Programs to teach subspecialty nursing in developing countries are effective and can improve medical care. Such programs should be based on past experience and evaluated as to cost and effectiveness.

In countries with limited resources, the multidisciplinary hematology-oncology (H-O) treatment team model, which relies heavily on highly trained nurses, is generally not in use. Since 1996, St. Jude Children's Research Hospital has been working with medical centers in Mexico and Central and South America to improve the specialty training of nurses in pediatric H-O. In 1999, St. Jude developed a strategic plan to organize a cooperative nursing education project. The initial preparation consisted of three phases. In phase one, a curriculum was developed. A consultant was hired to create and institute an evaluation system for nurse graduates of the program and for the program itself. Phase two explored the possible collaborations among existing training centers and contracted with a nurse educator to provide on-site support. In phase three, a core team of skilled multicultural nursing educators was formed. To initiate the program, we used the "Teach the Teachers" method. Four classes to date have trained 76 nurses from different countries in Latin America. Development of the International Training Center for Hematology-Oncology Nurses in Latin America has been a challenging and rewarding experience. We hope that others will find it useful in planning international education programs that will not only serve the nursing profession, but also improve the quality of care of all children, regardless of their background, race, religion, or economic status.

In countries with limited resources, the multidisciplinary hematology-oncology (H-O) treatment team model, which relies heavily on highly trained nurses, is generally not in use. Since 1996, St. Jude Children's Research Hospital has been working with medical centers in Mexico and Central and South America to improve the specialty training of nurses in pediatric H-O. In 1999, St. Jude developed a strategic plan to organize a cooperative nursing education project. The initial preparation consisted of three phases. In phase one, a curriculum was developed. A consultant was hired to create and institute an evaluation system for nurse graduates of the program and for the program itself. Phase two explored the possible collaborations among existing training centers and contracted with a nurse educator to provide on-site support. In phase three, a core team of skilled multicultural nursing educators was formed. To initiate the program, we used the "Teach the Teachers" method. Four classes to date have trained 76 nurses from different countries in Latin America. Development of the International Training Center for Hematology-Oncology Nurses in Latin America has been a challenging and rewarding experience. We hope that others will find it useful in planning international education programs that will not only serve the nursing profession, but also improve the quality of care of all children, regardless of their background, race, religion, or economic status.

No abstract

The role of a nurse is to promote patient and family education and coordinate the complex care of children with Langerhans cell histiocytosis (LCH). A multidisciplinary approach toward the care of a child with LCH helps promote and maintain uniform diagnostic evaluation, treatment, and follow-up. LCH affects multiple organ systems resulting in varied clinical manifestations. As a result, children with LCH are often initially referred to a variety of specialists such as orthopedics, neurosurgery, dermatology, or endocrinology for treatment of the initial symptom. However, because LCH is a rare orphan disease of blood cells with an unpredictable course and long-term sequelae, primary management and follow-up should be directed by a pediatric hematology/oncology team with the most experience and knowledge in treating children with LCH. Nurses maintain the link between patients, families, and members of the multidisciplinary team. The goal of this session will be to advance nursing knowledge of the symptoms and presentation of LCH and to enhance awareness of the internationally accepted criteria for diagnostic evaluation of LCH as set by the Histiocyte Society. After completing this session, oncology nurses should be able to recognize patients whose differential diagnosis may include LCH and begin early patient care interventions. A nurse should also be able to communicate and provide written documentation to specialists regarding the appropriate pathologic diagnosis, clinical, laboratory, and radiographic studies. Finally, the nurse will learn about the importance of family support to provide accurate disease education and supportive resources to meet the psychosocial needs of children and their families coping with the diagnosis of LCH. Collaboration with specialists in a multidisci-plinary setting reduces the need for multiple clinic visits and provides a setting where families can adequately discuss concerns and receive answers to their many questions. If all involved work together to provide comprehensive and effective patient and family support, hopefully this orphan disease will not receive orphan care.