Integrating in- and out-patient nursing services for breast cancer patients undergoing mastectomy and breast conserving surgery

Abstract

Research has demonstrated the feasibility of discharging patients between the 6th and 7th day following mastectomy or breast conserving surgery. Although this possibility can be advantageous to patients it comprimises the time needed to achieve all the goals of nursing care. In order to provide comprehensive nursing care and continuity in the care process, our nursing department developed an integrated in-patient and out-patient nursing care service for breast cancer patients in this phase of their disease. This novel approach is coordinated by the nurse manager from the in-patient nursing department. Nurses from the ward rotate through the new ambulatory breast clinic giving them the opportunity to broaden the scope of their practice. This expanded role includes patient support at initial diagnoses, more extensive pre-operative patient information and post-operative symptom management and wound care. Continuity of care and documentation of the care delivered is the major goal of this approach. Nursing care goals are now set in the out-patient department following the initial nursing assessment. The nursing interventions can be carried out either during clinic visits prior to hospital admission or during the admission period. Documentation plays a vital role and a special patient file has been developed to reflect the steps of the care process. The patient is responsible for the file and presents it to the nurse during each visit. Nurses who assess the patient in the clinic are often those who care for the patient on the nursing ward. This provides the opportunity to build solid relationships with patients giving nurses an integral role in the patient's treatment trajectory. This role promotes a greater sense of proffesionalism and job satisfaction. The clinic is in its grassroots phase, but as our experience increases so will the possibilities for expansion to eventually provide the breast cancer patient with continuity of care beyond the borders of surgical treatment to include rehabilitation.