part.

Q: What is your vision for patient education for the future?

A: Once we know for sure a person has a cancer diagnosis, I would like to get to them earlier with both our education and our support services, providing the opportunity for them to be on a trial and so forth. I think we would be more effective.

I would like to get to a point where the patient loses as little function during treatment as possible so their rehabilitation, their ability to get back to a normal role in their families, their work, their church and their community involvement isn't such a huge struggle. We have about 10 million cancer survivors walking around this country now that we didn't have 10 to 20 years ago.

Q: What have you done differently since your last JCAHO visit?

A: We have a cancer-disease-site-specific certification from the Joint Commission as well as the general survey; so we have yearly assessments and accreditations for that. A multidisciplinary team selects measures to demonstrate we have a superior cancer program.

What we have decided to report relating specifically to my areas of responsibility are the cases presented at tumor conferences. For example, once a week a team of physicians and other clinicians get together to talk about our lung cases presenting the pathology and radiology reports or the diagnostic studies and come to an agreement on what the stage of the cancer is and what next step in treatment should be offered to the patient.

We report that as something we think we do a great job of and also our pain management initiatives. Also we always have quality improvement projects in progress. For example, with cancer patients who are neutropenic, we are trying to get them on an antibiotic within two hours of the time they come to the hospital with a fever whether they come through the emergency department or a physician's office. That is really tough, so that is a quality improvement project on which we are working.

Q: When trying to create and implement a new form, patient education materials, or program where do you go to get information/ideas from which to work?

A: The ideas usually come internally because we have a great group of people who are members of their professional organizations and keep very well connected both in the community and their professional groups. But if we want to benchmark or find out the standard of care, certainly we look to such organizations as the National Conference of Cancer Network, as well as state and federal legislation. We always look at the HIPPA perspective and the Oncology Nursing Society.

Sources

For more information about oversight of such areas as cancer education and support services, contact:

  • Mary Szczepanik, MS, BSN, RN, manager, cancer services, OhioHealth Cancer Services, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214. Phone: (614) 566-3280. E-mail: szczepm@ohiohealth.com.