Page 6 - Healthcare News Nov/Dec 2022

OPINION
o, I am not Nurse Ratched from One Flew over the Cuckoo’s Nest.
Yes, I have worked 20 years as a nurse and a tech in the field of behavioral
healthcare and now orient others to the role of nursing on inpatient units for individuals with mental illness.
Breast-cancer Treatment and De-escalation Iof Care
By Dr. HOLLY MASON
t was not all that long ago when all breast-cancer patients received a radical mastec- tomy no matter what the size of the cancer, the belief being that more surgery was better. For nearly 100 years, the radical mastectomy was the standard of care for
breast cancer, and many women were left disfigured from this procedure.
Back in the 1970s and 1980s, however, new research showed that such aggressive
surgery was not absolutely necessary. Those researchers were met with doubt and rebuke, but fortunately breast conservation (or breast preservation) came into the realm of ac- ceptable treatment for breast cancer — because the research showed that it was indeed safe.
We then saw research that showed that women did not need all of the lymph nodes removed from under the arm, a procedure known as a node dissection. This procedure can result in lymphedema, a chronic swelling of the arm that can be both disfiguring and debilitating. In the late ’90s, the sentinel-node biopsy procedure was developed so that only a few nodes were removed, thereby decreasing the risk of lymphedema. Recently, re- search has shown that older patients with small, slow-growing tumors and normal nodes on clinical examination can safely avoid lymph-node removal altogether.
The same can be said for medical therapy for breast cancer. We have gone from the days when no medical therapy was available to the belief that almost every patient with breast cancer needed chemotherapy. Now, we can provide tailored and targeted medical therapy so that a patient can know that the recommended treatment is the correct medi- cine to treat her or his particular tumor.
We now have many tools in our toolbox, including endocrine/anti-hormone treat- ment, medication to treat the cancers that have the Her-2 growth factor, medication specific for cancer associated with the BRCA gene mutation, and more. There is even a test called molecular profiling that can help sort out the benefit of chemotherapy in ad- dition to the benefit that is obtained from endocrine therapy so that, if chemotherapy is recommended, there is actual, specific data to support that recommendation, not just a best guess.
Even breast radiation has been modified from a six-week regimen so that many women now only need four to five weeks of radiation.
What does this all mean for a patient who is newly diagnosed with breast cancer?
It means that we can think about de-escalating care for many patients. We can opti- mize which treatments are recommended to provide optimal cancer benefit while balanc- ing issues such as quality of life.
It means that we know when we can safely avoid certain procedures because there won’t be a benefit.
It means that we can avoid chemotherapy in many patients who would have previously been prescribed it.
It also means that, when chemotherapy is recommended, there is a real reason to consider it.
It means that some patients who choose a lumpectomy may be able to avoid radiation. In a nutshell, it means there are options to be considered.
We have come a long way from where we once were, but we still have more to learn.
The good news is that our understanding of breast cancer continues to make progress. My advice to you is to work with your cancer team to understand the recommendations they give to you so that you feel comfortable that you are making the right choice for you. -
Dr. Holly Mason is section chief for Breast Surgery at Baystate Health.
Nurses Are Critical to Behavioral
HNealthcare By ERICA TRUDELL
No, care for such patients is not an authoritarian, one-size-fits-all approach, and, yes, I see patients leave better able to manage their diagnoses and, therefore, their lives.
Much advocacy has been done to dispel stigma and misinformation around mental ill- ness in recent years, but less so on misconceptions that linger in the public mind and that I hear frequently around perceptions of nursing on behavioral-health units.
Nursing on such a unit is not about altercations with patients. It is not about enforced routines. It is not about checking off boxes for tasks done.
It is about listening to patients, sitting with patients, and bringing our clinical expertise and, most importantly, our empathy, to support them at a very vulnerable time in their lives. I have sung with patients. I have danced with patients. I have been silly and cried with patients.
We try to help them see mental illness as a treatable, medical condition for which there should be no feeling of guilt or embarrassment in getting care for their diagnosis.
Nursing has been referred to as both a science and an art, and it is. We are not the patient’s therapist. We are not the patient’s psychiatrist or pharmacist. Nor are we at the bedside just to take vital signs.
We are often there in the moment when patients are the most vulnerable mentally. We get to support them and allow them to speak their truth without judgment.
What I reiterate to staff, old and new, is that all behavior is a form of communication. What is the patient trying to communicate that they are not able to verbalize? Are they anxious about being in the hospital? Do they want to leave? Did they have a bad phone call with family or a loved one?
Nursing takes critical thinking, problem solving, and detective work to determine what is behind behavior and to address it in a way that recognizes the person is upset and allows time to get whatever it is out of their system, as well as the space to talk about it calmly. When someone needs a lot of support, it is the nurse who attempts to determine how best to help them work through their thoughts and behaviors.
Nurses in behavioral health work at making patients feel good about receiving care for their mental illness and normalize what they are going through in receiving such care.
It is no different from inpatient care for any other serious medical condition that will not improve on its own, and it is routinely multi-faceted care involving education about lifestyle, medication, and therapy.
There are times when you will have a patient who is completely decompensated — that is, their mental health seriously deteriorates to the point where they have no interest in life or ability to function. Yet, once they start on medication and you form a relationship, their recovery is amazing to see. They begin to interact, engage in self-care, and feel good enough within a short time to leave the unit.
Seeing such improvement with individualized, trauma-informed care is what is so rewarding about what we do as nurses on a behavioral-health unit, and it is what feeds my soul.
We also work with families, too, teaching them what mental illness means, what are the warning signs and symptoms, and how they can support their loved ones as they go through some really difficult times.
I have seen lives change for the better and for the long term because of the measurable and meaningful difference a nurse has made. Yes, there are staffing shortages. However, there is no shortage, for those of us in this field, of compassion and care. -
Erica Trudell is director of Nursing for Inpatient Behavioral Health Services and Education at MiraVista Behavioral Health Center in Holyoke.
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