Strengthening of oncology nursing education and training in Africa in the year of the nurse and midwife: addressing the challenges to improve cancer control in Africa

Naomi Oyoe Ohene Oti1,2,3a , Martjie de Villiers4,5b , Prisca Adejumo3,6c , Roselyne Okumu3,7d , Biemba Maliti3,8,9e , Nagwa Elkateb3,10f and Nazik Hammad3,11g

1National Radiotherapy, Oncology and Nuclear Medicine Centre, Guggisberg Avenue, Harley Street, PO Box KB369, Korle Bu–Accra, Ghana 2Accra Cancer Registry, Guggisberg Avenue, Harley Street, PO Box KB369, Korle Bu–Accra, Ghana 3African Organisation for Research and Training in Cancer, 1ST Floor, Birkdale 1 River Park, Gloucester Road, Mowbray, Cape Town, 7901, South Africa 4Adelaide Tambo School of Nursing Science, Building 5, Room 327, Staatsartillerie Road, Pretoria West, Private Bag x 680, South Africa 5Tshwane University of Technology, Building 5, Room 327, Staatsartillerie Road, Pretoria West, Private Bag x 680, South Africa 6University of Ibadan, Oduduwa Road, Ibadan, 900001, Nigeria 7Kenyatta National Hospital, PO Box 20723-00202, Nairobi, Kenya 8Cancer Disease Hospital PO Box 51337, Lusaka, 10101, Zambia 9Zambia Oncology Nurses Society, PO Box UTH73, Lusaka, 10101, Zambia 10National Cancer Institute, Kasr Eleini St. fom Elkhalig, Cairo, 1196, Egypt 11Queens University, 99 University Ave, Kingston, ON K7L 3N6, Canada ahttps://orcid.org/0000-0002-1433-0364 bhttps://orcid.org/0000-0002-88109144 chttps://orcid.org/0000-0003-3065-8308 dhttps://orcid.org/0000-0002-2459-8532 ehttps://orcid.org/0000-0002-2552-7031 fhttps://orcid.org/0000-0002-3961-1736 ghttps://orcid.org/0000-0003-3963-5815 Short Communication Short

Abstract

The Cancer burden in Africa is increasing. Nurses play a pivotal role in health care systems Correspondence to: Naomi Oyoe Ohene Oti Email: [email protected] and find themselves in a key position to engage with patients, communities and other health professionals to address disparities in cancer care and work towards achieving ecancer 2021, 15:1209 https://doi.org/10.3332/ecancer.2021.1209 cancer control in Africa. The rapidly evolving nature of cancer care requires a highly skilled and specialised oncology nurse to either provide clinical care and/or conduct research to Published: 23/03/2021 improve evidence-based practice. Although Africa has been slow to respond to the need Received: 16/06/2020 for trained oncology nurses, much has been done over the past few years. This article Publication costs for this article were supported by aims to provide an update of Oncology nursing education and training in Africa with spe- ecancer (UK Charity number 1176307). cific focus on South Africa, Ghana, Nigeria, Kenya, Zambia and Egypt. Mapping oncology Copyright: © the authors; licensee nursing education and training in Africa in 2020, the International Year of the Nurse and ecancermedicalscience. This is an Open Access the Midwife, provides an opportunity to leverage on the essential roles of the oncology article distributed under the terms of the Creative Commons Attribution License (http:// nurse and commit to an agenda that will drive and sustain progress to 2030 and beyond. creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and Keywords: oncology nursing, education, training, cancer care, Africa reproduction in any medium, provided the original work is properly cited.

ecancer 2021, 15:1209; www.ecancer.org; DOI: https://doi.org/10.3332/ecancer.2021.1209 1 ecancer 2021, 15:1209; www.ecancer.org; DOI:https://doi.org/10.3332/ecancer.2021.1209 Nurses Network for input regardwith to Oncology nursing education andtraining programmes for information pertainingto education and also requested themembers of AfricanOrganisation for Research and Training inCancer (AORTIC) Nursing groupand the African Cancer Allied Health Literature asdatabases and‘education andtraining’, ‘Oncology ORCancer nursing’ and‘Africa’ assearch words. The authors more, aliterature search was conducted usingPublic/Publisher Scopus, MEDLINE, Web of Science andCumulative Index to Nursing and providingtional institutions oncology nursing education and training as well as the regulatory bodiesandchallenges experienced. Further This article was written by representatives from thedifferent countries involved, who could provide accurate information from- theeduca Method by their respective regulatory bodies andare representative of theselected regions in Africa. focuson South Africa,Ghana, Kenya, Zambia,Nigeria andEgypt. These countries have formal education and training programmes accredited This articleaimsto provide anupdate ononcology nursing education andtraining in Africa, challenges andthe way forward with specific Purpose by developing andimplementing innovative interventions andstrategies to enhance oncology nursing education andtraining inLMICs. [6, 15]. Therefore, theneedfor effective training of the Africannurses to provide expert oncology nursing care for thecontinent isparamount trol packages by identifying thusprovidingopportunities, on missed gaps the and closing for theholisticapproach incaringfor thesepatients edge andskills[13,14].In addition,nurses areof capable designinganddelivering innovative culturally acceptable cost-effective cancer con- Althoughnurses are key providers of cancer care across theeffectivenessspectrum, the of care isdependent onthenurse’s acquired knowl- Significance of specialisation inoncology nursing nursing [12]. in recent years, several other countries have since developed formal education andtraining programmes leadingto certification inoncology Africancountries as Southsuch Africaand Egypt have beenproviding specialisedoncology education andtraining for many years; however, the development of thecancer nursing workforce [10].Out of 22countries, sixreported having nooncology trained nurses [9]. tality outcomes to survivorship care andultimately end-of-life carecontributing [10]thus to both areduction of cancer burden andimprovement inpatients’ ogy nursing workforceprovide can care throughoutcancerthe continuum –from prevention, early detection, various treatment modalities system There ispressingfor demand Oncology specialised personnel, especially nurses. Nurses, who are seenasthebackboneof thehealthcare were found inSouth Africa ised healthcare personnel [1,5,6].In 2015,it was found that there were only 102cancer treatment centres onthecontinent, of which 38 disease at of thetime diagnosis[1].LMIC’s ability to respond to thecancer burden ishampered by thelimited resources, especially special- middle-income countries (LMIC) 506,000 for thesameperiod[3,4].Moreover, itisprojected that thecancer burden will increase by more than60%by 2030inlow-and an estimatednewly 752,000people diagnosed cancer;with that is 4%of thetotal globalcancer incidence rate; cancerwith deaths totaling population andmore westernised lifestylechanges, cancer hasbecome healththreat apublic [2].In 2018,the African continent hasseen Traditionally, cancer was not Africa’s mostconcerning healthcare problem [1].However, over recent years, with anincreasingly ageing Background [5, 11].Despitekey the contributionnursesoffer can to control cancer, devote LMICs few resources andpay limited attention towards [8], are oftenfirst the point of entry tosystem the and play apivotal role incancer control programmes [9]. An effective, skilledoncol- [6]. Research hasshown that having ahighly competent andskillednurse who provides quality care leadsto reducing patient mor

[7]. [2]. Of thepeoplediagnosed cancerwith insub-Saharan Africa, approximately 80%present advancedwith 2 - -

Short Communication ecancer 2021, 15:1209; www.ecancer.org; DOI:https://doi.org/10.3332/ecancer.2021.1209 However,education duringthe90s,most andtraining in Africa were donethrough theprovision of in-serviceessential, training [15]. While meetingsas nurses incancer care, respectively. This propelledstart ofthe formal oncology nursing education andtraining inboth countries. cess andside-effects. Anecdotal data suggest that inthe1980s,nurses incountries asEgypt such andSouth Africa heldtheir first national side effectsmanaging of bothradiation and chemotherapy andhealtheducation of patients andtheir families disease,treatment about pro- returnand upon mantletookthe up of ‘Train-the-Trainer’ initiative to train others nurses intheadministration of chemotherapy to patients, training and terminally ill patients. In thelatenurses 70sand80s, most in Africa joinedintheadministration of chemotherapy through on-the-job [24–27]. Patients presented latewith stage cancers andtherole of thenurse was limited to inpatient care of surgical hospitalised patients cancers in Africauntil the1970s when additionaltherapyas chemotherapy such was addedand was solely administered by physicians Similar tohigh income the countries around(HIC), century,mid-20th the surgery andradiotherapy were the main treatment modality for Evolution of oncology nursing education and training in Africa patient outcomes by increasing thequality of care andadvocating for cost-effective interventions for patients/clients [17,22,23]. ticipating inpolicy formulation andconductingresearch [20].In addition,effective leadership isof importance utmost inorder to influence symptomsof cancer,treatment the side effects, guidance ofpatient the and family through thecancer continuum, advocating for and par systemictherapy (chemotherapy,and targeted hormonal therapy) andradiotherapy, theassessmentand management of acute andchronic The scope of competenciesothers,amongst includes advanced knowledge andskillina variety of treatment assurgery, modalitiessuch munity services [21]. body to practiseas such knowledge base,complexcompetences decisionmakingskillsandclinical inthefieldof oncology nursing licenced by appropriate regulatory the Advance Practice Nurses arewho professional nurses additional postgraduatewith training (minimum of aMaster’s degree) with expert conductingresearch to improve evidence-basedcare areof some thebroad roles theoncology nurse fulfils. These roles are enhanced by tion of care, healtheducation, symptom management andsupportive care [18,19].In addition,effective nursing administration, training and are diverse and range from that of creating cancer awareness and cancer advocacy, which includes cancer prevention coordinaactivities, - These nurses haveroles unique andresponsibilities continuouslywhich change asthefieldof oncology continues to evolveroles [17].The nursingcrucial care toaffected people by cancer basedonhis/her evidence-based, specialisedethical andpersonal knowledge andskills[16]. The EuropeanOncology Nursing Society defineda cancer nurse asaregistered nurse who hasthemandate andfullresponsibility to provide Role of the oncology nurse Results training, challenges andenablingactions. Africa,the role of oncology nursing, theselected country-specific experience, modeof education, available oncology nursing education and combinedand captured onanExcel spreadsheetand plotted of onamap Africa. This paper highlights theevolution of Oncology Nursing in survey was posted onthe Telegram socialmediagroup. The information obtained from both thesurvey andthedirect phonecontact were contacted vial telephone through itsrepresentative in themain AORTIC network asto obtain information by meansof direct contact. A represented on the AORTIC Nursing group. In the instance where a countryspecific was not represented on the group, the country was were accredited byappropriate the regulatory body. This was supported by atelephonic interview of key personnel inthe various countries programme;the in termsof duration,of type certificate or degree offered, whether itispostgraduate and whether or not theprogramme/s group. Participants were asked whether or not an oncology nursing programme was currently being offered in their countries and details of tion from the AfricanCancer Nurse Network (171nurses representing 10countries) andadirect callto members of the AORTIC Nursing training available intheir countries. Data were obtained electronically via useof Telegram (a socialmediaapp) to reach andobtain informa- [27]. This increased nursing contributionto cancer care. Some of thenurses in Africa hadtraining intheUKandNorth America [16, 20]. The Oncology nursepractise can indifferent healthcare settings: ambulatory care, acute care andcom 3 - -

Short Communication ogy nursing practice in Africa affordedin education opportunities andtraining ofthe help with several non-governmental organisations inanattempt to strengthen oncol- trainingsuch did not provide nurses the skills towith reach their fullpotential in maximising patient outcome. Over the years, someHICs development of oncology nursing curricula which are offered at different levels [30,31]. seldom followed-upto ensure sustainability of theacquired knowledge andskill[15].Recently more African countries have initiated the ecancer 2021, 15:1209; www.ecancer.org; DOI:https://doi.org/10.3332/ecancer.2021.1209 tively) who were awarded apostgraduate certificate of membership from andcredentialed GCNM to practise asNurse Specialists [37]. Also, [37]. Training started in2015 and thefirst three cohorts inoncology nursing delivered atotal of 12graduates (2018, 2019 and2020,respec Science inNursing 3 about with years practisingexperience [37]. Also having amaster’s or aPhDin nursing or related area isanadvantage Nursing andMidwifery Council(NMC) of Ghana andtheeligibility for thisprogramme isthat, acandidate should have at leastaBachelor of Midwifery Ghana College of Nurses and Midwives (GCNM), mandatewhose isto provide postgraduateeducation specialist andtraining inNursing and SpecialistHealth training andPlant Medicine Research Act,2011 (ACT 833)[34,35].Part three of itsprovisions paved way for thebirthof for oncology nursing specialisation, anecessity for effective patient care andquality outcome. In 2011,theParliament of Ghana enacted the and inadequate trained health professionals in oncology was increasingly becoming a major challenge. The skills gap created made it crucial certificate,or diploma degree inoncology nursing. In-service training was alsodone. The limited access to training inthisspecialisedarea educational programmes hosted byin Europeinstitutions academic or North America. These programmes provided the nurse with either a cancerwith andtheir families.Others subsequently followed to attend oncology nursing education andtraining abroad or by meansof online return,and upon embarked on‘Train the Trainer’ initiative to train other registered nurses onthejobtogive help specialisedcare to people IAEA and the Ghana Atomic Energy Commission [33]. With thiscollaborative effort, two nurses were trained abroad; one for each centre Ghana haditsfirst oncology centre in1997andthesecond in2005,establishedthrough acollaboration between theGovernment of Ghana, Ghana Ministries of Health. forhub international studentsall over sub-Saharan Africa, arewho mostly sponsored by International Atomic Energy Agency (IAEA)or their ing. Fundingfor programme this is basically self-fundedsome studentsbut apply for student loans. These training programmes are alsoa Considering the Cancer burden inSouth Africaand thenumber of trained oncology nurses needed,efforts mustcontinue to train up-scale - level outcomes of the new Postgraduate Diploma in Oncology and Palliative care nursing were based on these newly defined competencies. of practice included thecompetencieswhich skill set andminimum of anOncology andPalliative care nurse inSouth Africaexit [32].The In preparationfor new the programme,and representativesacademics from Oncology nursing practice cametogether anddeveloped ascope The training allows vertical professional progress to aMaster’s degree innursing (Advanced specialistnurse). and Palliative Care Nursing. The holder of aPostgraduate Diploma will beknown asanurse specialistinOncology andPalliative care nursing. (South Africa, 2013). The new qualification to be rolled out thenextwithin year or two will beknown asaPostgraduate Diploma inOncology of Health to theDepartment of Higher Education and Training andtheneedto alignnursing degrees to theNational Qualification Framework Currently theseprogrammesare intheprocess of being phasedoutdueto nursing education andtraining beingmoved from theDepartment South African Nursing Council (SANC) register [32].Programmes are accredited by theSANC, as well astheCouncil for Higher Education. are acomprehensiveofon principles module palliative care nursing. Upto theendof 2018,atotal of 641Oncology nurses were onthe nursing college. The qualifications are offered at Honor’s-, Master’s-, Bachelors andDiploma level, respectively. Unique to theseprogrammes ing are available at different levels at various higher education two institutions; regular universities, two universities of technology and one arose to recognise skillneededtospecialised the practisean environment.in such Since then,formal training programmes inoncology nurs- Oncology nurse education andtraining started inthe90sduring which timethere were anincrease inoncology care facilities andaneed South Africa Country-specific situationanalysis [35]. The College started eightwith courses, of Oncologywhich nursing was oneof them[36]. The training iscredentialed by the [28, 29]. These education andtraining sessions were often provided ad-hoc by experts inthefieldand were 4 -

Short Communication ecancer 2021, 15:1209; www.ecancer.org; DOI:https://doi.org/10.3332/ecancer.2021.1209 training inadequate intheface of thegrowing Cancer incidence inGhana [3,38].The mainchallenge islimited oncology nursing faculty to support Currently,total the number offormal local trained oncology nurses is45(12Nurse Specialists and33nurses intraining). This numbers are allowed fellowshipand awarded afellowshipcertificate to progress from Nurse Specialist to Senior Specialist thento Nurse Consultant [37]. cadrethese of nurses are beingprepared toand academicians[35].Furthermore, beclinicians to allow career advancement,graduates are sponsored by thegovernment of Zambia. To date, three nurses have obtained Masters inOncology andPalliative Nursing from South Africa. A totalof 19registered nurses have becomeOncologyspecialised Nurses between 2008and2019,having trained inSouth Africa which was was completed andthefirst students enrolled in2020at the Levy Mwanawasa Medical University. programme priorwithout years of practice experience. In 2018,thesecond for curriculum a1-year Advanced Diploma inOncology Nursing ing isalsoconsidered allowswhich trainees to move from college nursing programmes via foundation nursing straight to oncology post-basic enrolledit nurses had atwho Registeredthe a minimum Nurse Diploma andat least2 years’ of clinicalexperience. Recognition of prior learn- InGNCZ. the forfirst 2017,the curriculum a2-year Bachelor of Science inOncology Nursing was completed andintroduced at theuniversity, programmedevelopment. Several localandinternational stakeholders were involved inthedevelopment of spearheaded by thecurriculum Zambia Oncology Nurses Society in2016, which was instrumental indrivingtheagenda for alocaloncology nurse education andtraining of Healthand General(MOH) Nursing Councilof Zambia(GNCZ) for support. The oncology nurses alsocame together andregistered the Inhospital’s 2009,the Nursing department wrote aconceptnote ondeveloping alocaloncology nursing training and lobbiedtheMinistry education andtraining inSouth Africa. nurses followingtosuit completeRadiationonline ONS the Oncology Nursing certificate. Registered nurses were alsosponsored to attend head of nursing completed theOncology Nursing Society’s (ONS) Chemotherapy andBiotherapy programme, with several other registered and palliativecine care services. In 2007,IAEA sentnurse experts totrain help thefirst registered nurses at the hospital. Thereafter, the available oncologyspecialised nurses. The hospital offers chemotherapy, radiotherapy, surgical oncology, pediatric oncology, nuclear medi- Zambia hasonededicated oncologythe Cancer hospital, Diseases Hospital, which openedin2006,during which timethere were nolocally Zambia students may befundedby partners like Pharma Companies. of pocketand sometimes byfunded studentloans from higher education loansboard dependingonthelevel of training. In few occasions, would influenceand practice policies around oncology nursing. The trained oncology nurses are few, yet thetraining ismainly by funded out ofpool oncology specialised nurses toto enablethem empower, educate andtrain prospective oncology nurses andto conduct research that clear jobdescription ofoncology specialised nurses to assist careerwith pathway progression. There isneedto strengthen anddevelop the ing ofmultidisciplinary the teamespecially nurses the working atthe chemotherapy units[41]. At present thegreatest needisto developa aroundthe country. Shortcourses onchemotherapy safety (Chemo-safe) training by various partners have gone along way incapacity build- Kenya Oncology Nurses Chapter alsoprovides alearningplatformby organising annualscientific conferences which are attended by nurses At present, 46and23nurses, respectively, are intraining at different colleges anduniversities across thecountry. ists. A total of 77nurses have successfully completed programme, thepost-basic whereas 11graduated asMScN oncology nurse specialists. and master’s level. Post-basicgraduates are known asoncology nurse generalists, while Master level graduates are Oncology Nurse Special- cancer care [40].Many have institutions leveraged ontheNCCS to develop andinitiate curriculums training. Training isprovided at post-basic The launchof theKenya National Cancer Control Strategy (NCCS, 2017–2022,) reinforced the needto improve resources thehuman for ogy nursing training was commenced and was accredited by thenursing council of Kenya. countrythe majoritythe but learntthrough training.on the-job In 2016,thehigher national training diploma equivalentto postbasiconcol- in Oncology Nursing (MScN) degree and has been ongoing for a period of 10 years. Prior to this a few oncology nurses were trained outside The firstoncology nursing educationand training inKenya started at theUniversity of Nairobi (UoN) inthe year 2010 with Master of Science Kenya . This programme isself-funded andsometimes asscholarships by pharmaceutical companies asHoffmann such LaRoche [39]. 5

Short Communication or to recruit international pioneers to present training locally. Oncology Nursing trainingthrough isfunded Scientific Activitiesfund. The only barrier islackof fundingto sendnurses abroad for training and palliative care programmes and workshops with theMECC in different Middle East countries as Turkey, Cyprus and Oman. At NCI, Egypt ing associationswith abroad hasledsomenurses to attend training incancer centres in theUSA, UKand Jordan as well asoncology nursing Oncologyis anannual nursing educationalconference presented inCairo for allnurses working incancer centres andunitsinEgypt. Partner workshopsare arranged incollaboration Unionwith of International Cancer Control andMiddle East Cancer Consortium (MECC). Also, there ing programmes, offered to nurses practisingat CairoNCI, the andother cancer centres andcancer unitsingeneral Sometimes, hospitals. faculty. Continuityprovision inthe of quality cancer care isensured through continuous education andtraining workshops andother train- DTNassociate degree, 35 Bachelorwith Oncology Nursing, 5 Masterwith degree inOncology Nursing and4 with aDoctor of Science as a Master’sinclude degree inOncology nursing andto expand theprogramme to other education So institutions. far 500nurses about with ist or Oncology nurse educator. This new programmeshould commence inthe2020/2021academic year. Other prospective changes also obtaina Bachelor degree inOncology nursing fromSupremethe Council of Egyptian Universities andpractise asanOncology nurse special- by a6-month internship incancer nursing to earnaDTN. This will befollowed by afurther 2-year specialisation inOncology nursing to necessitated changes inthecurrent programme,thatimplying enrolled students complete a2-year programme inGeneral nursing followed Supreme Council of Egyptian Universities stipulated that all nursing Education Institutes should follow the same bylaws. These requirements versity andare committed to practiseas astaff nurse at theNCI,Cairo. Recent introduction of new Bylaws andRegulations released by the care or stoma care. Graduates earnaDiploma in TechnicalNursing (DTN) certificate, anassociate degree incancer nursing from Cairo Uni- internship period,prepares nurses inareas of general Oncology nursing as well asa variety of sub-speciality areas, for example, palliative training programme, preparing graduates to provide total care for cancer patients in Egypt. The 2-year programme, followed by a 6 months’ In 1996,the TechnicalInstitute of Nursing, affiliated to theNational Cancer Institute (NCI),Cairo University, was establishedto develop a Egypt sometimes by employers of thetrainees asscholarships. Considering the cancer burden inNigeria, the number of trained oncology nurses isinadequate. Funding isprimarily by of out pocket and growth anddevelopment. Presently, there is not yet aclearly defined career pathway specifically for Oncology nurses inspite of diverse for opportunities professional sub-speciality. However, thisis yet to befinalisedasat thetimeof this write up. grammeto postgraduate programme the universities.within At theUniversity level, itis currently offered asacourse medical surgicalwithin There isanongoingby plan ofNMC the Nigeria to transformoncology nursing from itspresent status of postbasicpro hospital-based - lockdown. a total of 24nurses are enrolled intheaccredited oncology nursing training programme with theadmissionof anew set beinghalted by the efitsaccruing toas aresult them oftraining. the Before accreditation of theprogramme, atotal of 136nurses have beentrained. Currently The graduates ofprogramme this are knownas oncology nurses andpractise inoncology unitsbut anywithout specialremuneration or ben- registered with theNMCof Nigeria. grammecountryin the andishospital-based. This programmeis offered over aperiodof 1 year with candidates for admissionbeingnurses ADiploma post-basic in Oncology nursing programme, which was recently accredited, istheonly available oncology nursing education pro - health of thecitizens [42]. An educated oncology nursing workforce isparamount to thesuccessful implementation of thisplan. established aNationalMOH Cancer Control Plan (NCCP)for a5-year periodbetween 2018and2022asacommitment to safeguarding the who were oncology specialised nurses haddonesoabroad [6].Realising theneedto meet theburden incancer care, theNigerian Federal in units various settingsrely onin-service training, short-term workshops, conference attendance andlearningonthejob[6]. The few nurses, Untilrecently, there were noformal accredited oncology nursing education andtraining programmes inNigeria. Nurses working inoncology Nigeria ecancer 2021, 15:1209; www.ecancer.org; DOI:https://doi.org/10.3332/ecancer.2021.1209 6 -

Short Communication ecancer 2021, 15:1209; www.ecancer.org; DOI:https://doi.org/10.3332/ecancer.2021.1209 to come the implementationwith of theNational Comprehensive Cancer Network Harmonised Guidelines AORTIC Nursing SpecialInterest Groupis currently developing standard competencies for oncology nursing. Hopefully, more success is yet Immensesuccess hascome from nurse leadership in Africa when looking at palliative care programmes inUganda andRwanda [9].The Policies, leadership andfunding Challenges to oncology nursing education andtraining in Africa ongoing oncology nursing programmes. programmesare offered andthedevelopment stages of Figure thecurricula. 1shows amapof Africa indicating the various countries with Table 1shows the various African countries oncologywith nursing education andtraining programmes, the various levels at which these are intheir developmental stages. Central Africa currently hasnoongoing formal training. levels; Five in East Africa, three in North Africa, two in West Africa and two in Southern Africa. The programmes in the other four countries survey anddirectcontact, we foundthat out 16countries hadsomeform of oncology nursing education andtraining going onat different Therecountriesin some hadbeensomestrides in Africadeveloping their own curriculato train oncology nurses at various levels. From the Available oncology nursing education andtraining in Africa modules onpalliative care nursing principles. the universities. All thetraining programmesdeliveryinclude of research training appropriate for thelevel of training. Training alsoincludes oncologyincludes which nurse educators, oncologists,physicistsmedical andother oncology healthprofessionals at andfromthe hospitals fromstaffhospital is foundwhich to bebeneficialto both staffclinical andstudents. Clinicalfacilitation isdoneby amultidisciplinary team ing as well asaclinicalpracticumcomponent. Thelearning experience clinical isfurther enhanced by clinicalandacademicpresentations The principle of andragogy is toapplied enable learners to meet the educational requirements and thus all programmes offer didactic learn- ing at various levels, oneneedsto beaqualifiednurse with varying years of practising experience. of 2 years or a3-year postgraduate residency programme.For a person to beeligibleto enrol informal oncology nursing education andtrain- diploma/degree offered asa 1-yeartime or full 2 years’programme,time part Masters of Science in oncology nursing isoffered over aperiod in designated teaching hospitals havewhich cancer centres. The level of training varies from country to country andincludesapostbasic Formal education andtraining of oncology nursing in Africais mostly doneat theuniversity or college level and the practicums are conducted obtains certification from andislicensed to practise by theprofessional regulatory body from thespecificcountry. leveland practice principles inthe of oncology nursing, combined with internshipfor acertain periodof time[19]. Thereafter, thenurse Specialisation inoncology nursing requires anurse to receive education andtraining to acquire advanced knowledgeto andskillup thePhD Mode of education, admission requirements andprogramme duration exposure to globallearning[45,46]. planning ers. This isnot only aproblem at government level,also at but level. institutional Cancer centres rarely recognise nurses inleadership and are not able to articulateprofessional specific matters, drive patient care as they desire hence theyfollowing end up decisionsmade by oth- ofrequired the leadershipin governmentpositions to beableto influence cancer care policiesto includeanursing perspective [10].Nurses clearly definedcompetencies informcan which education and training andultimately practice [5].In mostcountries, nurses donot form part Plan forPrevention the and Control of Non-CommunicableDisease: 2013–2020[44]. Also, there are nostandardised scope of practice, nor However, oncology nursing speciality educationand training hasnot yet beenimplemented by asproposed allLMICs by theGlobal Action [10, 23].Historically, nursing hasbeenseenasalow status profession with poor wages, limited inprofessional enhancement and TM for sub-Saharan Africa [43]. 7

Short Communication ecancer 2021, 15:1209; www.ecancer.org; DOI:https://doi.org/10.3332/ecancer.2021.1209 ment of continuous development programmes isalsodifficult developmentalso to andskills,but ensure jobsatisfaction.However, with thelow number of specialisedoncology nurses’ available, develop - faculty There isalso lackoffaculty qualified to teach oncology nursing programmes and few doctoral programmes inoncology nursing to prepare there islimited opportunity for specialisededucation. Informal training programmes are availableinsufficient [12],but and unsustainable[9]. ing workforce Oncology nursing education andtraining isnot yet well recognised in Africa and isamajor obstacleto broaden theoncology and upskill nurs- Educational pathways professional silos[50]. patients’ treatmentand outcomes outlines of patients [49]andisevident by thedominance of themedical profession andthecreation of areSomeinstitutions funding not interestednursing infunding education, with thefeeling that nurses are not thekey factor indecidingon influenced byeconomicsocial, the setting and political ofwill thecountry [47,48]. The prevalence of self-funding of training isunfortunate. Unfortunately, policy links directly Financial for with fundingopportunities. support oncology nursing training programmes is scarce and is [6]. Withthe constantly changingoncology environment, continuing education programmes are of importance, utmost not only for b a Table 1.Countries with Oncology Nursing training andeducation in Africa. Post Registration Bachelor’s degree alsoknown asPostgraduate Diploma Postgraduate Membership Certificate (3-year Postgraduate Oncology Nursing Residency) 12 11 10 [9]. In general, nurseshave inLMICs insufficientknowledge of cancer care andthesituation isexacerbated by thefact that 9 8 7 6 5 4 3 2 1 4 3 2 1 Sudan Ethiopia Egypt Kenya Zimbabwe Zambia South Africa Nigeria Ghana Algeria Morocco Rwanda Mauritius Tanzania Malawi Botswana Country (Higher National Diploma) Diploma Countries with developing programs andlevel of training     Bachelor’s [5].         Level of training/education Post Registration Bachelor’s degree   a Postgraduate Membership Certificate  b

Master’s degree        8

Short Communication ecancer 2021, 15:1209; www.ecancer.org; DOI:https://doi.org/10.3332/ecancer.2021.1209 need to formulateinstitutions to plans securefor funding oncology nursing education andtraining aspartof theirnot NCCPs [10].Although can make inthecancer control efforts [5].Governments, non-governmental organisations, pharmaceutical companies andhigher education for theirofin positions inclusion authority atas institutional well asgovernmental level to advocate for the valuable contribution nurses oncologyspecialist nurses at various levels –certificate, bachelors, diploma, masters andDoctorate [10]. Also, nurse-leaders shouldlobby practice ofnurse. the The scopeof practicebe aligned should competencies,with roles andresponsibilities andexit level outcomes for the The role ofoncologyspecialist the nurse incancer control shouldberecognised andsupported by athorough review of thelegalscope of Policy Recommendations the challenges andrecommendations are shown inFigure. 2 reliable, healthy workforce to andinformgovernments how and where to invest interms of healthandoutcomes [53]. A summary of practice. The InternationalCouncil of Nurses conference in2019reiterated theimportance of having reliable data andevidence to ensure a the keysupport role nurses play incancer control programmes Funding isneededfor research,the reverse but research isalsotrue, isalsoneeded to drive funding. There ispaucity of research to output Research Figure 1. African mapshowing countries with oncology nursing education andtraining. [51, 52].Research informs education andtraining as well asevidence-based 9

Short Communication nursing in Africa. nursing nurses proven to ensure attritionof nurses, specialised provision shouldbemadeto adequately compensate andremunerate specialisedoncology Figure 2. A summary of the challenges and way forward of oncology nursing andeducation in Africa. ecancer 2021, 15:1209; www.ecancer.org; DOI:https://doi.org/10.3332/ecancer.2021.1209 to obtain by-in from therequired ministries Education and training programmes shouldbe evaluated and accredited by required governmental agencies to ensure good standard also but cancer care to their populace. should bepromoted sothat countries as useofsuch online-platforms, to helpcompensate for theshortage innursing faculty in Africa [54–56].Regional training programmes strengthenfurther specialisation andtraining opportunities edge thePhD andskillup level to develop oncology soasto nursing beableto curriculum train oncology nurses andcollaborate with HICto graduatethis nursing curriculum; will assist bridging thegapincancerwith knowledge [10].Nursing faculty shouldbeequipped with knowl- Learningthe cancer about continuumand therole anurse plays incancer control shouldalready beincorporated into thegeneral under Education and training [5]. AORTIChas aspecially designated seatfor oncology nursing initsexecutive council andispromotingof thescalingup oncology who donot have formal education andtraining inoncology nursing canaccess training to deliver [5]. [5, 10]. There isalsotheneedto harnessthepower of Information Technology 10 -

Short Communication ecancer 2021, 15:1209; www.ecancer.org; DOI:https://doi.org/10.3332/ecancer.2021.1209 All authors contributed to thefinal version of thepaper. Authors’ contributions tor of Philosophy; UON,University of Nairobi NationalCancer Institute;MinistryMOH, of Health;DTN, Diploma in Technical Nursing; MECC, Middle East Cancer Consortium; PhD, Doc Nurses andMidwives;Nursing NMC, andMidwifery Council;MSc.N, Masters of Science inNursing;General GNC, Nursing Council; NCI, ety;HIC, High income countries;SANC, South AfricaNursing Council; IAEA,International Atomic Energy Agency; Ghana GCNM, College of Low-middleLMIC, income countries; AORTIC, AfricanOrganisation for Research and Training inCancer Care; Oncology ONS, Nursing Soci- List care andimprove outcomes in Africa. practice. Addressing oncology nursing needsandstrengthening oncology nursing leadership will contribute to theeffectiveness of cancer ture andcurricular upgrades, mitigatingidentified challenges inthepathways of education andtraining, research, policy andprofessional Investing inthemassiveof upscale nursing education andtraining isurgently needed.Enabling actionsare faculty development, infrastruc of theoncology nurse andcommit to anagenda that will drive andsustainprogress to 2030andbeyond [63,64]. training in AfricaInternationalin 2020asthe Year ofNurse the andtheMidwife provides anopportunity to leverage ontheessential roles ofoncology the nursing workforce inline Statethe with of the world’s nursing report,2020 [62].Mapping oncology nursing education and team-basedera,and digital agenda noglobalhealth be realised can concertedwithout and sustainedefforts to maximisethecontributions Nursing is the largest group in the healthcare sector, accounting for approximately 59% of healthcare professionals. In a highly connected, Conclusion findings [5,10]. conductinghealth services research ortrials inorder clinical to expand knowledge bestpractices about andclinicalapplication of research practice, policy andstrengthen nursing knowledge [10,17,60,61]. Thus nurses shouldbeintegral members of multidisciplinary teams Oncology nursing researchtobe prioritised should provideoutput evidence that isculturally appropriate andcaninform evidence based Research Africa hasbeenset inmotion by organisations suchastheInternational Society of Nurses inCancer Care and AORTIC Nursing group cancerthe continuumand provide asafeenvironment clinical Policy development, standard operating procedures andstandards of practice shouldbedeveloped to guideroles andresponsibilities across oncology nursing tips,sharingbest-practice andproviding support. in their developmental phase,there have been various socialmediagroups, providing oncology nurses from allacross Africa, with helpful and creatingtion research opportunities to promote cancer control. The focusof associations these should beto raise awareness interms of theneedfor oncology nursing specialisa- cancer care should be sittingat thetableespecially in organisations where all health professionals in cancer care meet to engage in activities Regional andnationaloncology nursing associationsbe developedshould andnurses committed to oncology nursing shouldjoin.Nurses in Professional practice

of abbreviations [10]. Atpresent, few countries in Africa have national oncology nursing associations [57–59].Still [5, 10]. At present, aprocess of developing oncology nursing competencies for [10]. 11 - -

Short Communication 10. ecancer 2021, 15:1209; www.ecancer.org; DOI:https://doi.org/10.3332/ecancer.2021.1209 ahia M(2018)Countering theriseof cancer insub-Saharian Africa [Internet] Cancerworld [https://cancerworld.net/cancerworld-plus/ References This research received nospecificgrant from any funding agency commercialin thepublic, or Funding statement The authors declare that there are noconflicts of Confl write during the International Services, Were, Pamela Ms Bu, Korle Centre, Medicine Cancer Nuclear and Oncology Radiotherapy National Vanderpuye, Verna Dr The authors would like to acknowledge the AORTICOncology Nursing group,Professor Lize Maree andthe AfricanCancer Nurse Acknowledgments 9. 8. 7. 6. 5. 4. 3. 2. 1. G 16(8) 887–888https://doi.org/10.1016/S1470-2045(15)00144-8 net] 13944PMID: M 41(1) e1–e11https://doi.org/10.4102/curationis.v41i1.1766 29781698PMCID:6091651 PMID: B JGO.2015.000406 PMID: S Asia-Pacific J Oncol Nurs [Internet]4(1) 18 https://doi.org/10.4103/2347-5625.199074 N S B iarc.fr/] I D countering-the-rise-of-cancer-in-sub-saharian-africa/ Y tries: challenges andstrategies JCancer Policy [Internet]8 10–16https://doi.org/10.1016/j.jcpo.2016.03.002 30207593 ity worldwidefor 36cancers in185countries in Africa plans nternational Agency for Researchon Cancer (IARC) (2018)GLOBOCAN 2018: LatestGlobal Cancer Data (September) 13–15[http://gco. tefan(2015) Cancer DC care in Africa:an overview of resources o WKW, Cummingsand deCalvoGG, LEA, vumbwe TM andMtshali(2018) A NG middle-range formodel improving quality of educationMalawinursing in ray F, Ferlay J, andSoerjomataramI, et cancer (2018)Globalal statistics 2018:GLOBOCAN estimates of incidence andmortal- alassi A andChallinor (2015) StrengtheningJ the oncology nurse workforce in low-income and middle-income countries uncan K, CiraK, uncan and Barango MK, P, et (2019)Challengesal andopportunitiesinthecreation andimplementation of cancer-control wozichiC, Ojewole F, andOluwatosin A (2017)Understanding the challenges of providing holistic oncology nursing care in Nigeria itema A, Maree L,and Young A (2019)Cancer treatment in Africa: theimportance of therole of nursing icts of i Institute, Dr Miriam Wagoro, UoN, Mr David Makumi, Non-Communicable Disease Alliance, Mr Umar Aliu, Director of Nursing of Director Aliu, Umar Mr Alliance, Disease Non-Communicable Makumi, David Mr UoN, Wagoro, Miriam Dr Institute, ainl optl Aua n Poesr ae Au lae, en NI Cio nvriy Eyt o ter mes support immense their for Egypt University, Cairo NCI, Dean, Elkasem, Abu Hatem Professor and Abuja Hospital, National up ofthispaper. n terest

Ecancermedicalscience [Internet] 13938https://doi.org/10.3332/ecancer.2019.938 PMID:31552111 PMCID: 6722107 31552117 PMCID: 28804769 PMCID: 6722106 et al(2016)Enhancement of oncology nursing education in low- and middle-income coun- in 5551648 terest. CA Cancer J Clin [Internet] ] PMID:26248831

J Glob Oncol [Internet] 1(1)30–36https://doi.org/10.1200/ 68(6) 394–424 no https://doi.org/10.3322/caac.21492 PMID: t-for-pro fit sectors. Ecancermedicalscience [Inter Curationis [Internet] Lancet Oncol Network, 12 -

Short Communication 28. 27. 26. 25. 24. 23. 22. 21. 20. 19. 18. 17. 16. 15. 14. 13. ecancer 2021, 15:1209; www.ecancer.org; DOI:https://doi.org/10.3332/ecancer.2021.1209 12. 11. 40(4) 1410–1416[https://doi.org/10.1002/1097-0142(197710)40:4%3C1410::AID-CNCR2820400408%3E3.0.CO Program Topazian H,Cira M,andDawsey S,etal (2016)Joining forces to overcome cancer: theKenya Cancer Research andControl Stakeholder files/2016/08/CANSA-85-years.pdf Cancer Association of South AfricaC (2020)85 Year Anniversary: CANSA &Cancer History [Internet] [https://www.cansa.org.za/ cancer-institute-cairo#] Date accessed: 3/09/20 Union for International Cancer Control U(2020)National Cancer Institute –Cairo [Internet] [https://www.uicc.org/membership/national- org/10.1002/1097-0142(197710)40:4<1410::AID-CNCR2820400408>3.0.CO;2-M PMID:907960 NkrumahPerkinsFK, IV, andBiggar(1977) Combination RJ chemotherapy inabdominalBurkitt’s lymphoma Nkrumah F andBiggar R(1979)High dosecycloposphamidein drugresistant andrelapsing Burkitt’sMed J64–69 lymphomaGhana a systematic review Int J Nurs Stud CummingsGG, Tateand Lee K, S, tings: asystematic review Healthcare 5(4)73https://doi.org/10.3390/healthcare5040073 Sfantou D, Laliotis set- healthcare A, andPatelarouin measurestowardsofqualitycare style ofleadership A, et al (2017)Importance [Internet] (Hamilton (ON): BCDecker) [https://www.ncbi.nlm.nih.gov/books/NBK13570/] YC PT Rieger [https://www.icn.ch/system/files/documents/2020-04/ICN_APN InternationalCouncil of Nurses (2020)InternationalCouncil of Nurses Guidelines on Advanced Practice Nursing 2020[Internet] 44p ing Society) pp1–84 Lubejkoand BG Wilson BJ (2019)Oncology Nursing Scope and Standards of practice edDepartment OP, editor (Pittburgh: Oncology Nurs - income countries Challinor GalassiJM, and AL, Al-RuzziehMA, fcgi?artid=PMC6516934 net] CummingsLeeGG, SD, and Tate KC (2018)The evolutionof oncology nursing: leadingthepath to change Society EON (2018) 5625.199082 MakumiD (2017)Cancer nursesin africa theirfinding footing org/10.33160/yam.2018.03.001 PMID:29599616PMCID: Fukada M(2018)Nursingcompetency: definition, structure anddevelopment nursing profession Cobanand GI Yurdagul(2014) TheG relationshipbetween cancer patients’ perception of nursing care andnursing attitudes towards S1470-2045(12)70482-5 fromthe AfricanOrganisation for Research and Trainingin Cancer Morhason-Bello IO, Odedina F, and Rebbeck TR, et al (2013) 21945978 PMCID: different nurse workenvironments AikenCimiotti LH, JP, andSloane DM, 28(4) 314–317 [http://www.ncbi.nlm.nih.gov/pubmed/31148787%0Ahttp://www.pubmedcentral.nih.gov/articlerender. JCancer Policy 7https://doi.org/10.1016/j.jcpo.2015.12.001 PMID: Roleof theoncology nurse J Glob Oncol [Internet] 2(3)154–163https://doi.org/10.1200/JGO.2015.001974 PMID:28717695PMCID:5495453 Asia-Pacific J Oncol Nurs [Internet] 1(1)16–21https://doi.org/10.4103/2347-5625.135816 PMID: 3217062 The EONS Cancer Nursing Education Framework Contents ] PMID: et al(2018)Leadership andoutcome styles patterns for thenursing workforce and work environment: 23561745 [Internet] 8519–60https://doi.org/10.1016/j.ijnurstu.2018.04.016 PMID: MedCare [Internet] 49(12) 1047–1053https://doi.org/10.1097/MLR.0b013e3182330b6e PMID: ] Date accessed: 11/09/20 et al(2011)Effects of nurse staffing andnurse education onpatient deaths inhospitals with Holland-Frei Cancer Medicine 4thedn,edsKufe DW, Pollock and RE, Weichselbaum RR et al(2016)Nursing’s potential to address thegrowing cancer burden inlow-and middle- 5871720 Challenges andopportunitiesincancer control in Africa: aperspective Asia-Pacific J Oncol Nurs [Internet] 4(1) https://doi.org/10.4103/2347- Report_EN_WEB.pdf] Lancet Oncol [Internet] 14(4) e142–e151https://doi.org/10.1016/ 26942109 PMCID: YonagoMed Acta [Internet] 61(1) 1–7https://doi. 4770827 29807190 Can Oncol Nurs J [Inter

Cancer [Internet] 27981078 ] https://doi. et al 13 -

Short Communication ecancer 2021, 15:1209; www.ecancer.org; DOI:https://doi.org/10.3332/ecancer.2021.1209 47. 33. 32. 31. Bla 30. 29. 46. 45. 44. 43. 42. 41. 40. 39. 38. 37. 36. 35. 34. ijans.2018.10.005 education intheadvanced healthcare environment Fawaz MA,Hamdan-mansour AM, and Tassi A (2018)International Journal of Africa Nursing Sciences Challenges facing nursing Vanderpuye V and Aryeetey NA (2016)Cancer Radiotherapy inGhana Nursing CouncilSA (2020)South Africa Nursing CouncilStatistics [Internet] [https://www.sanc.co.za/stats.htm perspective Ecancermedicalscience 141079 UwayezuSegoMG, and Nikuze R, B, survey BMCPalliat Care 16(1)74https://doi.org/10.1186/s12904-017-0257-1 ence Lancet Oncol 16e405–e413https://doi.org/10.1016/S1470-2045(15)00161-8 StulacBinagwahoS, A, and Tapela N, ihj.2015.07.003 PMID: Mishra S(2015)Respect for nursing professional:silence mustbeheard paper JAdvNurs 70(2)295–309 https://doi.org/10.1111/jan.12177 Hoeve Y, Jansen G, and Roodbol P (2014) 388(10053) 1659–1724 and metabolic risksor clusters of risks,1990–2015:asystematic analysis for theGlobal Burden of Disease Study 2015Lancet 2016 Collaborators RF (2017)Global, regional, andnationalcomparative riskassessment of 79behavioural, environmental andoccupational, 10/07/20 Network NCC (2020)NCCNHarmonised Guidelinesfor Sub-Saharan Africa [Internet] [https://www.nccn.org/harmonized/ ] Date accessed: Federal Minstry of Health (2018)Nigeria National Cancer Control Plan 2018–2022 in-sub-saharan (Pittsburgh: ONS VOICE)[https://voice.ons.org/news-and-views/chemosafe-program-aims-to-strengthen-access-to-cancer-treatment- Oncology Nursing Society O(2017)ChemoSafe Program Aims to Strengthen Access to Cancer Treatment in Sub-Saharan Africa [Internet] plans/KENYA NATIONAL CANCERCONTROL STRATEGY 2017-2022_1.pdf Kenyan Ministry of Health(2017) National Cancer Control sreategy 2017–2022[Internet] [https://www.iccp-portal.org/system/files/ 6/09/20 www.gcnm.edu.gh/news/2017 news/GCNMSPONSORSHIPSIGNS AGREEMENT ROCHEWITH FOUNDATION.pdf Ghana College of NursesRocheFoundation andMidwiferySponsorship Agreement with Signs [Internet] (2017)Gcnm (Accra)phttps:// 3[ factsheets/populations/288-ghana-fact-sheets.pdf International Agency for Research onCancer (2018) GhanaWHO Cancer Facts Sheet [Internet] Vol. 645[https://gco.iarc.fr/today/data/ bers_and_fellows.php Ghana College of Nurses andMidwifery (2015)Members and Fellows [Internet] [https://www.gcnm.edu.gh/members_and_fellows/mem- cialties.php Ghana College of Nurses andMidwifery (2020)Specialty Programmes [Internet] [https://www.gcnm.edu.gh/resident_programmes/spe - accessed: 29/06/20 Ghana College of Nurses andMidwiferyWe (2020)What do [Internet] [ https://www.gcnm.edu.gh/about_us/what_we_do.php#] Date Parliament of Ghana (2011)Specialist Health Training andPlant Medicine Research Act 833(Part III)(Ghana) control.info/cc2016/cancer-radiotherapy-in-ghana/ A, Newland ] Date accessed: 6/09/20 ] Date accessed: 11/09/20 JA, and ] Date accessed: 16/08/20 26432724 PMCID: Vilija Č, et al(2017)Oncology nurses’ perceptions of obstaclesandrole at theend-of-life care: cross sectional et al(2020)Oncology nursing educationand practice: forward looking back,looking andRwanda’s et al(2015)Capacity buildingfor oncology programmes insub-Saharan Africa: theRwanda experi- The nursingprofession: publicimage, self-concept andprofessional identity. A discussion 4593846 ] ] Int J Africa Nurs Sci [Internet] 9(February) 105–110https://doi.org/10.1016/j. Indian Heart J[Internet]Indian 67(5)413–415https://doi.org/10.1016/j. Cancer Control [Internet] CC2016 Ra 1–17[http://www.cancer ] PMID:26248848 ] Date accessed: 10/07/20 ] Date accessed: 14 -

Short Communication ecancer 2021, 15:1209; www.ecancer.org; DOI:https://doi.org/10.3332/ecancer.2021.1209 64. 63. 62. 61. 60. 59. 58. 57. 55. 54. 53. 52. 51. 50. 49. 48. 56. nurse-and-the-midwife-2020] Date accessed: 11/09/20 [Internet] 2020 [https://www.who.int/campaigns/year-of-the- Midwife the and Nurse the World Health of Organization (2020)Year the-midwife#:~:text=The World Health Organization (WHO,in 2020 with thisinitiative www.oncnursingnews.com/publications/oncology-nurse/2020/april-2020/2020-whos-international-year-of-the-nurse-and- Jakel P (2020)2020: WHO’s International Year of the Nurse and the Midwife [Internet] Oncology NEWS NURSING [https:// item/9789240003279] World HealthOrganization (2020) Stare Of World’s Nursing Report 2020[Internet] [https://www.who.int/publications/i/ countries: acallto action Galassi A, Burg A, and Schneider J, et al(2014)Buildingcapacity for oncology nursing education andtraining inlow-and middle-income 5357497 a systematic review CattS, Starkings R,andShilling V, et al (2017)Patient-reported outcome measures of theimpactof cancer onpatients’ everyday lives: ety-110109560393420/?_rdc=1&_rdr EthiopianOncology Nursing SocietyUs(2019) About E [Internet] [https://web.facebook.com/Ethiopian-Oncology-Nursing-Soci- 3/09/20 ZambianOncology Nursing SocietyUs (2016)About [Internet]https://web.facebook.com/zons2016/?_rdc=1&_rdr [ oncology-nurses-chapter/] Date accessed: 27/08/20 NationalNurses Associationof Kenyaus,Kenya (2019)About Oncology Nursing Chapter [Internet] [https://chapters.nnak.or.ke/kenya- 25083128 PMCID: developmenttainable goals:a mixed-methods evaluation of the Peoples-uni online platform Sridharan S, Bondy M,and Nakaima A, bringing-the-power-of-platforms-to-health-care Review [https://hbr.org/2016/11/Business Harvard [Internet]. Care Health to Platforms of Power Bush the J andFox J (2016)Bringing goals Goals [Internet][ https://www.icn.ch/news/data-dialogue-and-decision-investing-nursing-can-help-achieve-sustainable-development- International Councilof Nurses (2019)Data, Dialogueand Decision –Investing inNursing can helpachieve Sustainablethe Development 1016 https://doi.org/10.1016/j.ijnurstu.2015.01.012 SunmidwiferynursingC andLarsonand (2015) Clinical E research in African countries: ascoping review 28204996 patterns inpatients with breastcancer Song SJ, Min J, and Suh SY, 8e0a7f52/1?pq-origsite=gscholar&cbl=18750&diss=y ProfessionalPrograms ? [Internet](Hawaii: University of Hawaii) [https://search.proquest.com/openview/8d182654533d91cfd1d54113 Delnat CC (2020) https://doi.org/10.1016/j.outlook.2015.10.007 systems–aening health studylandscaping of innovationsin low- andmiddle-incomecountries KrubinerSalmon CB, and SynowiecM, C, et al(2016)Investing innursing andmidwifery enterprise: Empowering womenand strength - Gender Equality andSupport Economic Growth Promote Health, Improve will Nursing All-PartyDeveloping ParliamentaryHow Group on Global Health(APPG)-UK(2016) Triple Impact: Ventola CL (2014) https://doi.org/10.1186/s12961-018-0381-2 ] Date accessed: 10/07/20 Social media and health carehealth and media Social professionals: benefits, andbestpractices risks, oe ad oto i Mdcn ad usn -ol Itisc edr eif Ipc Itrrfsinl dcto i Pre- in Education Interprofessional Impact Beliefs Gender Intrinsic -Could Nursing and Medicine in Control and Power 4103576 J Cancer Surviv [Internet] 11(2)211–232https://doi.org/10.1007/s11764-016-0580-1 PMID:27834041PMCID: AsiaPac J ClinOncol 109 et al(2017) ] Date accessed: 3/09/20 etal (2018) SupportCare Cancer Incidence of taxane-induced peripheral neuropathy receiving treatment and prescription (Geneva: WHO) ] Date accessed: 19/09/20 The potential of anonlineeducational platformto contribute to achieving sus- PMID: ] 25707997 25(7) 2241–2248https://doi.org/10.1007/s00520-017-3631-x PMID: ] Date accessed: 11/09/20

Heal Res Policy Syst [Internet] 16(1)106 Nurs Outlook [Internet] 64(1)17–23 Nurs P T [Internet] Int J Nurs Stud 39(7) 491–520 PMID: ] Date accessed: 52(5) 1011– 15

Short Communication