Competency-based training for cancer nurses: a qualitative inquiry

Competency-based training for cancer nurses: a qualitative inquiry | 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 Competency-based training for cancer nurses: a qualitative inquiry Ibrahim Ghoul, Aidah Alkaissi, Abdullah Abdullah, Fateh awwad, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6378843/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Competency-Based Training (CBT) is increasingly recognized as a critical strategy for enhancing cancer nursing practice, yet its specific impacts on nurses’ knowledge, skills, attitudes, and care quality remain underexplored. This study investigated how CBT influences cancer nurses’ professional competencies and care delivery, with a focus on identifying actionable recommendations to optimize training effectiveness in low-resource settings, such as Palestine. Methods A qualitative grounded theory design, informed by Charmaz’s constructivist framework and Strauss and Corbin’s systematic coding techniques, was employed. Purposive sampling recruited 18 nurses (7 male, 11 female; 5–16 years of experience) from An-Najah National University Hospital. Data were collected via Google Forms with open-ended questions addressing CBT’s impact on knowledge, skills, attitudes, consistency, and care quality. Ethical approval was secured from the Arab American University’s IRB, with participant anonymity ensured. Iterative line-by-line coding, memo writing, and external auditing ensured analytical rigor and theoretical saturation. Results CBT significantly enhanced knowledge in patient evaluation, emergency response (e.g., chemotherapy allergies), and chemotherapy side-effect management. Skills improvements included advanced medical equipment proficiency, precise chemotherapy administration, and palliative care. Nurses reported more empathetic attitudes, prioritizing psychological support and patient-centered care. Consistency in practice increased through standardized protocols (e.g., infection control, chemotherapy administration) and teamwork. Participants noted improved care quality via better symptom management, hygiene adherence, and holistic risk understanding. However, variability in individual practices and perceived training efficacy underscored the need for tailored approaches. Recommendations included integrating clinical simulations, expanding practical training hours, continuous education, patient engagement in training, and alignment with global standards. Conclusion CBT strengthens oncology nursing competencies, fostering standardized, empathetic, and high-quality care. While the training elevated knowledge, skills, and attitudes, sustained improvements require context-sensitive adaptations, ongoing education, and robust evaluation mechanisms. This study advocates for systemic implementation of CBT frameworks enriched with practical, patient-centered elements to optimize both professional development and cancer patient outcomes. Competency-Based Training oncology nursing qualitative study nursing education patient-centered care grounded theory Figures Figure 1 Background Cancer care is a rapidly evolving field requiring nurses with specialized competencies to manage complex treatments, including chemotherapy, blood transfusions, and emergencies like code blue or rapid response team (RRT) activations [ 1 ]. Nurses play a pivotal role in administering therapies, managing side effects, and delivering holistic care [ 2 , 3 ]. Cancer nursing is uniquely challenging due to the complexity and intensity of cancer treatments [ 4 ]. However, the preparation of cancer nurses remains inconsistent globally, with many healthcare systems relying on traditional training methods or lacking structured programs [ 5 , 6 ]. Competency-based training (CBT) has emerged as a transformative approach to standardize nursing education, focusing on predefined competencies such as venous access management, chemotherapy handling, and infection control [ 7 , 8 ]. This topic is critical because standardized training ensures nurses can meet the demands of modern cancer care, reduce errors, and improve patient outcomes [ 9 , 10 ]. Existing studies highlight CBT’s role in enhancing oncology nursing competencies. The utilization of a competency-based curriculum framework establishes a solid groundwork for ongoing health education across a variety of practice settings and healthcare provider organizations [ 11 ]. Key areas include managing venous access devices [ 9 ], administering blood transfusions [ 10 ], handling chemotherapy [ 12 ], responding to emergencies [ 13 ], and controlling infections [ 9 ]. Implementing competency-based education is crucial in ensuring that nursing graduates possess the necessary skills and knowledge to effectively address the present and future healthcare requirements of society [ 14 ]. Studies such as Srioetari’s [ 15 ] competence-enhancing model emphasize continuous training for chemotherapy proficiency, while Yang et al. [ 16 ], demonstrate CBT’s effectiveness in advance care planning. However, training programs vary widely: some institutions use traditional methods like lectures [ 5 ], whereas others adopt CBT frameworks [ 7 ]. Qualitative research has enriched understanding of curriculum design [ 17 ], yet gaps persist. For instance, studies by Molinaro et al. [ 18 ] and Adejumo et al. [ 19 ] reveal institutional constraints and training needs but face limitations in generalizability and methodology. Additionally, cultural competence [ 20 ] and inter-professional collaboration [ 21 ] remain underexplored in CBT contexts. Critically, the Arab world lacks robust research on nursing education [ 22 ], and comparative studies on CBT’s long-term efficacy versus traditional methods are scarce [ 23 ]. This study is urgently needed to address disparities in cancer nurse training and the lack of region-specific research in the Arab world [ 22 ]. While institutions like AN-Najah National University Hospital have implemented CBT, many healthcare systems lack structured programs, leading to inconsistencies in pain management, infection control, and emergency readiness [ 6 , 24 ]. Non-specialized nurses often struggle with insufficient training, jeopardizing patient safety [ 25 ]. By investigating CBT’s impact on knowledge, skills, attitudes, and care consistency, this study fills critical gaps in understanding how competency-based frameworks can be optimized for diverse settings. The findings will inform policy adaptations, advocate for standardized training, and address systemic inequities in nursing education [ 26 ]. This study aims to explore the implementation of Competency-Based Training (CBT) at An-Najah National University Hospital and evaluate its impact on enhancing oncology nursing competencies and the overall quality of patient care. Specifically, it seeks to assess how CBT influences nurses' knowledge, particularly in areas such as modern treatment protocols and emergency response, as well as their practical skills, including chemotherapy administration and palliative care. Beyond technical proficiency, the study also examines shifts in nurses’ attitudes, focusing on their approach to patient-centered and empathetic care. Additionally, it investigates whether CBT fosters greater consistency in nursing practices, particularly in infection control measures and teamwork. The study further aims to determine the extent to which CBT contributes to improved care quality, including symptom management and risk mitigation. By identifying both the challenges and opportunities associated with implementing CBT, this research provides valuable insights to inform future training initiatives. Ultimately, the findings aim to contribute to the advancement of oncology nursing education and practice on a broader scale. Methods This study employed a qualitative grounded theory methodology, grounded in Charmaz’s [ 27 ] constructivist framework and informed by Strauss and Corbin’s [ 28 ] systematic coding techniques. Grounded theory was selected to allow for the emergence of a theory from participants’ lived experiences regarding the implementation and impact of Competency-Based Training (CBT) in oncology nursing. Sampling A purposive sampling approach was utilized to select participants for this case study, ensuring a diverse range of nursing staff with varying levels of experience. This approach was aimed at obtaining a comprehensive understanding of the nurses’ experiences with CBT and its effects on their professional development and practice. Ethical considerations Data collection The Google Form included a series of open-ended questions designed to elicit detailed responses about their experiences with CBT. Responses were automatically stored in a secure database, ensuring both convenience and confidentiality. The questions developed based on the research objectives and explore participants' experiences, perceptions, and challenges related to knowledge, skills, attitude, adherence, quality of care and recommendations to the implementation of the CBT. The interview questions included: How has the competency-based training influenced your knowledge in cancer care? Can you provide specific examples of how it has affected your understanding or explain why it hasn't? How has the competency-based training influenced your skills in cancer care? Can you describe particular instances where your skills were impacted or discuss why there was no impact? How has the competency-based training influenced your attitude towards cancer care? Could you share specific changes in your attitude or reasons why it remained unchanged? In what ways has the competency-based training fostered consistency in the training and practice of cancer nursing among your colleagues? Can you provide examples of consistent practices or explain why there has been no consistency? How do you perceive the impact of the competency-based training on your ability to provide high-quality care to cancer patients? Could you share specific examples of improved care or reasons why the training has not influenced your ability? What recommendations do you have for improving the implementation of the competency-based training in cancer nurse training? Data analysis The responses collected from Google Forms were exported into text format for analysis. Following grounded theory principles, the data were coded line-by-line, and domains were identified based on the emerging patterns in the data. Memo writing was used to capture insights and connections between concepts. An external auditor reviewed the analysis to ensure reliability and validity. This iterative process allowed for the development of core ideas and themes related to the implementation of CBT, ultimately leading to the construction of a grounded theory about the effects of CBT on cancer nursing practice. Research Question The central research question that guided this study was: How has Competency-Based Training (CBT) influenced cancer nurses’ knowledge, skills, attitudes, consistency in practice, and the quality of care they provide to cancer patients, and what recommendations do nurses have for improving the implementation of CBT in their professional development? Results Participants The study involved 18 nurses from An-Najah National University Hospital, including 7 males and 11 females. Participants had a wide range of experience, from 5 to 16 years, and most were married. Their ages varied from 27 to 50 years, with male nurses mostly aged between 30 and 36, while female nurses ranged from 27 to 50 years. This mix of ages, experience levels, and marital statuses provided a comprehensive view of how competency-based training impacts different segments of the nursing staff. Knowledge domain The analysis of nurses' responses regarding the impact of CBT on their knowledge in cancer care reveals several key themes. These themes highlight the areas where training has significantly improved their understanding and practice, ultimately leading to better patient outcomes. Enhanced understanding of patient evaluation and modern protocols One of the primary areas where CBT has made a substantial impact is in the evaluation of patient conditions and the application of modern protocols. Nurses reported a marked improvement in their ability to assess patients using the latest standards and protocols, which is crucial for early symptom detection and appropriate intervention. This enhanced capability allows nurses to tailor their care to meet the specific needs of each patient more effectively. For instance, one respondent noted, "Training significantly improved my knowledge of cancer patient care. Enhanced my ability to evaluate patient conditions and apply modern protocols." This sentiment was echoed by many others, who emphasized that the training provided them with a solid foundation of essential knowledge, enabling them to deliver personalized and effective care. Improved emergency handling and rapid response teams (RRT) The training has also significantly bolstered nurses' knowledge in handling emergencies, particularly those related to chemotherapy drug allergies. Nurses highlighted their improved preparedness in managing such emergencies, including a better understanding of the protocols for activating and working with Rapid Response Teams (RRT). This increased competence ensures timely and efficient patient care during critical situations. One nurse illustrated this improvement by stating, "There was a noticeable impact on understanding Rapid Response Teams (RRT). Improved knowledge on handling chemotherapy drug allergies and better comprehension of the protocol for quickly managing patient emergencies." This enhancement in emergency handling capabilities is crucial for maintaining patient safety and improving outcomes during acute medical situations. Effective management of chemotherapy side effects CBT has profoundly affected nurses' understanding of chemotherapy side effects and their management. Nurses reported a deeper comprehension of the potential side effects of various chemotherapy drugs and how to address them, which is essential for providing comprehensive and effective care. This understanding extends to recognizing the impact of treatments on lab results and managing complications arising from immune suppression. One respondent shared, "The training positively impacted my knowledge. Understanding the effects of chemotherapy on lab results and subsequent complications such as immune suppression." This deeper insight into side effects allows nurses to anticipate and manage adverse reactions more effectively, thereby improving the overall quality of care provided to cancer patients. Emphasis on standardization and error prevention Another significant benefit of the training is the emphasis on standardized practices, which has led to a reduction in errors and improved care quality. Nurses highlighted that the training, based on standardized protocols and procedures, has enhanced their consistency in administering treatments and reduced the likelihood of mistakes. This standardization is crucial for ensuring patient safety and delivering high-quality care. For example, one nurse remarked, "The training positively impacted my knowledge by providing a stable reference for handling cancer patients and chemotherapy, including managing side effects." This focus on standardization not only benefits patients by providing consistent care but also supports nurses in maintaining high standards in their practice. Overall knowledge enhancement and increased confidence The overall impact of CBT on nurses' knowledge in cancer care is overwhelmingly positive. Nurses expressed increased confidence in their ability to provide high-quality care, apply protocols accurately, and manage side effects and emergencies effectively. This comprehensive knowledge enhancement has led to a more confident and competent nursing workforce, capable of delivering better patient outcomes. One nurse encapsulated this sentiment by stating, "Significant increase in knowledge about cancer care. Learned to use modern chemotherapy protocols. Deeper understanding of drug side effects and management. Increased confidence in providing patient care." This increased confidence and competence among nurses are essential for fostering a supportive and effective care environment for cancer patients. The CBT has had a profound and multifaceted impact on nurses' knowledge in cancer care. It has improved their understanding of patient evaluation, emergency handling, side effects management, and the application of standardized protocols. These enhancements not only increased their confidence and problem-solving abilities but also contributed to a more consistent and error-free care environment. The positive outcomes emphasize the importance of continuous CBT in maintaining high standards in oncology nursing, ultimately leading to better patient care and improved outcomes. Skills domain The analysis of the nurses' responses regarding the impact of CBT on their skills in cancer care revealed several critical areas where their abilities have been significantly enhanced. These areas include proficiency with medical equipment, improved chemotherapy administration, enhanced communication, and better emergency handling. Proficiency with advanced medical equipment One of the significant outcomes of CBT is the improvement in nurses' proficiency with advanced medical equipment used in cancer care. Nurses reported becoming more adept at handling complex devices, which is essential for delivering precise and effective treatments. For instance, one nurse mentioned, "Training has significantly improved my skills in using advanced medical equipment for cancer treatment." This enhanced proficiency ensures that patients receive the best possible care through the correct usage of sophisticated tools. Improved chemotherapy administration and management Another critical area where the training had a profound impact is in the administration and management of chemotherapy. Nurses reported a marked improvement in their ability to manage chemotherapy drugs, including handling different protocols and understanding their side effects. This improvement has not only increased their confidence but also reduced the likelihood of errors. For example, one nurse noted, "The training has enhanced my ability to manage chemotherapy protocols and reduced errors." Another added, "I have gained precise knowledge in administering various treatments, which has significantly boosted my confidence in handling cancer patients." These improvements are vital for ensuring that patients receive accurate and effective treatment, minimizing the risks associated with chemotherapy. Enhanced communication skills with patients and families CBT has also significantly enhanced nurses' communication skills with patients and their families. Effective communication is crucial in cancer care, where patients and their families often need emotional support and clear information about treatments and outcomes. One nurse stated, "The training has developed my communication skills with patients and their families, allowing me to provide better emotional and social support." This improvement in communication ensures that patients and their families feel supported and well-informed, which is essential for their overall well-being. Better emergency handling and symptom detection The training has also significantly improved nurses' skills in handling emergencies and detecting symptoms early. Nurses reported being more capable of quickly responding to adverse reactions, such as allergies to chemotherapy drugs, and managing emergencies with professionalism. For instance, one nurse shared, "The training has enhanced my skills in monitoring vital signs and responding to specific situations during treatment." Another highlighted, "I have become more adept at handling emergencies, particularly in managing chemotherapy allergies." These enhanced skills are crucial for maintaining patient safety and improving outcomes during critical situations. Increased precision in intravenous therapy and palliative Care CBT has also led to noticeable improvements in the precision of intravenous therapy and palliative care. Nurses reported becoming more accurate in administering intravenous treatments and more effective in managing pain for cancer patients. One nurse mentioned, "I have become more precise in applying intravenous treatments and providing palliative care, which has helped manage pain more effectively." These skills are essential for ensuring that patients receive the most appropriate and effective care, particularly in managing the complex needs of cancer patients. Standardization and error prevention The training emphasized standardized practices, which have led to a reduction in errors and improved care quality. Nurses highlighted that the training, based on standardized protocols and procedures, has enhanced their consistency in administering treatments and reduced the likelihood of mistakes. One respondent noted, "The training provided a stable reference for handling cancer patients and chemotherapy, which has positively impacted my skills by ensuring consistency and reducing errors." This focus on standardization not only benefits patients by providing consistent care but also supports nurses in maintaining high standards in their practice. Improved problem-solving abilities CBT has also enhanced nurses' problem-solving abilities. Nurses reported being better equipped to handle unexpected situations and solve problems that arise during cancer care. This improvement is critical for providing high-quality care and ensuring that patients receive the most appropriate treatments. One nurse remarked, "The training improved my problem-solving abilities, which has been crucial in managing patient care effectively." Enhanced problem-solving skills enable nurses to respond quickly and effectively to various challenges, ensuring that patients receive the best possible care. Comprehensive skill development and confidence boost Overall, the CBT has significantly improved nurses' skills in cancer care, leading to a more confident and competent nursing workforce. Nurses expressed increased confidence in their ability to provide high-quality care, apply protocols accurately, and manage emergencies effectively. This comprehensive skill development has resulted in better patient outcomes and a more supportive care environment. One nurse encapsulated this sentiment by stating, "The training has significantly enhanced my skills in providing nursing care to cancer patients, eliminated fear and hesitation, and enabled me to mentor new colleagues." This increased confidence and competence among nurses are essential for fostering a supportive and effective care environment for cancer patients. CBT has had a profound and multifaceted impact on nurses' skills in cancer care. It has improved their proficiency with medical equipment, chemotherapy administration, communication with patients and families, emergency handling, and intravenous therapy. These enhancements have led to increased confidence, better problem-solving abilities, and reduced errors, ultimately resulting in improved patient outcomes. The positive outcomes underscore the importance of continuous CBT in maintaining high standards in oncology nursing, ensuring that patients receive the best possible care. Attitude domain The CBT has significantly influenced nurses' attitudes towards cancer care. This shift in attitude can be observed across several key dimensions, including increased empathy and understanding, commitment to high-quality care, improved psychological support for patients, and enhanced confidence in professional capabilities. Increased empathy and understanding A recurrent theme among the nurses' responses is the profound increase in empathy and understanding towards cancer patients. Many nurses reported that the training helped them recognize and appreciate the emotional and psychological challenges that cancer patients face, leading to a more compassionate approach to care. One nurse shared, "The training has significantly improved my empathy and understanding of the challenges faced by cancer patients. I now appreciate the importance of listening to patients and providing psychological support, which I previously did not fully grasp." This enhanced understanding is crucial for delivering patient-centered care that addresses not only physical health needs but also emotional and psychological well-being. Commitment to high-quality care The training has reinforced nurses' commitment to providing high-quality care. Several respondents noted that their dedication to patient care has deepened, with a particular emphasis on reducing errors and ensuring that treatments are administered accurately and effectively. For example, one nurse stated, "The training positively changed my attitude by improving my knowledge and competency in administering medication, especially for cancer patients. This has nearly eliminated the chance of errors." This commitment to excellence ensures that patients receive the best possible care, enhancing overall treatment outcomes. Improved psychological support for patients Another significant impact of the training is the improved ability to offer psychological and emotional support to patients and their families. Nurses emphasized the importance of understanding patients' emotional states and providing appropriate support, which is essential for holistic cancer care. One nurse explained, "The training was crucial for understanding and empathizing with patients' emotions. This has effectively impacted compassionate care delivery and treatment administration, improving patient and family reception of care." By focusing on emotional support, nurses can help patients and their families cope better with the stresses of cancer treatment, leading to better mental health outcomes and adherence to treatment plans. Enhanced confidence and professional capabilities The training has also boosted nurses' confidence in their professional abilities. Many nurses reported feeling more competent and assured in their roles, which translates into better patient care and more effective communication with patients and their families. A nurse highlighted this by saying, "The training increased my confidence in performing tasks with cancer patients. It has made me feel proud to provide care according to global standards." This increased confidence is crucial for nurses as it enables them to perform their duties more effectively and instills a sense of pride and professionalism in their work. Positive change in attitude Overall, the training has led to a noticeable positive change in nurses' attitudes towards cancer care. Nurses have reported a shift towards a more compassionate, patient-centered approach, recognizing the importance of addressing all aspects of a patient's health, including their emotional and psychological needs. One respondent summarized this change by stating, "The training significantly changed my attitude towards cancer care. I have become more empathetic and understanding of patients' and families' needs, and I now realize the importance of psychological and social support." This positive change in attitude is critical for fostering a supportive and caring environment for cancer patients. Examples of specific changes Several specific examples illustrate the changes in attitude brought about by the training. Understanding patient psychology: Nurses reported better understanding of the psychological impact of cancer on patients, leading to more effective communication and support. One nurse mentioned, "I now better understand each patient's psychological state and can provide more individualized care." Formation of support groups: The training encouraged the formation of support groups for cancer patients, highlighting the role of social workers in providing emotional support. A nurse noted, "The training emphasized the importance of forming support groups and the role of social workers in cancer care." Specialized care for pediatric patients: The training also highlighted the unique needs of pediatric cancer patients, leading to more focused and compassionate care. One respondent said, "The training changed my attitude towards pediatric cancer patients, emphasizing the importance of psychological support and comprehensive care." CBT has profoundly impacted nurses' attitudes towards cancer care, fostering a more empathetic, understanding, and committed approach. This positive shift in attitude enhances the overall quality of care provided to cancer patients, ensuring that their physical, emotional, and psychological needs are met. The training has not only increased nurses' professional confidence and competence but also reinforced the importance of compassionate, patient-centered care. These improvements are essential for delivering high-quality cancer care and supporting patients and their families throughout their treatment journey. Consistency in training and practice domain The CBT has played a crucial role in fostering consistency in the training and practice of cancer nursing among colleagues. This consistency manifests in several key areas, including standardized care practices, adherence to treatment protocols, unified approaches to infection control, and enhanced teamwork and communication. Standardized care practices The training has led to the implementation of standardized care practices among nursing staff, particularly in pain management and chemotherapy administration. Nurses reported that these unified practices have significantly improved the quality of care provided to cancer patients. For instance, one nurse mentioned, "The training has resulted in standardized care practices among colleagues. We all follow the same approach in pain management and chemotherapy administration, leading to a consistent and high-quality care experience for patients." This standardization ensures that patients receive reliable and effective treatment regardless of the nurse attending to them. Adherence to treatment protocols Consistency has also been enhanced through strict adherence to treatment protocols. The training emphasized the importance of following comprehensive guidelines, which has led to a more structured and uniform approach to patient care. A specific example provided by a nurse illustrates this: "The training strengthened adherence to treatment protocols, ensuring compliance with double-checking procedures involving two nurses and verifying patient identity and treatment accuracy." This practice reduces the likelihood of errors and increases patient safety, fostering a reliable care environment. Unified approaches to infection control A significant area where consistency has been observed is in infection control protocols. The training has standardized the procedures for preventing infections, which is crucial for immunocompromised cancer patients. One nurse highlighted this impact: "The training enhanced consistency among colleagues by unifying our approach to infection prevention protocols, significantly reducing infection rates among patients." By following these standardized protocols, nurses can effectively minimize the risk of infections, which is essential for patient safety and recovery. Enhanced teamwork and communication The CBT has also fostered a spirit of teamwork and improved communication among colleagues. This collective approach ensures that all team members are on the same page regarding patient care, leading to a more cohesive and effective work environment. A nurse noted, "The training facilitated consistency through teamwork, enabling staff to work cohesively and track patient treatment stages." This collaborative approach ensures that patient care is continuous and coordinated, improving overall treatment outcomes. Examples of consistent practices Several specific examples illustrate the consistent practices fostered by the training. Infection control: Nurses reported a unified adherence to infection control policies, such as hand hygiene and wearing masks during procedures. One nurse shared, "The consistency among colleagues has improved, with everyone following infection control policies like hand sanitizing and wearing masks when inserting port catheters." Chemotherapy protocols: The training standardized the procedures for administering chemotherapy, including patient monitoring, preparatory treatments, and accompanying fluids. One nurse explained, "The training promoted uniform practices in administering chemotherapy protocols, ensuring good patient outcomes." Teamwork in infection control: The training emphasized the importance of working together to follow infection prevention protocols. A nurse commented, "The training unified our approach to managing immunocompromised cancer patients by implementing consistent infection control practices." Lack of consistency Despite the overall positive impact, some respondents noted areas where consistency was lacking. Differences in individual approaches to care were attributed to diverse backgrounds and practical experiences among nurses. One nurse observed, "There has been no noticeable increase in consistency among colleagues. Each individual still uses their own approach to care, likely due to different backgrounds and practical experiences." This highlights the challenge of achieving complete uniformity in practice despite standardized training. The CBT has significantly enhanced consistency in the training and practice of cancer nursing among colleagues. This consistency is evident in standardized care practices, strict adherence to treatment protocols, unified approaches to infection control, and improved teamwork and communication. These consistent practices ensure high-quality, reliable, and safe care for cancer patients, ultimately improving treatment outcomes and patient satisfaction. However, some variability in individual approaches remains, highlighting the ongoing need for continuous training and reinforcement of standardized protocols. Impact of CBT on quality of care The CBT has significantly influenced nurses' ability to provide high-quality care to cancer patients. This impact is seen in various aspects, including improved patient experience, enhanced symptom management, adherence to hygiene practices, and a deeper understanding of treatment risks. Below is a detailed analysis of these results. Enhanced patient experience The training has positively impacted nurses' attitudes towards cancer patient care, enabling them to meet individual patient needs more effectively and manage treatment side effects proficiently. This has improved the overall patient experience and quality of life. One nurse shared, "Thanks to the training, I am now more capable of identifying and addressing individual patient needs, which has improved the overall patient experience." This indicates that the training has equipped nurses with the skills necessary to tailor care to each patient's unique circumstances, enhancing their satisfaction and well-being. Effective symptom management The training has significantly improved nurses' ability to manage the side effects of cancer treatment. Nurses now possess better skills in monitoring symptoms and conducting comprehensive assessments, leading to early detection and timely treatment of health issues. For instance, a nurse mentioned, "The training enhanced my skills in symptom monitoring and comprehensive assessments, allowing me to detect problems early and provide appropriate treatment." This early intervention is crucial in managing cancer effectively and improving patient outcomes. Adherence to hygiene practices Emphasis on hygiene practices, such as sterilization, handwashing, and glove usage, has been a key component of the training. This has led to improved safety and efficiency in patient care, reducing the risk of infections. One nurse highlighted, "The training emphasized hygiene practices like handwashing and wearing gloves, which has improved the safety and efficiency of patient care." This focus on infection control is vital in protecting both patients and healthcare workers, particularly in an oncology setting. Understanding of treatment risks The training has improved nurses' understanding of the risks associated with cancer treatment, including its physical, psychological, and social impacts on patients. This comprehensive knowledge allows nurses to better manage these risks and provide holistic care. A nurse noted, "The training improved my understanding of treatment risks and the impacts on patients' health, helping me provide better care." This awareness enables nurses to address the multifaceted challenges faced by cancer patients, enhancing their overall care. Unified care system The training has promoted a unified care system based on competencies derived from previous experiences and research. This system helps in evaluating and adjusting care practices to ensure high service quality. One respondent explained, "The training's unified care system, based on competencies from previous experiences and research, helps in evaluating and adjusting care practices." This structured approach ensures consistency in care and facilitates continuous improvement. Increased confidence and emotional support The training has boosted nurses' confidence in managing cancer care, particularly in areas like pain management and providing emotional and social support to patients and their families. A nurse shared, "The training increased my confidence in managing pain and symptoms and providing emotional and social support." This confidence is essential for delivering compassionate and effective care, which is crucial for the well-being of cancer patients. Challenges and unchanged attitudes Despite the overall positive impact, some nurses reported that the training did not significantly enhance their ability to provide high-quality care. These individuals felt that they were already providing good care before the training, and it did not add much to their existing skills or knowledge. One nurse stated, "The training did not significantly enhance the quality of care I provide. I believe I was already offering good care before, and the training added little to my existing skills." This highlights the variability in training impact, suggesting the need for tailored training approaches to meet different levels of expertise and experience. CBT has had a substantial positive impact on the ability of nurses to provide high-quality care to cancer patients. It has enhanced patient experience, improved symptom management, emphasized hygiene practices, and deepened understanding of treatment risks. While some nurses felt the training did not significantly change their practice, the majority reported significant improvements in their skills and confidence, leading to better patient outcomes and higher satisfaction levels. This underscores the importance of continuous training and adaptation to meet the evolving needs of healthcare professionals and patients. Enhancing CBT for cancer nurses The CBT for cancer nurses is essential for ensuring high-quality patient care. Based on the collected feedback, several key recommendations have emerged to improve the implementation of this training. These recommendations focus on practical training, continuous education, patient engagement, regular evaluation, utilization of experienced trainers, interdepartmental training, adherence to international standards, and promoting scientific updates. Enhancing practical training Incorporate realistic clinical simulation programs: One of the most effective ways to enhance practical training is by incorporating realistic clinical simulation programs. These simulations allow nurses to practice handling complex cancer cases in a controlled, risk-free environment. By simulating real-life scenarios, nurses can develop and refine their skills, which translates into better preparedness and improved patient care. For example, a nurse who has practiced emergency procedures in a simulation is more likely to perform effectively in actual critical situations. Increase practical training hours: Expanding the number of practical training hours is another crucial step. Practical experience is invaluable in nursing, as it allows for the application of theoretical knowledge in real-world settings. Increasing these hours ensures that nurses gain the hands-on experience needed to excel in their roles. Nurses who spend more time in practical training are better equipped to handle diverse patient needs and deliver high-quality care consistently. Continuous education and advanced training Offer continuous education courses: Providing ongoing educational courses is vital to keep nurses updated with the latest advancements in cancer treatment. Continuous education ensures that nurses are aware of new treatments, techniques, and best practices, thus maintaining a high standard of care. For instance, regular courses on the latest chemotherapy protocols and emerging cancer treatments will help nurses stay at the forefront of oncology nursing. Provide advanced training tailored to experience levels: Designing advanced training programs tailored to the experience levels of nurses is also recommended. Such programs can address the specific needs of both novice and experienced nurses, ensuring that each group receives the appropriate level of training. Advanced courses can cover more complex topics and skills, helping experienced nurses further develop their expertise, while foundational courses can support new nurses in building a strong base of knowledge and skills. Engagement and evaluation Engage patients in training programs: Engaging patients in training programs can significantly enhance the practical understanding of nurses. Patient participation helps nurses gain insights into patient experiences and needs, leading to more empathetic and patient-centered care. For example, incorporating patient testimonials and real-case discussions into training sessions can help nurses understand the emotional and psychological aspects of cancer care, improving their ability to provide comprehensive support. Regularly evaluate training effectiveness: Implementing regular assessments to evaluate the effectiveness of training programs is crucial. Continuous evaluation allows for the identification of strengths and areas for improvement, ensuring that the training remains relevant and effective. Feedback from these assessments can guide necessary adjustments to the training curriculum, thereby enhancing its overall impact. Regular evaluations help ensure that the training evolves to meet changing healthcare standards and patient needs. Utilizing experienced trainers and interdepartmental training Involve experienced trainers: Utilizing trainers with extensive experience in oncology nursing is highly beneficial. Experienced trainers bring a wealth of practical knowledge and real-world insights, which can significantly enhance the training experience. Their mentorship can provide nurses with practical advice and strategies that are crucial for effective cancer care. For example, experienced trainers can share their expertise in managing complex cases and navigating challenging patient interactions. Implement job rotation and interdepartmental training: Introducing job rotation and interdepartmental training can prevent nurses from becoming overly specialized in one area, ensuring they maintain a broad competence across various tasks. Rotational training allows nurses to gain experience in different departments, fostering a well-rounded skill set. This approach helps nurses adapt to various situations and improves their overall versatility and effectiveness in patient care. Adhering to international standards and promoting scientific updates Follow global recommended policies: Continuously adhering to and integrating international standards and guidelines in training programs ensures that nurses are trained according to the best global practices. This adherence helps maintain high standards of care and aligns the training with the latest advancements and recommendations in oncology nursing. For instance, adopting global infection control protocols can help standardize practices and improve patient outcomes. Emphasize scientific updates and continuous improvement: Regularly updating training content based on the latest scientific research and developments is essential. Keeping the training materials current with scientific advancements ensures that nurses are equipped with the most effective techniques and knowledge. This continuous improvement helps maintain the relevance and effectiveness of the training, ensuring that nurses can provide the highest quality of care. For example, integrating the latest research on pain management and side effect mitigation into training can enhance the overall care provided to cancer patients. By implementing these recommendations, CBT for cancer nurses can be significantly improved, leading to better-prepared nurses and higher quality care for patients. See in Fig. 1 the key outcomes of CBT for cancer nurses. Discussion The findings from our study affirm the efficacy of CBT in enhancing the knowledge, skills, and attitudes of cancer nurses, thereby leading to improved patient care. This section discusses the results in the context of existing literature, highlighting how CBT addresses the unique demands of cancer nursing and aligns with previous research findings. Knowledge enhancement The study revealed that CBT significantly improved nurses' understanding of patient evaluation, modern protocols, emergency handling, chemotherapy side effects management, and error prevention. This aligns with the literature, which emphasizes the importance of specific competencies in cancer nursing [ 4 , 7 ]. For instance, key competencies such as managing venous access devices and responding to emergencies are critical for effective cancer care [ 9 , 13 ]. Our findings underscore the importance of a comprehensive knowledge base, as nurses reported enhanced capabilities in using the latest standards and protocols for early symptom detection and intervention. This is consistent with the emphasis on tailored care and improved patient outcomes highlighted in the literature [ 1 ]. Skills development CBT also significantly enhanced the practical skills of nurses, including proficiency with medical equipment, chemotherapy administration, communication, emergency handling, intravenous therapy, and palliative care. These improvements are in line with previous studies that advocate for competency in specific areas to ensure high standards of patient care [ 10 , 12 ]. The training's emphasis on standardized practices has led to a reduction in errors and improved care quality, echoing findings from the literature on the benefits of CBT in fostering consistent and safe care practices [ 9 ]. Moreover, the study's findings regarding improved problem-solving abilities and emergency response skills align with the literature's emphasis on the need for continuous training and updating of skills [ 15 ]. Attitudinal shifts The positive impact of CBT on nurses' attitudes towards cancer care was evident in increased empathy, a commitment to high-quality care, and improved psychological support for patients. This is supported by studies that highlight the importance of relational care and addressing the emotional and psychological needs of patients [ 18 ]. Nurses reported a more compassionate, patient-centered approach, which aligns with the literature's emphasis on cultural competence and the holistic needs of cancer patients [ 20 ]. The enhanced confidence in professional capabilities and the shift towards a more empathetic attitude underscore the critical role of CBT in fostering a supportive care environment [ 16 ]. Consistency in training and practice The study highlighted the role of CBT in fostering consistency among nursing practices, particularly in standardized care practices, adherence to treatment protocols, and unified infection control measures. This finding supports the literature's call for a structured and uniform approach to patient care [ 21 ]. The consistency achieved through CBT ensures that all nurses deliver reliable and effective treatment, enhancing overall patient outcomes and satisfaction [ 24 ]. Quality of care The overall quality of care provided by nurses improved significantly following CBT. Enhanced patient experience, effective symptom management, adherence to hygiene practices, and a deeper understanding of treatment risks were notable outcomes. This aligns with the literature's findings on the positive impact of competency-based education on healthcare quality [ 19 ]. The improved confidence and competence among nurses translate into better patient care, underscoring the need for continuous training to adapt to evolving healthcare standards and patient needs [ 29 ]. Limitations Despite the promising findings of this study, several limitations should be acknowledged. First, the study was conducted within a single healthcare setting, which may limit the generalizability of the results to other institutions or countries with differing healthcare infrastructures, resources, or cultural contexts. Additionally, the sample size, while sufficient for the scope of this study, was relatively small and may not fully represent the diverse range of cancer nurses across various specialties and experience levels. Furthermore, the study relied on self-reported data from nurses regarding their knowledge, skills, and attitudes, which may introduce bias due to the subjective nature of self-assessment. Although the study demonstrated significant improvements in competencies, the long-term impact of CBT on sustained behavior change and patient outcomes remains unclear, and further longitudinal studies are needed to assess its lasting effects. Finally, while the study focused on a structured CBT program, it did not explore other potential factors influencing nurse performance, such as organizational support, work environment, or personal characteristics, which may have contributed to the observed outcomes. Future research should address these limitations by including larger, more diverse samples, objective performance assessments, and long-term follow-up to strengthen the evidence base for the efficacy of CBT in cancer nursing. Recommendations for enhancing CBT Based on our findings, several recommendations emerge for improving CBT for cancer nurses. These include incorporating realistic clinical simulation programs, increasing practical training hours, offering continuous education courses, engaging patients in training programs, and utilizing experienced trainers. These recommendations are supported by the literature, which highlights the need for continuous training, practical experience, and adherence to international standards to maintain high-quality care [ 8 , 23 ]. Conclusion The study reaffirms the critical role of CBT in preparing nurses for the complex and demanding field of cancer care. By enhancing knowledge, skills, and attitudes, CBT not only improves the quality of patient care but also supports the professional development of nurses. Future research should continue to explore the long-term outcomes of CBT and compare its effectiveness with traditional training methods to further validate its benefits and identify areas for improvement. Abbreviations CBT: Competency-Based Training Declarations Acknowledgements The authors would like to thank An-Najah National University (www.najah.edu) for the technical support provided to publish the present manuscript Author contributions I.G. contributed to study design, data collection, and manuscript revision. A.A. led the conceptualization, data analysis, and manuscript drafting. A.A. assisted with data collection, interpretation, and critical review of the manuscript. F.A. contributed to the study design, data interpretation, and final manuscript revision. L.S. and W.Q. supported data collection and manuscript preparation. M.H. assisted with data analysis and manuscript review. E.A. contributed to data interpretation and manuscript editing. All authors approved the final version of the manuscript. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Data Availability The data that support the findings of this study are available from the corresponding author upon a reasonable request. Ethics approval and consent to participate The Institutional Review Board at Arab American University approved the research, and permission was obtained from the hospital. All participants signed a consent form outlining the study's aims, objectives, data collection. Respondents were ensured about the confidentiality of information obtained and the respondents did not ask to tell their names during data collection. All methods were performed in accordance with the relevant guidelines and regulations. sectors. Clinical trial registration This research did not involve a clinical trial; no clinical trial registration is applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Alfaro-Díaz C, Svavarsdottir EK, Esandi N, Klinke ME, Canga-Armayor A. Effectiveness of nursing interventions for patients with cancer and their family members: A systematic review. J Fam Nurs. 2022;28(2):95–114. Koutsopoulou S, Papathanassoglou ED, Katapodi MC, Patiraki EC. Nurses as information providers to cancer patients: Critical review of the evidence. J Clin Nurs. 2010;19(5–6):749–65. Borja ABY, Vacacela BPD, Barrera MVC, Espin BOP, Zurita MAS. The role of nursing in pain management in patients with terminal cancer. Sapienza: Int J Interdisciplinary Stud. 2023;4(SI1):e23039–23039. Charalambous A, Wells M, Campbell P, Torrens C, Östlund U, Oldenmenger W, Patiraki E, Sharp L, Nohavova I, Domenech-Climent N. A systematic review of clinical trials led or delivered by cancer nurses. Int J Nurs Stud. 2018;86:36–43. Sato T, Ishimaru M. Hypothetical model for on-the‐job training through case conferences of public health nurses. Public Health Nursing 2022, 39(6):1334–1345. Gill F, Duffy A. Caring for cancer patients on non-specialist wards. Br J Nurs. 2010;19(12):761–7. Chen S, Zhang C, Li W. The effects of competency-based training model in the training of new nurses: A meta-analysis and systematic review. PLoS ONE. 2022;17(11):e0277484. Liu M, Geng J, Gao J, Mei Z, Wang X, Wang S, Liu Y. Construction of a training content system for new nurses in cancer hospital based on competency. Front Surg. 2022;8:833879. Zhang R, Chen P, Yang L, Li Y, Zong Y, Deng L. Prevention of hematogenous infection in peripheral venous catheterization with integrated medical assistance in patients undergoing chemotherapy. Ann Ital Chir. 2021;92(1):70–6. Graham CA, DuBois D, Gleason C, Kumagai J, Sanford J. Identifying and Understanding Transfusion Reactions in the Oncology Population. Seminars in Oncology Nursing: 2021. Elsevier; 2021. p. 151137. Jackson MJ, Gallis HA, Gilman SC, Grossman M, Holzman GB, Marquis D, Trusky SK. The need for specialty curricula based on core competencies: a white paper of the Conjoint Committee on Continuing Medical Education. J Continuing Educ Health Professions. 2007;27(2):124–8. Khemnar ASS. Importance of Nursing Protocol in administering chemotherapy drugs. J Rural Nurs 2022, 10(2). Junior MMG, Araújo L. Oncological emergency: An assistant and sensitive look from nursing. Int J Health Sci 2023. Fater KH, Ready R. An education-service partnership to achieve safety and quality improvement competencies in nursing. J Nurs Educ. 2011;50(12):693–6. Srioetari SP. Chemotherapy Training Model To Improve Nurse Competence In The New Life Order Era. J World Sci. 2022;1(5):260–72. Yang Z, Wang H, Zheng C, Wang A. An exploratory model of advance care planning clinical training for oncology nurses: a constructivist grounded theory study. Nurse Educ Pract. 2022;65:103484. Flocke SA, Antognoli E, Daly BJ, Jackson B, Fulton S, Liu T, Surdam J, Manne S, Meropol NJ. The role of oncology nurses in discussing clinical trials. In: Oncology nursing forum: 2017 ; 2017: 547. Molinaro ML, Polzer J, Rudman DL, Savundranayagam M. I can't be the nurse I want to be: Counter-stories of moral distress in nurses' narratives of pediatric oncology caregiving. Soc Sci Med. 2023;320:115677. Adejumo PO, Oluwasanu MM, Ntekim A, Awolude OA, Kotila OA, Aniagwu T, Brown BJ, Dzekem BS, Duncan S, Tito-Ilori M. Oncology training needs assessment among health care professionals in Nigeria. JCO Global Oncol. 2022;8:e2200017. Üzar-Özçetin YS, Tee S, Kargın M. Achieving culturally competent cancer care: A qualitative study drawing on the perspectives of cancer survivors and oncology nurses. Eur J Oncol Nurs. 2020;44:101701. Johansen M-L, Ervik B. Teamwork in primary palliative care: general practitioners’ and specialised oncology nurses’ complementary competencies. BMC Health Serv Res. 2018;18:1–8. Devadas B. A Critical Review of Qualitative Research Methods in Evaluating Nursing Curriculum Models: Implication for Nursing Education in the Arab World. J Educ Pract. 2016;7(7):119–26. Muraraneza C, Mtshali GN. Conceptualization of competency based curricula in pre-service nursing and midwifery education: A grounded theory approach. Nurse Educ Pract. 2018;28:175–81. Moradi Y, Ahmadi F, Sadeghi A, Oshvandi K. Conceptualizing and determining core clinical competencies in nursing students: a qualitative study. Int Nurs Rev. 2019;66(4):530–40. Kim HR, Kwon IS. A phenomenological study on oncology adaptation experiences of new nurses. Asian Oncol Nurs. 2014;14(2):127–38. Obwoge ME, Edwin Obwoge M. Competency-based education and training: A fresh green leaf from the Australian context for TVET in Africa. Int Educ Multidisciplinary Stud. 2016;3(3):538–45. Charmaz K. Reconstructing grounded theory. SAGE Handb social Res methods 2008:461–78. Strauss A, Corbin J. Basics of qualitative research techniques. 1998. Suikkala A, Tohmola A, Rahko EK, Hökkä M. Future palliative competence needs–a qualitative study of physicians’ and registered nurses’ views. BMC Med Educ. 2021;21:1–12. Additional Declarations No competing interests reported. Supplementary Files Appendix1CBT.docx Cite Share Download PDF Status: Posted Version 1 posted 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-6378843","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":447610499,"identity":"07276e39-4146-48e3-9750-3696391dcfcf","order_by":0,"name":"Ibrahim 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University","correspondingAuthor":false,"prefix":"","firstName":"lamise","middleName":"","lastName":"shawahin","suffix":""},{"id":447610504,"identity":"bba1a129-143c-4fed-b152-bf5a27b2a073","order_by":5,"name":"Mohammed Hayek","email":"","orcid":"","institution":"An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"","lastName":"Hayek","suffix":""},{"id":447610505,"identity":"83d25869-3c33-4bd0-ba28-fc74215c6a01","order_by":6,"name":"Eman Alshawish","email":"","orcid":"","institution":"An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Eman","middleName":"","lastName":"Alshawish","suffix":""},{"id":447610506,"identity":"5f56756e-fd9a-47f2-9c9e-d04a2f09a727","order_by":7,"name":"Wafaa Qaysi","email":"","orcid":"","institution":"An-Najah National University Hospital, An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Wafaa","middleName":"","lastName":"Qaysi","suffix":""}],"badges":[],"createdAt":"2025-04-04 21:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6378843/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6378843/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82119127,"identity":"631b6c30-9a28-459c-b970-6d60ffb95f40","added_by":"auto","created_at":"2025-05-07 03:08:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":245018,"visible":true,"origin":"","legend":"\u003cp\u003eKey outcomes of Competency-Based Training (CBT) for cancer nurses across knowledge, skills, attitude, consistency in practice, quality of care, and training enhancement.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6378843/v1/65f1e688c0948b05006a66f1.png"},{"id":90935597,"identity":"eaf8ad74-14c0-40d8-8a1a-3e11e08a7ecf","added_by":"auto","created_at":"2025-09-09 17:01:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1660395,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6378843/v1/caa33164-2432-4f9b-bb73-5a6f46f5081e.pdf"},{"id":82119123,"identity":"196554fd-f604-45fd-9db9-e89319ef0ca2","added_by":"auto","created_at":"2025-05-07 03:08:49","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":13171,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1CBT.docx","url":"https://assets-eu.researchsquare.com/files/rs-6378843/v1/c996189805ec6cb81d042632.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Competency-based training for cancer nurses: a qualitative inquiry","fulltext":[{"header":"Background","content":"\u003cp\u003eCancer care is a rapidly evolving field requiring nurses with specialized competencies to manage complex treatments, including chemotherapy, blood transfusions, and emergencies like code blue or rapid response team (RRT) activations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Nurses play a pivotal role in administering therapies, managing side effects, and delivering holistic care [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Cancer nursing is uniquely challenging due to the complexity and intensity of cancer treatments [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, the preparation of cancer nurses remains inconsistent globally, with many healthcare systems relying on traditional training methods or lacking structured programs [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Competency-based training (CBT) has emerged as a transformative approach to standardize nursing education, focusing on predefined competencies such as venous access management, chemotherapy handling, and infection control [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This topic is critical because standardized training ensures nurses can meet the demands of modern cancer care, reduce errors, and improve patient outcomes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eExisting studies highlight CBT\u0026rsquo;s role in enhancing oncology nursing competencies. The utilization of a competency-based curriculum framework establishes a solid groundwork for ongoing health education across a variety of practice settings and healthcare provider organizations [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Key areas include managing venous access devices [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], administering blood transfusions [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], handling chemotherapy [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], responding to emergencies [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and controlling infections [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Implementing competency-based education is crucial in ensuring that nursing graduates possess the necessary skills and knowledge to effectively address the present and future healthcare requirements of society [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Studies such as Srioetari\u0026rsquo;s [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] competence-enhancing model emphasize continuous training for chemotherapy proficiency, while Yang et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], demonstrate CBT\u0026rsquo;s effectiveness in advance care planning. However, training programs vary widely: some institutions use traditional methods like lectures [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], whereas others adopt CBT frameworks [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Qualitative research has enriched understanding of curriculum design [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], yet gaps persist. For instance, studies by Molinaro et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and Adejumo et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] reveal institutional constraints and training needs but face limitations in generalizability and methodology. Additionally, cultural competence [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and inter-professional collaboration [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] remain underexplored in CBT contexts. Critically, the Arab world lacks robust research on nursing education [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and comparative studies on CBT\u0026rsquo;s long-term efficacy versus traditional methods are scarce [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study is urgently needed to address disparities in cancer nurse training and the lack of region-specific research in the Arab world [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. While institutions like AN-Najah National University Hospital have implemented CBT, many healthcare systems lack structured programs, leading to inconsistencies in pain management, infection control, and emergency readiness [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Non-specialized nurses often struggle with insufficient training, jeopardizing patient safety [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. By investigating CBT\u0026rsquo;s impact on knowledge, skills, attitudes, and care consistency, this study fills critical gaps in understanding how competency-based frameworks can be optimized for diverse settings. The findings will inform policy adaptations, advocate for standardized training, and address systemic inequities in nursing education [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study aims to explore the implementation of Competency-Based Training (CBT) at An-Najah National University Hospital and evaluate its impact on enhancing oncology nursing competencies and the overall quality of patient care. Specifically, it seeks to assess how CBT influences nurses' knowledge, particularly in areas such as modern treatment protocols and emergency response, as well as their practical skills, including chemotherapy administration and palliative care. Beyond technical proficiency, the study also examines shifts in nurses\u0026rsquo; attitudes, focusing on their approach to patient-centered and empathetic care. Additionally, it investigates whether CBT fosters greater consistency in nursing practices, particularly in infection control measures and teamwork. The study further aims to determine the extent to which CBT contributes to improved care quality, including symptom management and risk mitigation. By identifying both the challenges and opportunities associated with implementing CBT, this research provides valuable insights to inform future training initiatives. Ultimately, the findings aim to contribute to the advancement of oncology nursing education and practice on a broader scale.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study employed a qualitative grounded theory methodology, grounded in Charmaz\u0026rsquo;s [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] constructivist framework and informed by Strauss and Corbin\u0026rsquo;s [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] systematic coding techniques. Grounded theory was selected to allow for the emergence of a theory from participants\u0026rsquo; lived experiences regarding the implementation and impact of Competency-Based Training (CBT) in oncology nursing.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSampling\u003c/h2\u003e \u003cp\u003eA purposive sampling approach was utilized to select participants for this case study, ensuring a diverse range of nursing staff with varying levels of experience. This approach was aimed at obtaining a comprehensive understanding of the nurses\u0026rsquo; experiences with CBT and its effects on their professional development and practice.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eThe Google Form included a series of open-ended questions designed to elicit detailed responses about their experiences with CBT. Responses were automatically stored in a secure database, ensuring both convenience and confidentiality. The questions developed based on the research objectives and explore participants' experiences, perceptions, and challenges related to knowledge, skills, attitude, adherence, quality of care and recommendations to the implementation of the CBT. The interview questions included:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHow has the competency-based training influenced your knowledge in cancer care? Can you provide specific examples of how it has affected your understanding or explain why it hasn't?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHow has the competency-based training influenced your skills in cancer care? Can you describe particular instances where your skills were impacted or discuss why there was no impact?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHow has the competency-based training influenced your attitude towards cancer care? Could you share specific changes in your attitude or reasons why it remained unchanged?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIn what ways has the competency-based training fostered consistency in the training and practice of cancer nursing among your colleagues? Can you provide examples of consistent practices or explain why there has been no consistency?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHow do you perceive the impact of the competency-based training on your ability to provide high-quality care to cancer patients? Could you share specific examples of improved care or reasons why the training has not influenced your ability?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat recommendations do you have for improving the implementation of the competency-based training in cancer nurse training?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe responses collected from Google Forms were exported into text format for analysis. Following grounded theory principles, the data were coded line-by-line, and domains were identified based on the emerging patterns in the data. Memo writing was used to capture insights and connections between concepts. An external auditor reviewed the analysis to ensure reliability and validity. This iterative process allowed for the development of core ideas and themes related to the implementation of CBT, ultimately leading to the construction of a grounded theory about the effects of CBT on cancer nursing practice.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eResearch Question\u003c/h3\u003e\n\u003cp\u003eThe central research question that guided this study was: How has Competency-Based Training (CBT) influenced cancer nurses\u0026rsquo; knowledge, skills, attitudes, consistency in practice, and the quality of care they provide to cancer patients, and what recommendations do nurses have for improving the implementation of CBT in their professional development?\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe study involved 18 nurses from An-Najah National University Hospital, including 7 males and 11 females. Participants had a wide range of experience, from 5 to 16 years, and most were married. Their ages varied from 27 to 50 years, with male nurses mostly aged between 30 and 36, while female nurses ranged from 27 to 50 years. This mix of ages, experience levels, and marital statuses provided a comprehensive view of how competency-based training impacts different segments of the nursing staff.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eKnowledge domain\u003c/h3\u003e\n\u003cp\u003eThe analysis of nurses' responses regarding the impact of CBT on their knowledge in cancer care reveals several key themes. These themes highlight the areas where training has significantly improved their understanding and practice, ultimately leading to better patient outcomes.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEnhanced understanding of patient evaluation and modern protocols\u003c/h2\u003e \u003cp\u003eOne of the primary areas where CBT has made a substantial impact is in the evaluation of patient conditions and the application of modern protocols. Nurses reported a marked improvement in their ability to assess patients using the latest standards and protocols, which is crucial for early symptom detection and appropriate intervention. This enhanced capability allows nurses to tailor their care to meet the specific needs of each patient more effectively.\u003c/p\u003e \u003cp\u003eFor instance, one respondent noted, \"Training significantly improved my knowledge of cancer patient care. Enhanced my ability to evaluate patient conditions and apply modern protocols.\" This sentiment was echoed by many others, who emphasized that the training provided them with a solid foundation of essential knowledge, enabling them to deliver personalized and effective care.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eImproved emergency handling and rapid response teams (RRT)\u003c/h2\u003e \u003cp\u003eThe training has also significantly bolstered nurses' knowledge in handling emergencies, particularly those related to chemotherapy drug allergies. Nurses highlighted their improved preparedness in managing such emergencies, including a better understanding of the protocols for activating and working with Rapid Response Teams (RRT). This increased competence ensures timely and efficient patient care during critical situations.\u003c/p\u003e \u003cp\u003eOne nurse illustrated this improvement by stating, \"There was a noticeable impact on understanding Rapid Response Teams (RRT). Improved knowledge on handling chemotherapy drug allergies and better comprehension of the protocol for quickly managing patient emergencies.\" This enhancement in emergency handling capabilities is crucial for maintaining patient safety and improving outcomes during acute medical situations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eEffective management of chemotherapy side effects\u003c/h2\u003e \u003cp\u003eCBT has profoundly affected nurses' understanding of chemotherapy side effects and their management. Nurses reported a deeper comprehension of the potential side effects of various chemotherapy drugs and how to address them, which is essential for providing comprehensive and effective care. This understanding extends to recognizing the impact of treatments on lab results and managing complications arising from immune suppression.\u003c/p\u003e \u003cp\u003eOne respondent shared, \"The training positively impacted my knowledge. Understanding the effects of chemotherapy on lab results and subsequent complications such as immune suppression.\" This deeper insight into side effects allows nurses to anticipate and manage adverse reactions more effectively, thereby improving the overall quality of care provided to cancer patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eEmphasis on standardization and error prevention\u003c/h2\u003e \u003cp\u003eAnother significant benefit of the training is the emphasis on standardized practices, which has led to a reduction in errors and improved care quality. Nurses highlighted that the training, based on standardized protocols and procedures, has enhanced their consistency in administering treatments and reduced the likelihood of mistakes. This standardization is crucial for ensuring patient safety and delivering high-quality care.\u003c/p\u003e \u003cp\u003eFor example, one nurse remarked, \"The training positively impacted my knowledge by providing a stable reference for handling cancer patients and chemotherapy, including managing side effects.\" This focus on standardization not only benefits patients by providing consistent care but also supports nurses in maintaining high standards in their practice.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eOverall knowledge enhancement and increased confidence\u003c/h2\u003e \u003cp\u003eThe overall impact of CBT on nurses' knowledge in cancer care is overwhelmingly positive. Nurses expressed increased confidence in their ability to provide high-quality care, apply protocols accurately, and manage side effects and emergencies effectively. This comprehensive knowledge enhancement has led to a more confident and competent nursing workforce, capable of delivering better patient outcomes.\u003c/p\u003e \u003cp\u003eOne nurse encapsulated this sentiment by stating, \"Significant increase in knowledge about cancer care. Learned to use modern chemotherapy protocols. Deeper understanding of drug side effects and management. Increased confidence in providing patient care.\" This increased confidence and competence among nurses are essential for fostering a supportive and effective care environment for cancer patients.\u003c/p\u003e \u003cp\u003eThe CBT has had a profound and multifaceted impact on nurses' knowledge in cancer care. It has improved their understanding of patient evaluation, emergency handling, side effects management, and the application of standardized protocols. These enhancements not only increased their confidence and problem-solving abilities but also contributed to a more consistent and error-free care environment. The positive outcomes emphasize the importance of continuous CBT in maintaining high standards in oncology nursing, ultimately leading to better patient care and improved outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSkills domain\u003c/h2\u003e \u003cp\u003eThe analysis of the nurses' responses regarding the impact of CBT on their skills in cancer care revealed several critical areas where their abilities have been significantly enhanced. These areas include proficiency with medical equipment, improved chemotherapy administration, enhanced communication, and better emergency handling.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eProficiency with advanced medical equipment\u003c/h2\u003e \u003cp\u003eOne of the significant outcomes of CBT is the improvement in nurses' proficiency with advanced medical equipment used in cancer care. Nurses reported becoming more adept at handling complex devices, which is essential for delivering precise and effective treatments. For instance, one nurse mentioned, \"Training has significantly improved my skills in using advanced medical equipment for cancer treatment.\" This enhanced proficiency ensures that patients receive the best possible care through the correct usage of sophisticated tools.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eImproved chemotherapy administration and management\u003c/h2\u003e \u003cp\u003eAnother critical area where the training had a profound impact is in the administration and management of chemotherapy. Nurses reported a marked improvement in their ability to manage chemotherapy drugs, including handling different protocols and understanding their side effects. This improvement has not only increased their confidence but also reduced the likelihood of errors.\u003c/p\u003e \u003cp\u003eFor example, one nurse noted, \"The training has enhanced my ability to manage chemotherapy protocols and reduced errors.\" Another added, \"I have gained precise knowledge in administering various treatments, which has significantly boosted my confidence in handling cancer patients.\" These improvements are vital for ensuring that patients receive accurate and effective treatment, minimizing the risks associated with chemotherapy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eEnhanced communication skills with patients and families\u003c/h2\u003e \u003cp\u003eCBT has also significantly enhanced nurses' communication skills with patients and their families. Effective communication is crucial in cancer care, where patients and their families often need emotional support and clear information about treatments and outcomes.\u003c/p\u003e \u003cp\u003eOne nurse stated, \"The training has developed my communication skills with patients and their families, allowing me to provide better emotional and social support.\" This improvement in communication ensures that patients and their families feel supported and well-informed, which is essential for their overall well-being.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eBetter emergency handling and symptom detection\u003c/h2\u003e \u003cp\u003eThe training has also significantly improved nurses' skills in handling emergencies and detecting symptoms early. Nurses reported being more capable of quickly responding to adverse reactions, such as allergies to chemotherapy drugs, and managing emergencies with professionalism.\u003c/p\u003e \u003cp\u003eFor instance, one nurse shared, \"The training has enhanced my skills in monitoring vital signs and responding to specific situations during treatment.\" Another highlighted, \"I have become more adept at handling emergencies, particularly in managing chemotherapy allergies.\" These enhanced skills are crucial for maintaining patient safety and improving outcomes during critical situations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eIncreased precision in intravenous therapy and palliative Care\u003c/h2\u003e \u003cp\u003eCBT has also led to noticeable improvements in the precision of intravenous therapy and palliative care. Nurses reported becoming more accurate in administering intravenous treatments and more effective in managing pain for cancer patients.\u003c/p\u003e \u003cp\u003eOne nurse mentioned, \"I have become more precise in applying intravenous treatments and providing palliative care, which has helped manage pain more effectively.\" These skills are essential for ensuring that patients receive the most appropriate and effective care, particularly in managing the complex needs of cancer patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eStandardization and error prevention\u003c/h2\u003e \u003cp\u003eThe training emphasized standardized practices, which have led to a reduction in errors and improved care quality. Nurses highlighted that the training, based on standardized protocols and procedures, has enhanced their consistency in administering treatments and reduced the likelihood of mistakes.\u003c/p\u003e \u003cp\u003eOne respondent noted, \"The training provided a stable reference for handling cancer patients and chemotherapy, which has positively impacted my skills by ensuring consistency and reducing errors.\" This focus on standardization not only benefits patients by providing consistent care but also supports nurses in maintaining high standards in their practice.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eImproved problem-solving abilities\u003c/h2\u003e \u003cp\u003eCBT has also enhanced nurses' problem-solving abilities. Nurses reported being better equipped to handle unexpected situations and solve problems that arise during cancer care. This improvement is critical for providing high-quality care and ensuring that patients receive the most appropriate treatments.\u003c/p\u003e \u003cp\u003eOne nurse remarked, \"The training improved my problem-solving abilities, which has been crucial in managing patient care effectively.\" Enhanced problem-solving skills enable nurses to respond quickly and effectively to various challenges, ensuring that patients receive the best possible care.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eComprehensive skill development and confidence boost\u003c/h2\u003e \u003cp\u003eOverall, the CBT has significantly improved nurses' skills in cancer care, leading to a more confident and competent nursing workforce. Nurses expressed increased confidence in their ability to provide high-quality care, apply protocols accurately, and manage emergencies effectively. This comprehensive skill development has resulted in better patient outcomes and a more supportive care environment.\u003c/p\u003e \u003cp\u003eOne nurse encapsulated this sentiment by stating, \"The training has significantly enhanced my skills in providing nursing care to cancer patients, eliminated fear and hesitation, and enabled me to mentor new colleagues.\" This increased confidence and competence among nurses are essential for fostering a supportive and effective care environment for cancer patients.\u003c/p\u003e \u003cp\u003eCBT has had a profound and multifaceted impact on nurses' skills in cancer care. It has improved their proficiency with medical equipment, chemotherapy administration, communication with patients and families, emergency handling, and intravenous therapy. These enhancements have led to increased confidence, better problem-solving abilities, and reduced errors, ultimately resulting in improved patient outcomes. The positive outcomes underscore the importance of continuous CBT in maintaining high standards in oncology nursing, ensuring that patients receive the best possible care.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eAttitude domain\u003c/h2\u003e \u003cp\u003eThe CBT has significantly influenced nurses' attitudes towards cancer care. This shift in attitude can be observed across several key dimensions, including increased empathy and understanding, commitment to high-quality care, improved psychological support for patients, and enhanced confidence in professional capabilities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eIncreased empathy and understanding\u003c/h2\u003e \u003cp\u003eA recurrent theme among the nurses' responses is the profound increase in empathy and understanding towards cancer patients. Many nurses reported that the training helped them recognize and appreciate the emotional and psychological challenges that cancer patients face, leading to a more compassionate approach to care.\u003c/p\u003e \u003cp\u003eOne nurse shared, \"The training has significantly improved my empathy and understanding of the challenges faced by cancer patients. I now appreciate the importance of listening to patients and providing psychological support, which I previously did not fully grasp.\" This enhanced understanding is crucial for delivering patient-centered care that addresses not only physical health needs but also emotional and psychological well-being.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eCommitment to high-quality care\u003c/h2\u003e \u003cp\u003eThe training has reinforced nurses' commitment to providing high-quality care. Several respondents noted that their dedication to patient care has deepened, with a particular emphasis on reducing errors and ensuring that treatments are administered accurately and effectively.\u003c/p\u003e \u003cp\u003eFor example, one nurse stated, \"The training positively changed my attitude by improving my knowledge and competency in administering medication, especially for cancer patients. This has nearly eliminated the chance of errors.\" This commitment to excellence ensures that patients receive the best possible care, enhancing overall treatment outcomes.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eImproved psychological support for patients\u003c/h2\u003e \u003cp\u003eAnother significant impact of the training is the improved ability to offer psychological and emotional support to patients and their families. Nurses emphasized the importance of understanding patients' emotional states and providing appropriate support, which is essential for holistic cancer care.\u003c/p\u003e \u003cp\u003eOne nurse explained, \"The training was crucial for understanding and empathizing with patients' emotions. This has effectively impacted compassionate care delivery and treatment administration, improving patient and family reception of care.\" By focusing on emotional support, nurses can help patients and their families cope better with the stresses of cancer treatment, leading to better mental health outcomes and adherence to treatment plans.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eEnhanced confidence and professional capabilities\u003c/h2\u003e \u003cp\u003eThe training has also boosted nurses' confidence in their professional abilities. Many nurses reported feeling more competent and assured in their roles, which translates into better patient care and more effective communication with patients and their families.\u003c/p\u003e \u003cp\u003eA nurse highlighted this by saying, \"The training increased my confidence in performing tasks with cancer patients. It has made me feel proud to provide care according to global standards.\" This increased confidence is crucial for nurses as it enables them to perform their duties more effectively and instills a sense of pride and professionalism in their work.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePositive change in attitude\u003c/h3\u003e\n\u003cp\u003eOverall, the training has led to a noticeable positive change in nurses' attitudes towards cancer care. Nurses have reported a shift towards a more compassionate, patient-centered approach, recognizing the importance of addressing all aspects of a patient's health, including their emotional and psychological needs.\u003c/p\u003e \u003cp\u003eOne respondent summarized this change by stating, \"The training significantly changed my attitude towards cancer care. I have become more empathetic and understanding of patients' and families' needs, and I now realize the importance of psychological and social support.\" This positive change in attitude is critical for fostering a supportive and caring environment for cancer patients.\u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003eExamples of specific changes\u003c/h2\u003e \u003cp\u003eSeveral specific examples illustrate the changes in attitude brought about by the training. Understanding patient psychology: Nurses reported better understanding of the psychological impact of cancer on patients, leading to more effective communication and support. One nurse mentioned, \"I now better understand each patient's psychological state and can provide more individualized care.\"\u003c/p\u003e \u003cp\u003eFormation of support groups: The training encouraged the formation of support groups for cancer patients, highlighting the role of social workers in providing emotional support. A nurse noted, \"The training emphasized the importance of forming support groups and the role of social workers in cancer care.\"\u003c/p\u003e \u003cp\u003eSpecialized care for pediatric patients: The training also highlighted the unique needs of pediatric cancer patients, leading to more focused and compassionate care. One respondent said, \"The training changed my attitude towards pediatric cancer patients, emphasizing the importance of psychological support and comprehensive care.\"\u003c/p\u003e \u003cp\u003eCBT has profoundly impacted nurses' attitudes towards cancer care, fostering a more empathetic, understanding, and committed approach. This positive shift in attitude enhances the overall quality of care provided to cancer patients, ensuring that their physical, emotional, and psychological needs are met. The training has not only increased nurses' professional confidence and competence but also reinforced the importance of compassionate, patient-centered care. These improvements are essential for delivering high-quality cancer care and supporting patients and their families throughout their treatment journey.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eConsistency in training and practice domain\u003c/h2\u003e \u003cp\u003eThe CBT has played a crucial role in fostering consistency in the training and practice of cancer nursing among colleagues. This consistency manifests in several key areas, including standardized care practices, adherence to treatment protocols, unified approaches to infection control, and enhanced teamwork and communication.\u003c/p\u003e \u003cdiv id=\"Sec33\" class=\"Section3\"\u003e \u003ch2\u003eStandardized care practices\u003c/h2\u003e \u003cp\u003eThe training has led to the implementation of standardized care practices among nursing staff, particularly in pain management and chemotherapy administration. Nurses reported that these unified practices have significantly improved the quality of care provided to cancer patients.\u003c/p\u003e \u003cp\u003eFor instance, one nurse mentioned, \"The training has resulted in standardized care practices among colleagues. We all follow the same approach in pain management and chemotherapy administration, leading to a consistent and high-quality care experience for patients.\" This standardization ensures that patients receive reliable and effective treatment regardless of the nurse attending to them.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section3\"\u003e \u003ch2\u003eAdherence to treatment protocols\u003c/h2\u003e \u003cp\u003eConsistency has also been enhanced through strict adherence to treatment protocols. The training emphasized the importance of following comprehensive guidelines, which has led to a more structured and uniform approach to patient care.\u003c/p\u003e \u003cp\u003eA specific example provided by a nurse illustrates this: \"The training strengthened adherence to treatment protocols, ensuring compliance with double-checking procedures involving two nurses and verifying patient identity and treatment accuracy.\" This practice reduces the likelihood of errors and increases patient safety, fostering a reliable care environment.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eUnified approaches to infection control\u003c/h3\u003e\n\u003cp\u003eA significant area where consistency has been observed is in infection control protocols. The training has standardized the procedures for preventing infections, which is crucial for immunocompromised cancer patients.\u003c/p\u003e \u003cp\u003eOne nurse highlighted this impact: \"The training enhanced consistency among colleagues by unifying our approach to infection prevention protocols, significantly reducing infection rates among patients.\" By following these standardized protocols, nurses can effectively minimize the risk of infections, which is essential for patient safety and recovery.\u003c/p\u003e\n\u003ch3\u003eEnhanced teamwork and communication\u003c/h3\u003e\n\u003cp\u003eThe CBT has also fostered a spirit of teamwork and improved communication among colleagues. This collective approach ensures that all team members are on the same page regarding patient care, leading to a more cohesive and effective work environment.\u003c/p\u003e \u003cp\u003eA nurse noted, \"The training facilitated consistency through teamwork, enabling staff to work cohesively and track patient treatment stages.\" This collaborative approach ensures that patient care is continuous and coordinated, improving overall treatment outcomes.\u003c/p\u003e \u003cdiv id=\"Sec37\" class=\"Section2\"\u003e \u003ch2\u003eExamples of consistent practices\u003c/h2\u003e \u003cp\u003eSeveral specific examples illustrate the consistent practices fostered by the training. Infection control: Nurses reported a unified adherence to infection control policies, such as hand hygiene and wearing masks during procedures. One nurse shared, \"The consistency among colleagues has improved, with everyone following infection control policies like hand sanitizing and wearing masks when inserting port catheters.\"\u003c/p\u003e \u003cp\u003eChemotherapy protocols: The training standardized the procedures for administering chemotherapy, including patient monitoring, preparatory treatments, and accompanying fluids. One nurse explained, \"The training promoted uniform practices in administering chemotherapy protocols, ensuring good patient outcomes.\"\u003c/p\u003e \u003cp\u003eTeamwork in infection control: The training emphasized the importance of working together to follow infection prevention protocols. A nurse commented, \"The training unified our approach to managing immunocompromised cancer patients by implementing consistent infection control practices.\"\u003c/p\u003e \u003cdiv id=\"Sec38\" class=\"Section3\"\u003e \u003ch2\u003eLack of consistency\u003c/h2\u003e \u003cp\u003eDespite the overall positive impact, some respondents noted areas where consistency was lacking. Differences in individual approaches to care were attributed to diverse backgrounds and practical experiences among nurses.\u003c/p\u003e \u003cp\u003eOne nurse observed, \"There has been no noticeable increase in consistency among colleagues. Each individual still uses their own approach to care, likely due to different backgrounds and practical experiences.\" This highlights the challenge of achieving complete uniformity in practice despite standardized training.\u003c/p\u003e \u003cp\u003eThe CBT has significantly enhanced consistency in the training and practice of cancer nursing among colleagues. This consistency is evident in standardized care practices, strict adherence to treatment protocols, unified approaches to infection control, and improved teamwork and communication. These consistent practices ensure high-quality, reliable, and safe care for cancer patients, ultimately improving treatment outcomes and patient satisfaction. However, some variability in individual approaches remains, highlighting the ongoing need for continuous training and reinforcement of standardized protocols.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec39\" class=\"Section2\"\u003e \u003ch2\u003eImpact of CBT on quality of care\u003c/h2\u003e \u003cp\u003eThe CBT has significantly influenced nurses' ability to provide high-quality care to cancer patients. This impact is seen in various aspects, including improved patient experience, enhanced symptom management, adherence to hygiene practices, and a deeper understanding of treatment risks. Below is a detailed analysis of these results.\u003c/p\u003e \u003cdiv id=\"Sec40\" class=\"Section3\"\u003e \u003ch2\u003eEnhanced patient experience\u003c/h2\u003e \u003cp\u003eThe training has positively impacted nurses' attitudes towards cancer patient care, enabling them to meet individual patient needs more effectively and manage treatment side effects proficiently. This has improved the overall patient experience and quality of life.\u003c/p\u003e \u003cp\u003eOne nurse shared, \"Thanks to the training, I am now more capable of identifying and addressing individual patient needs, which has improved the overall patient experience.\" This indicates that the training has equipped nurses with the skills necessary to tailor care to each patient's unique circumstances, enhancing their satisfaction and well-being.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEffective symptom management\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe training has significantly improved nurses' ability to manage the side effects of cancer treatment. Nurses now possess better skills in monitoring symptoms and conducting comprehensive assessments, leading to early detection and timely treatment of health issues.\u003c/p\u003e \u003cp\u003eFor instance, a nurse mentioned, \"The training enhanced my skills in symptom monitoring and comprehensive assessments, allowing me to detect problems early and provide appropriate treatment.\" This early intervention is crucial in managing cancer effectively and improving patient outcomes.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAdherence to hygiene practices\u003c/b\u003e \u003c/p\u003e \u003cp\u003eEmphasis on hygiene practices, such as sterilization, handwashing, and glove usage, has been a key component of the training. This has led to improved safety and efficiency in patient care, reducing the risk of infections.\u003c/p\u003e \u003cp\u003eOne nurse highlighted, \"The training emphasized hygiene practices like handwashing and wearing gloves, which has improved the safety and efficiency of patient care.\" This focus on infection control is vital in protecting both patients and healthcare workers, particularly in an oncology setting.\u003c/p\u003e \u003cp\u003e \u003cb\u003eUnderstanding of treatment risks\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe training has improved nurses' understanding of the risks associated with cancer treatment, including its physical, psychological, and social impacts on patients. This comprehensive knowledge allows nurses to better manage these risks and provide holistic care.\u003c/p\u003e \u003cp\u003eA nurse noted, \"The training improved my understanding of treatment risks and the impacts on patients' health, helping me provide better care.\" This awareness enables nurses to address the multifaceted challenges faced by cancer patients, enhancing their overall care.\u003c/p\u003e \u003cp\u003e \u003cb\u003eUnified care system\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe training has promoted a unified care system based on competencies derived from previous experiences and research. This system helps in evaluating and adjusting care practices to ensure high service quality.\u003c/p\u003e \u003cp\u003eOne respondent explained, \"The training's unified care system, based on competencies from previous experiences and research, helps in evaluating and adjusting care practices.\" This structured approach ensures consistency in care and facilitates continuous improvement.\u003c/p\u003e \u003cp\u003e \u003cb\u003eIncreased confidence and emotional support\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe training has boosted nurses' confidence in managing cancer care, particularly in areas like pain management and providing emotional and social support to patients and their families.\u003c/p\u003e \u003cp\u003eA nurse shared, \"The training increased my confidence in managing pain and symptoms and providing emotional and social support.\" This confidence is essential for delivering compassionate and effective care, which is crucial for the well-being of cancer patients.\u003c/p\u003e \u003cp\u003e \u003cb\u003eChallenges and unchanged attitudes\u003c/b\u003e \u003c/p\u003e \u003cp\u003eDespite the overall positive impact, some nurses reported that the training did not significantly enhance their ability to provide high-quality care. These individuals felt that they were already providing good care before the training, and it did not add much to their existing skills or knowledge.\u003c/p\u003e \u003cp\u003eOne nurse stated, \"The training did not significantly enhance the quality of care I provide. I believe I was already offering good care before, and the training added little to my existing skills.\" This highlights the variability in training impact, suggesting the need for tailored training approaches to meet different levels of expertise and experience.\u003c/p\u003e \u003cp\u003eCBT has had a substantial positive impact on the ability of nurses to provide high-quality care to cancer patients. It has enhanced patient experience, improved symptom management, emphasized hygiene practices, and deepened understanding of treatment risks. While some nurses felt the training did not significantly change their practice, the majority reported significant improvements in their skills and confidence, leading to better patient outcomes and higher satisfaction levels. This underscores the importance of continuous training and adaptation to meet the evolving needs of healthcare professionals and patients.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eEnhancing CBT for cancer nurses\u003c/h3\u003e\n\u003cp\u003eThe CBT for cancer nurses is essential for ensuring high-quality patient care. Based on the collected feedback, several key recommendations have emerged to improve the implementation of this training. These recommendations focus on practical training, continuous education, patient engagement, regular evaluation, utilization of experienced trainers, interdepartmental training, adherence to international standards, and promoting scientific updates.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEnhancing practical training\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIncorporate realistic clinical simulation programs: One of the most effective ways to enhance practical training is by incorporating realistic clinical simulation programs. These simulations allow nurses to practice handling complex cancer cases in a controlled, risk-free environment. By simulating real-life scenarios, nurses can develop and refine their skills, which translates into better preparedness and improved patient care. For example, a nurse who has practiced emergency procedures in a simulation is more likely to perform effectively in actual critical situations.\u003c/p\u003e \u003cp\u003eIncrease practical training hours: Expanding the number of practical training hours is another crucial step. Practical experience is invaluable in nursing, as it allows for the application of theoretical knowledge in real-world settings. Increasing these hours ensures that nurses gain the hands-on experience needed to excel in their roles. Nurses who spend more time in practical training are better equipped to handle diverse patient needs and deliver high-quality care consistently.\u003c/p\u003e \u003cp\u003e \u003cb\u003eContinuous education and advanced training\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOffer continuous education courses: Providing ongoing educational courses is vital to keep nurses updated with the latest advancements in cancer treatment. Continuous education ensures that nurses are aware of new treatments, techniques, and best practices, thus maintaining a high standard of care. For instance, regular courses on the latest chemotherapy protocols and emerging cancer treatments will help nurses stay at the forefront of oncology nursing.\u003c/p\u003e \u003cp\u003eProvide advanced training tailored to experience levels: Designing advanced training programs tailored to the experience levels of nurses is also recommended. Such programs can address the specific needs of both novice and experienced nurses, ensuring that each group receives the appropriate level of training. Advanced courses can cover more complex topics and skills, helping experienced nurses further develop their expertise, while foundational courses can support new nurses in building a strong base of knowledge and skills.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEngagement and evaluation\u003c/b\u003e \u003c/p\u003e \u003cp\u003eEngage patients in training programs: Engaging patients in training programs can significantly enhance the practical understanding of nurses. Patient participation helps nurses gain insights into patient experiences and needs, leading to more empathetic and patient-centered care. For example, incorporating patient testimonials and real-case discussions into training sessions can help nurses understand the emotional and psychological aspects of cancer care, improving their ability to provide comprehensive support.\u003c/p\u003e \u003cp\u003eRegularly evaluate training effectiveness: Implementing regular assessments to evaluate the effectiveness of training programs is crucial. Continuous evaluation allows for the identification of strengths and areas for improvement, ensuring that the training remains relevant and effective. Feedback from these assessments can guide necessary adjustments to the training curriculum, thereby enhancing its overall impact. Regular evaluations help ensure that the training evolves to meet changing healthcare standards and patient needs.\u003c/p\u003e \u003cp\u003e \u003cb\u003eUtilizing experienced trainers and interdepartmental training\u003c/b\u003e \u003c/p\u003e \u003cp\u003eInvolve experienced trainers: Utilizing trainers with extensive experience in oncology nursing is highly beneficial. Experienced trainers bring a wealth of practical knowledge and real-world insights, which can significantly enhance the training experience. Their mentorship can provide nurses with practical advice and strategies that are crucial for effective cancer care. For example, experienced trainers can share their expertise in managing complex cases and navigating challenging patient interactions.\u003c/p\u003e \u003cp\u003eImplement job rotation and interdepartmental training: Introducing job rotation and interdepartmental training can prevent nurses from becoming overly specialized in one area, ensuring they maintain a broad competence across various tasks. Rotational training allows nurses to gain experience in different departments, fostering a well-rounded skill set. This approach helps nurses adapt to various situations and improves their overall versatility and effectiveness in patient care.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAdhering to international standards and promoting scientific updates\u003c/b\u003e \u003c/p\u003e \u003cp\u003e Follow global recommended policies: Continuously adhering to and integrating international standards and guidelines in training programs ensures that nurses are trained according to the best global practices. This adherence helps maintain high standards of care and aligns the training with the latest advancements and recommendations in oncology nursing. For instance, adopting global infection control protocols can help standardize practices and improve patient outcomes.\u003c/p\u003e \u003cp\u003eEmphasize scientific updates and continuous improvement: Regularly updating training content based on the latest scientific research and developments is essential. Keeping the training materials current with scientific advancements ensures that nurses are equipped with the most effective techniques and knowledge. This continuous improvement helps maintain the relevance and effectiveness of the training, ensuring that nurses can provide the highest quality of care. For example, integrating the latest research on pain management and side effect mitigation into training can enhance the overall care provided to cancer patients.\u003c/p\u003e \u003cp\u003eBy implementing these recommendations, CBT for cancer nurses can be significantly improved, leading to better-prepared nurses and higher quality care for patients. See in Fig.\u0026nbsp;1 the key outcomes of CBT for cancer nurses.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings from our study affirm the efficacy of CBT in enhancing the knowledge, skills, and attitudes of cancer nurses, thereby leading to improved patient care. This section discusses the results in the context of existing literature, highlighting how CBT addresses the unique demands of cancer nursing and aligns with previous research findings.\u003c/p\u003e\n\u003ch3\u003eKnowledge enhancement\u003c/h3\u003e\n\u003cp\u003eThe study revealed that CBT significantly improved nurses' understanding of patient evaluation, modern protocols, emergency handling, chemotherapy side effects management, and error prevention. This aligns with the literature, which emphasizes the importance of specific competencies in cancer nursing [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. For instance, key competencies such as managing venous access devices and responding to emergencies are critical for effective cancer care [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Our findings underscore the importance of a comprehensive knowledge base, as nurses reported enhanced capabilities in using the latest standards and protocols for early symptom detection and intervention. This is consistent with the emphasis on tailored care and improved patient outcomes highlighted in the literature [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eSkills development\u003c/h3\u003e\n\u003cp\u003eCBT also significantly enhanced the practical skills of nurses, including proficiency with medical equipment, chemotherapy administration, communication, emergency handling, intravenous therapy, and palliative care. These improvements are in line with previous studies that advocate for competency in specific areas to ensure high standards of patient care [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The training's emphasis on standardized practices has led to a reduction in errors and improved care quality, echoing findings from the literature on the benefits of CBT in fostering consistent and safe care practices [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Moreover, the study's findings regarding improved problem-solving abilities and emergency response skills align with the literature's emphasis on the need for continuous training and updating of skills [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eAttitudinal shifts\u003c/h3\u003e\n\u003cp\u003eThe positive impact of CBT on nurses' attitudes towards cancer care was evident in increased empathy, a commitment to high-quality care, and improved psychological support for patients. This is supported by studies that highlight the importance of relational care and addressing the emotional and psychological needs of patients [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Nurses reported a more compassionate, patient-centered approach, which aligns with the literature's emphasis on cultural competence and the holistic needs of cancer patients [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The enhanced confidence in professional capabilities and the shift towards a more empathetic attitude underscore the critical role of CBT in fostering a supportive care environment [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eConsistency in training and practice\u003c/h3\u003e\n\u003cp\u003eThe study highlighted the role of CBT in fostering consistency among nursing practices, particularly in standardized care practices, adherence to treatment protocols, and unified infection control measures. This finding supports the literature's call for a structured and uniform approach to patient care [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The consistency achieved through CBT ensures that all nurses deliver reliable and effective treatment, enhancing overall patient outcomes and satisfaction [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eQuality of care\u003c/h3\u003e\n\u003cp\u003eThe overall quality of care provided by nurses improved significantly following CBT. Enhanced patient experience, effective symptom management, adherence to hygiene practices, and a deeper understanding of treatment risks were notable outcomes. This aligns with the literature's findings on the positive impact of competency-based education on healthcare quality [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The improved confidence and competence among nurses translate into better patient care, underscoring the need for continuous training to adapt to evolving healthcare standards and patient needs [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eDespite the promising findings of this study, several limitations should be acknowledged. First, the study was conducted within a single healthcare setting, which may limit the generalizability of the results to other institutions or countries with differing healthcare infrastructures, resources, or cultural contexts. Additionally, the sample size, while sufficient for the scope of this study, was relatively small and may not fully represent the diverse range of cancer nurses across various specialties and experience levels. Furthermore, the study relied on self-reported data from nurses regarding their knowledge, skills, and attitudes, which may introduce bias due to the subjective nature of self-assessment. Although the study demonstrated significant improvements in competencies, the long-term impact of CBT on sustained behavior change and patient outcomes remains unclear, and further longitudinal studies are needed to assess its lasting effects. Finally, while the study focused on a structured CBT program, it did not explore other potential factors influencing nurse performance, such as organizational support, work environment, or personal characteristics, which may have contributed to the observed outcomes. Future research should address these limitations by including larger, more diverse samples, objective performance assessments, and long-term follow-up to strengthen the evidence base for the efficacy of CBT in cancer nursing.\u003c/p\u003e\n\u003ch3\u003eRecommendations for enhancing CBT\u003c/h3\u003e\n\u003cp\u003eBased on our findings, several recommendations emerge for improving CBT for cancer nurses. These include incorporating realistic clinical simulation programs, increasing practical training hours, offering continuous education courses, engaging patients in training programs, and utilizing experienced trainers. These recommendations are supported by the literature, which highlights the need for continuous training, practical experience, and adherence to international standards to maintain high-quality care [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study reaffirms the critical role of CBT in preparing nurses for the complex and demanding field of cancer care. By enhancing knowledge, skills, and attitudes, CBT not only improves the quality of patient care but also supports the professional development of nurses. Future research should continue to explore the long-term outcomes of CBT and compare its effectiveness with traditional training methods to further validate its benefits and identify areas for improvement.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eCBT: Competency-Based Training\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank An-Najah National University (www.najah.edu) for the technical support provided to publish the present manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI.G. contributed to study design, data collection, and manuscript revision. A.A. led the conceptualization, data analysis, and manuscript drafting. A.A. assisted with data collection, interpretation, and critical review of the manuscript. F.A. contributed to the study design, data interpretation, and final manuscript revision. L.S. and W.Q. supported data collection and manuscript preparation. M.H. assisted with data analysis and manuscript review. E.A. contributed to data interpretation and manuscript editing. All authors approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon a reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Institutional Review Board\u0026nbsp;at Arab American University approved the research, and permission was obtained from the hospital. All participants signed a consent form outlining the study\u0026apos;s aims, objectives, data collection. Respondents were ensured about the confidentiality of information obtained and the respondents did not ask to tell their names during data collection. All methods were performed in accordance with the relevant guidelines and regulations. sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not involve a clinical trial; no clinical trial registration is applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlfaro-D\u0026iacute;az C, Svavarsdottir EK, Esandi N, Klinke ME, Canga-Armayor A. Effectiveness of nursing interventions for patients with cancer and their family members: A systematic review. J Fam Nurs. 2022;28(2):95\u0026ndash;114.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoutsopoulou S, Papathanassoglou ED, Katapodi MC, Patiraki EC. Nurses as information providers to cancer patients: Critical review of the evidence. J Clin Nurs. 2010;19(5\u0026ndash;6):749\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBorja ABY, Vacacela BPD, Barrera MVC, Espin BOP, Zurita MAS. The role of nursing in pain management in patients with terminal cancer. Sapienza: Int J Interdisciplinary Stud. 2023;4(SI1):e23039\u0026ndash;23039.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCharalambous A, Wells M, Campbell P, Torrens C, \u0026Ouml;stlund U, Oldenmenger W, Patiraki E, Sharp L, Nohavova I, Domenech-Climent N. A systematic review of clinical trials led or delivered by cancer nurses. Int J Nurs Stud. 2018;86:36\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSato T, Ishimaru M. Hypothetical model for on-the‐job training through case conferences of public health nurses. \u003cem\u003ePublic Health Nursing\u003c/em\u003e 2022, 39(6):1334\u0026ndash;1345.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGill F, Duffy A. Caring for cancer patients on non-specialist wards. Br J Nurs. 2010;19(12):761\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen S, Zhang C, Li W. The effects of competency-based training model in the training of new nurses: A meta-analysis and systematic review. PLoS ONE. 2022;17(11):e0277484.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu M, Geng J, Gao J, Mei Z, Wang X, Wang S, Liu Y. Construction of a training content system for new nurses in cancer hospital based on competency. Front Surg. 2022;8:833879.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang R, Chen P, Yang L, Li Y, Zong Y, Deng L. Prevention of hematogenous infection in peripheral venous catheterization with integrated medical assistance in patients undergoing chemotherapy. Ann Ital Chir. 2021;92(1):70\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGraham CA, DuBois D, Gleason C, Kumagai J, Sanford J. Identifying and Understanding Transfusion Reactions in the Oncology Population. Seminars in Oncology Nursing: 2021. Elsevier; 2021. p. 151137.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJackson MJ, Gallis HA, Gilman SC, Grossman M, Holzman GB, Marquis D, Trusky SK. The need for specialty curricula based on core competencies: a white paper of the Conjoint Committee on Continuing Medical Education. J Continuing Educ Health Professions. 2007;27(2):124\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhemnar ASS. Importance of Nursing Protocol in administering chemotherapy drugs. J Rural Nurs 2022, 10(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJunior MMG, Ara\u0026uacute;jo L. Oncological emergency: An assistant and sensitive look from nursing. Int J Health Sci 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFater KH, Ready R. An education-service partnership to achieve safety and quality improvement competencies in nursing. J Nurs Educ. 2011;50(12):693\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSrioetari SP. Chemotherapy Training Model To Improve Nurse Competence In The New Life Order Era. J World Sci. 2022;1(5):260\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang Z, Wang H, Zheng C, Wang A. An exploratory model of advance care planning clinical training for oncology nurses: a constructivist grounded theory study. Nurse Educ Pract. 2022;65:103484.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlocke SA, Antognoli E, Daly BJ, Jackson B, Fulton S, Liu T, Surdam J, Manne S, Meropol NJ. The role of oncology nurses in discussing clinical trials. In: \u003cem\u003eOncology nursing forum: 2017\u003c/em\u003e; 2017: 547.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMolinaro ML, Polzer J, Rudman DL, Savundranayagam M. I can't be the nurse I want to be: Counter-stories of moral distress in nurses' narratives of pediatric oncology caregiving. Soc Sci Med. 2023;320:115677.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdejumo PO, Oluwasanu MM, Ntekim A, Awolude OA, Kotila OA, Aniagwu T, Brown BJ, Dzekem BS, Duncan S, Tito-Ilori M. Oncology training needs assessment among health care professionals in Nigeria. JCO Global Oncol. 2022;8:e2200017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026Uuml;zar-\u0026Ouml;z\u0026ccedil;etin YS, Tee S, Kargın M. Achieving culturally competent cancer care: A qualitative study drawing on the perspectives of cancer survivors and oncology nurses. Eur J Oncol Nurs. 2020;44:101701.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohansen M-L, Ervik B. Teamwork in primary palliative care: general practitioners\u0026rsquo; and specialised oncology nurses\u0026rsquo; complementary competencies. BMC Health Serv Res. 2018;18:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDevadas B. A Critical Review of Qualitative Research Methods in Evaluating Nursing Curriculum Models: Implication for Nursing Education in the Arab World. J Educ Pract. 2016;7(7):119\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuraraneza C, Mtshali GN. Conceptualization of competency based curricula in pre-service nursing and midwifery education: A grounded theory approach. Nurse Educ Pract. 2018;28:175\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoradi Y, Ahmadi F, Sadeghi A, Oshvandi K. Conceptualizing and determining core clinical competencies in nursing students: a qualitative study. Int Nurs Rev. 2019;66(4):530\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim HR, Kwon IS. A phenomenological study on oncology adaptation experiences of new nurses. Asian Oncol Nurs. 2014;14(2):127\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eObwoge ME, Edwin Obwoge M. Competency-based education and training: A fresh green leaf from the Australian context for TVET in Africa. Int Educ Multidisciplinary Stud. 2016;3(3):538\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCharmaz K. Reconstructing grounded theory. SAGE Handb social Res methods 2008:461\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStrauss A, Corbin J. Basics of qualitative research techniques. 1998.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSuikkala A, Tohmola A, Rahko EK, H\u0026ouml;kk\u0026auml; M. Future palliative competence needs\u0026ndash;a qualitative study of physicians\u0026rsquo; and registered nurses\u0026rsquo; views. BMC Med Educ. 2021;21:1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Competency-Based Training, oncology nursing, qualitative study, nursing education, patient-centered care, grounded theory","lastPublishedDoi":"10.21203/rs.3.rs-6378843/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6378843/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCompetency-Based Training (CBT) is increasingly recognized as a critical strategy for enhancing cancer nursing practice, yet its specific impacts on nurses\u0026rsquo; knowledge, skills, attitudes, and care quality remain underexplored. This study investigated how CBT influences cancer nurses\u0026rsquo; professional competencies and care delivery, with a focus on identifying actionable recommendations to optimize training effectiveness in low-resource settings, such as Palestine.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA qualitative grounded theory design, informed by Charmaz\u0026rsquo;s constructivist framework and Strauss and Corbin\u0026rsquo;s systematic coding techniques, was employed. Purposive sampling recruited 18 nurses (7 male, 11 female; 5\u0026ndash;16 years of experience) from An-Najah National University Hospital. Data were collected via Google Forms with open-ended questions addressing CBT\u0026rsquo;s impact on knowledge, skills, attitudes, consistency, and care quality. Ethical approval was secured from the Arab American University\u0026rsquo;s IRB, with participant anonymity ensured. Iterative line-by-line coding, memo writing, and external auditing ensured analytical rigor and theoretical saturation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eCBT significantly enhanced knowledge in patient evaluation, emergency response (e.g., chemotherapy allergies), and chemotherapy side-effect management. Skills improvements included advanced medical equipment proficiency, precise chemotherapy administration, and palliative care. Nurses reported more empathetic attitudes, prioritizing psychological support and patient-centered care. Consistency in practice increased through standardized protocols (e.g., infection control, chemotherapy administration) and teamwork. Participants noted improved care quality via better symptom management, hygiene adherence, and holistic risk understanding. However, variability in individual practices and perceived training efficacy underscored the need for tailored approaches. Recommendations included integrating clinical simulations, expanding practical training hours, continuous education, patient engagement in training, and alignment with global standards.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eCBT strengthens oncology nursing competencies, fostering standardized, empathetic, and high-quality care. While the training elevated knowledge, skills, and attitudes, sustained improvements require context-sensitive adaptations, ongoing education, and robust evaluation mechanisms. This study advocates for systemic implementation of CBT frameworks enriched with practical, patient-centered elements to optimize both professional development and cancer patient outcomes.\u003c/p\u003e","manuscriptTitle":"Competency-based training for cancer nurses: a qualitative inquiry","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 03:08:44","doi":"10.21203/rs.3.rs-6378843/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d9602da9-9b57-4cd5-9aa2-e9fac9dc54af","owner":[],"postedDate":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-09T16:53:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-07 03:08:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6378843","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6378843","identity":"rs-6378843","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}