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Authors

  1. Frank-Stromborg, Marilyn Ed.D., F.A.A.N., J.D.
  2. Weir, Theresa R.N., B.S.N.

Article Content

Private and public nursing schools alike have been weathered by the national economic climate of recent years. "Scarce resources" are well known to educators, researchers, and practicing nurses. Yet the demand for quality oncology nursing care and research continues to expand with the increase in national cancer rates (1). It has been reported that within the next decade, cancer will become the leading cause of death in the United States. The American Cancer Society (ACS) estimated that in 1999 more than 2 million people in the U.S. will be diagnosed with invasive cancer and in site skin cancers (2).

 

With continuing national demand for oncology nursing faculty, federal and private funding is critical for not only educating students, but also for retaining high-caliber faculty through the provision of adequate salaries, technical support, equipment, release time, and seed money for research (3). The availability of such resources creates a milieu. The milieu of an institution may either foster or inhibit productivity of faculty (4). The availability of release time, for example, has been directly related to faculty productivity (3). Productive faculty, in turn, contribute to nursing educational programs and the nursing profession by advancing nursing theory and practice and also generate income for their institutions when they obtain external support for their work. Budget cuts have had a serious impact on nursing education, research, and clinical practice (5-10).

 

External support can be a significant tool for generating a milieu of research and productivity. As resources become scarcer, external support is less readily available. The concept of diversification of support as a means of surviving, and even thriving, in the era of cost containment is thus gaining the attention of many authors (11-13).

 

An attractive source of support potentially available to oncology nursing educational programs is the ACS's Program of Professorships in Oncology Nursing. The ACS established this program to enhance the care of cancer patients, their families, and individuals at risk through cancer education. ACS Professorship funding can provide support for faculty salaries and release time from teaching, research, and service pursuits. Typically, if funding is achieved, the recipient's academic institution is awarded from $25,000 to a maximum of $35,000 annually from the state ACS Division. The recipient may then negotiate with the academic institution for release time or use the funding to augment existing resources such as employment of research assistants, printing of research instruments, or research-related travel. Applications for the Professorships originate with the academic institution, the faculty candidate, and the appropriate ACS Division providing the financial support. Applicants must be tenure-track faculty at an academic institution that awards a master's degree with a focus in oncology nursing.

 

Since 1982, 20 Professorships have been awarded. Recipients are required to submit annual reports on their accomplishments following specific criteria. However, until recently, no analysis had been done to provide insight into the impact of the funding or to evaluate the appropriateness of the data required. The ACS Professors in Oncology Nursing invited a faculty member from a state without a Professorship in Oncology Nursing to analyze data provided by a subset of recipients for one calendar/academic year and devise a reporting tool. The selection of a non-recipient was for the purpose of avoiding any conflict of interest.

 

THE EVALUATION DESIGN

The evaluation had two goals: (a) to document and describe the activities being conducted by virtue of the ACS Professorship, and (b) to develop a reporting tool to enable rapid quantification of ACS Professor activities and outcomes in the future.

 

METHODOLOGY

Design

This is a descriptive study. The content of narrative responses was analyzed, and supporting documentation, to the yearly request to the Professors for a summary of their accomplishments.

 

Sample

The sample consisted of the Professors in Oncology Nursing who were funded during the survey period. At the time of the survey, there were nine Professorships at the following academic institutions: Case-Western Reserve University, University of California at Los Angeles, University of California at San Francisco, University of Maryland, University of Minnesota, University of Pennsylvania, University of South Florida, University of Utah, and University of Washington.

 

Instrument

At the end of the year, Professors are asked to submit a summary of their accomplishments based on Professor-specific and ACS-approved objectives for five program goals. The required report is to be organized using the five objectives for ACS Professorships in Oncology Nursing. These objectives are as follows:

 

1. Providing an interface between the theoretical and clinical practice components of cancer nursing and strengthening the cancer nursing curriculum in the undergraduate and graduate programs.

 

2. Facilitating continuing education related to oncology nursing.

 

3. Contributing to the scientific foundation of oncology nursing by conducting or directing research, encouraging collaboration in research, and supporting nursing contributions to the literature.

 

4. Collaborating with the ACS and other ACS Professors.

 

5. Providing leadership in cancer nursing through consultation and community activities.

 

 

Each ACS Professor responded in a narrative form to the above program goals.

 

Narrative responses for the academic year surveyed ranged in length from 8 to over 20 pages, and many Professors attached appendixes with details in graph and table format, as well as newsletters, copies of syllabi, and other information. This reporting method was not only extremely labor intensive for the Professors, but was difficult to analyze in an efficient and consistent manner secondary to variation in style among the individual respondents.

 

Phase 1

Analysis occurred in two phases. First, after reading these narratives and studying them for content and common themes corresponding to the Professorship goals, the authors derived from common themes a checklist of "types of activities" that met behavioral objectives associated with the five goals.

 

For instance, after reading the narrations under the broad Professorship goal, "Facilitating continuing education related to oncology nursing," two categories were established: 1) Continuing education of professionals without much oncology experience, and 2) Continuing education of oncology professionals. Then, under each of these categories, subcategories were developed based on the Professor's responses. For instance, under the category "Continuing education of oncology professionals" the following subcategories were established:

 

1. designed, implemented, or participated in local ongoing meetings/projects

 

2. designed, implemented, or participated in staff development

 

3. designed, implemented, or participated in a regional ongoing project

 

4. delivered a national presentation

 

5. designed, implemented, or participated in national conference of one day

 

6. designed, implemented, or participated in an international project.

 

 

The narrations were then re-read and analyzed for content corresponding to the behavioral objectives of the new tool. This type of evaluation survey using a checklist of activities has been used by other authors to evaluate ACS and other funded programs (14-19). The purpose of evaluation research of this kind is to find out how well a program, practice, or policy is working (20). A survey style can be used to obtain information regarding the prevalence...of variables with a population (20, p. 191). In this case, the population consisted of ACS Professors of Oncology Nursing, and the program being evaluated was the ACS Professorship in Oncology Nursing.

 

Two types of reliability were addressed by the authors (21). Following the initial establishment of the categories and subcategories, intercoder reliability was established by having the authors reread all the narratives from the Professors, independently recode the data, and check the agreement between the two coders. The authors agreed on 89% of the initial coding categories. Stability was ascertained by checking the agreement between the first coding of each individual author and that individual's second coding. Agreement between the first coding and the second coding of each individual was over 90%.

 

The checklist used was similar to questionnaires frequently used in such "survey research," the difference being that the authors assigned the categories based on the narrations supplied by the Professors. Classification by the authors rather than the respondents introduced error related to the possibility of misinterpretation of the narrative responses. The level of this error is difficult to evaluate; however, since the behavioral objectives were fairly concrete, the error was thought to be fairly low. Also, error may have occurred when certain Professors may have failed to enter significant information into their narratives, being unaware of some of the specific types of behaviors that were under study (e.g., "encouraging minority applicants").

 

Phase II

During the second phase, the authors measured the frequency of occurrences within each category and subcategory. The nominal measurements obtained allowed the authors to measure the frequency of occurrences within each category. Since surveys as a method of description, are "inherently nonexperimental," it cannot be proven that the changes seen were caused by ACS funding (20, p. 191). It can only be determined whether the goals of the ACS program were being met, and infer an effect caused by the support provided.

 

RESULTS

The Medical Affairs Advisory Group on Scholarship and Professorships in Oncology Nursing of the ACS established five goals for the Nursing Professorships. The results of the analysis of the Professors' yearly reports are reported as they address each one of the five stated goals for the Professorship.

 

Goal 1.

Provide an interface between the theoretical and clinical practice components of cancer nursing and strengthen the cancer nursing curriculum in the undergraduate and graduate programs.

 

This goal involved curricular activities of the Professors at the departmental, college, and university levels, assigned teaching responsibilities, advisement of graduate students, and service on academic committees.

 

The Professors reported a wide range of activities to accomplish this goal. In all, the Professors participated in 41 university curriculum projects, of which 30 were completed and 11 are ongoing. They developed 13 new courses, established relationships with 15 new clinical sites or new preceptors, revised 2 courses, designed 2 new curricula, implemented 3 new tracts or specialty areas in a curriculum, and developed 4 new or revised audiovisual materials.

 

Specific examples of unique oncology-related curricular projects include:

 

* worked on a tobacco prevention/cessation interactive video disk for undergraduate and graduate students

 

* developed a master's course within the School of Nursing that is also open to medical students

 

* modified the curriculum to blend the nurse practitioner/clinical nurse specialist role

 

* redesigned the curriculum to reflect minority issues by expanding the clinical sites that are used by graduate students

 

* developed new specialty oncology master's courses

 

* developed a "caseload" for master's students to follow through their graduate program

 

* offered new graduate courses with other academic departments for students in graduate nursing and non-nursing programs

 

* developed a new Ph.D. course

 

 

The Professors were responsible for a variety of courses and lectures. Specifically, they taught 6 courses, gave 61 hours of lectures, were involved in 5 independent studies, 2 group projects, and led 2 seminars.

 

In addition, they were actively involved in educational programs for faculty. Specifically, they gave 18 formal programs/workshops/retreats for faculty. Of the 18 faculty-related programs, 15 programs were related to developing a new clinical site or new preceptors, 2 were retreats specifically for faculty, and 1 was a training program for new preceptors. These educational activities were included with this curriculum-related goal because they were viewed as strengthening the oncology curriculum content.

 

The Professors reported involvement with a large number of graduate students. They were advising 7 post-doctoral, 12 doctoral, and 53 master's students, and were on 8 doctoral committees as well as on 32 masters' theses committees. Furthermore, they reported they were involving 26 graduate students in their research activities. They also reported several recruitment activities including 2 active minority recruitment programs, and expanded recruitment efforts by 1 academic program. One Professor had received a grant to encourage graduate education of minority students. As part of their recruitment efforts, the Professors had involved over 40 students in ACS events.

 

Along with actively teaching and advising students, the Professors provided leadership on committees in their academic settings. They were chairs or directors of 8 university committees and participated in 7 university committees. The committees they served on were related to admissions, graduate education, research, and continuing education.

 

Illustrative of activities that were designed to link education with practice is the following example:

 

My faculty colleagues and I met individually and in groups with master's-prepared oncology nurses from the Cancer Center, Johns Hopkins Oncology Center, the Clinical Center at the NIH...[t]hese meetings were particularly helpful to the faculty in validating the relevance of course content and clinical experiences for students in the oncology program. These clinicians... gave useful insights into advanced practice as it is being shaped by changes in the health care system. The impact of these changes is reflected in additional course emphasis on cost effectiveness, case management, home/hospice care, and preventive education.

 

Goal 2.

Facilitate continuing education related to oncology nursing.

 

This goal involved designing, implementing, participating, and presenting at conferences, workshops, short programs, and courses for oncology and non-oncology professionals at the local, state, regional, and international level. This goal also included the development of audiovisual materials to support these continuing education offerings. The Professors were involved in a sizable number of continuing education activities designed for both oncology and non-oncology professionals. Specifically, they were involved in conducting 54 continuing education programs for non-oncology professionals. These programs included:

 

* 7 regional conferences ranging from 1 day to 10 weeks

 

* 40 regional presentations

 

* 2 national presentations

 

* 2 self-contained courses ranging from 6 to 12 hours

 

 

Examples of these continuing education activities included: organizing a 2-day conference on pain management; giving 25 talks to multidisciplinary groups given regionally as an ACS Professor; developing a 6-hour self-contained course on pain management with slides, audio, video, and written materials for health care professionals, and; developing a 12 hour basic course in cancer nursing to be given by regional experts to nurses in underserved areas.

 

A creative approach to continuing education was taken by one Professor who was able to secure grant support from the state for continuing education offerings in pain management. Another creative approach developed by a Professor that addressed the time constraints of the nurses attending the education offering is illustrated below:

 

The first Symptom Management Workshop has been developed and is planned...it will focus on cancer related fatigue and sleep disturbances. Feedback from clinical agencies indicated that staff would only be able to attend a one-day conference so it has been designed as a one-day meeting with follow-up visits to each clinical agency that sends staff to provide clinical rounds to reinforce workshop content.

 

One Professor's innovative idea was to use one continuing education offering to pilot test and refine another continuing educational program.

 

The Summer Colloquium in Oncology Nursing is being used as a means by which two workshops, in development by the ACS, will be pilot tested. Colloquium participants' evaluations of the workshops (radiation and immunology) will assist developers to refine them into self-contained workshops.

 

Interestingly, the Professors were involved to a lesser extent in the continuing education of oncology professionals than non-oncology professionals. The Professors gave 8 programs at the local level, 1 at the regional level, 1 national presentation, 1 national all-day conference, and 1 ongoing international program. The Professors had a definite commitment to the continuing education of health professionals, particularly to those who were not specializing in the care of oncology patients.

 

Goal 3.

Contribute to the scientific foundation of oncology nursing by conducting or directing research, encouraging collaboration in research, and supporting nursing contribution to the literature.

 

The activities under this goal were in the area of conducting research, publishing research, writing grants, and giving research-related presentations.

 

The Professors gave evidence of prolific productivity in the area of writing articles, books, and grants. The Professors reported 28 research studies in progress and 8 studies in the planning stages. The Professors' mentoring role was evident from their efforts to involve nonacademic RNs in their research activities. The Professors involved over 50 RNs in their research activities. Forty-two RNs were assisting the Professors with their research, two RNs were writing papers with the Professors, and six published their own research with the Professor's help.

 

Two students served as my co-investigators on the study "Early Support Visit" of the Reach to Recovery Program. Our 1993 activities included analyzing the data, writing the final report, preparing an abstract for submission to the Third National American Cancer Society Nursing Research Conference (it was accepted for a poster presentation) and preparing the poster. A manuscript is in process.

 

In addition to writing multiple articles, the Professors were participating in 20 grants that they had received before the funding period. Four of the ongoing grants were intramural grants, 13 funded by extramural organizations such as the National Cancer Institute, National Center for Nursing Research, National Institute of Mental Health, and the Pennsylvania Health Department. Three grants were small grants from the ACS, Sigma Theta Tau, and the Oncology Nursing Foundation.

 

During the reporting period, the Professors wrote 12 grant proposals that received approval. Eight of these 12 grants received intramural funding, for example the University of California and the University of Minnesota, and the funding ranged from $4,700 to $23,000. The remaining four received extramural funding from federal and state departments. In addition, the Professors had submitted or were planning to submit nine additional grants. Illustrative of the grants funded was a study that investigated nursing's impact on quality of life outcomes in elders (22).

 

The specific aims of the study are: 1) to examine the effects of a standardized nursing intervention protocol on quality of life and outcomes for post-surgery older cancer patients at 3- and 6-months post-intervention; and 2) to examine the effects of a standardized nursing intervention protocol on the family care givers' perceived burden at 3- and 6-months post-intervention. The design is a multi-factorial examination of the effects of a short-term nursing intervention on quality of life of older cancer patients and their family care givers. (RO1-NR03229, NCNR, 9/30/92-9/29/96).

 

The Professors' contributions to the professional literature during the one-year finding period was impressive. Forty-three (43) articles published, 8 articles are in press, and 6 articles are in review. The journals in which they published included oncology and non-oncology nursing journals as well as nursing and non-nursing journals (Tables 1 and 2). In addition, the nine Professors wrote 3 books and 13 book chapters during the funding period.

  
Table 1 - Click to enlarge in new windowTABLE 1. Professors published 43 journal articles
 
Table 2 - Click to enlarge in new windowTABLE 2. Professors had articles in press or in review in 14 journals

Also impressive was the Professors' involvement in scientific conferences. They presented papers and helped to organize conferences. In all, they presented 25 papers at local, regional, national, and international scientific/research conferences. The majority of the conferences were national and international. The Professors served in leadership roles in 7 national scientific/research conferences. They organized 3 scientific conferences, 1 local, 1 national, and 1 international. The international conference on symptom management organized by one of the Professors was 3 days in length. Examples of other leadership roles were serving as chair of a plenary session, co-director of a 1-day course on nursing research, and coordinator of an instructional session. One Professor assisted in raising $12,000 for a national scientific conference on pain.

 

Two 2-day programs were planned and offered...to address research-identified knowledge deficits about the pharmacology of opioid analgesics. Findings from an oncology student's master's thesis indicates that RNs in our state show a severe knowledge deficit about pain control. The conferences were self-supporting with contributions obtained from several pharmaceutical companies and grants from the Division ACS ($12,000).

 

Several Professors received national recognition including two Professors who were elected Fellows of the American Academy of Nursing. Three Professors were active on national committees and one Professor was a member of a World Health Organization committee. Two Professors received institutional awards such as Alumni of the Year.

 

A specific example of how the Professorship support facilitated research is given below:

 

Data collection and entry and data cleaning have been completed on a study investigating clinicians' inference of pain, meanings associated with cancer pain, and efficacy of sublingual morphine sulfate. Development of a reliable scoring system for the behavioral data was quite a challenge, but accomplished with the assistance of two oncology graduate students and another graduate student. Final data transformations are being completed and analyses is ready to begin. Research assistants who have been supported by the Professorship have assisted with the data coding and entry for this study.

 

Goal 4.

Collaborate with the ACS and other ACS Professors.

 

This goal involved the Professor's activities in the ACS at the local, state, regional, and national level. The activities reported for this goal attest to the strong commitment of the Professors to the ACS and in donating their professional services to the community. The Professors were involved in providing consultation to the ACS on six different occasions which is on-going in three different areas. They reported being involved in 34 ACS committees and/or task forces and were chairing 5 of these (4 Division committees and 1 local unit committee). The Professors were participating in 6 national ACS committees, 16 Division committees, and 7 local ACS committees.

 

Not only were they devoting substantial amounts of time to all levels of the ACS, they were actively collaborating with other ACS Professors.

 

I continue to participate in a collaborative research project on the elderly's awareness of cancer risk factors and nature of self-examination practices which was developed by the ACS Professors at the ONS Congress in 1991.

 

They reported 25 different activities being conducted with the other Professors. Fourteen of these activities involved doing presentations or workshops for the ACS with other Professors. Six of the activities were research projects or conferences involving other Professors, and 4 were special projects done at the request of the ACS. For instance, the ACS Professors had devoted significant time and energy to identifying the critical and essential oncology content necessary for undergraduate curriculum, titled Cancer Nursing Curriculum Guide for Baccalaureate Education(23). Another group activity was planning, reviewing abstracts, and moderating sessions at the 3rd American Cancer Society Cancer Nursing Research Conference.

 

Goal 5.

Provide leadership in cancer nursing through consultation and community activities.

 

The major consultation activity reported towards this goal was in terms of being on editorial boards of the leading nursing journals. Nine of the Professors were on editorial boards of both oncology and non-oncology journals and a major book publisher (Table 3 lists the editorial boards). In addition, the Professors were involved in providing curriculum consultation to 3 university programs, consultation on clinical practice to 4 settings that was still ongoing, and 9 days of research consultation. They had provided consultation to 3 funded grants and one dissertation and to 2 conferences. Interestingly, political testimony had been given by a Professor at 4 different local and state hearings. The political activity ranged from testifying about the importance of oncology funding to both local and state commissions and marshaling national support to prevent the closing of a baccalaureate nursing program.

  
Table 3 - Click to enlarge in new windowTABLE 3. Editorial boards award committees on which the Professors served

DISCUSSION

This evaluation was designed to identify the activities being conducted by a selected nursing faculty supported by an ACS Professorship. While productivity per se is influenced by multiple factors, the contribution of availability of release time and additional resources can not be minimized. Barhyte and Redman (9) found a significant correlation between the productivity of faculty and release time available to them. Our study identified the diversity of activities the Professors engaged in because of the outside funding which made a significant contribution to the nursing profession in general, and oncology nursing in particular.

 

While the Professors had been a highly productive faculty involved in all aspects of oncology nursing at the time they received the Professorship, they commented that their productivity and involvement increased after receiving ACS external funding. According to Fox (24), 70% of most university faculty members, during any given year, have not published. In contrast, these Professors were extremely productive. They provided evidence of a remarkable degree of commitment to the continuing education of both oncology and non-oncology professionals as well as the general public. Their reported publications, professional activities, and research programs gave evidence of a high degree of dedication to contributing and improving the quality of life of cancer patients and their families.

 

The Professors' research, writing, and public speaking topics all addressed the Oncology Nursing Society's top 10 research priorities for 1991 (25). Examples of activities that are consistent with the priority problem areas in oncology nursing are:

 

* developing a pain management elective college course

 

* offering a cancer prevention and detection course

 

* developing a proposal to a corporation to bring a mobile mammography van and breast health education to remote frontier sites in several Western states

 

* developing a nurse-directed symptom management service

 

* doing research on symptom distress and lung cancer

 

* chairing a committee to deliver statewide conferences on lung cancer

 

* chairing a committee to deliver statewide conferences on symptom management

 

 

CONCLUSIONS

The results of this study unquestionably demonstrated that the stated goals of the ACS Professorship were being met. Professors indicated that the funding and resultant release time enabled them to increase their involvement in all domains of oncology nursing at the local, regional, national, and international levels. Their narrations gave evidence of the opportunity to be involved in the community, academic settings, and with students because of the funding. The only barrier to more involvement in the state ACS was the observation by several of the Professors that the reorganizing and restructuring of the state Divisions significantly decreased both the amount of time they could devote and the type of activities in which they could be involved. Aside from this observation, the Professors thought that the funding and release time enabled them to strengthen their involvement and influence on cancer care. Professors wrote that the funding supported activities they were not normally able to support (e.g., secretarial time, research assistants, travel, and extra computer support). A typical response from a Professor was the statement, "I was able to purchase resources to ease the burden of my work."

 

The contributions the Professors were making to the body of literature comprising oncology and non-oncology nursing are highly commendable. The Professors demonstrated that they were able to balance their commitments to teaching, professional/community activities, and scholarship with obvious success. The result was a high level of productivity in each of these.

 

Recipients of American Cancer Society's Professorships in Oncology Nursing

Anne Belcher, Ph.D., R.N., F.A.A.N., Associate Professor/Chairperson, University of Maryland, School of Nursing, Baltimore

 

Patricia J. Larson, D.N.S., R.N., F.A.A.N., Associate Professor, College of Nursing Arts & Science, Hyogo, Akashi, Hyogo, Japan

 

Ruth McCorkle, Ph.D., R.N., F.A.A.N., Professor, University of Pennsylvania, Philadelphia

 

Susan C. McMillan, Ph.D., R.N., F.A.A.N., Professor, University of South Florida, College of Nursing, Tampa

 

Kathi Mooney, Ph.D., R.N., A.O.C.N., F.A.A.N, Professor, University of Utah, College of Nursing, Salt Lake City

 

Janice Post-White, Ph.D., R.N., Assistant Professor, University of Minnesota, School of Nursing, Minneapolis

 

Linda Sarna, D.N.Sc. R.N., F.A.A.N., Associate Professor, University of California, School of Nursing, Los Angeles

 

Diana Wilkie, Ph.D., R.N., A.O.C.N., F.A.A.N., Associate Professor, University of Washington, Department of Biobehavioral Nursing, Seattle

 

M. Linda Workman, Ph.D., M.S.N., F.A.A.N., Associate Professor, Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland

 

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