Navigating the Course from Diagnosis to Survivorship: The Implementation of the Nurse Navigator Role in a Pediatric Oncology Cancer Center

November 2017 Vol 8, No 11
Jackie Gonzalez, DNP, MBA, ARNP, NEA-BC, FANN
Nicklaus Children's Hospital, Miami, FL
Lilliam Rimblas, RN, BSN, CPHON
Nicklaus Children's Hospital, Miami, FL
Peggy Townsend, MSN, RN, CPON
Nicklaus Children's Hospital, Miami, FL

Background: Navigation is defined as the “guiding force promoting the timely movement of the patient through a complex system of care.” Evidence from leading adult cancer centers has shown that the implementation of a nurse navigator role has had marked improvement in care coordination, timeliness, and increased patient satisfaction. Despite advances in pediatric cancer programs, children and families with childhood cancer continue to face multiple challenges upon diagnosis trying to navigate through systems. Currently there is minimal research regarding a nurse navigator in a pediatric oncology setting. A collaborative nursing leadership in a South Florida pediatric hospital was the visionary behind the implementation of a nurse navigator role for the cancer center. The oncology nurse navigator role was implemented at this institution to provide care coordination and a central point of contact for the families and the interdisciplinary team. A survey showed that families of patients diagnosed prior to the navigation program reported lower satisfaction in the realms of understanding about the diagnosis or treatment plan and in understanding how to obtain financial and transportation assistance.

Objectives: The proposed outcome by this role implementation is an increase in patient satisfaction, as reported by families on a Likert scale, regarding their ease in navigating this hospital system, and to assess caregivers’ perceptions of how well the interdisciplinary team coordinated care and provided education to prepare the family for care of the oncology patient at home during the first month after an oncology diagnosis.

Methods: This oncology nurse navigator’s caseload includes oncology patients receiving chemotherapy at this institution. A tracking tool was developed to help the navigator follow the patients’ courses of treatment. The navigator first meets families at the time of diagnosis and follows them until the end of treatment. A survey has been developed to rate the effectiveness of the navigation role and the patient’s hospital experience. The caregivers of 60 pediatric oncology patients at the institution were approached to fill out the patient experience survey. The same questions were asked to assess the services provided to families diagnosed before the commencement of the navigation program and after the commencement of the program. Survey results 6 months postimplementation will be presented.

Results: The survey asked questions regarding the realms of patient education, care coordination, knowledge of resources, and overall satisfaction with the program. The postintervention surveys showed an improvement across all fields compared with the preintervention surveys, even though scores were generally high across all surveys.

Conclusions: The increase in all fields of patient satisfaction shows that, although this institution has historically provided well-rounded services to new patients, the navigation program helped to assure a more consistent provision of those services to new patients and their families. Currently, the team continues to receive positive feedback for the role from staff, physicians, patients, and families, which emphasizes that it is an essential part of the continuum of care for all pediatric oncology patients.

Note: Abstract previously presented at Association of Pediatric Hematology/Oncology Nurses 2016 Annual Conference.

Sources

Becze E. Get an overview of a successful oncology nurse navigator program. ONS VOICE. https://voice.ons.org/news-and-views/get-an-overview-of-a-successful-oncology-nurse-navigator-program. 2013.

Horner K, Ludman EJ, McCorkle R, et al. An oncology nurse navigator program designed to eliminate gaps in early cancer care, Clin J Oncol Nurs. 2013;17:43-48.

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