At Baptist Memorial Hospital-Memphis, nurses man a 19-bed surgical oncology unit, taking care of a full range of surgical oncology patients “who have had complex surgery, for example, Whipple procedures, colon procedures, advanced gynecologic, ovarian debulking, as well as some of the newer procedures, which are the robotic hysterectomies and robotic prostatectomies,” says Betsy Brooks, manager of the surgical oncology unit.
Opened in 2000, the surgical oncology unit joined the medical and myelosuppression units already onsite at the Tennessee hospital. From postoperative care to discharge, these registered nurses and patient care assistants care for all of their patients’ needs. “It starts out with the drains, the dressings, the clinical interventions, and along with those things we are educating patients, preparing them for discharge, and keeping their families informed,” Brooks, who is a founding member of the unit, tells The Oncology Nurse- APN/PA.
Caring for surgical oncology patients requires the nurses to have what amounts to 2 specialties, says Patricia Davidson, head nurse of the unit: “I consider oncology a specialty and surgery a specialty.” This level of professionalism necessitates a knowledgeable and experienced staff who “have more information about what these types of patients need,” explains Brooks. Surgical oncology patients may receive chemotherapy or go for radiation therapy from the unit. In addition, many patients, because of the complexity of their surgery, experience multiple medical issues that require nurse follow-up. “Many people require TPN [total parenteral nutrition] and a lot of management of their glucose levels. Many of our patients also have a lot of comorbidities so they are at a higher risk,” says Brooks.
For this reason, “the doctors tend to want to send their patients to an area where the nurses are used to taking care of these types of illness,” Davidson shares. “The same doctors request our unit because they know the continuity of care is here; they know we are used to taking care of their patients, we understand the surgical part of it and we understand the oncology part of it.” And this dedication to both specialties is welcomed by patients. “I think patients sense that we are knowledgeable in both areas, and we are here to get them through this dire time in their life. Usually they get a bad diagnosis, and in my opinion we handle it very well and are able to help the patients through it,” says Davidson, a surgical nurse who went on to become oncology-certified because of her love of the specialty and desire to give her patients “the best that I have.”
Teamwork
“We have a great group of people to work with. They are all very well educated and very caring. Teamwork is a must; we don’t accept anything less. The doctors and the patients see that and they do appreciate that,” Davidson explains. This means that along with hands-on nursing interventions, the unit’s staff provides patients a full continuum of care. “In the oncology world, some of our patients get a diagnosis where they have to get beyond the major surgery but they also have to deal with other issues postoperatively— follow-up care, chemotherapy, those types of things—or just getting well from the major surgery, which takes them a little bit longer. So our team has social workers and our patients have a case manager, who is in and out of everybody’s room every day, helping them to plan for home IVs, home antibiotics, catheter placement, and those types of things,” explains Brooks.
“We try to meet everyone within 24 hours of getting on the unit, just to introduce ourselves initially,” says Kathy Ketchum, a case manager with the surgical oncology unit. “Then we look at how they functioned prior to hospitalization and prior to surgery. Next, we start looking at where they are planning to be on discharge.” In a population consisting of elderly and fragile patients, often with comorbid chronic conditions, many require help with placement after discharge. “We try to begin [getting everything ready] initially, so when the patient is ready for discharge, we are prepared also. If we know they are going home and they are young enough to learn how to give their own TPN or IV antibiotics, we start that process, verifying their benefits for home coverage and teaching the family members who are going to be with them how to flush lines, how to do dressing and drain changes. We try to start that early, so that we don’t lengthen their stay for teaching at the very end.”
The nursing staff also participates in bedside rounds, including the families in the bedside report, plus discharge callbacks, says Brooks. And the unit also helps out when needed. “We are adjacent to the myelosuppression unit, and we do take some overflow of those patients who are not neutropenic. They might have a leukemia or an issue with their cancer, so sometimes we have that overflow,” Brooks explains.
Patient Success
All this work has its rewards for the surgical oncology team. Patients often return to express their appreciation. “They come back to us, you don’t even recognize them because they look so different, thanking us, bringing us gifts, just thanking us for really making a difference in their life at that time and that means so much to us,” shares Davidson. And for patients who require additional surgical interventions, “they do come back sometimes for additional surgery or maybe they get dehydrated and they want to come back to the surgical area because they feel comfortable with our care on this area,” Brooks explains.
To sign up for our newsletter or print publications, please enter your contact information below.
