This post is a contribution from Amanda Kuller, RN, an oncology nurse navigator for HonorHealth. She was an ER nurse for 8 years prior to switching to oncology. Her passion for educating patients and helping them navigate healthcare led her to her collaboration with Bosom Buddies of Arizona. Thank you, Amanda!
A breast cancer diagnosis is like receiving a declaration of war. Bringing together a team of battle buddies is essential for the fight ahead. Depending on type and staging, potential recruits include Medical, Radiation, and Surgical Oncologists. These specialists are great for designing a plan of action and initiating care, but they cannot always be available when the fight gets hard. Fortunately, a new fighter, Oncology Nurse Navigators (ONNs), is emerging onto the battlefield.
Nurse navigation is a quickly expanding field in outpatient and inpatient practices. They are specialized registered nurses committed to leading patients through the minefield that healthcare has become. Responsibilities and roles vary depending on the specialty and facility, but the general goal of navigation is to increase patient compliance with treatment plans. In Oncology, this is done by empowering patients with education, managing treatment side effects, assessing patient needs and implementing resources.
Education
Sometimes referred to as “chemo counseling,” this is an in-depth teaching session between the nurse navigator and patient and their caregiver(s). Topics covered include a breakdown of the treatment regimen, common side effects, explaining treatment tools for side effects, and health and safety guidelines while receiving chemotherapy. During this visit, the nurse may also assess Social Determinants of Health. This includes financial ability to care for oneself, transportation to treatment, a safe place to live, access to food, and emotional distress. Once assessed, the nurse can provide referrals and resources.
Symptom Management
Chemotherapy, whether it is infusion or oral, unfortunately, comes with potentially life-threatening side effects. Many navigation programs have a triage line patients can call to report and receive advice about uncontrollable symptoms, like nausea or loose stools. Symptom management aims to keep patients as healthy as possible and out of the hospital. The sooner patients report their symptoms to the nurse navigator, the better their chance of keeping patients at home and treatment on track.
Nurse navigators often have treatment protocols that allow them to quickly prescribe care without waiting for the oncologist. They are trained to recognize when symptoms can be managed at home or if a higher level of care is needed. If they advise Emergency Room care, they have decided through a complex decision-making process that the benefits outweigh the risks.
Survivorship
The battle against cancer is not over on the final infusion day. There is a recovery period of 3-6 months after treatment completion, during which the patient is still at risk for side effects. Nurse navigators will prepare a survivorship care plan that details the treatment received. This document is provided to the patient so they may disperse it to their current and future healthcare team members. Potential long-term side effects are covered, as well as dosages received, as some chemotherapy agents have a lifetime dose restriction.
Interdisciplinary Team
Some healthcare facilities have recognized the need for interdisciplinary navigation teams to assist the nurse navigator in caring for the patient as a whole individual and not just as a cancer patient. Teams can include Social Workers, Dieticians, and Patient Navigators. Social workers can assist with counseling needs and connecting patients with support groups. They are also able to help address social toxicities, like financial assistance. Oncology Dieticians are specially trained to guide patients toward the best possible nutrition to support their bodies during and after treatment. They also provide valuable guidance with side effect management, especially those affecting the gastrointestinal system. Patient navigators offer practical support to remove barriers to care and enhance quality of life. They place orders for medical equipment, engage in social toxicity management, and connect patients with community resources like food resources and home health care.
Most services provided by the navigation team are free to the patient. Some facilities charge for dietician services, but nurse navigation is always free. Because patients shouldn’t just survive treatment but thrive.
Photo by Patty Brito on Unsplash
