Specialist Nursing Roles for the Patient with Metastatic, Recurrent & Intractable Breast Cancer Su Jin Lee Dankook Univ. Hospital
Intro Breast Nurse Specialist in the world CBCN BCN??? SBN
USA CBCN Certified Breast Care Nurse ONCC : The Oncology Nursing Certification Corporation OCN CPHON CBCN BMTCN AOCNP AOCNS
UK BCN 1970`, Breast Care Nurse 1 st country to have defined the role of BCN Lv1. Breast Care Nurse Lv2. Clinical Nurse Specialist Lv3. Nurse Consultants
AUS SBN Specialist Breast Nurses 1998, The SBN Project E-B recommendations of current oncology, & psychosocial clinical practice (NHMRC NBCC, 2000) MBCNP clinical pathway
KOREA Who are you? 13 개분야의전문간호사 (2006) 종양, 임상, 호스피스, 중환자, 정신, 마취 가정, 노인, 아동, 감염관리, 보건, 산업 Oncological Nurse(care) APN OO전담간호사, OO전문간호사 CNS, NP, PA, SA. Coordinator 명칭, 역할, 업무모두모두달라요 ~
KOREA 전문간호사 (Advanced Practice Nurse, APN) 정의 : 보건복지부장관이인증하는전문간호사자격을가진자로서해당분야에대한높은수준의지식과기술을가지고자율적으로의료기관및지역사회내에서간호대상자 ( 개인, 가족, 지역사회 ) 에게상급수준의전문가적간호를제공하는자를말한다 주요역할 전문가적간호실무제공 (Direct Clinical Practice) 교육과상담 (Coaching and Guidance) 연구 (Research) 리더십 (Clinical and Professional Leadership) 자문및협동 (Consultation and Coordination) 전문간호사의정의및주요역할 ( 대한간호협회,2004)
종양전문간호사직무기술서및직무명세서한국간호교육평가원 유방내분비외과전담간호사직무기술서 DKUH 1~10 Page
Specialist Nursing Roles for the Patient with Metastatic, Recurrent and Intractable Breast Cancer 01 02 03 Direct Clinical Practice Assessment / Triage / Planning Symptom Mx. Medications Wound care Coaching and Guidance Assess distress Discuss Provide counselling Consultation & Coordination MDT
Specialist Nursing Roles 1 Direct Clinical Practice 1. Advanced Assessment / Triage disease symptoms treatment s/e, complications oncology emergencies phone/clinic triage arrange direct to Ward/ICU/ER adm. when required 2. Advanced Planning; conduct diagnostic w/u
Specialist Nursing Roles 1 Direct Clinical Practice 3. Advanced Symptom management oncologic emergencies Hypercalcemia TLC SIADH Metabolic Cardiovascular Malignant Pericardial Effusion SVC syndrome Spinal Cord Compression Brain mets Neurologic Hematologic Hyperviscosity Hyperleukocytosis DIC
Specialist Nursing Roles 1 Direct Clinical Practice 4. Appropriate Medications Prescribing & Ceasing Symptom management Chemotherapy : ECOG PS 3 or Karnofsky 50 Hormone therapy Target therapy 6 th 유방암진료권고안. 재발및전이유방암흐름도. KBCS
Specialist Nursing Roles 1 Direct Clinical Practice Chemotherapy regimens
Specialist Nursing Roles 1 Direct Clinical Practice Kadcyla Faslodex Perjeta Halaven
SNR1 Direct Clinical Practice 5. Wound care The pt's experience Pruritus Guilt self-esteem Bleeding Denial Sexuality Infection Malodor Revulsion Fear Ulceration Exudate Shame Pain Tunneling Social isolation
SNR1 Direct Clinical Practice 5. Wound care The pt's experience Pruritus Guilt self-esteem Bleeding Denial Sexuality Infection Malodor Revulsion Fear Ulceration Exudate Shame Pain Tunneling Social isolation
SNR1 Direct Clinical Practice 5. Wound care 1) Malodor by bacterial infection Debridement removes Metronidazol Powder Gel s/e, nausea, neuropathy, alcohol intolerance
SNR1 Direct Clinical Practice 5. Wound care 1) Malodor
SNR1 Direct Clinical Practice 5. Wound care 2) Exudate absorbent dressings 4 3 Foam Hydrocolloids 1 Hydrofiber 2 Aquacel Ag Calcium alginate SeaSorb filler Ag Allevyn Biatain Medifoam Mepilex
SNR1 Direct Clinical Practice 5. Wound care 3) Bleeding Reduce the risk Sucralfate paste Alginate Spongostan Topical adrenaline Tranexamic acid referral to surgeon
SNR1 Direct Clinical Practice 5. Wound care 4) Pain Moist environment Non-adherent dressings Irrigation with warm saline Foam + Ibuprofen Contact layer : Physiotull, Bactigras, Vaseline Gauze Topical opioids : morphine 1mg + hydrogel 1g
SNR1 Direct Clinical Practice 5. Wound care 5) Skin protection Skin barrier Surgifix #6~ Silicon tapes Surgibra Cotton EB
SNR1 Direct Clinical Practice 5. Wound care 6) New material NPWT Growth factors Antimicrobial dressing Honey dressing
Specialist Nursing Roles / Wound care Case F/62. MBC. Tx. Refuse
Specialist Nursing Roles / Wound care Case Q. To surgeon What will you do? A. Vaseline gauze + gauze + E-B bandage
Specialist Nursing Roles / Wound care Case : by BCN 1. Assessment Malodor Bleeding Exudate Pain Pruritus Necrotic tissue Why?
Specialist Nursing Roles / Wound care Case : by BCN 2. Intervention Malodor : metronidazole powder Bleeding : alginate filler Exudate : foam Pain : contact layer, foam+ibu Pruritus : cleansing, moisture, steroid lotion Necrotic tissue : hydroid gel Skin protection : skin barriers, silicon tape
Specialist Nursing Roles / Wound care How much are these?
Specialist Nursing Roles / Wound care How much are these? 210 23,000 Cost effective, Timesaving, Easy to use, Self care, Private Insurance etc.
Specialist Nursing Roles 2 Coaching & Guidance Assess Pt's Lvs of distress Gendered Discuss Provide counselling practical strategies reassurance advocacy self-management strategies Physical including family, sexuality, grief issues Psychological Information Social Spiritual Provide ongoing individual support
Specialist Nursing Roles 2 Coaching & Guidance
Specialist Nursing Roles 2 Coaching & Guidance in DKUH 초진상담 암환자교육 수술전후 항암화학요법 전화상담 SNS 상담 Anytime, Anything
Specialist Nursing Roles 3 Consultation & Coordination [ MultiDisciplinary Team ] Breast cancer Surgeon Breast Care Nurses Medical oncologist Psychologist 자문제공하기자문의뢰하기 Radiation oncologist Social worker 협동관계구축및유지사례관리하기 Palliative care specialist Dietician Breast Care Nurses other specialist Nurses = Patient Advocacy
Speaker`s Suggestion Nursing in the GOP Close Neighbor, Supporter Patient Advocacy Multi Professional 기관별역할, 명칭다양함 역할규명및직무에대한표준화 지속적인성과연구필요함 유방전문간호사들의긴밀한협력체계구축 전문적, 표준화된교육프로그램의확대 KBCS 간호위원회연수강좌 건강네비게이터양성교육과정