Patient Navigation and Care Coordination: An Integral Part of the Patient Protection and Affordable Care Act

Patient Navigation and Care Coordination

By Carol Cannon, RN, BSN, OCN®

There are so many aspects to the Patient Protection and Affordable Care Act. In fact, it wasn’t too long ago that I learned about the “Patient Protection” part of its very name. I also recently learned that patient navigation is directly referenced in Section 3510, which amends part of the Public Health Service Act to award grants to the Patient Navigator Program. These programs must employ navigators that have minimum core proficiencies as defined by the institution. Additionally, patient navigators are designated in the act to help the public understand their choices related to the healthcare marketplace products and assist them in making the selection that best fits their needs. Some states use the term “in-person assisters,” as patient navigators do much more than just help people understand their insurance coverage.

Patient navigation and care coordination are woven throughout the Patient Protection and Affordable Care Act. Aims of navigation and care coordination—eliminating disparities of medically underserved populations, promoting a patient-centered model of healthcare delivery, eliminating barriers to appropriate, time-sensitive care, and easing transitions of care throughout the fragmented, complex system—are well aligned with the premise of the act.

Navigation is particularly important in the chronic, complex care of patients and families dealing with a diagnosis of cancer. Racial and ethnic minorities and those with low socioeconomic status are more likely to die from cancer than the general population. Patient navigation allows nurses, other professionals, and trained lay people to help patients overcome barriers to care in a culturally sensitive and coordinated approach.

Many of us may not have the title of “oncology nurse navigator,” yet we coordinate care of our patients in our daily professional lives. Others may be formal navigators, in multiple capacities, guiding patients and families through the difficult cancer care trajectory. Clearly, as it is written into our national health law, this role is necessary as people of multiple backgrounds are accessing our healthcare system.

At the ONS 40th Annual Congress, two speakers with very different experiences in patient navigation will talk about the dynamic environment of oncology care coordination in a session called “Care Coordination Throughout the Cancer Trajectory: Improving Communication, Developing Metrics, and Measuring Impact.”

How many of you were aware that this critical role was written into the Patient Protection and Affordable Care Act?

Understand the Psychosocial Challenges of Young Adults With Cancer

ONS Booth Chats_8

By Nonniekaye Shelburne, CRNP, MS, AOCN®, 2014–2015 ONS Congress planning team chair

With 70,000 new cancer diagnoses in young adults each year and more than one million survivors, this patient population is growing rapidly. Young adults with cancer have traditionally fallen between the two worlds of pediatric and adult cancer. They are not children with cancer, yet they aren’t older adults either. They are instead a unique population with developmental tasks and life experiences that differ from those in other life stages.

I had the opportunity to care for a man in his early twenties who was undergoing a hematopoietic stem cell transplant for leukemia. He and his wife had been married for four years and had three children—the youngest only four months old. Understandably, their concerns going into treatment included how to talk to their preschool children about why daddy was in the hospital, how they would maintain their health insurance while the husband wasn’t working during treatment, and how his wife could be a caregiver to her husband as well as three small children. As the patient transitioned to survivorship care, important topics for this family became how to safely integrate the patient back into the workplace, managing fatigue while keeping up with an active family, and redefining intimacy while considering body image changes due to graft-versus-host disease and treatment-related infertility.

The young adult population poses unique challenges and multiple unmet needs, many of them in the psychosocial domain. Nurses are ideally situated to provide psychosocial care to these individuals, their families, and partners.

“Young adults have developmental milestones that must be achieved in order to transition to full adulthood. Cancer causes a biological and psychosocial interruption, leading to many different challenges in daily life and future planning.”— Anne Katz, RN, PhD

Anne Katz, RN, PhD, will provide a session at the ONS 40th Annual Congress titled “Psychosocial Challenges for the Young Adult With Cancer—How Can We Help?” Join us to address these issues and take away tools to use in your work with these individuals, their partners, and families. Follow Katz on Twitter @DrAnneKatz. You can also learn more from Katz in her most recent book, This Should Not Be Happening: Young Adults With Cancer.

What Do Ebola and Hazardous Drugs Have in Common? Safe Handling Procedures

PPE

By Marci Andrejko, BSN, RN, OCN®

In light of the recent Ebola outbreak, there has been a heightened sense of awareness regarding personal protective equipment (PPE). Although contact with Ebola as an oncology nurse would be unusual, contact with hazardous drugs is a frequent occurrence. Despite the increased awareness of safe handling, there is still resistance to its implementation. Without the use of safe handling procedures, nurses are at an increased risk for exposure, leading to serious and potentially life-threatening adverse outcomes.

Resistance is often grounded with reasons. For example, I think back to when I was working on a busy oncology unit. I would always wear the required PPE, double gloves and a closed front gown. However, thinking I was saving the facility money, I would reuse the gown. I thought since I did not spill on it, it must be safe to use again.

My practice changed after an oncology nurse colleague shared her personal story regarding infertility issues, which were possibly caused by exposure to chemotherapy drugs. My heart broke for her. I knew then, I did not want to tell the same story myself. From that day forward, I pledged to protect others and myself from the risks of exposure. Resistance to following safe handling procedures not only puts you at risk, but also your colleagues, patients, and visitors as well.

I am honored to be coordinating a preconference session on safe handling at the ONS 40th Annual Congress, to be held April 23-26 in Orlando, FL. The session will feature experts in safe handling guidelines and first-hand experiences of the implementation of a safe handling program.

Take the time to review your institution’s safe handling procedures and think about how you can decrease the risk of exposure. Do not let reasons for resistance cause undue harm.

ONS Beefs Up Its Social Media Presence for the ONS 40th Annual Congress

Social Media

By Carol Cannon, RN, BSN, OCN®

“Tweet or Die” was the name of a session held during the American College of Surgeon’s annual conference several years ago. Since reading about it, I cannot get that phrase out of my head. It’s a twist on “publish or perish,” a phrase commonly cited by PhD-prepared scholars in the world of academia. These strong words convey the seriousness of the issue. If you aren’t using social media, you aren’t practicing to the best of your abilities. In the wake of the Institute of Medicine’s Future of Nursing’s recommendation to practice to the full extent of your license, I believe wholeheartedly that that includes responsible use of social media.

Social media allows us to connect and create an online community with other nurses and members of the healthcare world. It helps us to stay on top of the massive amounts of new research coming out that will change our clinical practice, and it offers a forum where we can share challenges and propose strategies to meet those challenges.

Some nurses are afraid of social media. Certainly, horrible stories of nurses losing their jobs over posts on Facebook are circulating out there, but these are the exceptions. Social media is not to be feared; it is to be used and embraced, especially by nurses!

I am so excited to be coordinating a session on professional use of social media at the ONS 40th Annual Congress, to be held April 23–26 in Orlando, FL. The session is currently under construction, but it will feature nurses and colleagues who have seen the light and found the exponential benefits that social media can offer one’s professional practice.

A perfect example of social media’s benefits is the way this year’s Congress content planning team will be striving to engage members and attendees. Here are a few things you can expect in the months leading up to Congress.

  • Weekly updates from the team explaining what we’re working on, like coordinating interesting sessions and finding expert speakers
  • Blog posts! The Congress blog is set to launch in December when registration opens. Until then, read about Congress highlights on the ONS Connect blog.
  • Questions for you: Follow ONS on Facebook and Twitter, and help us plan the Congress sessions. We want to know what you want to see and learn at Congress. For starters, what would you like to learn or share about social media in your practice? Any fears? Hesitations? Success stories?

Although we’re more than six months away from Congress, the content planning team is already shoulder-deep in planning. We want to share our excitement with you . . . through social media. So log on and get connected!

All Oncology Nurses, Especially Those New to Oncology, Should Attend Congress

Young Nurses

By Anne Ireland, MSN, RN, AOCN®, CENP

Sometimes I hear nursing colleagues of my generation say that younger nurses are not engaged in their work environments, are not driven to develop new skills, and are not interested in giving to their professional organizations. These conversations make me personally sad and professionally afraid for the future of nursing and the viability of ONS. Being the eternal optimist that I am, I look for exemplars and data that prove this conversation is simply not accurate. I am not disappointed.

I see young nurses (who are often also young parents) advancing their education, presenting at conferences, taking on leadership roles in their local chapters, and engaged in councils and committees at their organizations.

Reviewing the ONS database, 10% of the 2014 ONS Congress attendees last year were younger than 30 years old. More than 38% of attendees had been in nursing for less than five years and 46% had worked in oncology for less than five years. When I compare this to the full ONS membership, this is a representative cohort.

So to all of you who are relatively new to oncology, I extend a special invitation to attend the ONS 40th Annual Congress from April 23–26, 2015, in Orlando, FL. To those of you who are older than 30 and coming again, I look forward to seeing you there and challenge you to bring a young oncology nursing colleague with you.

I recall my first year at Congress, more than 25 years ago now, and feel indebted to the experienced Congress attendee who took it upon herself to help me navigate the multitude of sessions, exhibits, forums, and educational programs.

As you may have heard, ONS moved to a single annual meeting. Our goal is to hold a single meeting that will meet the needs of our entire membership: new nurses, “new to oncology” nurses, frontline nurses, advanced practice nurses, nurse researchers, corporate/industry nurses, and nurse educators. We need your input and invite your active participation in helping us transform our annual meeting into a venue that not only meets but exceeds your expectations.

We invite and welcome your suggestions so we can deliver a meeting that has each of you wanting to attend every year. Please send your ideas to us directly at educationtopics@ons.org.

I hope to see you all in Orlando—young or not-so-young!

Submitting an Abstract for ONS Congress Doesn’t Have to Be Scary

Abstract

photo credit: Express Monorail via photopin cc

By Nonniekaye Shelburne, CRNP, MS, AOCN®, 2014–2015 ONS Congress planning team chair

Let’s challenge ourselves to think outside the box. In the past 18–24 months,

  • Have you been a part of implementing evidence-based practice changes?
  • Have you implemented or modified assessment tools, products, bar coding, alert systems, or algorithms to improve patient outcomes?
  • Have you implemented or modified new staffing models, assignment models or tools, scheduling software, or lunches or break coverage models to support colleagues?
  • Have you implemented or modified new hand-off communication processes, isolation-monitoring guidelines, or signage or posters to support patient care?
  • Have you implemented or modified new patient education tools or classes, assessment forms, patient portals, or social media to support patient access to information and education?
  • Have you implemented or modified orientation plans, online learning for nurses, ways to improve education uptake by nurses on all shifts, or systems or awards to encourage nurses attending conferences or obtaining certification?
  • Has your local ONS chapter implemented a new approach to meetings, educational offerings, use of social media, or processes for restructuring the way you meet the needs of local oncology nurses?

If so, we all want to hear about it. Tell us why and how you made it happen. What were the successes and failures? What do I need to know before trying to do the same in my work environment?

You’ve asked the question of why we practice the way we do, why that policy exists, and what the evidence says. You’ve most likely even helped change the way we practice oncology nursing. Yet when we hear that it’s time to submit abstracts for the ONS 40th Annual Congress, our minds go blank and we can’t think of anything to write. Why is that?

ONS is accepting general abstracts for the ONS 40th Annual Congress from now until October 20 at midnight EST. If you want help preparing your abstract, use the ONS Mentorship Program for Abstract Writers, in which you are partnered with experienced mentors. Contact the ONS Education Department at absquestion@ons.org to learn more or participate.

I wrote my first abstract with a lot of encouragement from my clinical nurse specialist. When she returned her edits on my first draft, there were more changes than original text. But that was a part of the process of learning how to organize my thoughts and get my message clearly stated within a short word limit. But I did it. I learned, and the next abstract I wrote didn’t have as many changes (still plenty, believe me!). Now, I have the pleasure of helping others write abstracts, and once accepted, develop posters and podium sessions.

What words of wisdom do you have for those who are considering writing an abstract or are afraid to do so?