Introduction and background:
Cancer is a major health issue worldwide. While advances in cancer care are leading to improved survival, health care for this group requires a skilled and well-prepared nursing workforce. As with all developed nations, having such nursing workforce is a critical component of providing quality cancer services in Saudi Arabia. Attracting new nursing graduates to cancer specific clinical areas as their place of work can be a challenge. The experience of students during their academic studies, including clinical placements, could play a significant role in facilitating an interest to work in the cancer field.
Statement of the research study problem and aim:
As an academic nurse and clinical facilitator of a Bachelor of Nursing program in Saudi Arabia, I noted that students were reluctant to be allocated to cancer units or assigned to care for cancer patients in medical-surgical wards. There are few studies that explored the experiences of nursing students when undertaking clinical placement in the cancer ward, and no published studies that have explored the experiences of Saudi undergraduate nursing students. This study, therefore, aimed to gain an in-depth understanding of the Saudi undergraduate nursing students’ experiences of caring for cancer patients. This may inform approaches to increase the number of Saudi nursing graduates in the oncology field.
Hermeneutic inquiry, an interpretive qualitative methodological approach, was chosen to explore and capture the students’ experiences. Examining the perspectives of those students who had cared for patients with cancer seeking to capture their reflections on their experiences. The study was conducted in the Kingdom of Saudi Arabia (KSA), the home country of the researcher. The settings were two tertiary teaching hospitals in the capital city, Riyadh. Thirty-six students, who were on their final year clinical placement (internship) of the nursing degree, were recruited using purposive sampling. Semi-structured individual interviews were conducted with the participants in their native Arabic language which focused on their experience of providing cancer care. The interviews were audio recorded, transcribed and then translated into English. Data analysis were undertaken through thematic analysis.
Three major themes were identified; transition from feeling unable to being able to care, learning to build therapeutic relationships, and gaps in preparation to care. The analysis of the interviews identified the interns perceived caring for cancer patients as different to other patient groups. The extent to which cultural beliefs regarding cancer influenced this was not clear. Students described being overwhelmed by the sense of not knowing how to provide the care, and feeling fearful of causing distress to the patients. They experienced challenges in not knowing or being confident in how to communicate with cancer patients, how to provide psychological care, and how to care for children with cancer, or individual’s in the palliative care phase of their illness. Aspects of care such as caring for newly diagnosed cancer patients, patients in pain and witnessing the patients’ death were also identified as impacting the interns.
Of note, the interns’ sense of not knowing, and receiving support from their clinical preceptors became a motivation to acquire the knowledge and practical skills to care for cancer patients. As they developed knowledge and skills throughout their experiences, they became less fearful and more confident to care and interact with the patients. Leaning how to build therapeutic relationships, to communicate effectively, and to gain the patients’ trust and acceptance were the major factors contributing to their increased confidence. The third theme of the study identified the gaps in the interns’ preparation about how to respond to and manage challenging situations that may occur when caring for cancer patients. The interns reflected on the academic preparation that would have better prepared them for caring for cancer patients and to manage their relationships with them.
This study highlighted how this group of nursing students in Saudi Arabia used their fear and concern as motivation to learn and develop their skills to effectively care for cancer patients. This reinforces that clinical experience in the cancer setting is an important component of undergraduate nursing students. Opportunities to better prepare students in the area of both clinical knowledge and communication would potentially decrease some of the initial fear and concerns the interns experienced. As cancer will continue to be major health condition for Saudi Arabia in the future, a better understanding of the perspectives and attitudes for the boarder society of cancer and how this may impact health professionals is needed.