Benefits to women
Discharge nurse: She was well received by patients. And they felt happier and safer and little bit more secure too.
Treatment team members and SBNs viewed the SBN role as providing important benefits to women. The perceived benefits provided by SBNs can be summarised as follows:
• continuity of care;
• psychosocial support;
• information; and
• increased opportunities for discussion of concerns and issues.
View 1: Continuity of care is enhanced by SBNs, since they coordinate women’s progress through the treatment process. Within the focus group discussion, SBNs described their role as a “trouble shooter”. SBNs felt well placed to deal with any failures in the coordination of appointments or treatments, and to ensure that no one became “lost” within the system:
SBN: My main job role … was to coordinate the lady’s care, so to meet her as early as possible … in her progress through the system and to make sure her care was coordinated if possible. So liaising with all the different areas that she would come in contact with, making sure she had someone that she could refer back to, making sure that she had as much information as she needed and was relevant to her. That she was able to access different resources and literature as well, like through the [State] Cancer Council and the BCSS.
View 2: The SBN’s focus on providing support and information means that the psychosocial needs of women are given serious attention. This emphasis also means that women are treated as individuals, and in a more holistic manner, with attention paid to sexuality, spirituality and relationships:
C h a p t e r 5 : H o w t h e t r e a t m e n t t e a m a n d s p e c i a l i s t b r e a s t n u r s e s v i e w t h e s p e c i a l i s t b r e a s t n u r s e r o l e
Interviewer: Did you perceive the breast nurse as being an integral member of the treatment team?
Clinical nurse consultant (Women’s health): Mhmm … I guess because of the support, the fact that the patient has got someone to turn to, and they can put a face with a name, and someone they can relate to, quietly and privately. It just seems to make such a huge difference to their psychosocial wellbeing.
Interviewer: Did you feel that the clinical pathway assisted you in detecting women at risk of psychological morbidity?
SBN: It certainly helps to really bring out different types of issues that could be adding stress to an individual coming through treatment. I think it’s very positive that it helps to give a defined structure, and it certainly gives a much more holistic picture and a much greater assessment of women’s needs than purely looking just at … physical information or treatment management with that information. It recognises the effects of breast cancer are much greater than just on the breast.
View 4: As non-medical health specialists, SBNs help women to discuss concerns and issues they may not feel comfortable discussing with surgeons or oncologists. They also have time for detailed discussions with patients that other health professionals may not have. The skills that SBNs have in the area of counselling and support were also seen as important here:
Surgeon: Well, I think the [SBN] possesses better skills about some aspects of patient counselling, not to say the doctors don’t have them, but I mean I think probably the [SBNs] are more attuned to some of the aspects that the patients are concerned about. And I think also not being a specialist figure, the patients will often tell [SBNs] about problems they don’t think the doctors need to hear about, and they’re usually social issues, or marital problems and things that might impact on their treatment.
Conclusion
When asked “Do you feel that the breast nurse is important for ensuring high quality care for women?” 75% of medical specialists and 100% of all other groups interviewed answered positively. This result indicates a highly positive view of the benefits that SBNs provide for women.
C h a p t e r 5 : H o w t h e t r e a t m e n t t e a m a n d s p e c i a l i s t b r e a s t n u r s e s v i e w t h e s p e c i a l i s t b r e a s t n u r s e r o l e
Benefits to the treatment team
Participants also stressed the benefits of the SBN model to treatment team members and to the functioning of the team in general. These benefits can be summarised as follows:
• women were better prepared for treatment procedures;
• consultation times of other treatment team members were decreased;
• referrals to other treatment team members increased; and
• SBNs provided education and support to treatment team members.
View 1: Treatment team members felt that women were better prepared for treatment procedures after having discussed these with the SBN. This made the task of organising, discussing and undertaking treatment procedures easier:
Clinical nurse consultant (Oncology): I find [the SBNs] extremely helpful, in the sense that the patients come to the ward with very good pre- operative knowledge. They’re well informed of what’s going to occur, what to expect pre-operatively, post-operatively. They are aware of the fact that they have drains, etcetera. So it’s a huge help to the ward staff.
View 2: Consultation times required by some other treatment team members are reduced. This was seen to be due to the SBNs’ information and support-giving roles. General information and support previously given by other health
professionals were now given by the SBN, and thus only required reinforcement by others:
Discharge coordinator: I think our nurses would have a shorter time with the patients out in the community because of the role [the SBN] has. She takes over a lot of the counselling and quite often we’re providing backup to the counselling she’s already done, rather than being snowed down in among it all.
Interviewer: Did you find that the presence of [a SBN] influenced your own workload?
Medical oncologist: Yes, it probably eased my workload a little bit because a lot of the explanation and a lot of the work that I had to do was a bit quicker and a bit easier.
C h a p t e r 5 : H o w t h e t r e a t m e n t t e a m a n d s p e c i a l i s t b r e a s t n u r s e s v i e w t h e s p e c i a l i s t b r e a s t n u r s e r o l e In other cases, consultation time was not thought to have been reduced by the woman’s having seen the SBN, but it was believed that the consultation time of other health professionals was better spent (this perception is reinforced by the economic analysis in Chapter 9).
View 3: Some treatment team members reported receiving more referrals from the SBN (this includes psychologists, physiotherapists and BCSS volunteers):
Physiotherapist: I’m actually attending Clinic now … and that was on the invitation of the breast nurse. And also … if someone comes to Clinic who’s got a problem with movement or swelling, then she’ll tend to ring me, far more than … she used to.
View 4: SBNs provide education to other treatment team members regarding breast cancer. They become an informational resource for other staff members:
Discharge nurse: She educated all of the staff here. I’d say she was a resource person. If we … needed to know something well, we could just ring her up, get some help.
SBNs also provide emotional and practical support to some treatment team members, especially nursing colleagues:
Nursing unit manager: She’s been able to … give the staff lots of advice and confidence in dealing with the patients, both from an emotional and physical point of view.
Conclusion
SBNs are viewed as a positive resource within the treatment team. They ensure that care flows smoothly: namely, that referrals happen when needed, that other health professionals have adequate information aboutpatients and breast cancer issues, and that women are prepared for each treatment stage. They also provide support to their colleagues.
C h a p t e r 5 : H o w t h e t r e a t m e n t t e a m a n d s p e c i a l i s t b r e a s t n u r s e s v i e w t h e s p e c i a l i s t b r e a s t n u r s e r o l e