September 2011 VOL 2, NO 5

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AONN 2011 Second Annual Meeting Coverage

A Professional Model for Practice: Kolcaba’s Comfort Theory and the Breast Health Nurse Navigator

Sharon Lieb Inzetta, RN, MS 

Background: Currently there is no standard definition for a patient navigator. Defining a breast health nurse navigator (BHNN) and adopting a theoretical framework1 and model development to guide professional practice has been a collaborative project for our Mount Carmel Women’s Health Centers (East and West in Columbus, St. Ann’s in Westerville, Ohio). Increasing staff and community awareness for the BHNN has become vital as the shift in the paradigm of care moves toward survivorship care planning. We have been able to provide breast healthcare across an ongoing lifetime continuum for our patients, beginning with an abnormal mammogram, breast biopsy, pre- and postoperative education followed by support, and community programs throughout our patient’s ongoing survivorship. The role of BHNN is professional and specialized, functioning as part of a multidisciplinary team. The BHNN uses a holistic, collaborative, and communicative approach to identify the patient’s comfort needs. The BHNN develops and implements individualized comfort interventions, coordinating breast care by enhancing patient comfort. Enhanced comfort strengthens the patient’s health-seeking behaviors. Increased health-seeking behaviors result in improved patient and nurse satisfaction. As a result of this increased patient satisfaction, patients return to this “comfortable” safe place, entrusting the BHNN and the healthcare system for their follow-up, preventive, and ongoing survivorship care. The BHNN is an ideal example of the move to redefine nursing as a profession rather than a job. As we continue to work toward shared governance and magnet readiness, defining nursing roles and adopting individual professional practice models for each nursing specialty area is essential. The BHNN role at Mount Carmel has existed for more than 20 years, yet the role has continued to grow and change to meet our patients’ needs. The BHNN functions as a member of an interdisciplinary team involved in providing evidence-based care for our breast cancer patients. The Women’s Health Centers have shifted care delivery from site-specific to across-the-system, helping to assure continuity of care across all 3 hospital sites. As staff is shifted based on patient volumes, our care delivery is facilitated with scheduling patients in the most efficient and timely manner, keeping patients in the Mount Carmel system and ensuring customer satisfaction.

Objectives: (1) Define the BHNN role. (2) Differentiate the 4 types of patient comfort and possible outcomes with comfort care delivery. (3) Discuss “Gift of Grace” Comfort Bear Program.

Methods: (1) Collaboration and shared decision-making between clinical leader, Pam Mascari, RN, NP, and BHNNs tocoordinate, clarify, and define the role of BHNN. Developed professional practice model for care, grounded in Kolcaba’s Comfort Theory. Goals attained for targeting best practice and same standard-of-care delivery across all sites. (2) Shift in care delivery from site-specific to system definition of BHNN, which helps to assure continuity of care across all 3 hospital sites. As staff is shifted based on patient volumes, our care delivery is facilitated with scheduling patients in the most efficient and timely manner, keeping patients in the Mount Carmel system and ensuring customer satisfaction. (3) BHNN collaborated with the Mount Carmel Hospital Foundation and Susan G. Komen for the Cure—Columbus developing grant-sponsored programs to meet the needs of our breast cancer survivors. (4) Initiated “The Gift of Grace” Comfort Bear Program, with funding awarded through application to the Mount Carmel Foundation.

Results: (1) Developed BHNN model to guide professional practice. (2) BHNN participated in community-wide survivorship planning committee, Komen Medical/Survivorship Advisory Councils. (3) The aquatic program, lymphedema arm classes/clinics, breast cancer exercise classes and gentle yoga have all received grantee awards for the 2011/2012 grant cycles. (4) “The Gift of Grace” Comfort Bear Program funding has shifted to be self-sustaining through patient, family, and community support.

Conclusions: The BHNN model uses Kolcaba’s Comfort Theory to guide nursing interventions that identify patients’ physical, psychosocial, sociocultural, and environmental comfort needs. Meeting our patients’ comfort needs has resulted in improved overall patient and healthcare provider satisfaction, thereby improving overall intuitional integrity. Our customer satisfaction scores have been mea sured in the upper 90th percentile consistently over the past 5 years. We have used our “The Gift of Grace” Comfort Bear Program to foster an environment of security and comfort. Reference: 1. Kolcaba K. Comfort Theory and Practice: A Vision for Holistic Health Care and Research. New York, NY: Springer Publishing; 2002.

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