The Essential Roles and Responsibilities of the Upper Gastro Intestinal Clinical Nurse Specialist - Essay Example

 Introduction The upper gastrointestinal cancers refer collectively to the cancers of the esophagus, stomach, and pancreas. It accounts to approximately 13.5% of all cancer deaths. Most patients of upper gastrointestinal system cancer are able to maintain life for just few months after the diagnosis has been made. Its management is essential for provision of health care services meeting patient satisfaction. A large number of research studies have brought to knowledge that treatment of upper gastrointestinal system cancer patients in hospitals managing a large number of these patients provides better services. The NHS Plan (2001) has put forth the need to develop better health care services which are more convenient for the patient and provide better quality of life. It focuses on cancer services in preference and believes improvement in this sector as crucial. Emphasis has been given on prevention of cancer, on research, and on improvement in the quality of services. The Cancer Plan has now chalked out the important steps that should be undertaken to set to practice the decided improvement. The Cancer Plan puts forth the benefit of increased investment in staff. It dictates that an increase in investment shall result in an increase in the facilities that can meet the existent shortages in the important specialties. This shall also help in the expansion of services. The Cancer Plan also brings to knowledge the manner in which wise investment in the new, updated, important equipments shall result in faster access to diagnosis and treatment. The Plan points out the need of reform as an essential result of investment. This reform shall take place by implementing new and better ways of working. This shall streamline cancer services according to the needs of the patient. And this shall gain possibility by adding more potential to the responsibilities of radiographers, nurses and other staff. There shall be a prominent need to provide guidance so as to ensure the practice of high standard of treatment and care. The Cancer Plan is a document of practical application for the NHS and its partners, setting out the actions with an aim to provide the fastest improvement in cancer services anywhere in Europe over the next five years. The Cancer Plan aims to increase this survival rate to the highest in Europe. The Cancer Plan had been supported by new funding, rising to an extra £570 million a year for cancer services by 2003/04. It has been expected that by 2006 there will be some 1,000 extra cancer specialists, more radiographers, more nurses, and focused steps to meet the shortages of other staff who contribute to cancer diagnosis and treatment. The plan in partnership with voluntary organizations, with the New Opportunities Fund, and others, shall work with an aim to increase the variety and accessibility of cancer services. It has been found that family doctors and community nurses play an important role in enabling people reduce the risks of cancer, in promoting early detection and fast referral for investigation and also as and when essential providing support for patients and relatives. This support imparted to the patients living and dying with the painful cancer disease is a crucial element of the Clinical Nurse Specialist in the upper gastrointestinal cancer. The plan considers it essential to provide important training and knowledge to the specialist nurses in the area of cancer care. In an attempt to tackle inequalities in access to health care services, the primary care teams i.e. GPs, health visitors and practice nurses play an important role. They help ensure that the patients receive the required guidance on screening and lifestyle and access to cancer services where required through immediate referral to the hospital. They also address the people from minority ethnic groups and people with learning disabilities and those having specific requirements including culturally sensitive information. Important roles and responsibilities of the upper gastrointestinal Clinical Nurse Specialist Important work is being done by the cancer services collaborative improvement partnership (CSCIP) to redesign services, reduce waiting times and increase the quality of life of the cancer patients and their relatives. The NHS Cancer Plan puts forth the idea that the new investments in health care professionals and equipments needs to be accompanied with a better organization of the health care services. The area of focus of the CSC IP has been on supporting the health care professionals who can work to check the manner of delivery of care and add to the improvement of the health-care system. The management of patients with upper gastrointestinal cancer is challenging. A good management results by the joint efforts of health care professionals belonging to different specialties. The changes in the delivery of care of upper gastrointestinal cancer patients have been activated by the publication of the Improving Outcomes Guidance. The clinical teams by their constructive efforts have implemented more than 50 improvements in the upper gastrointestinal cancer care. The upper gastrointestinal service guide assimilates many different and important areas of good practice and some efficient tools that can add to the efficiency of the health-care professionals. These practice directions and tools help provide better quality of life to the cancer patients. Thus, important and dedicated work has been done and is being done with an aim to improve the quality of healthcare services to the upper gastrointestinal cancer patients. The essential focus of the NHS modernization agency and the CSC IP is on the improvement in the manner of providing health care services to the cancer patients. Its goal is to help improve the experience and out comes of the patients diagnosed with cancer. It considers the need of optimization of the health care delivery system as an essential necessity for delivering better care. The CSC IP holds the aim to provide certainty and choice for patients by pre-planning and pre-scheduling care at times that meet patient's convenience and thereby reducing unnecessary delays and restrictions on access of healthcare services first to the CSC IP also aims to improve the expedients of both the patient and his relative by ensuring that the best possible care is being provided to the patient. As per the guidelines of the NHS and other important health imparting services to the cancer patients, the role of Clinical Nurse Specialist is crucial and complex. It is important to address the needs of the patient with the greatest possible ability and maturity. Also, it is equally essential to coordinate and communicate on important aspects to the important health care professionals involved in delivering optimum service to the cancer patients and their relatives. Co-ordination not only helps present the problems faced but also helps in the implementation of better service to the patients in need. It is essential for the Clinical Nurse Specialist to be available for at least five days per week. Development, maintenance and following of a proforma to co-ordinate the tertiary referral system are also essential. This helps in the Confirmation of all supporting information and diagnostic tests. It is essential that system flow guide for all team members should be developed. All people being involved in the new referral staging protocols should know their role and who to contact, what information to include and when to act. This is inclusive of the Clinical Nurse Specialist team. It is also essential to form a multi-disciplinary team and have team meetings on regular basis so as to discus the needs of the patient. For the primary care of the patients the dietary information packs are provided for the ward by the nutrition department. The nurse linked to nutrition is required to ensure that patients receive all essential information during their inpatient stay. A patient diary should be developed with an aim to offer patients equity of information. Also, multiple free text feed back slips should be included within the maintained diary so as to provide patients with a way to make comments at any time. Some important findings have found that upper gastrointestinal nurse specialists wasted clinic-time tracking down histology results. This can be saved by making the availability of the histology results online. This can help reduce the time required for the patient to wait for the dietician. Other important roles and responsibilities of the upper gastrointestinal Clinical Nurse Specialist It has been recommended by a recent UK report that upper gastrointestinal cancer patients are required to be managed by a specialist team (NHS, 2001). The Clinical Nurse Specialist can perform the most essential role in such specialist teams. Their responsibilities should confine not only to investigative and nursing care but should also encompass continuity of support and education to patients and their family members (National Cancer Alliance, 1996). It is essential to define the roles of nursing in cancer. This helps to address the shortages in nursing as they have an essential impact on the delivery of cancer care. Oncology nurses have a major role to play in the delivery of optimum cancer care. Oncology nursing, when adequately defined and supported, can benefit the cancer delivery system, patients, and families. It was seen that a primary nursing model is of significant importance in the delivery of optimum cancer care. Primary nursing as a health care service enhances continuity of care, coordination of a patient's care plan, and a standard ongoing relationship with the patient and his relatives. On delivery of primary nursing in collaboration of a nurse-physician team, it sets conditions for the appropriate use of medical resources. The well defined and designed roles enable in the better management of the patients within their scope of practice in collaboration with physicians. An enactment of other nursing roles, such as nurse practitioners and advanced practice nurses, also promotes the ability to the health care system to manage a large number of patients with more complex needs. Thus, the patients of upper gastrointestinal cancer are in need of care which is complex and requires as a rule of thumb the essential coordination between the healthcare professionals. It is therefore essential for the Clinical Nurse Specialist to work with utmost coordination so as to ensure better quality of service to the patients and their relatives. It can be beneficial if the appointment of the surgical oncologist, radiation oncologist, medical oncologist and Clinical Nurse Specialist nurse is made feasible at the same place and on the same day. Each clinic should ideally begin with a planning session attended by the clinic physicians and Clinical Nurse Specialist nurses, radiologists, pathologists and research nurses. The nurses act as an essential coordinator so as to manage the visits of the patient and thereby serve as an essential navigator. The Clinical Nurse Specialist nurses keeps in check and progress the diagnosis and treatment of the patient. The upper gastrointestinal cancer patients benefit by the support of the Clinical Nurse Specialist nurses and with the well-planned healthcare services. Thus, from the above presented information we may state that the primary role of the Clinical Nurse Specialist is to provide advice and support to patients with upper gastrointestinal cancers. The Clinical Nurse Specialist is required to work in close proximity with the other health care professionals including the gastroenterologists, surgeons, oncologists and radiologists. Thus, an assurance of a smooth platform for comfortable journey from diagnosis to care and cure for both the patient and his relatives are provided by the Clinical Nurse Specialist. Also, the provision of ongoing support to the patients and their relatives with GPs, District Nurses and the Hospice Team is an essential role of Clinical Nurse Specialist. The second essential part of the role of Clinical Nurse Specialist is to provide guidance and support to the patients presented with inflammatory bowel disease. The work also encompasses the responsibility of providing professional advice about treatments to patients with worsening health conditions. Further Emphasizing the Role of Clinical Nurse Specialist- Reference to Colorectal Cancer Clinical Nurse Specialist can help assure a better quality of care for upper gastrointestinal cancer patients (Melville, 2001). The important nurse specialists working for the management of colorectal cancer patients include the colorectal nurse specialist, the stoma therapist and the chemotherapy nurse specialist (Campbell T, 1999). The Clinical Nurse Specialist is required to integrate management, consultation, research and education functions along with the clinical role. The Clinical Nurse Specialist provides guidance and essential education to the patient and his family members. The guidance showered helps in the better survival of the patients after diagnosis of cancer. It is therefore essential for the Clinical Nurse Specialist to understand the colorectal cancer (Nattress, 1999). The role of the Clinical Nurse Specialist in the follow up of patients after colorectal cancer surgery may be intensive or minimal. (Fitzgerald-Smith, 2003). It can be considered as an essential role of Clinical Nurse Specialist to document and maintain patient support and audit. Clinical nurse specialists also play a crucial role in palliative care of upper gastrointestinal cancer patients (Skilbeck, 2002). Randomized controlled clinical trial reports that in an attempt to improve the effectiveness of screening for colorectal cancer it is an essential need to involve nurse clinicians (Cargill, 1991). An increase in the administrative and clinical responsibilities may many a times necessitate the need of an additional clinical expert to have the availability for the management of the acute care private practice patients. Thus, a Clinical Nurse Specialist while working for both the departments of medicine and nursing may be required to meet the primary responsibilities within the ambulatory care area. The additional responsibility does really leave a place and scope for increased benefits at both personal and professional level (Sawyers, 1993). The genetic family history assessment is an essential component for intelligent and competent gastroenterology nursing practice (Dudley-Brown, 2004). The genetic factors have been proved to be influential factors of risk for disease and the complete health of the patient. A systematic collection and documentation of the family history information is a crucial role of Clinical Nurse Specialist. This helps exposure to genetics as an additional means of diagnosis and evaluating the susceptibility to upper gastro intestinal cancer. The Clinical Nurse Specialist also plays an important role in chemotherapy. The role of chemotherapy in treatment and the need of Clinical Nurse Specialist in substantiating this role is outstanding (Wright, 2003). Clinical Nurse Specialist also provides pertinent advice and essential knowledge for administration of chemotherapy to the patients and if required even to the family members of the patient. Important relevant findings and reviews Several important research papers have discussed about the upper gastrointestinal cancer and have emphasized the role of nurse in its prevention, management and treatment (Sideranko, 1993; Held, 1992; Bourbonniere, 2004; Mackenzie, 2004). Gregoire (1998) and colleagues in the paper “Esophageal cancer: multisystem nursing management” have presented esophageal cancer as a challenging disease with a multisystem impact on patients. The critical care nurses, case managers, and advanced practice nurses hold the high responsibility of management of the patients through an aggressive preoperative diagnostic phase, surgical intervention, and postoperative course. The coordination of health care services finds it essential to collaborate with critical care and advanced practice nurses. The need of the patients is of close post-operative assessments and interventions so as to reduce the occurrence of complications. The importance, significance and need of Nursing Specialist have been put forth to the scientific world in the review written by Quinn (1999) and experts. They wrote on the various treatment approaches, complications, and nursing management of patients with esophageal cancer. The data sources of the review comprised of review articles, staging manual, textbook chapters, and research studies. From the literature collected, studied and reviewed it was finally concluded that the diagnosis and treatment of esophageal cancer is a complicated process. And that combined multimodal therapy with chemotherapy, radiotherapy, and surgery shows better quality results. However, it should also be considered that each and every treatment remedy breathes its own complications and adverse effects that need to be managed. The implications set for nursing care were that it is complicated and holds a prominent need of coordination of different health care support services, patient and family education, clinical assessment, nutritional management, management of side effects, and palliative care. Management of Constipation in Patients of upper gastrointestinal cancer Constipation can be defined as a decrease or difficult in evacuation of the feces which is associated with both functional and organic causes. The problem holds its prominent presence in a large number of hospitalized patients and therefore needs essential addressing and management. The essentials for the management, treatment and prevention of constipation consider mainly the use of laxatives. A list of important laxatives that can find their place in the management and treatment of constipation in the upper gastrointestinal cancer patients have been listed in Table 1. Table1. The important laxatives and their essential mode of action in the human body Type of laxative Mechanism of action Bulk laxative Example - Psyllium seed, Bran It results in increases in the fecal bulk and the fluid retained in the bowel lumen. Emollients and stool softeners Example- Dioctyl sodium, Calcium sulfosuccinate It helps in the lubrication and softening of the fecal mass. Stimulants and irritants Example- Bisacodyl, Senna, Cascara Sodium bicarbonate plus potassium bitartrate It results in the alteration of the intestinal mucosal permeability and stimulates the activity of the muscle and fluid secretions Osmotic laxative Example- Ricinoleic acid, Lactulose, Magnesium salts, Sodium salts, Sorbitol These salts help to retain fluid in the bowel lumen, with a total increase of fluid secretions in the small intestines. Enema Example -Tap water, Saline, Sodium phosphate, Oil It helps in constipation relief by causing reflex evacuation. Nonabsorbable solutions Example -Polyethylene glycol It helps in the increase in the volume of the feces and thereby cause bowel evacuation Conclusions It is essential to address the important need of the gastrointestinal cancer patients with fastest possible speed and the greatest possible efficiency. Training, coaching and guidance to the Clinical Nurse Specialist have been made available for doing so. The NHS and other supportive teams have positively added to the required efficiency of the Clinical Nurse Specialist dealing with cancer patients of the upper gastro intestinal cancers. The education or knowledge imparted to patients and their relatives helps them focus more on their need and thereby achieve better care for themselves from the available facilities. The coordination and essential communication with the health care staff delivering service to the upper gastrointestinal cancer patients is also essential. It is all the more important since the diagnosis and treatment procedure of the upper gastrointestinal cancer is complex and demands the efforts of medical professionals of different specialties. A link between what is being done by who in the medical circle so as to impart care to the patient has to be established. It is essential to consider that the Clinical Nurse Specialist plays a central role in such communications. Realizing the benefit imparted by the Clinical Nurse Specialist in the care delivered to cancer patients the Cancer Plan has stressed on an increase in the investment in the nurse staff. The increase in the need of quality education to the Clinical Nurse Specialist certainly adds to the efficiency of the health care service as a whole. References Bourbonniere, M and Kagan, S. (2004) Nursing intervention and older adults who have cancer: specific science and evidence based practice. Nurs Clin North Am, 39(3), p.529-43. Campbell, T and Borwell, B. (1999) Colorectal cancer. Part 4: Specialist nurse roles. Prof Nurse,15(3) p.197-200. Cargill, V., Conti, M., Neuhauser, D and McClish, D. (1991) Improving the effectiveness of screening for colorectal cancer by involving nurse clinicians. Med Care, Dudley-Brown, S. (2004) The genetic family history assessment in gastroenterology nursing practice. Gastroenterol Nurs, 27(3), p.107-10.29(1), p.1-5. 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