By Rachael Hayes-Brown.
Choosing a career in nursing has been both rewarding and challenging.
I discovered where my interests lay and the type of nursing career I wanted to pursue at the end of my training. I am one of the rare hospital trained nurses who gained experience doing “on the job” training in a variety of speciality areas, and I knew oncology was where I wanted to work. Twenty three years later, I am still working in oncology, as an Oncology Nurse Specialist in the community. With Healthcare at Home, I have a renewed energy for my work having made the transition from hospital-based nursing to nursing in the community.
Changes in treatments, and management and care of the people with cancer have evolved enormously during that time. Improvements in these areas generated from research and key initiatives have enhanced the quality of care that is available for people diagnosed with cancer.
Having worked in the hospital system for most of my career, I have become acutely aware of areas that, in my view, do not adequately meet the needs of the oncology patient, particularly in relation to quality of life and capacity to make choices. As a nurse working in the community giving direct care and cancer treatments to people in their own homes, I am, in a small way, helping to improve their quality of life and enabling them to have choice about where they receive their care.
I feel my job now has purpose, and I am absolutely passionate about my work. I thoroughly enjoy playing a part in providing patient-focused specialist nursing care. This new approach to patient care gives the patient an alternative to hospital-based care, offering them choice at a time when they commonly feel disempowered with few options available to them.
When patients are faced with a diagnosis of “cancer “ and the fear and dread that that entails, the impact is also felt by their loved ones and carers. Dealing with stress and anxiety subsequently becomes a “normal” part of their lives. As a nurse working in the hospital system, I would see patients ‘come and go’ with only enough time to administer their treatments and very little time to sit down and get to know them. Many cancer patients have a great deal going on in their world that, in the hospital setting, I had little time to discover or discuss. As a nurse working in the community, I am compelled by an obligation to ensure I provide the best possible clinical and supportive care that I can deliver. I am sensitive to the fact that each person is unique, and that I need to give individualised care to everyone.
Entering a patient’s home to deliver chemotherapy and other aspects of their treatment in the comfort of a person’s home immediately decreases the patient’s level of anxiety. Patients appear much more relaxed and display a confidence about them, that is rarely seen in the hospital environment. They feel they can cope better with what their treatments involves. They are in the comfort of their own space and surroundings without the added concerns of watching other very sick people struggle to endure their own treatments. They don’t have the stress of having to get into the hospital, finding somewhere to park the car and waiting long periods for their treatments. I have one patient who says he “…feels physically sick as he is approaching the hospital in his car”!
One of the most enjoyable parts of nursing patients in their homes is that I now have time to really get to know patients and their families intimately. I feel privileged to be entrusted to come into the patient’s private world. I have meaningful conversations with them, quickly establishing a rapport that enables them to open up and talk about every aspect of their lives. I get a much better picture of their whole experience of life and with this insight, and can offer help which comprehensively meet their needs. With the additional one-on-one time I have, I can perform thorough assessments and give more complete advice, subsequently improving the quality of care; this provides me with great personal and professional satisfaction. For me, it is paramount to be able to look beyond just administering treatments and better peoples’ lives in some way.
Patients have told me it is very reassuring and comforting knowing that they can have treatments in their own homes, particularly as some patients have great difficulties with transport to and from hospitals, and attending doctors appointments. This is particularly pertinent for many elderly people, and people who are keen to retain a sense of normality in their lives as they endeavour to maintain their working life and family commitments. Having the reassurance that there is someone who knows them well that they can trust and call upon is another positive aspect to the ongoing care given in a home-based service. Continual and prompt communication with the patient’s oncologist and other health professionals is maintained as it would be if they were having hospital-based treatment and care.
My role as an oncology nurse has varied, as I have worked in both public and private health systems, in Oncology/Haematology and Bone Marrow Transplant wards and Day Chemotherapy and Apheresis Units. In my view, although I have gained many clinical skills and the work with cancer patients in hospitals has been both rewarding and satisfying, no single area has been as fulfilling as using my skills and knowledge to care for cancer patients in their home. Healthcare at Home provides an innovative approach to the delivery of cancer care that offers patients a choice when their world has become uncertain, they are rocked by a diagnosis of cancer, and they appear to have few choices.
The warmth with which patients greet me each visit, the ready-made peppermint tea waiting for me to drink while we chat and I distract them from the formalities of why I am there in the first place, is enormously rewarding. I thrive in my role providing excellent clinical care that clearly improves the patient’s quality of life and keeps them so very satisfied with the Healthcare at Home service.
 Transforming choice for early stage HER-positive breast cancer patients: Healthcare at Home UK (2008).
 Wardley et al, (2005) Zoledronic acid significantly improves pain scores and quality of life in breast cancer patients with bone metastases: a randomised, crossover study of community vs. hospital bisphosphonate administration. British Journal of Cancer (2005) 92, 1869–1876.
 Deloitte, Economic analysis of Hospital in the Home (HITH), Hospital in the Home Society of Australasia, (2011).
 Evaluation of the Healthcare at Home Scheme within the NHSSB area: February 2001 – March 2002. Northern Ireland Health and Social Services Board (2002).
 Twelve Month Evaluation Report of a Privately Insured Cohort Healthcare at Home Australia (HaH)