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ONLINE EXCLUSIVE
Revising the Blueprint for the
Oncology Certified Nurse (OCN )
Examination: A Role Delineation Study
Susan C. McMillan, PhD, ARNP FAAN, Karen Heusinkveld, DPH, RN, FAAN,
,
Sally Chai, PhD, Cynthia Miller-Murphy, RN, MSN, CAE, and Chi-Yu Huang
Key Points . . .
Purpose/Objectives: To conduct a role delineation study
of basic oncology nursing practice as a basis for revision of
the blueprint for the Oncology Certified Nurse (OCN) ex-
Certification is a desirable way to protect healthcare consum-
amination.
ers, validate nurses' qualifications, establish minimal compe-
Design: Three-phase study of oncology nurses' practice.
tency standards, and recognize nurses who meet those stan-
Sample: 735 oncology nurses randomly chosen from all
dards.
nurses who are OCN certified.
Methods: A pilot survey was mailed to a small group to
A role delineation study is the best way to link current oncol-
allow refinement of the survey instrument. The revised sur-
ogy nursing practice with the Oncology Certified Nurse
vey then was e-mailed to a total sample of 3,000 OCNs.
(OCN) examination, which certifies competency in oncology
The results and input from experts on the subject matter
nursing.
were used to revise the test blueprint.
Main Research Variables: Frequency and importance of
Oncology nurses reported an increased focus on quality-of-
223 oncology nursing activities previously identified by the
life activities related to comfort and coping and a decreased
group of experts in oncology nursing.
focus on health-promotion activities, such as cancer preven-
Findings: The highest ranked items for the combined fre-
tion and detection.
quency and importance scales pertained to the subscales
Professional Performance, Patient/Family Education, Com-
fort, Protective Mechanisms, and Coping. The lowest
ranked activities pertained to subscales Research, Detec-
tion, Sexuality, and Prevention.
opment of specialty areas of nursing by establishing minimal
Conclusions: The blueprint for the OCN examination re-
competency standards and recognizing those who have met
flects entry-level oncology nursing practice and includes
the standards (Nielsen et al., 1990). Certification publicly at-
eight domains of practice: Quality of Life (36%), Protective
tests to nurses' achievement of specific criteria and stan-
Mechanisms (13%), Gastrointestinal and Urinary Function
dards and, therefore, strengthens patients' confidence in
(10%), Cardiopulmonary Function (8%), Oncologic Emer-
nurse caregivers.
gencies (7%), Scientific Basis for Practice (12%), Health Pro-
motion (3%), and Professional Performance (11%).
Implications for Nursing: Because oncology nursing is
changing, reconfirming and updating the blueprint for the
Susan C. McMillan, PhD, ARNP, FAAN, is the Lyall & Beatrice Th-
certification examination is necessary. Certification exami-
ompson professor of oncology quality of life in the College of Nurs-
nations beginning in April 2003 will be based on the revised
ing at the University of South Florida in Tampa; Karen Heusinkveld,
blueprint.
DPH, RN, FAAN, is the Myrna R. Pickard professor of nursing in the
School of Nursing at The University of Texas at Arlington; Sally
Chai, PhD, is a principle consultant in the Professional Services
Development Division at ACT, Inc., in Iowa City, IA; Cynthia Miller-
ertification is an important means of protecting
C
Murphy, RN, MSN, CAE, is executive director of the Oncology Nurs-
healthcare consumers. Nursing certification is the
ing Certification Corporation (ONCC) in Pittsburgh, PA; and Chi-
process by which a nongovernmental agency uses
Yu Huang is a psychometrician at ACT, Inc., in Iowa City. Funding
predetermined standards to validate registered nurses' quali-
for this study was provided by ONCC. (Submitted June 2002. Ac-
cepted for publication July 15, 2002.)
fications and knowledge of practice in a defined functional
or clinical area of nursing. Certification promotes the devel-
Digital Object Identifier: 10.1188/02.ONF.E110-E117
ONF VOL 29, NO 9, 2002
E110
Methods
The Oncology Certified Nurse (OCN), Advanced Oncol-
ogy Certified Nurse (AOCN), and Certified Pediatric Oncol-
The study was guided by the authors and a Committee of
ogy Nurse (CPON) credentials enable the public and employ-
Subject Matter Experts (see Figure 1) who represented all
ers to identify nurses who have attained a qualifying level of
geographic areas of the United States and many different ar-
knowledge in oncology nursing. Therefore, OCN, AOCN,
eas of oncology nursing practice. A three-phase process was
and CPON examinations must measure the knowledge neces-
used to conduct the study and develop the revised test blue-
sary for the competent practice of oncology nursing at the
print: Phase 1 was a pilot study of the survey instrument,
basic and advanced levels. To satisfy this requirement, role
phase 2 was the role delineation survey of a national sample
delineation studies are necessary to ensure that certification
of oncology nurses, and phase 3 used the results of the survey
examinations remain connected to actual current practice.
to make revisions to the OCN examination.
The major priorities of the Oncology Nursing Society
(ONS) since its inception in 1975 have been the education and
Phase 1: Pilot Study
development of oncology nurses and the advancement of
The purpose of the pilot study was to obtain feedback about
oncology nursing as a specialty. As ONS grew in size and
the adequacy of the survey that would be used in the study and
broadened its goals, the leadership and membership at large
to make improvements to its design before distributing it to a
became interested in developing an oncology nursing creden-
national sample. To draft the pilot survey, the Committee of
tial as a way of obtaining formal recognition of professional
Subject Matter Experts met with ACT, Inc., an organization
expertise. In 1984, a core curriculum was finalized and a com-
that provides educational assessment and workforce develop-
mittee of nursing experts prepared an outline of the knowl-
ment, and ONCC staff on March 31 and April 1, 2001, in
edge required for basic practice as an oncology nurse. Be-
Tampa, FL. The committee began with the survey form that
cause no role delineation study preceded the outline, it
had been designed and used in the role delineation study pub-
provided the framework for the first test blueprint. The ONS
lished in 1997 and made revisions based on their perceptions
leadership realized that a systematic certification program was
of changes in practice that had occurred in the intervening
essential for the development, administration, and evaluation
years.
of certification; therefore, it formalized the Oncology Nursing
Sample: Because the draft survey was based on the same
Certification Corporation (ONCC) in l984. Headed by its
well-established format used for the survey conducted in 1997,
Board of Directors, ONCC has successfully guided the oncol-
a small sample of convenience was used for the pilot study.
ogy nursing certification process for the past 18 years.
This sample of 110 OCNs was contacted via e-mail to respond
The first certification examination was administered at the
and provide feedback on the adequacy of the pilot instrument,
1986 ONS Annual Congress, and 1,384 RNs successfully
which was posted on a private site on the World Wide Web. As
earned the OCN credential. Because certification examinations
many as 60 of the invitations were not delivered or seen by the
must reflect nurses' knowledge and ability to apply that knowl-
intended recipients because of delivery errors or expired e-mail
edge to current practice, ONCC undertook the first role delin-
addresses. With the assumption that the invitation was delivered
eation study for the generalist oncology nurse in 1989 (Ropka,
to at least 50 valid e-mail addresses, the 13 responses obtained
Norback, Rosenfeld, Miller, & Nielson, l992). The study was
represented a response rate of 26%.
conducted to define the responsibilities and knowledge neces-
Instrument: The survey instrument had three sections.
sary for competent job performance of newly certified nurses.
The first contained 16 demographic items. Section 2 pre-
The study findings provided a core body of important tasks and
sented 223 activities of oncology nursing at the generalist
knowledge on which substantial professional agreement ex-
level that respondents were asked to rate in terms of fre-
isted. The results were to be used to assess and document the
quency and importance. The response choices for impor-
content validity and job-relatedness of the existing certification
tance and frequency are presented in Figure 2. Section 3
program for oncology nursing and to provide input for the
presented a seven-item questionnaire designed to elicit feed-
structure and content of future examinations.
back from respondents about adequacy of the pilot survey
The second role delineation study of the basic oncology
form. The sample of nurses was invited to participate via e-
nurse was published in 1997. It was intended to determine
mail, and the nurses were asked to respond to the survey on
whether and how the test blueprint and future examination
the Web. The results of the survey were analyzed by ACT
questions should be revised (McMillan, Heusinkveld, & Spray,
l997). From the data gathered, the blueprint for the OCN ex-
amination was redesigned to include eight domains of practice.
Currently, oncology nurses face more complex cancer-re-
Helen Bolf, RN, BSN, OCN, Duluth, MN
lated responsibilities than in previous years because of
Christine Ellis, RN, BSN, OCN, Tampa, FL
changes in technology, clinical research, treatment options,
Linda Flemm, RN, BSN, OCN, Darien, IL
Beth Goodkin, BSN, RN, OCN, Portsmouth, NH
healthcare structuring, public expectations of quality care, and
Dawnell Gregory, RN, OCN, Sarasota, FL
the nursing shortage. Sicker patients and fewer nurses make
Elizebeth Harwood, RN, OCN, Beaverton, OR
it imperative for nurses to increase their knowledge and com-
Cathy Jackowski, RN, OCN, Dayton, OH
petency in managing the complexities of cancer care.
John Kitchens, RN, OCN, Crosby, TX
ONCC policy states that role delineation studies should be
Wilma Knutson, RN, OCN, Duluth, MN
conducted every five years, thus it was time for the third gen-
Kimberly Luebbers, RN, BSN, OCN, Burlington, VT
eralist oncology nursing role delineation study to be con-
Daryll Lee Wells, RN, CHPN, MS, Latrobe, PA
ducted. The purpose of it was to describe the current practice
Kathy Wilkinson, RN, BSN, OCN, Billings, MT
of oncology nurses in the United States to provide a basis for
Figure 1. Committee of Subject Matter Experts
the revised test blueprint for the OCN examination.
MCMILLAN VOL 29, NO 9, 2002
E111
The software program used by ACT was designed to al-
Importance: How important is the performance of this activity to
low each subject matter expert to link a knowledge/skill/
the safe and effective outcomes of your nursing practice?
ability with any activity on the survey for which the knowl-
0 = Not important
edge/skill/ability is required at entry level. For this study,
1 = Somewhat important
each major heading in the current OCN test blueprint was
2 = Important
used as a knowledge/skill/ability. For example, for the first
3 = Extremely important
domain, Quality of Life, the subject matter experts consid-
Frequency: How often do you perform this activity during the
ered whether each knowledge/skill/ability in that domain
course of a year?
0 = Never: I never do this.
(i.e., comfort, coping, sexuality, and supportive care) was re-
1 = Seldom: I do this once or twice a year.
quired to perform each of the activities or tasks on the sur-
2 = Monthly: I do this once a month.
vey. ACT compiled the results of the linking assignments in
3 = Weekly: I do this every week.
a table that identified whether an activity and knowledge/
4 = Daily: I do this daily.
skill/ability were linked for purposes of further analysis. An
5 = More than once a day: I do this more than daily.
activity and a knowledge/skill/ability were considered to be
linked if the majority of the subject matter experts had linked
Figure 2. Response Choices for Importance and
them. After each survey task item was linked to one or more
Frequency Scales
major knowledge/skill/ability in the test blueprint, the major
categories within each domain received weight from the as-
staff and revealed that the instrument required no revision.
sociated tasks. The result was a preliminary revised OCN
The instrument was finalized for use in the major study.
test blueprint.
Validity of the final survey instrument was ensured by the
From April 57, 2002, the subject matter experts met with
manner of its development and through item-by-item review
ACT representatives to construct the test blueprint. At the start
by content experts. Reliability was assessed using an internal
of the meeting, the purpose of the study was reviewed, as
consistency method and reported as coefficient alphas.
were the major phases of the study, with emphasis on the re-
sults of the task survey and the schedule and anticipated out-
Phase 2: National Survey
comes of the meeting.
Role delineation involved sending the revised survey form
In subsequent sessions, the subject matter experts reviewed
to a large sample of oncology nurses.
the preliminary OCN test blueprint that had been generated by
Sample: A random sample of 3,000 OCNs was generated
ACT as a result of the survey and the linking assignment. First,
by ONCC staff from a database of more than 20,000 OCNs.
they reviewed the content outline, considering ways to better
The 3,000 nurses were identified as candidates to be invited
define and organize the categories of content. They then re-
to participate in the survey.
viewed the preliminary weights and their knowledge of entry-
Procedures: To initiate the survey in November 2001, an
level generalist practice to make decisions about adjusting the
alert letter was sent to the initial random sample of 3,000
weights and the corresponding number of test items assigned to
OCNs. The alert letter announced the survey initiative and
each category. The final result of the meeting was the revised
the importance of the study to the profession and offered in-
OCN test blueprint, which will be implemented in 2003.
structions for participants to answer the Web-based version of
Results
the survey. About a week later, participants who did not an-
swer the Web survey received a follow-up letter, which in-
Phase 2: The Survey
cluded a postcard that could be sent to ONCC to request a
Sample: A total of 735 OCNs responded to the survey.
paper version of the survey. A third mailing was planned to
consist of a letter reminding nonrespondents to answer the
Table 1 summarizes the response numbers and percentages by
Web survey. However, because the response rate after the sec-
survey format and total group. Of the respondents who an-
ond mailing was lower than in previous ONCC practice analy-
swered the demographic items, 96% were women and 91%
sis surveys, the third mailing, which was conducted in early
were Caucasian. The average age of respondents was 46 years.
February 2002, was changed to include a copy of the paper
The largest number (45%) had been certified for five years or
survey. Prior to mailing via e-mail or the U.S. Postal Service,
less. The sample represented most regions of the country, with
the survey was divided into two forms, A and B, with about
slightly more respondents coming from the more densely popu-
half of the activity statements in Section 2 appearing on each
lated northeastern United States (see Table 2).
form. All of the surveys included Section 1, which asked
about demographic variables. The survey was split to shorten
Table 1. Survey Response Numbers and Percentages
the task of responding to the 223-item questionnaire.
Phase 3: Test Revision
Variable
n
%
The results of the survey were used to revise the test blue-
Respondents who returned Web surveys
367
47
print. Before the final meeting of the Committee of Subject
Respondents who returned paper surveys
418
53
Matter Experts, ACT prepared an assignment for the panel.
Respondents who completed survey form A
385
52
For the assignment, each subject matter expert was given
A software program used to facilitate the linking of knowl-
Respondents who completed survey form B
350
48
edge, skills, and abilities to survey activities or tasks
Total number of completed surveys received
735
25
An instruction sheet for using the program
A copy of the OCN test blueprint.
N = 3,000
ONF VOL 29, NO 9, 2002
E112
Table 2. Demographic Data
their primary functional area of responsibility. Most often,
they reported working in urban communities (48%). The
Characteristic
%
majority of their time was spent in outpatient settings.
The largest number of respondents reported working in
Gender
community hospitals (23%), followed by physicians' offices
Female
96
(16%). The specialties cited most often were medical oncol-
Male
4
ogy (40%) and chemotherapy (24%).
Racial or ethnic origin
Ranked survey items: The highest ranked activity items in
African American
3
the total survey are presented in Table 3, categorized by their
Hispanic
1
respective subscales. Professional Performance had the largest
Native American Indian or Alaskan Native
0
number of top-ranked items (four). Other subscales represented
Asian or Pacific Islander
4
in the top 10 were Patient/Family Education (two items), Com-
Caucasian
91
fort (two items), Protective Mechanisms (two items), and Cop-
Other
1
ing (two items). The lowest ranked items (see Table 4) were
Total years as an OCN
predominantly from the Sexuality (four items), Prevention (two
05
45
items), and Detection (four items) subscales. Further informa-
610
30
tion was gained by observing which items in each subscale
1115
25
were ranked highest by survey respondents (see Table 5).
U.S. region
North
00
Discussion
Northeast
17
East
12
Subject Matter Experts
Southeast
14
Great Lakes
14
The subject matter experts who comprised the committee
North Central
11
were diverse in that they represented most geographic areas of
Midplains
10
the United States and were from varied practice settings and
South
08
ethnic groups. Although only one man served as a subject
Southwest
03
matter expert, the number of male OCNs is very low. This
West
12
diversity was an important element in helping to ensure that
the process represented all certified oncology nurses. In addi-
Note. Because of rounding, percentages may not total 100.
tion, the study investigators (authors Susan C. McMillan and
Karen Heusinkveld), the ONCC representative (author
The majority of respondents (85%) said that they were not
Cynthia Miller-Murphy), and ACT staff (author Sally Chai)
enrolled in school. Among those who identified themselves as
were very experienced with role delineation studies and blue-
full- or part-time students (n = 110), 41% were pursuing a
print development.
master's degree in nursing. For most, the highest degree in
Survey Sample
nursing held was a baccalaureate (42%) or master's (10%).
The survey sample also was representative of all OCNs.
The highest degree held in any other field predominantly was
The 735 OCNs who responded were predominantly female,
a baccalaureate (52%).
Respondents most often reported that they had worked in
with slightly more men (4%) responding compared to the
nursing 2125 years (19%), with 1115 years in oncology
1997 survey (2%). The average age of respondents (46 years)
nursing (29%). The majority (76%) identified patient care as
was somewhat older than those in the 1997 survey (41.4
Table 3. Top Ten Ranked Items From the Total Survey
Subscale
Rank
Nursing Activity
Professional Performance
01
Follow occupational safety guidelines related to universal (i.e., standard) precautions.
Professional Performance
02
Advocate for patients and families.
Professional Performance
03
Use ethical principles in decision-making.
Patient/Family Education
04
Provide information specific to patient and family needs regarding disease process, treat-
ment and procedures, management of potential side effects, follow-up care, and com-
munity resources.
Patient/Family Education
05
Reinforce information presented as needed.
Comfort
06
Assess patients' perceptions of comfort and well-being.
07a
Assess patients' hematopoietic status and immune status (i.e., lab results, history, physical
Protective Mechanisms
assessment).
07a
Coping
Provide patients and families with support (emotional, spiritual) throughout the disease process.
Follow occupational safety guidelines related to chemotherapy.
Professional Performance
08
Comfort
09
Evaluate patients' pain management outcomes.
Protective Mechanisms
10
Maintain a safe environment for patients.
a
Two items tied for the seventh rank.
MCMILLAN VOL 29, NO 9, 2002
E113
Table 4. Bottom Ten Ranked Items From the Total Survey
Subscale
Rank
Nursing Activity
01 (highest)
Research
Teach patients and family members about research protocols.
Detection
02
Participate in screening activities.
03a
Sexualityb
Determine if patients can recognize changes that occur related to the dis-
ease process or treatment that affect sexuality.
03a
Sexuality
Evaluate patient or family knowledge of available resources (e.g., sperm
banking).
04a
Prevention
Educate patients and families about available community resources.
04a
Detection
Participate in educational programs for target populations within the com-
munity.
05
Detection
Participate in planning for public education about early detection programs.
Sexuality
06
Discuss with patients and their partners alternative methods for expression of
sexuality.
07
Detection
Participate in planning for public education about early detection programs.
Professional Performance
08
Participate in support group activities.
09
Sexuality
Incorporate interventions for maintenance of sexuality into plan of care.
10 (lowest)
Prevention
Plan educational programs for target populations within the community.
a
Two items tied for the third rank and the fourth rank.
b
Entire subscale contained only four items.
years). This may be a further reflection of the aging of the
believed in their importance. However, sexuality issues re-
nursing force. The respondents continued to be predominantly
mained low in importance and frequency for most of the re-
C a u c a s i a n (91%). More than half (52%) had either a
spondents despite the fact that sexual problems are very com-
bachelor's or master's degree in nursing, compared with 45%
mon among people who are being treated for cancer. This was
consistent with results of the earlier survey, indicating that no
who had that level of education in the earlier survey. An ap-
propriate amount of variability existed in the number of
progress had been made in that area. Nurse educators should
years in nursing and the number of years in oncology nursing.
focus on this area in both formal educational programs and
The majority (76%) spent most of their time providing patient
continuing education.
care in a wide variety of settings, with the majority (59%)
Each subscale in the total survey included items about as-
providing outpatient care. This represented a shift from the
sessment; intervention, including patient and family educa-
tion; and evaluation. Thirty of the 60 top-ranked items (50%)
previous survey, when the largest proportion (48%) provided
presented in Table 5 focused on assessment activities, and
inpatient care, compared to outpatient care (42%). This may
be a reflection of the shortage of nurses working in inpatient
only 20 (33%) focused on intervention. Perhaps this is be-
cause every patient must be assessed, but only certain patients
settings and also may be a result of shorter inpatient stays. As
require intervention. Thus, assessments are conducted more
before, the largest numbers identified medical oncology and
chemotherapy as their areas of specialization. The variability
frequently than interventions.
in the survey sample increased confidence in the generaliz-
Evaluating the Survey Scale
ability of the results.
The two scales (i.e., frequency and importance) used to
Ranked Survey Items
rate the nursing activities in the survey were evaluated by
correlating them. A very high correlation would indicate that
The subscale with the largest number of highly ranked nurs-
ing activities was Professional Performance (see Table 3). The
the two scales were measuring the same things. The very
moderate mean correlation between the scales (0.53) im-
four activities were highly ranked because they were deemed to
plied that, although the scales were somewhat related be-
be both important and frequently occurring in oncology nurs-
ing practice. Because the items reflect safety, advocacy, and
cause the activity measured was the same, the scales mea-
sured unique components of oncology nursing practice at
ethical decision-making, that they came out near the top is not
the entry level. This increased confidence in the appropri-
surprising. Among other highly ranked activities, Patient/Fam-
ily Education, Comfort, and Protective Mechanisms also were
ateness of the scales. Confidence in the validity of the
logical choices. The Professional Performance subscale also
scales was provided by the fact that they were generated
had some of the lowest ranked activities (see Table 4). This di-
and evaluated item-by-item by a group of content experts.
chotomy occurred possibly because the Professional Perfor-
R e l i a b i l i t y for the total survey was estimated using
Cronbach's alpha. The survey was found to have very
mance subscale, unlike the others, included a wide variety of
nursing activities.
strong reliability (a = 0.99).
Although some of the lowest ranked activities in the total
Revised Blueprint
survey were very understandable, others were somewhat dis-
turbing. Research received a low rank, which is understandable
A comparison of the major content areas on the previous
OCN blueprint and the newly revised blueprint is presented
because it is not part of the job description of most oncology
nurses and is not performed frequently. Also, cancer-screening
in Table 6. The content category that had the largest number
activities were performed infrequently, even by nurses who
of test items in the previous blueprint (McMillan et al., 1997),
ONF VOL 29, NO 9, 2002
E114
Table 5. Top Four Ranked Nursing Activities Within Each Subscale
Subscale
Rank
Nursing Activity
Professional Performance
1
Follow occupational safety guidelines related to chemotherapy.
2
Document nursing processes in specific patient records.
3
Document patients' informed consent to treatments.
4
Assist patients in negotiating the healthcare system.
Patient/Family Education
1
Provide information specific to patient and family needs regarding disease process, treat-
ment and procedures, management of potential side effects, follow-up care, and com-
munity resources.
2
Reinforce information presented as needed.
3
Assess patient and family understanding of treatment process (i.e., specific drugs, side ef-
fects, toxicities, diagnostic or evaluative tests).
4
Assess patients' and family members' preferred learning styles
1
Comfort
Assess patients' perceptions of comfort and well-being.
2
Evaluate patients' pain management outcomes.
3
Assess patients and families regarding pain management concepts and pain regimens.
4
Assess patients' side effects of analgesic therapy.
Protective Mechanisms
1
Assess patients' hematopoietic status and immune status (e.g., labs, history, physical as-
sessment).
2
Maintain a safe environment for patients.
3
Assess patients for factors that potentially would compromise the integumentary system
(e.g., chemotherapy, prolonged mobility, radiation, nutritional status, medications).
4
Assess patient and family understanding of actions and precautions to take during peri-
ods of altered hematopoietic and immune function.
1
Coping
Provide patients and families with support (e.g., emotional, spiritual) throughout the dis-
ease process.
2
Assess for symptoms and behavior of ineffective coping related to anxiety, anger, fear, fa-
tigue, or depression.
3
Evaluate patients' ability to verbalize concerns and needs.
4
Assess patients' ability to verbalize concerns and needs to care team.
Ventilation
1
Assess patients for risk factors that could alter respiratory function (e.g., radiation therapy,
medications, anxiety).
Assess patients' respiratory status (i.e., history, environmental risks, physical examination,
2
breathing pattern, and chest x-ray).
Determine if patients and families can recognize signs or symptoms of changes in respi-
3
ratory status and report to healthcare providers.
Assist patients in managing alterations in ventilation.
4
Manage and monitor administration of chemotherapy and biotherapy.
Circulation
1
Recognize and manage signs and symptoms of alteration in circulation, including deep
2
vein thrombosis.
Monitor and maintain vascular access devices.
3
Teach patients and families to recognize alterations in circulation.
4
Assess risks for impairment of baseline mobility (e.g., weakness, bone mets, lymphedema,
Mobility
1
fatigue).
Assess patient mobility and related factors (e.g., history, gait, strength, endurance, fa-
2
tigue).
Assess knowledge and ability of family caregivers to assist with patients' mobility needs.
3
Initiate interventions with patients and families to manage alterations in mobility, such as
4
adaptation of activities of daily living, energy conservation, modification of environment,
and appropriate referrals.
Assess factors that affect patients' nutritional status (e.g., nausea and vomiting, diarrhea,
Nutrition
1
anorexia, appetite changes, stomatitis, taste changes, dysphagia).
Provide patients and families with nutritional information specific to their needs.
2
Evaluate whether patients' nutritional needs are being met.
3
Facilitate optional nutrition with interventions such as medications, mouth care, manipu-
4
lation of environment, and timing and frequency of meals.
(Continued on next page)
MCMILLAN VOL 29, NO 9, 2002
E115
Table 5. Top Four Ranked Nursing Activities Within Each Subscale (Continued)
Subscale
Rank
Nursing Activity
Neurosensory
1
Identify and manage oncologic emergencies related to neurological functioning (i.e., syndrome
of inappropriate antidiuretic hormone, spinal cord compression, hypercalcemia, increased intrac-
ranial pressure, and tumor lysis syndrome).
2
Identify patients' additional risk factors for neurosensory deficits (e.g., chemotherapy, radiation,
medications, nutritional status).
3
Assess patients' neurosensory status (e.g., labs, history, physical assessment).
4
Maintain a safe environment for patients with neurosensory changes.
Elimination
1
Develop a plan to manage constipation and diarrhea.
2
Evaluate patients for complications of treatment or disease process (e.g., diarrhea, constipation,
dysuria).
3
Assess patients' elimination and related factors (e.g., mediations, chemotherapy, radiation, diet).
4
Assist patients in managing alterations in elimination.
Prevention
1
Assess patients' ability and willingness to comply with preventive health practices.
2
Teach preventive health habits (e.g., smoking cessation, dietary modification, sun protection, oc-
cupational exposure)
3
Assess patient and family understanding of preventive health practices.
4
Assess patient and family understanding of risk factors.
Detection
1
Evaluate patients' and families' early detection practices (e.g., breast self-examination, testicular
self-examination).
2
Assess patient and family understanding of early detection practices.
3
Assess patients' and families' skills in early detection practices.
4
Facilitate follow-up of positive findings from screening or self-detection.
Sexualitya
1
Assess knowledge and understanding related to contraception, safe sexual practices, and willing-
ness to comply with recommendations.
2
Assess patients' and their partners' perceptions and concerns related to sexuality.
3
Assess knowledge and understanding related to fertility (e.g., disease or treatment-related).
4
Determine whether patients can recognize changes that occur related to the disease process or
treatment that affect sexuality.
1
Review informed consent for research protocols and coordinate treatment (e.g., treatment plan
Research
calendars).
2
Participate in research through activities such as data collection and documentation of informa-
tion.
3
Provide basic assessment or screening for protocol eligibility.
4
Teach patients and family members about research protocols.
a
Entire subscale contained only four items.
vanced practice in oncology nursing continues to develop, pre-
Quality of Life, still was the most heavily weighted in the re-
vised blueprint, but it was more heavily weighted. This
vention and detection activities are seen more as in the province
of oncology advanced practice nurses.
seemed like a logical and desirable outcome given that much
of what oncology nurses do is related to enhancing quality of
life through providing physical and emotional comfort and
Table 6. Comparison of Previous and Current Blueprint
supporting coping. The increase in weight in the Quality of
Categories and Weights
Life category dictated decreases in other categories. For ex-
ample, Gastrointestinal and Urinary Function dropped from
1997
2002
15% to 10%. Cardiopulmonary Function saw a smaller de-
Content Category
Weight %
Weight %
crease, from 10% to 8%.
The category of Health Promotion, which included the Pre-
027
036
Quality of Life
vention and Detection subscales, decreased again, as it did in
Protective Mechanisms
015
013
the earlier revision. In the 1997 revision, the blueprint weight
010
Gastrointestinal and Urinary Function
015
010
008
Cardiopulmonary Function
for Prevention and Detection dropped from 10% to 8%. In the
Oncologic Emergencies
007
007
current revision, it dropped from 8% to 3%. Why the trend
012
Scientific Basis for Practice
012
away from health-promotion activities was occurring is unclear,
Health Promotion
008
003
perhaps because the nursing shortage is preventing nurses from
011
Professional Performance
006
participating in what is seen as "nice to do" activities versus
100
100
Totals
critical activities. Another possible explanation is that as ad-
ONF VOL 29, NO 9, 2002
E116
Conclusion
representative of current oncology nursing practice and
should lead to a test that is valid for assessing current entry-
The purpose of this study was to define the current role of
level practice. Not only can test developers use the blueprint
the oncology nurse in the United States as a basis for the blue-
for designing the OCN examination, but certification candi-
print for the OCN examination. The survey instrument was
dates also can use it to prepare for the test, and educators can
sound, and the sample was large and diverse. Activities per-
use it to guide development of educational programs in oncol-
formed most frequently and those most important to practice
ogy nursing.
were identified and ranked and then linked with knowledge,
skills, and abilities required for performing these activities.
Author Contact: Susan C. McMillan, PhD, ARNP, FAAN, can be
Shifts in practice were identified since the previous survey
reached at Smcmilla@hsc.usf.edu, with copy to editor at rose_mary
(McMillan et al., 1997). The resulting blueprint should be
@earthlink.net.
References
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McMillan, S.C., Heusinkveld, K., & Spray, J. (l997). A study of the role of
the generalist oncology nurse as a basis for revision of the blueprint for
Ropka, M.E., Norback, J., Rosenfeld, M., Miller, C., & Nielsen, B. (l992).
certification. Oncology Nursing Forum, 24, 13711379.
Evolving a blueprint for certification: The responsibilities and knowledge
comprising American professional oncology nursing practice. Oncology
Nielsen, B.B., Laszlo, J., Miaskowski, C., Heusinkveld, K., Hogan, C.,
Nursing Forum, 19, 745759.
Jenkins, J., et al. (l990). Certification for oncology nurses: Maturing of a
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E117