Empowerment And Teamwork


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Empowerment And Teamwork

  1. 1. Empowerment and Team Work: a complex symptoms management care model Anne Plante, M.Sc.inf. CSIO, CSISP Centre intégré de lutte contre le cancer de la Montérégie Vancouver AstraZeneca Septembre 2004
  2. 2. Regional Cancer Centre (Monteregie) Réseau Cancer Montérégie Hôpital Hôpital Hôpital Charles Charles Hôpital Hôtel- Hôtel- Brome- LeMoyne LeMoyne Brome- Dieu de Dieu de Missisquoi- Missisquoi- Sorel Perkins Sorel Perkins Hôpital Hôpital Centre Centre du Haut- du Haut- Hospitalier Hospitalier Richelieu Richelieu Pierre- Pierre- Boucher Boucher Centre Centre Centre Centre Hospitalier 19 local Hospitalier Hospitalier Hospitalier Régional Régional community de Granby de Granby du Suroît du Suroît centers Centre Centre Réseau Réseau Hospitalier Hospitalier Santé Santé Anna- Anna- Richelieu- Richelieu- Laberge Laberge Yamaska Yamaska
  3. 3. 1995- Task force committee on Cancer Care 1998- Quebec strategy for cancer Care (P.Q.L.C.) 2000- The philosophy of Monteregie Comprehensive Cancer Care Center (CICM) 2001- 9 hospitals /12 nurse navigators
  4. 4. 2002- Regional committees: Head nurses Psychosocial workers (social workers, psychologists) Oncologists Surgeons Pharmacists Nutritionists Physiotherapists Volunteers 2002- Regional oncology training program Evidence based practice Interdisciplinary team work Health promotion : the patient as « Captain of the boat »
  5. 5. P.Q.L.C.’s objectives ↑ prevention ↑ early detection ↑ quality of life ↑ quality of care and support ↑ patient satisfaction ↑ patient breathing space and adaptation ↑ professional satisfaction ↑ team stability ↑ everyone potential and resources ↑ flexibility
  6. 6. Flying 101 – Team Work 101
  7. 7. Model of care: Complex symptom management Diagnosis Oncologist referral to nurse navigator Nurse navitator meets with the patient and his family Assessment Teaching Support Empowerment Referrals (related to Related to practice complex limits) symptoms
  8. 8. Model of care: Complex symptom management Nurse navigator presents the complex cases at the interdisciplinary weekly meeting Specific care plan is designed for every patient and family (team coherence and continuity) (unity of action) Every professional is responsible for his/her assessment, teaching, support, referrals, work analysis process: Symptoms → Hypothesis → Interventions The patient is « The captain of the boat » with his resources and strengths
  9. 9. Flying 102 - Team Work 102
  10. 10. Care plans and speciality referral criteria Criteria are developed for referral to: Nurse navigator Pain management nurse specialist Oncologist Pharmacist Psychologist Social worker Pastoral worker Physiotherapist Nutritionist Psychiatrist Occupational therapist
  11. 11. Symptom assessment Patients are asked to complete their ESAS (self- management) Patients are invited to prepare their interview with the oncologist with the help of a check list The oncology clinic nurse discusses the symptoms with every patient (Q.O.L.) He/she makes the appropriate interventions He/she may consult a colleague Work analysis process: - Symptoms - Hypothesis - Interventions If the symptom is complex, a referral is made with a specific description of the request
  12. 12. Patient, family centered care Team-Building care strategies Family systems nursing approach Nurse navigator’s major role Reflective practice Symptom Hypothesis Interventions
  13. 13. Flying 103 - Team Work 103
  14. 14. CICM CLINIQUE D'HÉMATO-ONCOLOGIE Hôpital Charles-Lemoyne Report ESAS Auto-évaluation des symptômes Système pour l'évaluation des symptômes (ESAS) Symptom Assessment system scale Mettre une barre ci-dessous à l'endroit qui correspond à ce que vous ressentez actuellement Please make mark that best describe how you are feeling 0 10 Pas de douleur/ Douleur maximale/ no pain Worst possible pain 0 10 Pas de fatigue/ fatigue extrême/ Not tired Worst possible tiredness 0 10 Pas de nausées/ nausées maximales/ Not nauseated worst possible nausea 0 10 Pas de dépression/ Dépression extrême/ Not depressed Worst possible depression 0 10 Pas d'anxiété/ Anxiété maximale/ Not anxious Worst possible anxiety 0 10 Pas de somnolence/ Somnolence extrême/ Not drowsy Worst possible drowsiness 0 10 Excellent appétit/ Pas du tout d'appétit/ Excellent appetite/ Worst possible appetite 0 10 Bien-être parfait/ Mal-être le pire possible/ Perfect feeling of well-being Worst feeling of well-being 0 10 Respiration normale/ Essoufflement maximal/ Not short of breath Worst possible shortness 0 10 Autres problèmes/ Others problems ESAS- Système d'Edmonton pour l'évaluation des symptômes, Rev. 2/11/99
  15. 15. CICM CLINIQUE D'HÉMATO- ONCOLOGIE Hôpital Charles-Lemoyne (Plotting to identify patterns) Graphic report Système pour l'évaluation des symptômes (ESAS) Symptom Assessment system scale date 10 Douleur 8 (Pain) 6 4 2 0 10 Fatigue 8 (Fatigue) 6 4 2 0 10 Nausées 8 (Nausea) 6 4 2 0 10 Dépression 8 (Depression) 6 4 2 0 10 Anxiété 8 (Anxiety) 6 4 2 0 10 Somnolence 8 (Sleepiness- 6 drowsiness) 4 2 0 10 Appétit 8 (Appetite) 6 4 2 0 10 Bien-être 8 (Well being) 6 4 2 0
  16. 16. Patients and families are supported to use their own resources and strengths Teaching sessions are offered: Cancer and nutrition Cancer and sexuality Cancer and family Cancer and young children Cancer and spirituality Cancer and pain Cancer and fatigue Cancer and hope Cancer and emotion
  17. 17. Patients and families are supported to use their own resources and strengths Complementary and alternative medicines are offered: Therapeutic group support Art therapy Mental imagery Hypnosis Metastatic group support Nadeau technique
  18. 18. Model of care: Complex symptom management Results Planning for safe discharge Discharge from the unit Clinic treatment ↑ patient satisfaction ↑ doctor satisfaction ↑ professional satisfaction Community nurses and psychosocial workers ↓ staff absenteeism (continuity of care) ↑ patient autonomy and adaptation ↑ administrator support Evidence based practice for all disciplines
  19. 19. Flying 104 - Team Work 104
  20. 20. Conclusion A well-defined philosophy Educational Support A new Captain: the Patient A better attitude: everyone is responsible for simple symptoms The overwhelming role of the nurse navigator A better continuity and cooperation
  21. 21. Flying 105 – Team Work 105
  22. 22. Nurse navigators in Monteregie Rachel Mélanie Blandine Sonia Rémillard Fortier Danis Sylvie Joanette CHAL CHG BMP Cartier Lucie HCLM CHPB Louise Laporte Leduc Line CHRS Louise HCLM Roberge Raymond RSRY HHR
  23. 23. Recognition award from Ministry of health of Quebec « Prix Mérites C.Q.L.C. »