Contract learning for self-care activities. A protocol study among chemotherapy outpatients

Chemotherapy presents a challenge to patients and their families because of altered abilities for self-care. The nurse investigator initiated a protocol study with five patients responding to a query, "What do you need to know?," related to chemotherapy. Evaluation was done during February and March 1989 in a private oncology/hematology clinic in Hawaii. This was an evaluative study designed to measure the effectiveness of a contract learning protocol. A descriptive case study approach was used to analyze findings. Orem's self-care deficit theory of nursing provided the theoretical framework for the protocol. Based on Orem's supportive educative system, the nurse utilized the three types of self-care requisites to develop a learning needs assessment tool. Contract learning reinforced management of self-care deficits with self-care activities. Four of the subjects were able to recognize symptoms, weigh options for actions, initiate self-care behaviors, and evaluate the effectiveness of self-care activities. Findings suggest that the protocol provides a systematic and comprehensive approach to patient's self-care deficits using adult learning principles.