Graphical Representation of a Breast Cancer Services User’s Care Journey and Supporting Essay

Word Count: 1,598

1.0 Introduction

Figure 1 below covers the entire nursing care journey by a nursing officer to a breast cancer patient. Typically, the illustration covers all the activities that the nursing officer was engaged in right from the time the patient was diagnosed with breast cancer to when he was discharged following successful surgery, chemotherapy, radiotherapy, and follow-up care. While the nursing officer worked in a team of nursing officers as well as other medical professionals, they provided close medical, nutritional, informational, and psychological care to the patient throughout the care journey.

2.0 Identify the Patient and Their Complex Care Needs

2.1 Patients Background

Melvina is a 55-year-old mother of two living in Kent, London with her husband and their pet dog. Her two children are all adults living their own lives in different cities. Melvina noticed a small lump on her left breast about six months ago but thought it would go away after some days. Unfortunately, the lump worsened, and she had to seek medical attention from her nearby facility. She was shortly thereafter diagnosed with breast cancer. That is when she met with the nursing officer. As is common with a cancer diagnosis, Melvina was in emotional turmoil when she met the nursing officer. She was in shock and denial, not knowing how she would cope with the treatment and care journey. As DHSS (2018) shows, the nursing officer’s core job was to help Melvina manage shock and accept the condition in preparation towards embarking on the treatment and care journey. Fortunately, Melvina was a thoughtful woman who was always engaged in some form of deep reflection. As evidence from DHSS (2018) shows, her thoughts and reflections helped her to find acceptance and strong resolution to face the condition with hope. Overall, such acceptance made the nursing officer’s work easier.

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2.2 Patients Core Care Needs

Melvina’s core care needs span four core areas of psychological support, pain management, medical support, and nutritional support. As evidence from Parker and Tomlins (2016) regarding nursing care for breast cancer patient shows, psychological support helped Melvina to accept her diagnosis alongside the harsh treatment regime involving chemotherapies and radiotherapies. Further, Figure 1 below shows that the nursing officer helped Melvina to cope with the intense pain that emanate from the surgical procedures. It shoes that Melvina made the treatment and care journey easier by building a positive mindset regarding the condition’s outcome.  Moreover, Melvina needed to take healthy diet to supplement her treatment journey. NAO (2018) supports this observation by showing that nutritional support can help patients battling complex conditions such as breast cancer to improve the quality of their lives. Finally, the patient needed pain management drugs to ease the immense pain coming from the harsh treatment regimen involving chemotherapies and radiotherapies (DHSS, 2018). Overall, these nursing care activities helped to improve the patient’s quality of life by boosting her nutritional situation and easing pain.

2.3 Multiagency Collaboration

To deliver optimal nursing care to Melvina, the nursing officer worked within a multiagency team. Considering that breast cancer is a debilitating condition that requires delicate care to patients (De Calvo, Sepulveda-Carrillo & Judith, 2017), the nursing officer worked within a team of medics. For example, Figure 1 below shows that the nursing officer worked closed with the oncology and the nutritional team to offer relevant medical and nutritional care to Melvina. This observation is consistent with NAO (2018) position that complex medical conditions require a collaborative working environment. The health facility made working together easy through documentation – for example, the nursing officer relied on documentation from the oncology team to offer informational and psychological support to Melvina. Specifically, the nursing officer was able to manage the chemotherapy and radiotherapies’ side effects by following advice offered by the oncology team.

3.0 Application of Evidence and Guidance

3.1 Relevant Policies to Support the Patient

Breast cancer patients’ care journey is governed by robust frameworks. According to NICE guideline 1.2.2 of 2009 and amended in 2018 on managing early and locally advanced breast cancer, Melvina was entitled to being assigned at least a clinical nurse specialist or another equally qualified specialist as may be deemed fit to deliver informational and psychological support (NICE, 2018). To boost better outcomes, the NICE guideline requires that such specialist is required to work closely with a breast cancer patient throughout the care journey starting from diagnosis to treatment and follow-up. Harris et al. (2012) supports this guideline by reasoning that psychological and informational support helps patients with debilitating conditions to build positive mindsets and make better decisions regarding their nursing care journey. To guarantee better outcomes for Melvina’s treatment and care journey, Figure 1 above shows that the nursing officer provided prompt psychological support. As expected, Melvina developed a positive mindset that enabled her to battle the condition throughout the treatment and care journey. While there are other care frameworks, the nursing officer adopted the NICE framework because its guidelines are more relevant to breast cancer patients’ care journey (NICE, 2018). For example, the guideline 1.2.2 of the framework very clear on the need for informational and psychological support.  

3.2 Role of Patient’s Choice

Breast cancer patients have choice on their care journey. The NICE (2018) guidelines show that breast cancer patients in the UK have the freedom to elect the most appropriate care journey following advice by medical practitioners as well as care givers. Since Melvina was in distress when she was diagnosed with the breast cancer, she easily elected to undergo surgery and other aggressive interventions involving chemotherapies and radiotherapies. Part of the reason that Melvina elected to this aggressive treatment journey is because her children are adults, and she was not planning to have other children in the future. Unlike situations where breast cancer patients must balance between taking care of their young children and undergoing aggressive treatment regimens (Barni et al., 2011), Melvina situation was easy since she is only living with her husband. Finally, the nursing officer was a great advocate for the patient’s choice through facilitating better services. As Davoodvand, Abbaszadeh and Ahmadi (2012) The nursing officer demonstrated this through showing empathy and understanding to Melvina’s needs and expectations.

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4.0 Critique Relations Between Health Care Agencies and Patient

4.1 Critical Evaluation of Outcomes of the Care for Melvina and her Family

The nursing care journey produced better outcomes. Melvina was able to positively cope with the entire nursing care journey starting from the diagnosis, surgery, chemotherapy, radiotherapy, and follow-up care. While Biganzoli et al. (2012) show that the diagnosis part is always the hardest part of the care journey for complex conditions such as cancers, Figure 1 above shows that the nursing officer successfully helped Melvina to overcome emotional shock and to positively cope with the condition. As the NICE (2018) 1.2.2 guideline requires, the nursing officer helped Melvina to overcome this shock through informational and psychological support. While the journey was not smooth as Melvina was in denial during the initial days of the diagnosis, the nursing officer walked with her until she changed her mindset. She was in denial because she was misinformed about the condition in the initial days. Barni et al. (2011) agree with this position by showing that helping patients overcome shock is a major milestone towards successful nursing care journey. On a good note, a positive mindset from Melvina’s also had a positive impact on her husband who visited or accompanied her the entire care journey’s time. As evidence from Toi et al. (2016) regarding personalised care shows, the nursing officer evaluated this mindset through her show enthusiasm in adhering to the treatment and care regimen.  

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4.2 Self Reflection

My role largely involved offering informational, psychological, and medical support to Melvina. As the assigned nursing officer working closely with Melvina, I was required to offer informational and psychological support to her to cope with the condition and make objective decisions regarding her care journey. While considering that I worked closely with other medical professionals, I had the sole responsibility of helping Melvina to build a positive mindset for coping with the aggressive treatment and care journey. As NAO (2018) shows, this required me to take a professional stance by immersing myself in the patient’s situation and demonstrating genuine empathy to her concerns. Sometimes I felt inadequate when offering reassurances to Melvina’s concerns on her condition’s prognosis. To overcome this weakness, I encouraged her to adopt a positive mindset about the condition. As Scharl et al. (2015) on personalised care shows, I could tell that she was complying with my advice by the enthusiasm she showed in adhering to her treatment regimen. DHSS (2018) supports this stance by showing that clinical nursing officers should improve patients’ psychological wellbeing through offering positive care experiences. Fortunately, Melvina progressed well throughout the care journey.

4.3 Recommendations

Nursing care officers should adopt a personalised care stance when managing complex conditions. Melvina’s treatment and care journey has persuaded the nursing officer to realise that successful nursing care should be delivered from the patient’s point of view (Scharl et al., 2015). Nursing officers should firstly establish a patient’s background information or medical history beyond their diagnosis to craft a personalised nursing plan based on the actual needs of the patient (National Voices, 2022). As Collins (2020) shows, digitisation can facilitate successful patients’ background check. While diagnosis offers a foundational basis for nursing plan, establishing the history of a patient’s condition can help to customise the nursing plan to fit a patient’s needs and expectations (Scharl et al., 2015). Consequently, any informational and psychological support should be personalised.

5.0 Conclusion

A nursing officer should work closely with patients right from diagnosis through treatment and follow-up care. Working with Melvin gave the nursing officer a holistic view of what patients with complex conditions such as breast cancer go through. While the report shows that the nursing care journey is not always smooth, nursing officers should offer sufficient informational, psychological, nutritional, and medical support to allow patients make objective decisions for coping with their conditions. These support services should be tailored to patients’ needs. At the same time, nursing officers should adhere to any relevant guidelines such as the NICE 1.2.2 guideline on providing informational and psychological support to their patients. Further, nurses should allow patients to make better choices regarding their treatment and care journey. To improve the nursing care journey, it is recommended that nurses should establish a patient’s background information.

References

(DHSS) Department of Health and Social Care (2018) The future of healthcare: our vision for digital, data and technology in health and care. UK Government Policy Paper.

(NAO) National Audit Office (2018) Developing new care models through NHS vanguards. London: National Audit Office.

Barni S, Venturini M, Molino A, Donadio M, Rizzoli S, Maiello E, et al. (2011) Importance of adherence to guidelines in breast cancer clinical practice. The Italian experience (AIOM), Tumori,97(5), pp. 559–63.

Biganzoli L, Wildiers H, Oakman C, Marotti L, Loibl S, Kunkler I, et al. (2012) Management of elderly patients with breast cancer: Updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA), Lancet Oncology, 13(4), pp. e148–60.

Collins, B. (2020) Technology and innovation for long-term health conditions. London: Kings Fund.

Davoodvand, S., Abbaszadeh, A., & Ahmadi, F. (2016) Patient advocacy from the clinical nurses' viewpoint: a qualitative study, Journal of Medical Ethics and History of Medicine, 9(5), pp. 1 – 8.

De Calvo, A., Sepulveda-Carrillo, L.E. & Judith, G. (2017) Care needs of cancer patients undergoing ambulatory treatment, Enfermeria Global, 45, pp. 369 – 383.

Harris, S.R., Schmitz, K.H., Campbell, K.L. and McNeely, M.L. (2012) Clinical practice guidelines for breast cancer rehabilitation: syntheses of guideline recommendations and qualitative appraisals, Cancer,18(8), pp. 2312–24.

National Voices (2022) A narrative for person centred co-ordinated care [Online]. Available At: www.nationalvoices.org.uk/(Accessed: 23 January 2022).

NICE (2018, July 18) Early and locally advanced breast cancer: diagnosis and management [Online]. Available At: www.nice.org.uk/guidance/ng101/ (Accessed: 23 January 2022).

Parker, S. and Tomlins, A. (2016) Clinical guidelines for the management of breast cancer. London: West Midlands Expert Advisory Group for Breast Cancer.

Scharl, A., Kühn, T., Papathemelis, T. and Salterberg, A. (2015) The right treatment for the right patient–personalised treatment of breast cancer, Geburtshilfe und Frauenheilkunde, 75(07), pp. 683-691.

Toi, M., Winer, E., Benson, J. and Klimberg, S. Eds. (2016) Personalized treatment of breast cancer. Tokyo, Japan: Springer Publishing.