The SBN model of care is designed to ensure that women receive comprehensive supportive care throughout all phases of their treatment. This includes providing them with clinical and practical information, emotional support, supportive counselling and referral to other members of the treatment team and support agencies. Evidence reported in Chapter 4 underscores the diversity and complexity of demands placed on the SBN. If the model of care is to be routinely
implemented, the following skill base and training for SBN positions need to be considered.
C h a p t e r 1 0 : F e a s i b i l i t y o f t h e e v i d e n c e - b a s e d s p e c i a l i s t b r e a s t n u r s e m o d e l
Comprehensive knowledge of breast cancer and its treatments
The SBN clinical pathway was partly derived from evidence concerning the information needs of women during the different stages of treatment for breast cancer (Chapter 1). Central tasks at each treatment phase are as follows.
• At diagnosis SBNs have a key role in clarifying misconceptions and providing more detail about the diagnostic and prognostic issues and information about hospitalisation, travel, accommodation and financial issues may also be discussed.
• Pre-operatively, SBNs focus on psychologically preparing and supporting women for surgery, and informing them about what to expect afterwards.
• Post-operative consultations involve providing an array of clinical information, specifically in relation to wound care and drain
management and providing an overview of the next stage of treatment, including adjuvant therapy, breast reconstruction/ prosthesis and clinical trials.
• The follow-up consultations provide an opportunity to discuss the implications of surgical results and prognosis and to prepare women for the next treatment phases.
SBNs must have an appropriate knowledge base to support women through surgery, chemotherapy and radiotherapy. This knowledge base is strengthened by clinical experience in these areas, and requires a sound understanding of current, evidence-based, clinical practice guidelines for the treatment of women with breast cancer.
Communication skills Providing information
Perhaps the most important skills that SBNs use in implementing the clinical pathway relate to effective communication, both with women and with other health professionals. Effective communication skills are particularly important to ensure that women and their families can readily access information. Both the nature and the amount of information that women seek may alter over the
C h a p t e r 1 0 : F e a s i b i l i t y o f t h e e v i d e n c e - b a s e d s p e c i a l i s t b r e a s t n u r s e m o d e l c a r e course of their illness. SBNs must assess the amount of information that a woman requires at any given time, and be able to facilitate information provision accordingly.
Providing emotional support
SBNs provide emotional support to women through the stages of diagnosis and treatment. Therefore they must be able to discuss and appropriately respond to each woman’s feelings and concerns, and recognize key clinical events during which her support needs may be even greater. SBNs need to assess personally intimate issues, including relationships, sexual functioning and body image. Therefore communication skills-including effective listening skills and collaborative problem solving skills-are essential.
Psychological support and screening
The SBN model of care also aims to ensure that women with breast cancer receive adequate psychological support. This includes strategies to reduce the level of distress experienced, and the detection of women with significant
symptoms of anxiety and depression who may benefit from referral to a specialist mental health professional.
SBNs are not expected to have the skills of a mental health nurse or other mental health professional. Appropriate skills for the SBN role include knowledge of the risk factors associated with the development of significant psychological problems, and skills to properly assess a woman’s risk profile. SBNs must also be able to use risk information in the care they give women. As well as knowledge of risk, SBNs need adequate communication skills to identify and respond to the woman’s psychological cues, especially for signs that impairing psychological symptoms are developing.
Responding to cultural needs
A woman’s cultural needs, including spiritual beliefs, may be an important aspect of her supportive care. It is important that SBNs acknowledge women’s cultural and spiritual beliefs and the impact that these may have on her expectations of care. SBN training should therefore cover skills for discussing spiritual issues and also promote awareness of pastoral care services. It is likely that the SBN will also encounter women whose first language is not English. As these women may have
C h a p t e r 1 0 : F e a s i b i l i t y o f t h e e v i d e n c e - b a s e d s p e c i a l i s t b r e a s t n u r s e m o d e l
been excluded from the present study, additional research may need to be done to determine how the SBN can be most effective in providing support for such women and their families. Additional recommendations are made in the Psychosocial clinical practice guidelines: providing information, support and counselling for women with breast cancer (NHMRC NBCC, 2000).
Liaising with other professionals
Informing treatment team members and organising referrals
As the coordinator of supportive care, the SBN must be able to function as the conduit of information from the patient to treatment team members and to facilitate the exchange of information between members of the team. It is therefore important that the nurse can liaise effectively with all members of the multidisciplinary team, in order to improve their knowledge of a patient’s progress and needs, and that she can discuss and organise referrals when appropriate.
Peer education
Given that SBNs have training and expertise in the management and treatment of breast cancer patients, they must also be able to act as a resource for other
treatment team members. Involvement in education programs and participation in research are important components of the SBN’s professional development.