Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Nursing and Allied Health Professions

First Advisor

Kristy S. Chunta, Ph.D.

Second Advisor

Teresa C. Shellenbarger, Ph.D.

Third Advisor

Christoph Maier, Ph.D.


Medication errors have emerged as an increasing safety concern for hospitalized patients. Chemotherapy errors have topped the list of high-alert medications with errors occurring during administration, dispensing, and prescribing. Nurses are instrumental in the complex multidisciplinary high-risk process of chemotherapy administration. This study sought to determine if oncology nurses' use of two different self-directed learning (SDL) strategies increased their knowledge of national chemotherapy safety standards over time. This study also explored if selected demographic variables influenced knowledge retention. Lewin's Planned Change Theory guided this study utilizing a three-stage model to "unfreeze," "change," and "refreeze" knowledge over time. A quasi-experimental longitudinal repeated-measures design was used to assess oncology nurses' knowledge of national chemotherapy safety standards before, immediately following, and four weeks after participants completed the learning interventions. The sample included 48 chemotherapy competent registered nurses from six mid-Atlantic state healthcare facilities. Descriptive statistics and mixed between-within subject's analysis of variance were conducted to examine the research variables. Both absolute and adjusted measures of knowledge were investigated. Findings revealed a significant main effect for absolute knowledge (Wilks' Lambda = .76, F(2,32) = 4.95, p = .01, partial eta squared = .24) and adjusted knowledge (Wilks' Lambda = .79, F(2,32) = 4.58, p = .01, partial eta squared = .22) in the identification of errors over three time points. However, there was no significant main effect (F(1,33) = 2.04, p = .16, partial eta squared = .058) between the educational absolute or the adjusted knowledge groups (F(1,33) = 21.35, p = .25, partial eta squared = .039). Knowledge was also retained despite generational learning preferences, oncology certification, and years of administering chemotherapy. Results also revealed the commonly omitted errors by oncology nurses administering chemotherapy. These findings provide implications for oncology nurses, educators, and administrators on how SDL strategies impact knowledge over time and chemotherapy errors. Results should be used to standardize chemotherapy processes and to develop or redesign educational programs. Future studies should measure knowledge using multiple types of SDL methods, explore transfer of knowledge to practice, and examine knowledge in other disciplines.