Breast Care Nursing in North Wales 2: An evaluation of breast care nursing from the perspective of p

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Breast Care Nursing in North Wales 2 An
evaluation of breast care nursing from the
perspective of practice nurses and district nurses

• Ros Carnwell, Professor of Health and Community
  Research
• and
• Sally Baker, Research Assistant
• Centre for Health and Community Research, North
  East
• Wales Institute, Wrexham, Wales, UK.
• r.carnwell_at_newi.ac.uk

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Three stage evaluation study (N Wales, UK)

• Background Policy
• 1996 - government health gain targets within
  Health Improvement Programmes -breast cancer care
  to be delivered by specialist multi-disciplinary
  teams in cancer units treating at least 100 new
  breast cancer patients per year.
• National Assembly for Wales (1999, 2000),
  multi-disc teams to include two cancer care
  nurses within each NHS Trust, who had completed
  an accredited programme of education specifically
  related to their specialist area of care.

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Literature

• BCN role support and information restricted
  to time of diagnosis uncertainty around what
  information is needed and who should provide it.
• Evaluation - RCTs demonstrate benefits including
  higher satisfaction and lower anxiety, provision
  of information, emotional support, and
  identification of stress and lower scores for
  psychological morbidity.
• Psychological aspects of care- anxiety and
  depression, information and support.
• Patient participation in decision making.
• Training - Communication skills, counselling, and
  information needs of women.

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Methodology

• This paper reports on phase 3 (a) of a 3 phase
  study (see figure 1)
• Phase three (a) - postal questionnaire
• Sample
• Practice Nurses (n243)
• District Nursing Sisters (n97)
• employed within North Wales
• identified via community nurse managers and the
  Local Health Groups.
• 340 Questionnaires distributed
• Response rate 124 (70.1) from practice nurses
  and 53 (29.9) from district nurses

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Findings - reasons for using BCN service (n77)

• Examples
• Patient needed support I felt more confident
  after speaking to Breast Care Specialist.
• A worried lady with a strong family history of
  breast cancer needed to speak to nurse
  specialist.
• Patient with old, ill fitting bra attended
  surgery, I phoned the Breast Care Nurse and
  arranged appointment with her for patient.
• Post mastectomy patient had post radiotherapy
  burns.
• Measuring client for appropriate lymphoedema
  sleeve.
• To liase with Breast Care Nursing Service re
  wound management and follow up

• Theme
• Advice info (n24)
• Patient support (n19)
• Prosthesis appliance fitting (n16)
• Wound/skin care (n16)
• Symptom management (n10)
• Liaison/partnership in care (n9)

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Findings - reasons for using BCN service (n77)
cont...

• Gave role presentation at PHCT meting at surgery.
• A patient who had a mastectomy and reconstruction
  surgery developed an infection and the Breast
  Care Nurse got her seen by the Consultant sooner
  than planned.
• Referring patients who have not had contact with
  BCNS before
• New patient to my practice who had a mastectomy
  in a HA in England needed continued support and
  advice about what was available locally.
• They were very helpful and supportive to a
  relative of mine.

• Themes
• Education (n7)
• Fast tracking patients with problems (n5)
• Referral (n5)
• Patients new to area (n3)
• Personal experience (n3)

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Reasons for not using BCN service (n64)

• Theme
• No need (n28)
• Not part of role (n17)
• Patients have existing
• contact (n11)
• Lack of knowledge
• (n8)
• Patients seen by other specialists (n3)

• The need to do so has not arisen.
• No reason to refer
• We have a female doctor for patients to consult
  on breast problems.
• We as practice nurses just give breast awareness
  leaflets out and refer patients with any breast
  complaints to the GP.
• Patients deal directly themselves.
• Patients are able to contact the BCN directly if
  they have any problems
• Unsure how to access service mainly.
• I did not know it existed.
• Patients whom I have seen with breast cancer have
  been in the terminal phase and dying.
• Patient was involved with Macmillan Nurse.

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What BCNs do well

• Themes
• Support, counselling and information for patients
  and their families (n37)
• Responsive/ accessible service (n12)
• Resource for community nurses (n10)
• Excellent service (n7)
• Liaison and support for community nurses (n7)
• Continuity of care (n6)
• Patient satisfaction (n4)
• Care of women in acute setting (n3)

• Examples
• Provide counselling and information to patients
  on diagnosis and initially post operatively.
• Responds quickly to problems within the
  community.
• Easily accessible to patients.
• Willing to give up-to-date information to
  district nurses who request this in their clinic
  setting.
• Excellent in all aspects of care and support.
• A link between secondary and primary care.
  Support us as district nurses.
• Maintaining contact with patient.
• No negative comments from patients have been
  received.
• Care of women whilst undergoing
  investigations/treatment in the hospital setting.

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Areas for improvement (n41)

• Category
• Education
• Information communication
• Standard of service

• Sub theme
• Need for more education (n20)
• Provision of updates about current treatment
  management of patents (n9)
• Need to promote service more (n6)
• Information about individual patients (n10)
• Leaflet provision (n4)
• Multidisciplinary team working (n2)
• Quality of service (n2)

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Conclusion

• Positive evaluation
• Excellent clinical skills, provide resource for
  nurses
• Excellent support/advice for patients around time
  of diagnosis
• Responsive and accessible
• Need for improvement in
• Promoting service
• Educating other nurses
• Communicating with other nurses about patients
• Need resources including
• training in counselling and access to information
• increasing the numbers of BCNs.