Paula Madden, nurse consultant at Imperial NHS Trust who is taking a year’s sabbatical at Beating Bowel Cancer as Senior Nurse Advisor, shares details of an Information and Holistic Needs Assessment (HNA) session which she introduced at St Mary’s.
In 2012 at Imperial College Healthcare NHS Trust (ICHT) Paula felt that newly diagnosed colorectal cancer patients were not getting enough time in the Colorectal clinic with a CNS and it wasn’t always the right time to be going over detail of surgery or treatment straight after the diagnosis was given.
As there was usually just one CNS present in the clinic it wasn’t possible to be present at all consultations with a new bowel cancer patient to discuss new diagnosis and treatment options as per NICE guidance, and not always enough uninterrupted time to complete an Holistic Needs Assessment (HNA) and go through the next steps in detail.
The idea was to have a separate clinic for a dedicated CNS-Led 1:1 session with the patient within five days of the diagnosis being given. This could be done either on the same day as Pre-Assessment clinic (if appropriate) or on a separate day agreed between CNS and patient. If the patient is unable to attend this session for any reason prior to the planned treatment date the KW/CNS can offer either a telephone consultation or if enough time and appropriate can offer the IC session on the same day as diagnosis giving.
An Information/Communication (IC) session is an uninterrupted period of approximately one hour set aside for a Cancer CNS to assess each newly diagnosed cancer patient in an holistic manner to ensure patients (and relatives) have enough information to understand the cancer pathway ahead. This would be done outside of the normal colorectal clinic (where the diagnosis and treatment options are discussed and the CNS would be present).
Within this 1:1 session the CNS would undertake an HNA to help identify any key concerns that need addressing. If concerns are identified these are documented into a Care Plan. This initiative forms part of the National Cancer Survivorship Initiative.
This is an example of an HNA/Care Plan.
The second part of this CNS-led session is to clearly explain the next steps ahead. We used a checklist (covering aspects from the National Cancer Patient Experience Survey) and an Introduction document, which when complete, is given to the patient to take away, with any further relevant patient information leaflets.
On the day of giving diagnosis and treatment options with the Consultant,the Key Worker (KW)/Clinical Nurse Specialist (CNS) will be present to introduce herself/himself and ensure the patient is provided with:
At ICHT the Nurse Consultant trialed fifteen patients using the 1:1 session between October-December 2012. From this experience it allowed pre-empting of medical, nursing, emotional, mental & social issues with a valued, uninterrupted session, where patients have said they feel very well informed so anxiety was reduced. It has allowed a good rapport to be built in a relatively short space of time and patients feel listened to, cared for and well informed. Also noted was length of stay for the patients was no longer than 5 days and they had no surgical complications. All had laparoscopic or a SILs approach to their bowel cancer surgery. The NC achieved job satisfaction as it was felt she gave all the information required and developed a rapport with the patient. It was also noted that these patients rarely needed to contact the CNS after this session and before the first treatment as they had been given the time to go through their questions and concerns. This saved CNS time too.
This audit was presented to the Service Manager and Lead Colorectal Consultant who felt it made a significant impact to patient experience. They negotiated a coded session for this with the local CCG so this is now a funded session under the remit of the CNS. This is positive for the CNS role as this generates income for the Trust.
Allocating CNS time can be difficult, as initially this was done on an ad hoc basis rather than within a set session. CNS flexibility allowed the ability to fit around patients which is good, but maybe not practical long-term, so a dedicated session was needed. The Nurse Consultant reviewed CNS job plans to incorporate this into the service provided. The amount of time spent in the actual colorectal clinic was reduced as this was just for seeing newly diagnosed patients with the Consultant, general introduction to the patient and giving contact details and patient information.
There is a need to ensure there is a space for this session. This was available at St Mary’s but not at Charing Cross so this needed to be resolved. The room needs a telephone and ideally a PC but not essential. Access to patient information is useful too.
If you would like further information, please email Paula Madden.