Download Walking alongside you, against the tide - G-Care

Walking alongside you,
against the tide
Louise Pound.
Lead skin cancer specialist nurse
( Macmillan )
Gloucestershire N.H.S.F.T 2014
Clinical nurse specialist
• Acting as a key worker throughout care
pathway
• Advanced clinical skills
• In-depth knowledge which is tumour specific
• Advanced communication and advocacy skills
• Assessment of patients holistic needs
• Excellent decision making
• Empathy for families , partners , friends
• Leadership skills within M.D.T , and wider
clinical environment
• Initiate change and project management.
Your skin cancer C.N.S. Team
Meeting thru the 2wwr
• Perfect setting.
• Introduction into team , role , planned
surgery
• Clinical skills- history taking , clinical
exam, pharmacology, diagnostic skills,
dermatoscopic skills.
• Pre-diagnostic support.
• Surgery booked at a time to suit patient.
• Patient centred care.
• C.N.S. Contact details
Surgical appointment
Nurse-led surgical clinics.
annual audits ref diagnostic skills
Annual audit ref surgical skills.
accredited surgical training @ masters
level.
• Confident practitioners=happy
practitioners=safe well cared for
patients.
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Multi disciplinary team meetings
• Every Thursday morning.
• Dermatology, pathology, oncology,
plastic surgeon,, O.M.F.S, E.N.T.S,
radiology, skin cancer C.N.S. team,
coordinator.
• Patient case load discussed with all
modalities present, patient advocate.
• Appointments with skin cancer C.N.S
within ten days of path report.
Breaking bad/significant news
• C.N.S led clinics, based on mdt outcome .
• 45 min appts.
• supporting information ref diagnosis, adjuvant
therapy, disease progression, palliative
care(timely and appropriate consideration)
• Scan discussion. Discussion ref clinical trials/slnb
• physical examination.
• Emotional wellbeing assessment .
• holistic assessment .
• letter to G.P within 24hours.
Patient pathway.
• O.M.F.S/ oncology/plastic
surgeons/E.N.T.S/Dermatology.
• Key worker supports throughout.
• email/text/phone call/secretary
support
Jenny, Claire , Katy, your
lifelines
Ongoing follow up care
• PT1b and above=3/12, 3 years, then if
fit and well 6/12 for further 2 years ,
discharge back to G.P care.
• Pt3b and above = 3/12 for 3 years, 6/12
further 2 years , then annually for further
5 years .
• A.M.S/ Multiple mm= lifelong follow up.
• more than 3 family members with mm,
then geneticist referral.
What goes on at appts
• Holistic assessment .
• clinical exam of skin , scar, lymph nodes, general
health, emotional wellbeing.
• Teach patients to self exam lymph nodes, moles, lesions
• advice ref sun protection, vitamin d.
• free prescriptions'.
• Maggie's cancer care centre, Cotswold care, Sue Ryder
day hospice, Look good feel better, Winston's wish ,
willow foundation.
• Guidance ref benefits.
• Macmillan grants.
• war pension advice.
Depending on the tide..
• We see patients when they want to see us
if there is a problem , and will always see
within the week if they contact us.
• we will initiate fna, appropriate imaging
ongoing referral to palliative care early in
their pathway.
• We will continue to keep in contact if
they wish us to, by phone , or visit even
if they have palliative care.
Discharge….
• Most patients with melanoma will be
discharged by year five, and most will
continue to live their life disease free.
• a third will develop disease which will be
terminal.
• All will have benefited , in some way,
from having had contact with a specialist
nurse, continuity of care, a point of
liaison throughout their care, a hand to
hold onto against the tide.
Metastatic disease
Surgically excise if at all possible
Clinical trials offer- oxford,
Birmingham , royal Marsden , south
mead.
Chemotherapy- dacarbazine i.v
Cancer growth inhibitors-verumifenib,
debrafenib -oral medication
Monoclonal antibody therapyipiluminab-i.v.
Useful websites
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www.macmillan.org
www.cancerresearch.uk.org
www.maggiescentres.org
www.melanomafocus.com
www.pennybrohncancercare.org
www.canceradvice.co.uk/supportgrou
ps/wessex-cancer-trusts-marcs-line
Palliative care
• Identifying patient need through holistic assessment.
• Pain relief.
• Symptom control.
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Benefits advice
Psychology support.
Emotional wellbeing.
Family support.
Support with preparation of children
Coping with an uncertain future.
Coping with change in health .
Acceptance of incurable disease.
Symptom control.
Benefits advice.
Thank you.
[email protected]
0334225398/07785578150