The Head-and-Neck Clinical Nurse Specialist (CNS) Team at the Southern Health and Social Care Trust (SHSCT) is made up of Catherine English and Kate McGinn, who both specialise as key workers for patients with a head-and-neck or thyroid cancer diagnosis.
Head-and-neck cancer can impose many challenges for the patient and support throughout their cancer journey is paramount to their overall recovery and survival. Occasionally patients will require an altered airway, such as a tracheostomy or laryngectomy, either temporarily or permanently, and the team has worked tirelessly to enhance this service to provide better support and care for patients and staff by engaging with a range of stakeholders.
At the centre of care has been the ongoing communication and engagement with patients, which has helped to shape the delivery of the service. The nurses carry mobile phones Monday to Friday so they can address patients' problems at an early stage. Timely and early support is a lifeline for these patients and can help to avoid emergency department (ED) admission.
Feedback from patients and staff has ensured ongoing airway training and education for patients and their family members and for staff in secondary and community sectors. The setting up of a steering group with representation from community teams has ensured the appropriate sharing of information and support for new patients.
The team also acts as a community liaison service. The steering group is now fully established and has enabled better integration of support for patients moving from secondary to community care. Community staff know who to contact with any queries or issues and the group has enabled better communication between teams as well as acting as a support network.
‘At the centre of care has been the ongoing communication and engagement with patients, which has helped to shape the delivery of the service’
The service is provided across two hospital sites within the Trust.
The team carries out various nurse-led clinics. One of these is to see laryngectomy patients for valve changes or if they are experiencing difficulties with their airway or equipment at home. The team also runs nurse-led holistic needs assessments clinics to ensure their patients' individual needs are identified and met.
The impact of the Head-and-Neck CNS Team service has been demonstrated by:
- A reduction in the number of ED admissions
- A reduction in bed days
- Support provided to ward staff.
Tracheostomy and laryngectomy patients can contact the Head-and-Neck CNS Team and can be seen when needed. This avoids patients having to visit the ED and will free up space in the consultant's clinic for ‘red flag’ patients. Patients have advised that having a dedicated contact has been a lifeline.
Support is available for pre-operative patients to prepare them for surgery and to ensure they are ready to return home afterwards. The Head-and-Neck CNS Team advises on clinical and practical issues and enable multidisciplinary care and communication between the teams involved.
Training for staff across the different settings is continuous. The team has developed excellent working relationships with the ENT medical team and also embedded the key worker role for all patients by ensuring appropriate information and support is available.
Team members continue to learn and expand their skills and are currently becoming accomplished in the surveillance of post-treatment patients using flexible nasoendoscopy.
Team members have shared their success and learning by:
- Using the Trust's social media platforms to promote the range of support and services provided by the team
- Rolling out staff training across primary, community and secondary sectors
- Uploading all the policies and pathways developed on the Trust intranet and SharePoint site
- Participating and presenting at the regional Head-and-Neck Conference
- Hosting the main supplier of airways equipment for patients and helping them run 3 days of lunchtime teaching sessions for all staff
- Raising awareness of World Head-and-Neck Day each year
- Providing proof of financial benefits for the Trust
- Being invited to speak at the Clinical Education Centre in relation to the role of the Head-and-Neck CNS
- Receiving positive feedback from patient satisfaction surveys.
The team has developed close working relationships with patients and with staff right across the Trust and regionally. Team members continue to progress and develop in order to deliver an outstanding contribution to the quality of the service provided for patients with head-and-neck cancer.