Nurses Philosophy
Fiona Andersen, Anna Matthew's - Breast Care Nurses 01622 225743
Breast Care Nurses Philosophy
1. Every woman is unique and should be treated as such. A holistic approach that acknowledges physical, psycho social, spiritual and sexual components, will be an integral part of the care offered.
2. Every woman will have access to a specialist nurse who can provide psychological support, information pertaining to multiple modality treatments and advice to facilitate adjustment and enhance coping, to women who have, or fear they may have, breast cancer.
3.Every woman has the right to decline information /support at the time of diagnosis until she has adapted to the latter.
4. Contact numbers for a support groups//counseling services are offered to every woman and their families/significant others.
5. Careful assessment of the woman at the time of diagnosis is necessary to enable the correct amount of information to be given and detect any potential problems. The woman and her family/significant others, should be given verbal and written information regarding treatment options in a sensitive manner, in private and at appropriate times.
6. All individuals involved with the woman should be aware of current research pertaining to all aspects of breast disease, treatment and care to appreciate the complexity of the disease and the controversies that can surround its management.
7. To achieve maximum quality of patient care, clear liaison and effective communication between health care professionals is essential. Accurate and up to date patient documentation that is legally and ethically viable is necessary to ensure uniformity, clarity, prevention of repetition and conflicting advice being given.
8. The woman and her family/significant others have access to a referral unit that provides the highest standards of care in terms of humanity and science.
9. Privacy, professionalism and confidentiality will be maintained at all times.
10. All individuals dealing with the woman are aware of the emotional, physical, spiritual and psycho social impact of breast cancer on the woman and her family/significant others.
11. Health promotion/education is available on benign breast disease, breast self -examination, breast pain, hormone replacement therapy, menopausal symptoms, family history and genetic relevance and any other issues pertaining to women's' health in the form of verbal and written information.
12. Every woman undergoing mastectomy is given information on reconstruction options. If she does not take up this option then she should have access to a fitting service to offer restoration of body image as far as possible with a silicone prosthesis.
HOW PATIENTS ARE REFERRED TO THE BREAST CARE NURSES?
The Breast Care Nurses (BCN's) attend the breast clinics and routinely see patients who are diagnosed with breast cancer. If for some reason a Breast Care Nurse is not in attendance then referrals are made by phone, or letter and direct contact.
WHO REFERS PATIENTS TO BCNS AND AT WHAT POINT IN THEIR ILLNESS?
Referrals come through at any point along the patient journey from different members of the multi-disciplinary team (MDT). This depends what problems patients are experiencing at the time and can be for a variety of different reasons. For example a District Nurse may notice when doing a home visit that a patient is not coping psychologically or is experiencing body image problems and will refer to the Breast Care Nurses. Often such problems manifest at a later time often when surgery and other treatments have been completed.
Referrals come from:
Clinic staff, Ward staff, District Nurses, GP's, Oncology Staff (radiographers, chemotherapy nurses, ward staff), Other Breast Care Nurses, Consultants ( Oncologists and surgeons), Councellors, Plastic Surgeons, The patients themselves or their relatives.
On nearly every occasion the Breast Care Nurses are already aware of the patient, having met them at the time of their diagnosis.
AT WHAT POINT DO YOU SEE PATIENTS INDIVIDUALLY?
Patients are seen by the Breast Care Nurses at the following times:
At diagnosis, Post-operatively, One week after surgery when results of the operation are given and further treatment discussed.
All patients are given the Breast Care Nurses telephone number and will often ring for further information.
All patients are told that the Breast Care Nurses will see patients as many times as they feel they would like to be seen and this can be either in the form of home visits or by appointment at the hospital. If they prefer to discuss their diagnosis and proposed treatment over the phone then the Breast Care Nurses will ring them at home.
AT WHAT POINT DO YOU SEE THEM AS PART OF THE MD TEAM?
All patients are discussed at a meeting every Wednesday afternoon with the entire Multi-disiplinary team in attendance. The Breast Care Nurses are present when patients are seen by the breast surgeon or oncologist.
HOW DO YOU FEEL YOUR CONTRIBUTION INTEGRATES WITH THAT OF OTHER ELEMENTS IN THE CARE PACKAGE?
By providing a link between all disciplines. The Breast Care Nurses offers the patient a main focal point and can interact with other members of the MD team on behalf of the patient. Good working relations allows the Breast Care Nurses to communicate patients concerns to the appropriate person and vice versa.
HOW DO YOU REFER PATIENTS ON?
By phone, letter or face to face with the appropriate person. Any referrals are documented in the patients assessment form.
WHAT RANGE OF INTERVENTIONS ARE MADE TO IMPROVE THE CARE THAT PATIENTS RECEIVE?
Initial assessment at time of diagnosis looking at coping mechanisms, reactions, responses.
This skilled assessment provides the basis on which Breast Care Nurses can gauge how much a patient wishes to know. The timing here is crucial. Often patients may wish to arrange to see the Breast Care Nurse again when they have had time to think about their diagnosis. Information is given (verbal and written) when the patient is ready which may often mean several more contacts prior to surgery or neo adjuvant chemotherapy.
ASSESSMENT OF RISK OF PSYCHOLOGICAL MORBIDITY
An ongoing process which enables the Breast Care Nurses to identify those who may be at risk of not coping. Referrals can then be made to the counsellors. (refer to the working examples enclosed which demonstrates the latter).
INFORMATION GIVING
Information giving has been recognised as helping patients to cope with their situation. For most it reduces anxiety and gives back a sense of control. The Breast Care Nurses provide a wide range of literature on every aspect of breast cancer and breast care. Verbal and written information is offered to patient. Contact numbers are given for national organisations such as BACUP and Breast Cancer Care. All patients referred to the breast clinic receive a leaflet about the breast clinic with their appointment. Every patient is informed of potential and actual effects of treatments to ensure consent is informed.
Pre-operatively - Information is given at time of diagnosis but surgery may be four to six weeks after this. Breast Care Nurses will check the patients understanding to ensure consent is informed and re-iterate as necessary.
Post-operatively - Patients receive written information about who to contact should they develop lymphoedema or a seroma. Advice is given on going home with a drain.
OPA one week later - Patients are informed of their results and their medical treatment then planned by the oncologist. Treatments may include radiotherapy and chemotherapy. Breast Care Nurses will see patients and will go through these treatments in more detail backed up by written information as necessary.
PROVISION OF CONTACT NUMBER FOR BCN's
Every day the answer phone service for the BCN's receives an average of twelve calls from patients who wish to talk to a Breast Care Nurses. It is important that women feel they can phone to seek more information or discuss their fears and concerns.
Body Image/sexuality
Body image and sexuality are affected for many reasons. The entire treatment plan has implications for altered body image.
Breast conservation surgery can result in scarring to the breast and axilla and mastectomy obviously leaves patients asymmetrical and scarred.
Breast reconstruction gives symmetry but the new breast will look and feel different (nipple is taken, loss of sensation to the reconstructed breast). Breast reconstruction can often cause symmetry resulting in patients needing the other breast altered at a later stage. Symmetry can be achieved with prosthetics until surgical intervention has been completed.
Body image problems can occur from the administration of Tamoxifen (weight gain, menopausal symptoms) radiotherapy (changes to the skin, changes in breast texture) and chemotherapy (potential hair loss, nausea, weight gain)
Patients may express their fears over potential body image changes depending on their experiences of cancer treatments. These fears may need discussing from the out set or women may contact the Breast Care Nurses at various stages of their treatment for advice on symptom management or body image changes.
The Breast Care Nurses can prepare patients for such changes by discussion of potential body image problems. Also provided are visual aids to demonstrate what scarring and breast reconstruction looks like. If mastectomy is chosen without reconstruction the Breast Care Nurses can show women what external prosthetics look like. This preparation aims to increase individual coping and adaptation.
CONTACT WITH OTHERS
The Breast Care Nurses can put patients in touch with each other should they feel the need to talk to a woman who has been through a similar experience. The BCN's work closely with a volunteer from Breast Cancer Care (BCC) who assists with this option.
LYMPHOEDEMA CLINIC
A lymphoedema clinic is run by the cancer physiotherapist and is held in the oncology unit. The clinic aims to reduce the arm swelling that occurs in about 20% of patients often due to the removal of the axillary lymph glands for breast surgery. This condition can be controlled by an accurate assessment of the arm swelling, the provision of sleeves and health education on arm care. The aim is to keep swelling to a minimum so improving arm function and enhancing quality of life. Both BCNs are trained in lymphoedema management and often see patients outside of the alotted lymphoedema clinic time as there is a long waiting list to be seen.
NURSE LED CLINICS
There are now two breast care nurse led clinics at Maidstone hospital. The first clinic looks at family history and has input from the genetic centre at Guys and Thomas' hospital and the second deals with breast pain.
By allocating more time for each appointment these clinics aim to provide a comprehensive consultation with the emphasis on education/health promotion. By separating the clinics patients are removed from the general breast clinic which should have some impact in reducing the two week wait for out patients appointments and ensure that all breast problems are seen quicker.
Many patients fear they have a higher risk of cancer than they do (family history clinic) and think they have breast cancer if they have breast pain (breast pain clinic) part of the Breast Care Nurses role in the breast pain clinic is to recognise such feelings, allay fears where ever possible and provide information on the management of breast pain. With regards to family history an accurate assessment of risk can be made and the appropriate advice offered.
FOLLOW UP
The Breast Care Nurses automatically contact patients eight months, post diagnosis by letter as this is a time that has been recognised through research to be vulnerable times for patients. Anxiety and depression can often be worse at these times and patients can begin to suffer from the physical long-term effects of completed treatments. Response to these contacts has been positive with many problems being picked up at these times. A log is kept of detection of problems and this process is audited regularly.
HOME VISITS
The BCN's can visit patients at home if they wish. Often it is not appropriate at the time of diagnosis to discuss in detail the treatment plan due to the shock and disbelief that can happen when diagnosed with cancer.
TEACHING
The BCN's teach a variety of groups about the Breast Care Nurses role, breast awareness, breast screening, breast cancer and treatments. These groups include:
The degree course in cancer nursing at Kings college Hospital / Florence Nightingale Fund, London.
Benenden Hospital - Diploma in breast cancer nursing
Kimberely Clarke - teaching employees
East Sutton Park Prison - teaching in mates
Heart of Kent hospice
District nurses
Age concern
Talking at the local breast cancer support group run by the Breast Care Nurses
Due to the difficulty of releasing ward staff for teaching sessions, folders are being created in an A-Z format providing information for staff on all aspects of breast cancer.
Study days for staff dealing with breast cancer patients are run yearly.
BREAST SCREENING
The Breast Care Nurse in screening is called Charlotte Harris. She can be contacted via the screening office on 01622 710185. A quarter of the breast cancers diagnosed come through the screening programme. By having a Breast Care Nurse in screening who also works at the hospital continuity can be provided and assurance that the same information is being given to patients from the out set.
SEROMA DRAINAGE
One Breast Care Nurse has been trained to drain seroma's. This ensures a quicker service for patients who originally had to sit and wait for a doctor to be free often resulting in a wait for a couple of hours. The Breast Care Nurse has more flexibility and can make an appointment that is more suited to the patient.
SUPPORT GROUPS
The Breast Care Nurses run two support groups (Click here for details of support groups)
The breast cancer support group is well attended and speakers often give talks. Bosom Buddies is a support group for women who have been diagnosed with secondary breast cancer (often a neglected group) A volunteer from breast cancer care who has her self had breast cancer and has under gone specialised training assists with running this group.
THE SOMERFIELD HOSPITAL
One of the Breast Care Nurses also works at the private Somerfield hospital in Maidstone. Some patients choose to use medical insurance or pay privately for their surgery. They return to the Maidstone Hospital for further treatment at the oncology centre as necessary. Both Breast Care Nurses work together to ensure that continuity of care occurs and that the information given is the same.
