EONS Clinical travel Grant 2016 report from Charlotte Weston, Breast Clinical Nurse Specialist, The Royal Marsden NHS Foundation Trust

Transcription

1 EONS Clinical travel Grant 2016 report from Charlotte Weston, Breast Clinical Nurse Specialist, The Royal Marsden NHS Foundation Trust For the European Oncology Nursing Society, EONS, travel grant 2016 I travelled to America between 30th September 2016 and 16th October During this period I was able to visit three cancer centers; Dana Farber cancer institute, DFCI, in Boston, MD Anderson in Houston, Texas and Memorial Sloane Kettering, MSK, in New York. At all centers I was able to meet with the breast team, shadow nurse practitioners, NP, in the breast unit and meet with key members of the oncology team to discuss programs, research and how they work with patients to provide individualised, patient centered care. In this report I will brief summarise my role at The Royal Marsden, my experience during the clinical visit, key learning points and ideas for implementation. I would like to thank EONS, the three hosting hospitals and The Royal Marsden NHS Foundation Trust for this experience, I found it a valuable opportunity to enhance oncology patient care through experiential learning, sharing of ideas and connecting with other oncology nurses. I was impressed throughout my visit to all three centers by how welcoming the teams were and the thought and care put into my visit, from coordinating clinical visits to match my objectives to orientating me to the building and introducing me to a wide selection of the team. I was able to see practice in outpatient clinics, chemotherapy infusion units, research meetings, team meetings and complementary therapies. I used social media throughout my visit to share my experience via Twitter, sharing support and connecting with colleagues worldwide. Background on my role at The Royal Marsden NHS Foundation Trust I work as a breast oncology Clinical Nurse Specialist, CNS, at The Royal Marsden NHS Foundation Trust, RMH. This role encompasses being a named key worker for patients and supporting patients from diagnosis through treatment which can include surgery, chemotherapy, radiotherapy, endocrine therapy and targeted therapies. Patients living locally and throughout the UK come to RMH for treatment or an opinion on the care. As a CNS I offer expertise in my specialty to patients and working together with colleagues to improve patient care and experience. In the last year I have been involved in the development of a policy for risk reducing breast surgery for patients with a high risk genetic mutation including one to one sessions with a CNS and peer to peer group support in a group setting facilitated by a CNS and health psychologist. I have also started group information sessions for breast patients starting chemotherapy. I am particularly interested in developing support and communication tools to improve patient experience. As a member of EONS and Europa Donna, European Breast Cancer Coalition, I intend to share the experience from the clinical travel grant for the improvement of health services and support for cancer nursing across Europe. Through shared learning with colleagues I have seen first-hand the benefit of visits to healthcare organisations in different countries and cross cultural learning and sharing of information.

2 My objectives for the visit were to gain experience of Advanced Nursing Practice the role within the breast unit Self management strategies to support patients post diagnosis and during treatment Chemotherapy information provision pre treatment, support groups and patient information Breast care nurse education and development program Dana-Farber Cancer Institute (DFCI), Boston, USA DFCI is a globally renowned cancer centre; the breast unit focuses on providing personalised, compassionate care for breast patients. I spent one week here, coordinated by Anne Elperin, a nurse Clinical Specialist (CS) within the Center for Clinical & Professional Development, who has prior experience as a breast NP. The role of the CS at DFCI is centred on education and policy development which was interesting to discuss the variation in our roles. During my visit I was able to see interaction between members of the nursing team working together to provide specialist nursing care and observe the differentiation between the role of CNS and NP. At DFCI they have an established breast NP role, the NP works either with medical oncology or surgical team. Observing in a breast clinic I was able to see the NP working autonomously providing high quality patient care and establishing good relationships with patients and the team. I met with members of the breast oncology team including Dr Ann Partridge and Dr Jennifer Ligibel to learn about recent trails including the Breast Cancer Weight Loss Study, a study looking at lifestyle factors and weight maintenance as a way of reducing risk of breast cancer recurrence, and The Preoperative Health and Body Study, an interventional study comparing two interventions post diagnosis, a structured exercise program and a visualization program. DFCI had involved companies to provide healthy living tools, such as weighing scales and Fitbits, for the benefit of their patients. I attended an exercise class, run by Nancy Campbell, exercise physiologist at DFCI, provided for breast cancer patients at any point of treatment. This was an ongoing program, I was able to see through this the benefit of peer to peer support in an informal setting, the patients told me it had helped their confidence and several were now doing some form of moderate level activity several times per week. I was interested to see how all of these interventions used the time of diagnosis onwards to empower patients with simple tools, such as exercise and visualisation, which they could use to self-manage and improve their own health outcomes. I would be interested to explore further how partnering with well-known wellness brands effects public engagement with research.

3 Through the DFCI Young and Strong Program for younger women with breast cancer I was able to see high quality personalised care and communication to targeted groups of patients. The Young and Strong program are currently using myemma an tool used to resources and information to patients, this can be tailored to subgroups within the ing list based on demographics and need. I discussed with Dr Partridge implementing this for breast patients undergoing chemotherapy to connect and communicate services available to them. As at RMH DFCI has an established integrative therapies program and the tool could be used to inform patients of these services which are available or of other supportive groups or events they may choose to join. DFCI provided patients with visual timelines of chemotherapy treatment which they have developed, I would be interested to develop similar timelines for patients to take home with them. As at RMH DFCI serves a wide geographic area with many people travelling to the hospital to receive treatment. I met with social workers who run the support groups to discuss which support groups they had tried, what worked well and any challenges. I was particularly interested by a 6 week support group held via telephone conference for younger women. The group was advertised via Twitter and they have so far had good feedback with patients particularly benefiting from peer to peer support and sharing experience. They have trialled having a guest speaker speak on a topic. Benefits of a telephone group format included low running costs, being able to provide the group in the evening and through the small group patients were able to establish friendships and independently form support groups independently following the group through social media. MD Anderson Cancer Centre, Houston, USA MD Anderson is one of the largest breast cancer treatment centers in the USA treating 40, 000 patients per year. Despite this volume they specialise in providing personalised care for all breast patients, including patients with a BRCA diagnosis. My visit was coordinated by Lisa Green, a nurse educator with extensive experience of coordinating cross cultural learning and exchanges with partner organisations. The hospital was very large thus allowing for the incorporation of many services including scarf tying and a large information library for patients to access. I was impressed by the range of written resources available to help patients self manage including resources on menopausal symptoms and pain management, based on this I would like to look at the resources we have available and develop these further. MD Anderson uses a Professional Practice Model for nursing, to provide a quality patient experience where the patient feels cared for. This is based on eight caring factors; mutual problem solving; attentive reassurance; human respect; encouraging manner; appreciation of unique meanings; basic human needs and affiliation needs. Based on this every patient contact they have at the hospital be a good customer experience, the use of this model is evident

4 throughout the hospital with all members of staff demonstrating a welcoming and caring attitude. The collaboration of all members of staff to add to patient care was very powerful in creating a caring atmosphere and could be modelled in other hospitals. Like DFCI, MD Anderson have an established NP role with NPs working with the breast oncology and surgical teams. I shadowed a breast NP in clinic seeing new and follow up patients with a doctor and clinic nurse. The NP would often see the patient first, including talking with them about complex treatment plan decisions including chemotherapy regimens, I was able to observe this experience for the patients who expressed they found the interaction satisfying and reassuring despite the complex nature of the conversations and decisions being made. It was very beneficial to see the range of conversations and communication used by the NP and how this contributed to good patient experience. I met with the social work team, as at DCFI the social workers are responsible for implementing and running support groups. They told me that they face similar challenges due to patients geographical home location and work circumstances, they have trialed a general support group for breast cancer patients at any stage of treatment which they find is well attended however they described common challenges such as patients not wishing to attend multiple appointments during treatment and having to travel to the hospital as barriers to attending support groups. Memorial Sloane Kettering, New York, USA Memorial Sloane Kettering, MSK, has a dedicated breast center in a building specifically designed to improve patient experience and empower patients to partner in their care. I was able to see their breast center in action, the building has been designed with patients in mind. This includes a forward motion layout, so when going between the waiting room and clinic rooms the patients are moving forwards, rather than returning back the way they have come. Although it would be challenging to achieve this without a dedicated building the thought and attention to providing a positive holistic patient experience was very powerful. It would be interesting to see if this could be achieved in other hospital settings. I was able to see a variety of their patient education material including short animated videos available online on a variety of topics including chemotherapy side effects and management. From previous service evaluations at RMH I have seen that patients regularly access information via a range of media channels and many prefer to access information in this way. Since returning I have continued networking with Chasity Walters, the director of patient & caregiver education and Elizabeth Rodriguez, the lead for the patient portal with the intention of exploring the use of a patient portal and collaborating with MSK on a video for patient information regarding chemotherapy. I was able to meet with Dr Margaret Barton-Burke, Director of Nursing Research, to gain insight into research roles for nurses at MSK and NP involvement in research as well as her own involvement with ONS and EONS.

5 As with the previous two visits I was able to meet with NP in breast surgery and medical oncology, through this I was able to see similarities across the established roles and how this worked well within their teams. Breast care nurses are encouraged to become certified through undertaking the Certified Breast Care Nurse Oncology Nurse Certification, an exam covering a range of areas of breast care nursing. I met with Erica Fischer-Cartlidge a senior breast CNS who has developed an educational program for nurses preparing for this certification and was able to observe two breast nurse education days, her passion and enthusiasm for education for breast nurses was inspiring. Through this I could see the value of a specialised curriculum for nurses as it provided training in a comprehensive range of subjects related to the specialty. The nurses also reported a great sense of personal achievement and recognition when receiving this certification. Ideas for implementation 1. Nurse practitioner on treatment in breast unit medical and surgical departments 2. Telephone support groups for women: to promote these groups/ services via social media if appropriate 3. Communication for patients on chemotherapy: My Emma to groups with resources/ services available videos to inform/ empower patients about management of side effects visual hand outs with chemotherapy timelines 4. Develop specialist nurse education Conclusion The Travel Grant visit was overall an excellent experience both in exposure to a various range of clinical settings and experiences, meeting new people and establishing connections whilst on my visit and sharing my visit via Twitter with the EONS and UKONS community. I hope to implement the ideas learnt from my visit in practice, build on the relationships made and share my experience further. Overall the visit has also given me experience of being an overseas visitor which will help my understanding and care for visitors from overseas. I would like to thank EONS, the three hosting hospitals and The Royal Marsden NHS Foundation Trust for this experience and hope it inspires others to also apply for this or similar programs.

6 Photographs from the visit