Nursing specialization in the care of children with cancer provides the foundation for implementing successful childhood cancer and blood disorder treatment programs throughout the world. Excellence in nursing education is at the center of all that is needed to maximize cures for children with cancer in low- and middle-income countries (LMIC). While the burden of childhood cancer care is the highest in LMIC, opportunities for continuing nursing education and specialization are extremely limited. Capacity-building programs using distance-based learning opportunities have been successful in sub-Saharan Africa and provide insight into successful, continuing professional development. The Global Hematology-Oncology Pediatric Excellence (HOPE) program part of Texas Children’s Hospital in Houston, Texas, has developed and implemented a distance-based training program designed for nurses working in sub-Saharan Africa. Following a needs assessment, Global HOPE developed a program using both the Moodle (modular object-oriented dynamic learning environment) distance-based learning platform and computer notebooks that hold the course content. The program teaches basic principles of nursing care for a child with cancer and has been implemented in Malawi, Uganda, and Botswana. Courses are taught using a modular approach and core competencies are established for each module. Frequent teaching sessions using Zoom and WhatsApp reinforce independent learning experiences. Formal course evaluation includes written pre- and posttests, self-competency assessments, and simulated checkoffs on essential pediatric oncology nursing competencies. The success of this distance-based learning program emphasizes the importance of formal training for nurses in LMIC to become full-time specialists in pediatric oncology nursing.

To change pediatric oncology nursing management of peripheral intravenous catheter (PIVC) insertion and care based on current best evidence. Design and methods: Practice change strategies were developed, and nurses completed education on proper PIVC insertion, dressing placement, and ongoing PIVC assessment with emphasis on preventing chemotherapy extravasation. Nurses also completed a chemotherapy course as part of their orientation program. The plan for PIVC practice change was based on evidence from published research and established PIVC care guidelines. Preassessment data revealed numerous PIVC attempts and a high incidence of extravasation (42%) in children with cancer receiving treatment in Malawi. Results: Post-assessment data nine months later resulted in a reduced extravasation rate from 42% to 4% using point prevalence assessments. PIVC insertion attempts reduced following education and guideline implementation; 81% of children required more than 3 PIVC insertion attempts before the practice change. Only 1% of PIVC insertions required more than 3 attempts after education and practice change implementation. Nurses completed a 32-item written examination before the chemotherapy course; the mean score was 50/100. Upon completion of the chemotherapy course, nurses obtained a mean score of 97/100 on the written examination. Conclusions: Using an organized approach to nursing practice change improved PIVC care in children with cancer.Practice implications: This project provides evidence that nursing practice change strategies can be used in any setting including countries like Malawi with limited resources.

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PURPOSE Nursing specialization in the care of children with cancer provides the foundation for implementing successful pediatric oncology treatment programs throughout the world. Whereas the burden of childhood cancer care is highest in low- and middle-income countries (LMICs), opportunities for continuing nursing specialization are extremely limited. The Global HOPE Initiative, part of Texas Children’s Hospital in Houston, TX, has developed and implemented a distance-based training program for nurses working in sub-Saharan Africa. METHODS After a needs assessment, the program was developed using the Internet-based, open-sourced education platform, MOODLE. MOODLE is an acronym for Modular Object-Oriented Dynamic Learning Environment, an online learning management system that provides custom learning environments. As Internet access can be difficult at the clinical sites, computer tablets are provided with all educational materials downloaded from the MOODLE learning site. Courses are taught using a modular approach and core competencies established for each module. Zoom and WhatsApp technologies are used for shared learning discussions. A Project ECHO (Extension for Community Healthcare Outcomes) for Global HOPE Nursing was implemented monthly to support the growth of the distance-based learning network. RESULTS This distance-based education program teaches the principles of nursing care for a child with cancer and has been implemented in Malawi, Uganda, and Botswana, where 35 nurses are now enrolled. Formal course evaluation includes written pre- and post-tests and simulated checkoffs on essential pediatric oncology nursing competencies, such as chemotherapy administration. Sixteen nurses have completed the program in the first year and significant improvement in knowledge, self-competency, and skills was found. CONCLUSION The success of this distance-based learning program emphasizes the importance of formal training for nurses in LMICs to become full-time specialists in pediatric oncology nursing. Education programs that build capacity to develop specialists in pediatric oncology nursing are essential to improve global cure rates for children with cancer in LMICs.