UOG nursing students and faculty with the leadership of the National Institutes of Health Clinical Center in Washington, D.C., in July. (Back row, from left) Capt. Ann Marie Matlock, service chief for medical surgical specialties, U.S. Public Health Service; Lenora Holloway, nursing consultant, NIH; Deborah Kolakowski, service chief for oncology and critical care, NIH; Lt. Jennifer Jabara, clinical manager, U.S. Public Health Service; Lori A. Purdie, program director for the Office of Recruitment, Outreach, and Workforce Management, NIH; Kathy Feigenbaum, clinical nurse specialist; (front row, from left) Margaret Hattori-Uchima, dean of the School of Health; Janna Malig-on; Ariane Sagun; Chelsea Guiang; Destini Fejeran; Associate Professor and Nursing Division Chair Kathryn Wood; and Associate Professor Ana Joy Mendez, all with UOG.

The training focused on clinical research nursing, a nursing practice specializing in care for patients — often with advanced cancer or other diseases that haven’t responded to other treatments — who have agreed to participate in experimental research.

Clinical trials have never been approved to be conducted on Guam until this year following the National Cancer Institute's approval in January of FHP Health Center, facilitated by the UOG Cancer Research Center, to engage patients in NCI-sponsored clinical trials specifically related to cancer. Before that, patients from Guam could only enroll in clinical trials in Hawaii or the U.S. mainland.

“We are all participating in history in the making,” said Margaret Hattori-Uchima, dean of the School of Health.

Training designed for a need in Guam

The School of Health collaborated with the NIH Clinical Center to design a one-week training opportunity to expose UOG nursing students to an area of nursing now needed in Guam.

“Our nurses aren’t exposed to clinical trials because they haven’t ever existed on Guam,” Hattori-Uchima said. “For clinical trials to be a success on Guam, our nursing faculty and program must be at the forefront of training and research.”

Four students — Chelsea Guiang, Janna Malig-on, Destini Fejeran, and Ariane Sagun — were selected by the nursing faculty to attend based on their interest in research and their commitment to working in Guam after graduation. Their travel was funded by Take Care Insurance Co., the Guam Honor Society for Nurses, and the Office of the Senior Vice President of Academic & Student Affairs at the university.

The nursing students attended an all-day “Fundamentals of Clinical Research Nursing” course, which covered topics such as human subject protection, informed consent, clinical trial design, drug development, and the role of a clinical research nurse.

“Clinical trials are the foundation of health care and medication interventions that are implemented throughout the world, including Guam’s local hospitals and clinics,” Fejeran said. “Unfortunately, the clinical trials rarely involve Pacific Islanders. This means that the results do not specifically pertain to the minority and their genetic background. I am hoping to one day help improve this situation.”

The students also had opportunities to shadow nurses within the oncology program in clinic, day hospital, and inpatient settings.

‘We will take what we learned and apply it’

The experience further defined for Guiang the nature of the clinical research nursing profession, which involves both caregiving and advocacy, and the perspective of the patients.

“Many members of the health care team at NIH often referred to patients' participation in clinical trials as an altruistic act,” she said. “In other words, the patients understand that partaking in the clinical trials may or may not benefit them or help them overcome their disease or condition. Nevertheless, they join these clinical trials because they believe that their participation can help gather vital information that can help other individuals with the same disease.”

Malig-on said her perspective of the nursing profession was also broadened.

“After the NIH trip, I realized that there are more ways for nurses to serve the community,” Malig-on said. “We will take what we learned at NIH and apply it to the formation of a clinical trial protocol here on Guam.”

The impact that the training had on the students was reciprocated by the students’ impact on the NIH staff, Hattori-Uchima said.

Relationship to continue

“We received rave reviews every day on how high-functioning and skilled our nursing students are,” she said.

Hattori-Uchima, along with Associate Professors of Nursing Kathryn Wood and Ana Joy Mendez, attended the fundamentals course as well and were also invited to sit in on an Institutional Review Board meeting. Institutions conducting federally funded human research are mandated by federal law to have an IRB, a type of ethics committee to protect the rights, welfare, and privacy of patients who participate in research activities. Wood sits on the IRB for the University of Guam. 

After returning from their week at NIH, three of the students, who had graduated with their Bachelor of Nursing degrees in May, passed their nursing licensing exam and are now working nurses. The fourth, Fejeran, will graduate this coming May.

To pursue clinical research nursing further, the graduates would undergo specific training with their employer and could also pursue a clinical research nursing certification.

The School of Health will continue its relationship with the NIH Clinical Center on an annual basis.