Enhancing Nurse Competence in Early Recognition of Cardiotoxicity

Enhancing Nurse Competence in Early Recognition of Cardiotoxicity | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Enhancing Nurse Competence in Early Recognition of Cardiotoxicity Jeffry Kolbus, Mopelola Adeola, Caitlin Luebcke, Janelle Tipton This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4224250/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Sep, 2024 Read the published version in Cardio-Oncology → Version 1 posted 9 You are reading this latest preprint version Abstract Objective: To assess the impact of an educational intervention on nurses perceived self-efficacy in recognizing patients exhibiting symptoms of cancer treatment-related cardiotoxicity. Sample & Setting: The study was set in a 16-bed cardiac critical care unit (CCU) within a 462-bed hospital. The sample group was comprised of registered nurses (RNs) working on or floating to the CCU. Methods & Variables: The study used a within-subjects design. Participants completed a pre-education survey, attended a 30-minute education intervention, and completed a post-education survey. The outcome variables were 7 self-confidence questions from the Nursing Self-Efficacy Scale for Managing Cancer Treatment-Induced Cardiotoxicity (NSS-CTC) on a 5-point Likert scale and one yes or no self-efficacy question. Descriptive statistics and paired T-tests were applied to analyze pre- and post-education surveys. Results: The pre-and post-education comparative analysis for each of the 7 NSS-CTC self-confidence questions was statistically significant with test statistics ranging from t = 3.43 to t = 8.69 and p -values ranging from 0.0021 to less than 0.0001. All 26 RNs answered “yes” in their ability to detect symptoms of cancer therapy-related cardiotoxicity after the education. Implications for Nursing: The lack of education for cardiac nurses against the backdrop of increasing cardiotoxicity in cancer patients showcases the essential need for cardiac nurse early symptom recognition education. Cardio-oncology cardiotoxicity competence education nursing self-efficacy Problem Statement and Significance Advances in cancer treatment have improved the long-term survival of patients but have also led to life-threatening cardiac side effects. The escalating incidence of cardiovascular toxicity in cancer patients, both during and after cancer treatment, has emerged as a formidable challenge in healthcare (Lyon et al., 2020 ). This phenomenon, known as cardiotoxicity, manifests as detrimental effects on the heart's structure and function due to cancer therapies. Cardiotoxicity has alarmingly ascended to become the second predominant cause of long-term morbidity and mortality among cancer treatment recipients (Kelly et al., 2017 ; Lyon et al., 2022 ). In response to this critical issue, the field of cardio-oncology has been established, aiming to refine the management of cardiovascular complications stemming from cancer treatments (Ghizzardi et al., 2017 ). Nurses occupy a pivotal role in the early detection, monitoring and management of cardiotoxicity (Magon et al., 2023 ). However, a concerning gap in the preparedness and competence of nursing professionals in this realm exists. Self-efficacy, a critical component linked to nursing competency, influences nursing performance, motivation, and learning outcomes (Bandura & Schunk, 1981 ; Caruso et al., 2016 ; Dellafiore et al., 2020 ; Magon et al., 2021 ; Zimmerman, 2000 ). Preliminary research indicates a prevalent sense of inadequacy and limited knowledge among nurses in managing cardiotoxicity (Belloni et al., 2021 ; Kelly et al., 2017 ; Magon et al., 2023 ). Educational interventions are needed to improve nursing competence in cardiotoxicity given the limited cardiotoxicity management among nurses. Objective The objective was to assess the impact of an education intervention on nurses perceived self-efficacy in recognizing patients exhibiting symptoms of cardiotoxicity. The aim was to elevate the competence of cardiac nurses in the early recognition of cancer therapy-related cardiotoxicity symptoms, thereby enhancing the quality of patient care and outcomes in this specialized area. Methods and Variables The researcher gathered data through pre- and post-education self-efficacy surveys. The study focused on nurses ability to recognize early symptoms of cancer-therapy related cardiotoxicity. The outcome variables were the 7 self-confidence questions from the Nursing Self-Efficacy Scale for Managing Cancer Treatment-Induced Cardiotoxicity (NSS-CTC) on a 5-point Likert scale that ranged from no confidence = 1 to high confidence = 5 and one yes or no self-efficacy question. The NSS-CTC (Appendices A, B, and C) is a comprehensive 15-item self-report tool created to evaluate nursing self-efficacy in addressing cancer treatment-induced cardiotoxicity. This scale encompassed a balanced mix of five knowledge-centric questions and ten practice- oriented questions. Eight questions (5–13, and 15) were excluded from the survey since they were less pertinent to cardiac nurses roles in recognizing and monitoring cardiotoxicity symptoms, particularly for non-oncology nurses. The NSS-CTC has demonstrated psychometric reliability, underpinned by content assessment of knowledge-related self-efficacy (Cronbach’s α = 0.924) and practice-related self-efficacy (Cronbach’s α = 0.937) (Magon et al., 2023 ). Utilization of the NSS-CTC in this study is sanctioned by the authors. Additionally, a range of demographic variables were captured of survey participants profiles, ensuring comprehensive data analysis. Privacy and Confidentiality Measures To uphold privacy and confidentiality, all pre- and post-education survey data was anonymized. A unique participant identification system, involving partial personal identifiers, was employed to link pre- and post-project data, ensuring data integrity while safeguarding participant anonymity. The university Human Research Protection Program (HRPP) and the hospital site HRPP both determined the study qualified for exempt status from International Review Board review. Sample and Setting The study was set in a CCU of a major Midwest city hospital, targeting cardiac nurses caring for an oncology patient population at risk for cardiotoxicity. The unit, a 16-bed CCU within a 462-bed hospital, presented an ideal environment for this research. The hospital site has a cardio-oncology team made up of cardiologists and oncologists. The hospital in this study uses a cardio-oncology risk score which is embedded into electronic health record charting. Therefore, nurses who took part in this study have the ability to communicate at risk patients with cardio-oncology providers through the documentation of a cardio-oncology risk score. Study Design and Procedure The study employed a quasi-experimental within-subjects design, aimed at evaluating the impact of an education intervention on nurses self-efficacy in recognizing early cardiotoxicity symptoms. It encompassed baseline data collection, intervention implementation, and post-intervention data gathering. The education intervention involved six 30-minute sessions focused on enhancing knowledge and skills related to cancer therapy-induced cardiotoxicity symptom recognition. Data Analysis The alpha level chosen for statistical significance was < 0.05 while the Statistical Package for Social Sciences (SPSS) was used for data analysis. Data were collected at two time points, utilizing questionnaires derived from Qualtrics, a data collection software. Descriptive statistics were used to analyze the following: participants demographics, pre- and post-education survey mean (M), pre- and post-education survey standard deviation (SD), and the responses to a self-efficacy yes or no question. Paired T-tests were used to analyze variations in the responses to the 7 NSS-CTC self-confidence questions. The Bonferroni correction was used to control the family-wise error rate, adding rigor to the analysis. To keep the probability of at least one false positive across all 7 tests at 5%, the p -values for each test were compared to the multiple testing corrected cut off threshold of 0.00625 (i.e., 0.05/7). Results Demographic variables assessed (Table 1 ) included age, gender identity, employment status, years worked as a RN, highest nursing degree completed, highest non-nursing degree completed, previous oncology nursing experience, and primary unit of employment. The number of possible participants included 45 RNs. The target population was 30 RNs. The total number of subjects who completed the surveys was 26 RNs. Table 1 Demographic Characteristics of Participants Demographic Variable Sample N % Age 20–30 12 46.2% 31–40 11 41.3% 41–50 2 7.7% 51+ 1 3.8% Gender Identity Female 20 76.9% Male 6 23.1% Transgender 0 0% Other 0 0% Prefer not to answer 0 0% Employment Status Full-time 21 80.8% Part-time 3 11.5% PRN 2 7.7% Number of Years of RN Experience < 1 year 3 11.5% 1–4 years 7 26.9% 5–9 years 9 34.6% 10–14 years 7 26.9% 15–19 years 0 0% 20 + years 0 0% Highest Nursing Degree Completed Associate Degree in Nursing 2 7.7% Bachelor’s Degree in Nursing 22 84.6% Master’s Degree in Nursing 2 7.7% Doctorate Degree in Nursing 0 0% Highest Nursing Non-Degree Completed Associate Degree (Non-Nursing) 0 0% Bachelor’s Degree (Non-Nursing) 13 50% Master’s Degree (Non-Nursing) 0 0% Doctorate Degree (Non-Nursing) 0 0% Previous Oncology Nursing Experience Yes 0 0% No 26 100% Primary Unit of Employment CCU 21 80.8% Resource ICU Nurse 2 7.7% Travel ICU Nurse 2 7.7% Float ICU Nurse 1 3.8% The 20–30 age group included 12 RNs (46%) and the 31–40 age group included 11 RNs (42%). Female participants included 20 RNs (76.92%). RNs employed full-time included 21 participants (80.77%). Seven participants (27%) had 1–4 years of experience as a RN and 9 (35%) had 5–9 years of experience. In the highest nursing degree completed, 22 RNs (85%) had a bachelor’s degree in nursing; in the highest non-nursing degree completed, 13 RNs (50%) had a bachelor’s degree. None of the 26 participant RNs reported having prior oncology nursing experience. The CCU was the primary unit of employment for 21 RNs (80.77%). The NSS-CTC survey contained 7 self-confidence questions on a 5-point Likert scale rated 1 to 5 with 1 = no confidence, 2 = little confidence, 3 = some confidence, 4 = confidence, 5 = high confidence. Descriptive statistics and paired T-tests were applied to analyze pre- and post-education surveys from a sample of 26 RNs (N = 26), with statistical significance set at p < 0.05 (Table 2 ). Table 2 Pre- & Post-Education Survey Descriptive Statistics & Comparative Analysis Outcome Variables 7 NSS-CTC Self-Confidence Questions Descriptive Statistics Pre-Education Post-Education (M, SD) (M, SD) Paired T-tests Test Statistic (t, p- value) 1) Monitor signs/symptoms of deteriorating cardiovascular functions M = 3.19, SD = 0.80 M = 3.77, SD = 0.82 t = 3.43, p = 0.0021 2) Recognize symptoms/signs of secondary cardiotoxicity M = 1.88, SD = 0.86 M = 3.65, SD = 0.80 t = 7.90, p < 0.0001 3) Recognize which chemotherapy treatments cause (reversible/irreversible heart damage) M = 1.85, SD = 0.98 M = 3.50, SD = 0.76 t = 8.47, p < 0.0001 4) Recognize chemotherapy treatments leading to cardiovascular damage (early and late) M = 1.92, SD = 0.74 M = 3.50, SD = 0.71 t = 8.47, p < 0.0001 5) Identify risk factors for chemotherapy-related cardiovascular complications M = 1.78, SD = 0.91 M = 3.81, SD = 0.69 t = 8.69, p < 0.0001 6) Monitor factors that have a negative impact on cardiovascular clinical outcomes M = 2.23, SD = 0.90 M = 3.77, SD = 0.65 t = 3.43, p < 0.0001 7) Educate patients undergoing cardiotoxic chemotherapy on how to symptoms of altered cardiovascular function M = 2.23, SD = 0.91 M = 3.58, SD = 0.81 t = 6.04, p < 0.0001 Results for the 7 self-confidence questions were: Monitor for signs and symptoms of deteriorating cardiovascular functions over time: pre-education (M = 3.19, SD = 0.801), post-education (M = 3.77, SD = 0.82), test statistic ( t = 3.43, p = 0.0021). Recognize the signs and symptoms of secondary cardiotoxicity caused by chemotherapy treatments: pre-education (M = 1.88, SD = 0.86), post-education (M = 3.65, SD = 0.80) test statistic ( t = 7.90, p < 0.0001). Recognize which chemotherapy treatments can damage the heart in reversible and irreversible ways: pre-education (M = 1.85, SD = 0.98), post-education (M = 3.5, SD = 0.76), test statistic ( t = 6.86, p < 0.0001). Recognize chemotherapy treatments leading to early and late cardiovascular damage: pre-education (M = 1.92, SD = 0.74), post-education (M = 3.5, SD = 0.71), test statistic ( t = 8.47, p < 0.0001). Identify risk factors, both modifiable and not, for chemotherapy-related cardiovascular complications: (M = 1.78, SD = 0.91), post-education (M = 3.81, SD = 0.69), test statistic ( t = 8.69, p < 0.0001). Monitor the factors that may have a negative impact on cardiovascular clinical outcomes over time: pre-education (M = 2.23, SD = 0.90), post-education (M = 3.77, SD = 0.65), test statistic ( t = 3.43, p < 0.0001). Educate patients undergoing cardiotoxic chemotherapy on how to recognize the symptoms and indicators of altered cardiovascular function: pre-education (M = 2.23, SD = 0.91), post-education (M = 3.58, SD = 0.81), test statistic ( t = 6.04, p < 0.0001). Following the educational intervention, analysis revealed a significant increase in nursing self-efficacy across all 7 questions. Pre-education confidence levels indicated little confidence with questions 2, 3, 4, and 5 reporting mean scores below 2. Questions 6 and 7 reported a mean score of 2.23. Question 1 was the only question where a moderate level of confidence was reported (pre-education mean score of 3.19). Post-educational intervention, the mean scores for all 7 questions ranged from 3.50 to 3.81, denoting a substantial improvement in how nurses reported their self-efficacy in recognizing cancer treatment-induced cardiotoxicity. The pre- and post-education surveys included one self-efficacy yes or no question (Table 3 ). This question asked if RNs thought they could recognize a patient with symptoms of cancer therapy-related cardiotoxicity. Before participating in the educational intervention 2 RNs (7.7%) answered “yes” in their ability to recognize such symptoms. Whereas 24 RNs (92.3%) did not believe they had the capacity to recognize such symptoms. Following the educational intervention all 26 RNs (100%) answered “yes” in their ability to detect symptoms of cancer therapy-related cardiotoxicity. Zero RNs (0%) answered “no”. Table 3 Self-efficacy Question Participant Responses Before and After Educational Intervention Pre- and Post-Intervention Self-Efficacy Question Yes No N (%) N (%) Before taking part in this education, do you think you can recognize a patient with symptoms of cancer therapy-related cardiotoxicity? After taking part in this education, do you think you can recognize a patient with symptoms of cancer therapy-related cardiotoxicity? 2 (7.7%) 26 (100%) 24 (92.3%) 0 (0%) Discussion A bachelor’s degree in nursing emerged as the most common education level among participants, indicating a high-level of formal education. Zero nurses reported having prior oncology nursing experience, this is a critical data point given the context of the study. The majority of the respondents were employed in the CCU indicating a focused expertise in cardiac care within the participant group. Comparative analysis of pre-and post-education surveys underscored the effectiveness of the targeted educational intervention. The results showed the self-efficacy of cardiac nurses with no previous oncology experience can progress from little confidence towards confident after one educational intervention. Limitations The study presents valuable insights, but has limitations. The use of self-reported measures for self-efficacy could introduce subjective biases. Excluding certain questions from the NSS-CTC could limit the survey comprehensiveness. Environmental factors in the clinical setting, such as interruptions, could impact the effectiveness of the educational intervention. Additionally, the study's one-day intervention did not capture long-term knowledge retention or implemented practice changes. Future research should utilize mixed methods to validate self-reported data, and conduct longitudinal studies to assess the lasting impacts of educational interventions. Acknowledging these limitations is crucial for interpreting the results and guiding future efforts to enhance nursing practice in recognizing cancer-therapy related cardiotoxicity. Implications Implications for Healthcare Systems This research underscores the necessity for healthcare systems to embed cardiotoxicity recognition training for nurses. As cardiotoxicity in cancer patients continues to rise, integrating cardio-oncology into healthcare services becomes imperative (Lyon et al., 2020 ). Empowering nurses with education to detect early signs of cardiotoxicity is a strategic move to curtail the long-term morbidity and mortality linked to cancer treatments (Kelly et al., 2017 ). Such specialized training fosters interdisciplinary collaboration, enhancing the synergy between nurses and cardio-oncology experts. It also highlights the critical role of continuous nursing education within healthcare systems in elevating patient outcomes and overall healthcare quality (Alvarez-Cardona et al., 2020 ). Implications for Healthcare Policy The findings of this study highlight the lack of and advocates for cardiotoxicity recognition training for nurses. Enacting policies requiring consistent training and assessment of nursing competencies in specialized areas ensure nurses are adeptly equipped to address complex patient needs (Fadol, 2021 ). Policies should also cultivate an environment conducive to continuous professional development, providing the necessary support for nurse’s educational advancement (Magon et al., 2023 ). It is imperative for health care policies to acknowledge and address the unique challenges faced by cardiac nurses by enhancing self-efficacy in their roles. Implications for Healthcare Economics Investing in nursing education for cardiotoxicity recognition can lead to significant financial benefits for both hospitals and patients, including cost savings. Potential cost savings are derived from the reduced necessity for cardiotoxicity-related treatments and shorter hospital stays (Zimmerman, 2000 ). Focused educational interventions, such as the one in this study, can potentially reduce long-term costs associated with managing cardiotoxicity (Kelly et al., 2017 ). Wong et al. ( 2018 ) performed an assessment of health care costs associated with adverse cardiac events in 412,005 patients with cancer. Adverse cardiac events during treatment episodes for cancer were frequent (Wong et al., 2018 ). Common cardiotoxicity complications have high costs per treatment episode. The cost per episode for common cardiotoxic complications include treatment for hypertension at $ 28,983, chest pain/angina at $ 20,081, thromboembolic events at $ 26,080, arrhythmias at $ 25,232, heart failure at $ 26,348, and hypotension at $ 21,378 (Wong et al., 2018 ). Implementing educational interventions focused on nurse competence in early recognition of cardiotoxicity potentially could save both patients and hospital systems money by avoiding adverse cardiac events. Implications for Nursing Practice A cardiac nurse is a crucial member of the interdisciplinary cardio-oncology team. A patient receiving potentially cardiotoxic cancer treatment may first present signs of cardiotoxicity in the presence of an RN on a cardiac unit, rather than an oncology unit. This is the first known study that generated data concerning the impact of an educational intervention on the early cardiotoxicity recognition by the cardiac nurse population. Enhanced early recognition of cardiotoxic symptoms by nurses is crucial in preventing further deterioration and ensuring timely treatment (Magon et al., 2023 ). Intervening through medication stopping, pausing, adjusting, or adding cardio-protective medications is critical to prevention of cardiotoxicity progression. Increased self-efficacy among nurses leads to necessary consultations with cardio-oncology providers (Kelly et al., 2017 ). Educational programs tailored to the unique requirements of nurses in cardiac settings are vital. Additionally, improving nurse competence in the early recognition of cardiotoxicity can aid hospitals during a Joint Commission accreditation visit, help to achieve Magnet Status, and inform the development of cardio-oncology programs. Conclusion The lack of education for cardiac nurses against the backdrop of increasing cardiotoxicity in cancer patients showcases the essential need for cardiac nurse early symptom recognition education. This study demonstrates the effectiveness of an educational intervention on improving cardiac nurses self-efficacy. The impact will extend beyond nursing practice. Healthcare policies, economics, and systems can be influenced by the outcomes of this study. This study paves the way for the importance of setting aside resources for education surrounding cardiotoxicity. Knowledge Translation A cardiac nurse is a crucial member of the interdisciplinary cardio-oncology team. A patient may first present signs of cardiotoxicity in the presence of an RN on a cardiac unit, rather than an oncology unit. The self-efficacy of cardiac nurses with no previous oncology experience can progress from little confidence towards confident after one educational intervention. Declarations Disclosures : The authors have disclosed no potential conflicts of interest, financial or otherwise. The views expressed herein are those of the authors and do not necessarily reflect the view of Purdue University or Indiana Internal Medicine Consultants. Availability of data and materials The datasets used and/or analyzed during the current study are available from Qualtrics upon reasonable request to the corresponding author. Ethical Approval and consent to participate The Purdue University HRPP (IRB# 2023-1873) and the hospital site HRPP (IRBNet ID# 2085346-1) both determined the study qualified for exempt status from International Review Board review. All subjects provided informed consent to participate in the study. Competing interests Not applicable. Funding Publication of this article will be funded in part by Purdue University Libraries Open Access Publishing Fund. Author Contributions J.K. led the manuscript writing, data analysis, and interpretation. M.A. significantly contributed to the study's conception, manuscript revision, and section rewrites. 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Supplementary Files AppendicesABandC.docx J.KolbusManuscriptPresentation.pptx Cite Share Download PDF Status: Published Journal Publication published 14 Sep, 2024 Read the published version in Cardio-Oncology → Version 1 posted Editorial decision: Revision requested 30 Jun, 2024 Reviews received at journal 30 Jun, 2024 Reviewers agreed at journal 28 Jun, 2024 Reviews received at journal 16 May, 2024 Reviewers agreed at journal 06 May, 2024 Reviewers invited by journal 29 Apr, 2024 Editor assigned by journal 23 Apr, 2024 Submission checks completed at journal 11 Apr, 2024 First submitted to journal 05 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4224250","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":290283396,"identity":"34fffbd7-1270-43ca-9993-090380dad668","order_by":0,"name":"Jeffry Kolbus","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYBAC9h4GxsNAmocfxEsoIEILYw8DA0iLjGQDSIsBCVpsDA6AuMRpOXzgcGFbHY/x+dWJHx4YMMjzix0goKW3LeHwzLbDPGY33m6WADrMcObsBAJa+nkMDvO2HQBqObsBpCXB4DZxWoAOm3F28w+itAj29oC0MPMY8PduI84WaZ5jCYdnnDvMI3GDd5tFgoEEYb/w8SQffFxQVmfP3392880fFTby/NIEtCCABFilBLHKQYD/ACmqR8EoGAWjYCQBAJYYRCBBLv93AAAAAElFTkSuQmCC","orcid":"","institution":"Purdue University West Lafayette","correspondingAuthor":true,"prefix":"","firstName":"Jeffry","middleName":"","lastName":"Kolbus","suffix":""},{"id":290283397,"identity":"592f7555-6123-413d-8154-462bd0de7f6a","order_by":1,"name":"Mopelola Adeola","email":"","orcid":"","institution":"Purdue University West Lafayette","correspondingAuthor":false,"prefix":"","firstName":"Mopelola","middleName":"","lastName":"Adeola","suffix":""},{"id":290283399,"identity":"e7257da0-2d67-44a7-a3f0-18e3d27ea971","order_by":2,"name":"Caitlin Luebcke","email":"","orcid":"","institution":"Indiana Internal Medicine Consultants","correspondingAuthor":false,"prefix":"","firstName":"Caitlin","middleName":"","lastName":"Luebcke","suffix":""},{"id":290283401,"identity":"9adf3f5d-24ee-4e3e-8d8d-fcacd25ac4f0","order_by":3,"name":"Janelle Tipton","email":"","orcid":"","institution":"Purdue University West Lafayette","correspondingAuthor":false,"prefix":"","firstName":"Janelle","middleName":"","lastName":"Tipton","suffix":""}],"badges":[],"createdAt":"2024-04-05 17:12:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4224250/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4224250/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40959-024-00261-x","type":"published","date":"2024-09-14T15:57:28+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":64619397,"identity":"5f805b05-2c53-48b0-a913-8541fda56714","added_by":"auto","created_at":"2024-09-16 16:14:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":596847,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4224250/v1/884f4270-9fe1-40fd-99f3-1f89caa28b28.pdf"},{"id":54755885,"identity":"3e526822-be7e-42b3-9d05-d249806b3e08","added_by":"auto","created_at":"2024-04-16 09:50:15","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":39561,"visible":true,"origin":"","legend":"","description":"","filename":"AppendicesABandC.docx","url":"https://assets-eu.researchsquare.com/files/rs-4224250/v1/b54f25004688f7cfd965a33c.docx"},{"id":54755887,"identity":"427bcbb0-8212-4656-9ab5-30a52d893021","added_by":"auto","created_at":"2024-04-16 09:50:15","extension":"pptx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":4196199,"visible":true,"origin":"","legend":"","description":"","filename":"J.KolbusManuscriptPresentation.pptx","url":"https://assets-eu.researchsquare.com/files/rs-4224250/v1/1a3b8ce36fbb5ff6ac5e80c0.pptx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Enhancing Nurse Competence in Early Recognition of Cardiotoxicity","fulltext":[{"header":"Problem Statement and Significance","content":" \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eAdvances in cancer treatment have improved the long-term survival of patients but have also led to life-threatening cardiac side effects. The escalating incidence of cardiovascular toxicity in cancer patients, both during and after cancer treatment, has emerged as a formidable challenge in healthcare (Lyon et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This phenomenon, known as cardiotoxicity, manifests as detrimental effects on the heart's structure and function due to cancer therapies. Cardiotoxicity has alarmingly ascended to become the second predominant cause of long-term morbidity and mortality among cancer treatment recipients (Kelly et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Lyon et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). In response to this critical issue, the field of cardio-oncology has been established, aiming to refine the management of cardiovascular complications stemming from cancer treatments (Ghizzardi et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNurses occupy a pivotal role in the early detection, monitoring and management of cardiotoxicity (Magon et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). However, a concerning gap in the preparedness and competence of nursing professionals in this realm exists. Self-efficacy, a critical component linked to nursing competency, influences nursing performance, motivation, and learning outcomes (Bandura \u0026amp; Schunk, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e1981\u003c/span\u003e; Caruso et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Dellafiore et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Magon et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Zimmerman, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Preliminary research indicates a prevalent sense of inadequacy and limited knowledge among nurses in managing cardiotoxicity (Belloni et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Kelly et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Magon et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Educational interventions are needed to improve nursing competence in cardiotoxicity given the limited cardiotoxicity management among nurses.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Objective","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe objective was to assess the impact of an education intervention on nurses perceived self-efficacy in recognizing patients exhibiting symptoms of cardiotoxicity. The aim was to elevate the competence of cardiac nurses in the early recognition of cancer therapy-related cardiotoxicity symptoms, thereby enhancing the quality of patient care and outcomes in this specialized area.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Methods and Variables","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe researcher gathered data through pre- and post-education self-efficacy surveys. The study focused on nurses ability to recognize early symptoms of cancer-therapy related cardiotoxicity. The outcome variables were the 7 self-confidence questions from the Nursing Self-Efficacy Scale for Managing Cancer Treatment-Induced Cardiotoxicity (NSS-CTC) on a 5-point Likert scale that ranged from no confidence\u0026thinsp;=\u0026thinsp;1 to high confidence\u0026thinsp;=\u0026thinsp;5 and one yes or no self-efficacy question.\u003c/p\u003e \u003cp\u003eThe NSS-CTC (Appendices A, B, and C) is a comprehensive 15-item self-report tool created to evaluate nursing self-efficacy in addressing cancer treatment-induced cardiotoxicity. This scale encompassed a balanced mix of five knowledge-centric questions and ten practice- oriented questions. Eight questions (5\u0026ndash;13, and 15) were excluded from the survey since they were less pertinent to cardiac nurses roles in recognizing and monitoring cardiotoxicity symptoms, particularly for non-oncology nurses. The NSS-CTC has demonstrated psychometric reliability, underpinned by content assessment of knowledge-related self-efficacy (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.924) and practice-related self-efficacy (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.937) (Magon et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Utilization of the NSS-CTC in this study is sanctioned by the authors. Additionally, a range of demographic variables were captured of survey participants profiles, ensuring comprehensive data analysis.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePrivacy and Confidentiality Measures\u003c/h2\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eTo uphold privacy and confidentiality, all pre- and post-education survey data was anonymized. A unique participant identification system, involving partial personal identifiers, was employed to link pre- and post-project data, ensuring data integrity while safeguarding participant anonymity. The university Human Research Protection Program (HRPP) and the hospital site HRPP both determined the study qualified for exempt status from International Review Board review.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSample and Setting\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe study was set in a CCU of a major Midwest city hospital, targeting cardiac nurses caring for an oncology patient population at risk for cardiotoxicity. The unit, a 16-bed CCU within a 462-bed hospital, presented an ideal environment for this research. The hospital site has a cardio-oncology team made up of cardiologists and oncologists. The hospital in this study uses a cardio-oncology risk score which is embedded into electronic health record charting. Therefore, nurses who took part in this study have the ability to communicate at risk patients with cardio-oncology providers through the documentation of a cardio-oncology risk score.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Procedure\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe study employed a quasi-experimental within-subjects design, aimed at evaluating the impact of an education intervention on nurses self-efficacy in recognizing early cardiotoxicity symptoms. It encompassed baseline data collection, intervention implementation, and post-intervention data gathering. The education intervention involved six 30-minute sessions focused on enhancing knowledge and skills related to cancer therapy-induced cardiotoxicity symptom recognition.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe alpha level chosen for statistical significance was \u0026lt;\u0026thinsp;0.05 while the Statistical Package for Social Sciences (SPSS) was used for data analysis. Data were collected at two time points, utilizing questionnaires derived from Qualtrics, a data collection software. Descriptive statistics were used to analyze the following: participants demographics, pre- and post-education survey mean (M), pre- and post-education survey standard deviation (SD), and the responses to a self-efficacy yes or no question. Paired T-tests were used to analyze variations in the responses to the 7 NSS-CTC self-confidence questions. The Bonferroni correction was used to control the family-wise error rate, adding rigor to the analysis. To keep the probability of at least one false positive across all 7 tests at 5%, the \u003cem\u003ep\u003c/em\u003e-values for each test were compared to the multiple testing corrected cut off threshold of 0.00625 (i.e., 0.05/7).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003eDemographic variables assessed (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e) included age, gender identity, employment status, years worked as a RN, highest nursing degree completed, highest non-nursing degree completed, previous oncology nursing experience, and primary unit of employment. The number of possible participants included 45 RNs. The target population was 30 RNs. The total number of subjects who completed the surveys was 26 RNs.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDemographic Characteristics of Participants\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDemographic Variable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSample\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20\u0026ndash;30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41\u0026ndash;50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51+\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGender Identity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e76.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTransgender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOther\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrefer not to answer\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEmployment Status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFull-time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePart-time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePRN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNumber of Years of RN Experience\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;1 year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;4 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u0026ndash;9 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;14 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u0026ndash;19 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20\u0026thinsp;+\u0026thinsp;years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHighest Nursing Degree Completed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAssociate Degree in Nursing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBachelor\u0026rsquo;s Degree in Nursing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e84.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMaster\u0026rsquo;s Degree in Nursing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDoctorate Degree in Nursing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHighest Nursing Non-Degree Completed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAssociate Degree (Non-Nursing)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBachelor\u0026rsquo;s Degree (Non-Nursing)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMaster\u0026rsquo;s Degree (Non-Nursing)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDoctorate Degree (Non-Nursing)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrevious Oncology Nursing Experience\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrimary Unit of Employment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCCU\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eResource ICU Nurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTravel ICU Nurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFloat ICU Nurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003eThe 20\u0026ndash;30 age group included 12 RNs (46%) and the 31\u0026ndash;40 age group included 11 RNs (42%). Female participants included 20 RNs (76.92%). RNs employed full-time included 21 participants (80.77%). Seven participants (27%) had 1\u0026ndash;4 years of experience as a RN and 9 (35%) had 5\u0026ndash;9 years of experience. In the highest nursing degree completed, 22 RNs (85%) had a bachelor\u0026rsquo;s degree in nursing; in the highest non-nursing degree completed, 13 RNs (50%) had a bachelor\u0026rsquo;s degree. None of the 26 participant RNs reported having prior oncology nursing experience. The CCU was the primary unit of employment for 21 RNs (80.77%).\u003c/p\u003e\n\u003cp\u003eThe NSS-CTC survey contained 7 self-confidence questions on a 5-point Likert scale rated 1 to 5 with 1\u0026thinsp;=\u0026thinsp;no confidence, 2\u0026thinsp;=\u0026thinsp;little confidence, 3\u0026thinsp;=\u0026thinsp;some confidence, 4\u0026thinsp;=\u0026thinsp;confidence, 5\u0026thinsp;=\u0026thinsp;high confidence. Descriptive statistics and paired T-tests were applied to analyze pre- and post-education surveys from a sample of 26 RNs (N\u0026thinsp;=\u0026thinsp;26), with statistical significance set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003e\u003cem\u003ePre- \u0026amp; Post-Education Survey Descriptive Statistics \u0026amp; Comparative Analysis\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOutcome Variables\u003c/p\u003e\n\u003cp\u003e7 NSS-CTC Self-Confidence Questions\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eDescriptive Statistics\u003c/p\u003e\n\u003cp\u003ePre-Education Post-Education\u003c/p\u003e\n\u003cp\u003e(M, SD) (M, SD)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePaired T-tests\u003c/p\u003e\n\u003cp\u003eTest Statistic\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(t, p-\u003c/em\u003evalue)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1) Monitor signs/symptoms of deteriorating cardiovascular functions\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u0026thinsp;=\u0026thinsp;3.19, SD\u0026thinsp;=\u0026thinsp;0.80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u0026thinsp;=\u0026thinsp;3.77, SD\u0026thinsp;=\u0026thinsp;0.82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.43, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0021\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2) Recognize symptoms/signs of secondary cardiotoxicity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u0026thinsp;=\u0026thinsp;1.88, SD\u0026thinsp;=\u0026thinsp;0.86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u0026thinsp;=\u0026thinsp;3.65, SD\u0026thinsp;=\u0026thinsp;0.80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.90, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3) Recognize which chemotherapy treatments cause (reversible/irreversible heart damage)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u0026thinsp;=\u0026thinsp;1.85, SD\u0026thinsp;=\u0026thinsp;0.98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u0026thinsp;=\u0026thinsp;3.50, SD\u0026thinsp;=\u0026thinsp;0.76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8.47, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4) Recognize chemotherapy treatments leading to cardiovascular damage (early and late)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u0026thinsp;=\u0026thinsp;1.92, SD\u0026thinsp;=\u0026thinsp;0.74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u0026thinsp;=\u0026thinsp;3.50, SD\u0026thinsp;=\u0026thinsp;0.71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8.47, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5) Identify risk factors for chemotherapy-related cardiovascular complications\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u0026thinsp;=\u0026thinsp;1.78, SD\u0026thinsp;=\u0026thinsp;0.91\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u0026thinsp;=\u0026thinsp;3.81, SD\u0026thinsp;=\u0026thinsp;0.69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8.69, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6) Monitor factors that have a negative impact on cardiovascular clinical outcomes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u0026thinsp;=\u0026thinsp;2.23, SD\u0026thinsp;=\u0026thinsp;0.90\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u0026thinsp;=\u0026thinsp;3.77, SD\u0026thinsp;=\u0026thinsp;0.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.43, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7) Educate patients undergoing cardiotoxic chemotherapy on how to symptoms of altered cardiovascular function\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u0026thinsp;=\u0026thinsp;2.23, SD\u0026thinsp;=\u0026thinsp;0.91\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u0026thinsp;=\u0026thinsp;3.58, SD\u0026thinsp;=\u0026thinsp;0.81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6.04, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003eResults for the 7 self-confidence questions were:\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003eMonitor for signs and symptoms of deteriorating cardiovascular functions over time:\u003cbr /\u003epre-education (M\u0026thinsp;=\u0026thinsp;3.19, SD\u0026thinsp;=\u0026thinsp;0.801), post-education (M\u0026thinsp;=\u0026thinsp;3.77, SD\u0026thinsp;=\u0026thinsp;0.82), test statistic (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.43, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0021).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eRecognize the signs and symptoms of secondary cardiotoxicity caused by chemotherapy treatments: pre-education (M\u0026thinsp;=\u0026thinsp;1.88, SD\u0026thinsp;=\u0026thinsp;0.86), post-education (M\u0026thinsp;=\u0026thinsp;3.65, SD\u0026thinsp;=\u0026thinsp;0.80) test statistic (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.90, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eRecognize which chemotherapy treatments can damage the heart in reversible and irreversible ways: pre-education (M\u0026thinsp;=\u0026thinsp;1.85, SD\u0026thinsp;=\u0026thinsp;0.98), post-education (M\u0026thinsp;=\u0026thinsp;3.5, SD\u0026thinsp;=\u0026thinsp;0.76), test statistic (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6.86, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eRecognize chemotherapy treatments leading to early and late cardiovascular damage: pre-education (M\u0026thinsp;=\u0026thinsp;1.92, SD\u0026thinsp;=\u0026thinsp;0.74), post-education (M\u0026thinsp;=\u0026thinsp;3.5, SD\u0026thinsp;=\u0026thinsp;0.71), test statistic (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8.47, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eIdentify risk factors, both modifiable and not, for chemotherapy-related cardiovascular complications: (M\u0026thinsp;=\u0026thinsp;1.78, SD\u0026thinsp;=\u0026thinsp;0.91), post-education (M\u0026thinsp;=\u0026thinsp;3.81, SD\u0026thinsp;=\u0026thinsp;0.69), test statistic (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8.69, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eMonitor the factors that may have a negative impact on cardiovascular clinical outcomes over time: pre-education (M\u0026thinsp;=\u0026thinsp;2.23, SD\u0026thinsp;=\u0026thinsp;0.90), post-education (M\u0026thinsp;=\u0026thinsp;3.77, SD\u0026thinsp;=\u0026thinsp;0.65), test statistic (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.43, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003eEducate patients undergoing cardiotoxic chemotherapy on how to recognize the symptoms and indicators of altered cardiovascular function: pre-education (M\u0026thinsp;=\u0026thinsp;2.23, SD\u0026thinsp;=\u0026thinsp;0.91), post-education (M\u0026thinsp;=\u0026thinsp;3.58, SD\u0026thinsp;=\u0026thinsp;0.81), test statistic (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6.04, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/li\u003e\n\u003c/ol\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003eFollowing the educational intervention, analysis revealed a significant increase in nursing self-efficacy across all 7 questions. Pre-education confidence levels indicated little confidence with questions 2, 3, 4, and 5 reporting mean scores below 2. Questions 6 and 7 reported a mean score of 2.23. Question 1 was the only question where a moderate level of confidence was reported (pre-education mean score of 3.19). Post-educational intervention, the mean scores for all 7 questions ranged from 3.50 to 3.81, denoting a substantial improvement in how nurses reported their self-efficacy in recognizing cancer treatment-induced cardiotoxicity.\u003c/p\u003e\n\u003cp\u003eThe pre- and post-education surveys included one self-efficacy yes or no question (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). This question asked if RNs thought they could recognize a patient with symptoms of cancer therapy-related cardiotoxicity. Before participating in the educational intervention 2 RNs (7.7%) answered \u0026ldquo;yes\u0026rdquo; in their ability to recognize such symptoms. Whereas 24 RNs (92.3%) did not believe they had the capacity to recognize such symptoms. Following the educational intervention all 26 RNs (100%) answered \u0026ldquo;yes\u0026rdquo; in their ability to detect symptoms of cancer therapy-related cardiotoxicity. Zero RNs (0%) answered \u0026ldquo;no\u0026rdquo;.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003e\u003cem\u003eSelf-efficacy Question Participant Responses Before and After Educational Intervention\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePre- and Post-Intervention Self-Efficacy Question\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003cp\u003e(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003cp\u003e(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBefore taking part in this education, do you think you can recognize a patient with symptoms of cancer therapy-related cardiotoxicity?\u003c/p\u003e\n\u003cp\u003eAfter taking part in this education, do you think you can recognize a patient with symptoms of cancer therapy-related cardiotoxicity?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e(7.7%)\u003c/p\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003cp\u003e(100%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003cp\u003e(92.3%)\u003c/p\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003cp\u003e(0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eA bachelor’s degree in nursing emerged as the most common education level among participants, indicating a high-level of formal education. Zero nurses reported having prior oncology nursing experience, this is a critical data point given the context of the study. The majority of the respondents were employed in the CCU indicating a focused expertise in cardiac care within the participant group.\u003c/p\u003e \u003cp\u003eComparative analysis of pre-and post-education surveys underscored the effectiveness of the targeted educational intervention. The results showed the self-efficacy of cardiac nurses with no previous oncology experience can progress from little confidence towards confident after one educational intervention.\u003c/p\u003e \u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Limitations","content":"\u003cp\u003e \u003c/p\u003e\u003cp\u003eThe study presents valuable insights, but has limitations. The use of self-reported\u003c/p\u003e\u003cp\u003emeasures for self-efficacy could introduce subjective biases. Excluding certain questions from the NSS-CTC could limit the survey comprehensiveness. Environmental factors in the clinical setting, such as interruptions, could impact the effectiveness of the educational intervention.\u003c/p\u003e\u003cp\u003eAdditionally, the study's one-day intervention did not capture long-term knowledge retention or implemented practice changes. Future research should utilize mixed methods to validate self-reported data, and conduct longitudinal studies to assess the lasting impacts of educational interventions. Acknowledging these limitations is crucial for interpreting the results and guiding future efforts to enhance nursing practice in recognizing cancer-therapy related cardiotoxicity.\u003c/p\u003e"},{"header":"Implications","content":"\u003ch2\u003eImplications for Healthcare Systems\u003c/h2\u003e\u003cp\u003e \u003c/p\u003e\u003cp\u003eThis research underscores the necessity for healthcare systems to embed cardiotoxicity recognition training for nurses. As cardiotoxicity in cancer patients continues to rise, integrating cardio-oncology into healthcare services becomes imperative (Lyon et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Empowering nurses with education to detect early signs of cardiotoxicity is a strategic move to curtail the long-term morbidity and mortality linked to cancer treatments (Kelly et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Such specialized training fosters interdisciplinary collaboration, enhancing the synergy between nurses and cardio-oncology experts. It also highlights the critical role of continuous nursing education within healthcare systems in elevating patient outcomes and overall healthcare quality (Alvarez-Cardona et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003eImplications for Healthcare Policy\u003c/h2\u003e\u003cp\u003e \u003c/p\u003e\u003cp\u003eThe findings of this study highlight the lack of and advocates for cardiotoxicity recognition training for nurses. Enacting policies requiring consistent training and assessment of nursing competencies in specialized areas ensure nurses are adeptly equipped to address complex patient needs (Fadol, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Policies should also cultivate an environment conducive to continuous professional development, providing the necessary support for nurse’s educational advancement (Magon et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). It is imperative for health care policies to acknowledge and address the unique challenges faced by cardiac nurses by enhancing self-efficacy in their roles.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003eImplications for Healthcare Economics\u003c/h2\u003e\u003cp\u003e \u003c/p\u003e\u003cp\u003eInvesting in nursing education for cardiotoxicity recognition can lead to significant financial benefits for both hospitals and patients, including cost savings. Potential cost savings are derived from the reduced necessity for cardiotoxicity-related treatments and shorter hospital stays (Zimmerman, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Focused educational interventions, such as the one in this study, can potentially reduce long-term costs associated with managing cardiotoxicity (Kelly et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Wong et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) performed an assessment of health care costs associated with adverse cardiac events in 412,005 patients with cancer. Adverse cardiac events during treatment episodes for cancer were frequent (Wong et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Common cardiotoxicity complications have high costs per treatment episode. The cost per episode for common cardiotoxic complications include treatment for hypertension at \u003cspan\u003e$\u003c/span\u003e28,983, chest pain/angina at \u003cspan\u003e$\u003c/span\u003e20,081, thromboembolic events at \u003cspan\u003e$\u003c/span\u003e26,080, arrhythmias at \u003cspan\u003e$\u003c/span\u003e25,232, heart failure at \u003cspan\u003e$\u003c/span\u003e26,348, and hypotension at \u003cspan\u003e$\u003c/span\u003e21,378 (Wong et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Implementing educational interventions focused on nurse competence in early recognition of cardiotoxicity potentially could save both patients and hospital systems money by avoiding adverse cardiac events.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003eImplications for Nursing Practice\u003c/h2\u003e\u003cp\u003e \u003c/p\u003e\u003cp\u003eA cardiac nurse is a crucial member of the interdisciplinary cardio-oncology team. A patient receiving potentially cardiotoxic cancer treatment may first present signs of cardiotoxicity in the presence of an RN on a cardiac unit, rather than an oncology unit. This is the first known study that generated data concerning the impact of an educational intervention on the early cardiotoxicity recognition by the cardiac nurse population. Enhanced early recognition of cardiotoxic symptoms by nurses is crucial in preventing further deterioration and ensuring timely treatment (Magon et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Intervening through medication stopping, pausing, adjusting, or adding cardio-protective medications is critical to prevention of cardiotoxicity progression. Increased self-efficacy among nurses leads to necessary consultations with cardio-oncology providers (Kelly et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Educational programs tailored to the unique requirements of nurses in cardiac settings are vital. Additionally, improving nurse competence in the early recognition of cardiotoxicity can aid hospitals during a Joint Commission accreditation visit, help to achieve Magnet Status, and inform the development of cardio-oncology programs.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe lack of education for cardiac nurses against the backdrop of increasing cardiotoxicity in cancer patients showcases the essential need for cardiac nurse early symptom recognition education. This study demonstrates the effectiveness of an educational intervention on improving cardiac nurses self-efficacy. The impact will extend beyond nursing practice. Healthcare policies, economics, and systems can be influenced by the outcomes of this study. This study paves the way for the importance of setting aside resources for education surrounding cardiotoxicity.\u003c/p\u003e \u003c/div\u003e \u003cp\u003e\u003c/p\u003e"},{"header":"Knowledge Translation","content":"\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eA cardiac nurse is a crucial member of the interdisciplinary cardio-oncology team.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eA patient may first present signs of cardiotoxicity in the presence of an RN on a cardiac unit, rather than an oncology unit.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe self-efficacy of cardiac nurses with no previous oncology experience can progress from little confidence towards confident after one educational intervention.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclosures\u003c/strong\u003e: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors have disclosed no potential conflicts of interest, financial or otherwise. The views expressed herein are those of the authors and do not necessarily reflect the view of Purdue University or Indiana Internal Medicine Consultants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from Qualtrics upon reasonable request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Purdue University HRPP (IRB# 2023-1873) and the hospital site HRPP (IRBNet ID# 2085346-1) both determined the study qualified for exempt status from International Review Board review. \u0026nbsp;All subjects provided informed consent to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePublication of this article will be funded in part by Purdue University Libraries Open Access Publishing Fund.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJ.K. led the manuscript writing, data analysis, and interpretation. \u0026nbsp;M.A. significantly contributed to the study\u0026apos;s conception, manuscript revision, and section rewrites. J.T. and C.L. provided critical manuscript revisions and aided in data interpretation. All authors engaged in a thorough review and gave their approval to the final manuscript version, upholding the principles of accountability and collaboration as per BMC authorship criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge Zachary J. Hass Ph.D., of Purdue University for his contributions as a statistical consultant for this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlvarez-Cardona JA, Ray J, Carver J, Zaha V, Cheng R, Yang E, Mitchell JD, Stockerl-Goldstein K, Kondapalli L, Dent S, Arnold A, Brown SA, Leja M, Barac A, Lenihan DJ, Herrmann J. Cardio-oncology education and training: JACC council perspectives. 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Contemp Educ Psychol. 2000;25(1):82\u0026ndash;91. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1006/ceps.1999.1016\u003c/span\u003e\u003cspan address=\"10.1006/ceps.1999.1016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"cardio-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caon","sideBox":"Learn more about [Cardio-Oncology](http://cardiooncologyjournal.biomedcentral.com)","snPcode":"40959","submissionUrl":"https://submission.nature.com/new-submission/40959/3","title":"Cardio-Oncology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cardio-oncology, cardiotoxicity, competence, education, nursing, self-efficacy","lastPublishedDoi":"10.21203/rs.3.rs-4224250/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4224250/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To assess the impact of an educational intervention on nurses perceived self-efficacy in recognizing patients exhibiting symptoms of cancer treatment-related cardiotoxicity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample \u0026amp; Setting:\u003c/strong\u003e The study was set in a 16-bed cardiac critical care unit (CCU) within a 462-bed hospital. The sample group was comprised of registered nurses (RNs) working on or floating to the CCU.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u0026amp; Variables:\u003c/strong\u003e The study used a within-subjects design. Participants completed a pre-education survey, attended a 30-minute education intervention, and completed a post-education survey. The outcome variables were 7 self-confidence questions from the Nursing Self-Efficacy Scale for Managing Cancer Treatment-Induced Cardiotoxicity (NSS-CTC) on a 5-point Likert scale and one yes or no self-efficacy question. Descriptive statistics and paired T-tests were applied to analyze pre- and post-education surveys.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe pre-and post-education comparative analysis for each of the 7 NSS-CTC self-confidence questions was statistically significant with test statistics ranging from\u003cem\u003e t\u003c/em\u003e = 3.43 to\u003cem\u003e t\u003c/em\u003e = 8.69 and \u003cem\u003ep\u003c/em\u003e-values ranging from 0.0021 to less than 0.0001. All 26 RNs answered “yes” in their ability to detect symptoms of cancer therapy-related cardiotoxicity after the education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for Nursing:\u003c/strong\u003e The lack of education for cardiac nurses against the backdrop of increasing cardiotoxicity in cancer patients showcases the essential need for cardiac nurse early symptom recognition education.\u003c/p\u003e","manuscriptTitle":"Enhancing Nurse Competence in Early Recognition of Cardiotoxicity","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-16 09:50:10","doi":"10.21203/rs.3.rs-4224250/v1","editorialEvents":[{"type":"communityComments","content":1},{"type":"decision","content":"Revision requested","date":"2024-07-01T02:54:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-01T02:40:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"103068119804559191585277507032242243908","date":"2024-06-28T21:41:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-16T13:26:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1004658324402402697571701167499140685","date":"2024-05-06T08:53:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-29T21:44:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-23T16:05:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-11T23:20:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"Cardio-Oncology","date":"2024-04-05T17:10:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"cardio-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caon","sideBox":"Learn more about [Cardio-Oncology](http://cardiooncologyjournal.biomedcentral.com)","snPcode":"40959","submissionUrl":"https://submission.nature.com/new-submission/40959/3","title":"Cardio-Oncology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d60e6d5a-341f-4dca-ba01-ad959c995bd6","owner":[],"postedDate":"April 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-16T16:07:48+00:00","versionOfRecord":{"articleIdentity":"rs-4224250","link":"https://doi.org/10.1186/s40959-024-00261-x","journal":{"identity":"cardio-oncology","isVorOnly":false,"title":"Cardio-Oncology"},"publishedOn":"2024-09-14 15:57:28","publishedOnDateReadable":"September 14th, 2024"},"versionCreatedAt":"2024-04-16 09:50:10","video":"","vorDoi":"10.1186/s40959-024-00261-x","vorDoiUrl":"https://doi.org/10.1186/s40959-024-00261-x","workflowStages":[]},"version":"v1","identity":"rs-4224250","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4224250","identity":"rs-4224250","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}