What would you want to know froom a Nurse Navigator?

iodine

My local small town hospital (pulls from a large area, tho) is getting one.

I began the case mgt/discarge planning program at this hospital in the early 70's, one of the first nurses to do the programs.

I was then a catastrophic case manager --private consultant type, until I retired.

I would love to help this program and would apprciate a few major things that you feel should be addressed.

This is what they list as goals:

Facilitate communications between patients and healthcare providers
- Coordinate appointments with providers for timely delivery of diagnostic and therapeutic services
- Provide educational resources to patients and their families
- Serve as an educator while supporting the patient and family in coping with the psychological aspects of breast cancer
- Support the patient and family in understanding and coping with the strong emotions which accompany a cancer diagnosis
- Refer patients to appropriate cancer support programs and resources

Would love to hear what you have to say!!

gsg

I think that's a great list.  Two years out, my nurse navigator is still my point of contact for everything.  Recently, I needed a written referral for an MRI and she made sure it was waiting for me.  She was then, and continues to be, invaluable to me.

roseg

When I had my mastectomy the nurse navigator made a point to come by when I was in the pre-op area and say Hi.

After wards she made sure that there was a notice in my room that I was not to have any sticks on the surgery side.  I had not known before she told me that ANY breast surgery puts you at risk of lymphedema.

She also gave me a phamplet from bc.org about understanding your pathology report.

Binney4

Hi, iodine,

Good for you! Can't think of anyone better able to make this work.

Here's my suggestion for something she could do that would help. I'll just state it first, then explain it:
She needs to do pre-op patient assessment of both arms for follow-up lymphedema (LE) surveillance.

How?
There's a new easy-to-use low-frequency bioimpedance devise that can measure the amount of fluid in the interstitial spaces. It takes only a minute or two and is accurate and repeatable. With a pre-op measurement, comparisons at three-month intervals post-op can diagnose LE before it's visible or measurable with the usual tape measuring or water-displacement methods. It takes only a couple of minutes and uses a couple of EKG-like electrodes. It's a small unit, and even volunteers can be trained to use it. (http://www.l-dex.com/l-dex.htm)

Why?
BECAUSE WE NOW KNOW THAT, IF LE IS DISCOVERED AT THIS STAGE AND A COMPRESSION SLEEVE AND GLOVE ARE WORN FOR A BRIEF PERIOD OF TIME, WE CAN STOP LE BEFORE ANY SWELLING OCCURS. YES!! Women who discover their LE at this early stage are then advised to use the compression garments whenever they are doing strenuous activities or traveling, or any time their arm feels heavy or achy. They never have to go through the weeks of daily therapy or the "Michelin Man"wrapping. They're at much lower risk for serious cellulitis infection, and so far the studies show that the condition does not progress to fibrosis (hardening) or loss of range of motion or strength.

LE cannot be cured -- it's for life. Everyone of us who has ANY breast surgery or radiation is at risk for it, and the risk extends for the rest of our lives. But it can now be stopped in its tracks, and it sure as heck should be! If your nurse navigator takes only a couple of moments to measure (while also educating, of course!) she'll have offered one heck of a life-long gift to every patient she sees.

If you'd like the research for it either ask your area Impedimed rep for a visit, or I'll send it to you.

Hmmm. Can you tell I'm a little bit excited about this development?

Be well!
Binnney

iodine

Ahhhh, thank you both so much!  Amazing news Binney!

I had planned to discuss LE as an important issue, but this info is terriffic!

samon

What great advice Binney.  I think they need to explain more about LE and not just hand you a pamphlet that has a brief note about it.  I know before I had my mastectomy, I was given a large ring binder and two large books to read.  Of course I was so overwhelmed that I missed most of the important things in the binder and books like exercises I was suppose to do after my surgery and even that I should have done a little massage to my chest area.  The books were great, but sometimes we need someone to point out some of these important things.

AnneW

That would be such a great job, Dotti! I think the possibilities are limitless. From the diagnostic end of things in the radiology department, to making sure that drains are easily managed post-op. There are so many opportunities for teaching, and it's an area that's sorely overlooked, even at the larger hospitals!

FInd out what other NNs are doing in the area so you don't have to reinvent the wheel. But you'll make it unique with your personal experience!

Anne

iodine

In actuality, this is precisely what I did in the program I established as a discharge planner.  LOL

I did onc. counseling, education, referral, emotional support, liaison with docs, all of it.  I find it really interesting that this job has come full circle: from disch.plan. to "care management" (which is just keeping up with hosp..stays with the ins.co's and medicare) to what is now called  a NN.

LOL, wish I were looking for a job, but I'm not.  I just want to help set up the program and be a resource --- funny, I even established the first reach to recovery program in 9 counties!  Long before I was diagnosed. 

Margerie

Dotti,

Our town just got it's first cancer resource center and the nurse navigator has been in existence for one month.   She gets a lot of questions about insurance and how patients can navigate the insurance nightmare.  And questions about how to find financial and transportation assistance for medical appointments, etc.

I wish I had known where to go for a breast prosthesis.  Had to figure that out on my own....