SENSE IVA QUANTITAT A TRAMITAR

In this project, SBNs spent almost half (46%) of their time on non-clinical activities, including 11% on this project. At project completion, then, the SBNs would have freed up time. Almost three-quarters of consultations with SBNs involved women with breast cancer. Since the time spent on direct and indirect clinical activities remained constant, as the number of women seen by SBNs increased the number of working hours also increased.

Continuity of care provided by SBNs to women with breast cancer was observed in this project. Over 93% of women received a nurse-initiated consultation during most treatment phases. During the diagnosis phase, some women were difficult to contact, particularly if there was no diagnostic clinic, so only 61% of women received a nurse-initiated consultation. During the first follow-up phase (follow-up 1), almost a third of women initiated an additional consultation with SBNs, mainly by telephone. It may be beneficial to women with breast cancer if SBNs initiated an extra telephone consultation during this phase. Moreover, it appeared that a 12- week relationship between women and the SBNs was not long enough, as almost a third of women required more than 12 weeks. It may be better to plan for at least a 16-week relationship between women and the SBNs.

During the diagnosis and pre-operative phases, SBNs primarily provided women with information. Over the five treatment phases, psychological symptoms are major concerns for women with breast cancer, so providing psychological care is important. Providing care and referrals to deal with women’s physical symptoms and problems after treatment is also important. The majority of women received treatment and referrals during post-operative and follow-up phases. The main referral agents were physiotherapists, community nurses and the BCSS. Providing information, counselling, treatment and referrals for women with breast cancer are therefore essential activities for SBNs.

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

Chapter 5: How the treatment team and

specialist breast nurses view the

specialist breast nurse role

Introduction

The role of the specialist breast nurse (SBN) is best understood within the context of the multidisciplinary team. While the role is distinct and unique, it entails considerable interaction and some degree of overlap with the roles of other health professionals and volunteers involved in the care of women with breast cancer. A significant component of the SBN role involves coordination and liaison with other treatment team members. As will become clear in this chapter, SBNs are highly valued within the treatment teams involved in this project precisely because of their ability to move between members of the team, and between women (and their families and friends) and the team. Such movement, which often takes place across different physical locations, is valued as an information sharing system which allows all members of the treatment team to maintain significant levels of knowledge regarding the individual women’s progress, needs and concerns.

Surgeon: I think the breast nurse specialist is an essential component of a multidisciplinary team. They really add a lot to … the care of the patient, particularly with the provision of information. I think they also enhance the process within the Clinic. They also enhance the whole multidisciplinary team by acting as a common link between the members and the patient as their advocate as well.

SBN: We couldn’t actually function if we didn’t gain recognition from the multidisciplinary team.

This chapter examines how the full range of the treatment team and Breast Cancer Support Service (BCSS) volunteers viewed the SBN role performed within this study. Such an examination is essential: unless the SBN role is both well

understood and well received by the full range of treatment team members, SBNs will not be able to provide women with the continuity of care that is recognised to

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

improve health outcomes. The views of SBNs working in this project are also explored, including the nurses’ descriptions of the main factors contributing to the success of the SBN role in Australian clinical practice, and concerns raised

regarding the role.

Method

SBNs identified the frequency of contact they had with members of the treatment team and BCSS volunteers. A sample of up to 12 of these were contacted from each site and asked to participate in an interview. Fifty-three health professionals and BCSS volunteers as well as seven participating SBNs were interviewed by telephone about their views of the SBN model. Appendix 25 describes the sample interviewed. Five SBNs also took part in a face-to-face focus group discussion. Two independent interviewers conducted semi-structured telephone interviews of approximately 45 minutes duration. They collected both quantitative and qualitative data regarding the interviewees’ views of the SBN model. Questions were asked regarding both the model in a more abstract sense-an imagined, ideal situation, and its translation into practice within the interviewee’s actual local situation. Although interviews with SBNs differed from those with other treatment team members, similar issues were covered in both, with many questions being identical. In one case, a SBN was partially re-interviewed by one of the authors, due to a technical failure of audio-recording in the original interview.

Interviewees were questioned about their perceptions of six areas:

• the level of contact with the SBN, and perceptions of any change in her role over the last year;

• key aspects of the SBN role, and the relative importance of her consultations with women at different treatment phases;

• role overlap between the SBN and other treatment team members, and how any role overlap was handled;

• the SBN as part of the multidisciplinary team at the interviewee’s treatment centre-including the SBN’s caseload, resourcing, availability and skills, and utilisation of the SBN by treatment team members;

• the SBN’s actual skills and training, and views regarding their ideal training and skills; and

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

• the benefits and disadvantages to women, their families, members of the treatment team and the treatment centre of having contact with, or employing, a SBN.

In the SBN interviews, questions were also asked regarding:

• perceived differences between care for women using the structured model of this project, and previous care;

• the impact of the model on job satisfaction and utilisation of time;

• debriefing and professional support; and

• role renegotiation with other health professionals.

Interviews were audio-taped and qualitative data was transcribed verbatim and entered into a qualitative data analysis programme, The Ethnograph V4.0. The data was coded and sorted for recurring categories. Quantitative data was coded and analysed using The Statistical Package for the Social Sciences, version 8 for Windows (SPSS).

After the interviews were completed, a 90-minute focus group was run with five SBNs to clarify and discuss issues raised in the interviews. One SBN from each centre was present (two from Centre D), and the session was facilitated by the authors. This session was also audio-taped, transcribed and entered into The Ethnograph program. Again, transcripts were analysed for recurrent issues and concerns.