Under the Knife: Supporting Patients’ Needs Throughout Surgical Oncology Care
People often use idioms—such as “going under the knife” as a euphemism for surgery—to avoid confronting distressing situations, which is even more pronounced when it comes to life events as serious as cancer.
But for many patients with cancer, undergoing a surgical procedure is key to positive outcomes, and they count on the expert clinical care and support of their surgical oncology nurses to see them through it.
Nurses working in surgical oncology are vital to successful patient-centered care and ensure a high quality of life and level of symptom management for their patient populations. From preoperative care, through surgery, and into postoperative support and survivorship, surgical oncology nurses provide their patients with the best preparation, follow-up care, symptom management, and recovery possible.
Supporting Patients in Surgical Oncology
Understanding the surgical process, creating care plans, and working to educate patients are vital for nurses to provide successful care. ONS member Catherine Wickersham, RN, BSN, OCN®, office practice nurse for the thoracic surgical service at Memorial Sloan Kettering Cancer Center in New York City, recognizes that the role of surgical oncology nurses can vary widely based on the setting.
“As a surgical oncology nurse in the outpatient setting, we develop individual care plans under the physician during the patient’s continuum of care. We provide and promote health care to patients and their families or caregivers,” Wickersham says. “Our institution has two types of nurses in the outpatient setting—an office practice nurse (OPN) and a unit practice nurse (UPN). We also have perioperative nurses caring for patients undergoing an ambulatory procedure. The OPN collaborates with the physician and follows the patients from their initial consult through survivorship. The UPN supports the clinics and helps the OPN with their daily responsibilities.”
ONS member Sue Burke, BSN, RN, CNOR, nursing staff development coordinator for nursing education and perioperative services at the Ohio State University Comprehensive Cancer Center Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, adds that nurses serve in different roles throughout the surgical process.
“We have a wide variety of roles that work in the perioperative surgical oncology environment,” Burke says. “Based on nurses’ given roles, their skills will cover a spectrum of needs. If they’re caring for a patient in the preoperative area, they’ll address medical history, surgical consent, preop education for patients and families, ensuring research protocols are being met, and more. Our interoperative nurses care for patients with all different types of cancers, so they’ll need to be prepared for a wide array of surgical procedures and know what to do to support patients during the surgical oncology procedure. Postoperative nurses need to understand the disease lines, ensure patients are on track to recover from surgery, and balance patients with comorbidities that could impact their recovery.”
Meeting patients at their level and closing educational gaps are crucial to ensuring high-quality care, along with addressing patients’ emotional needs prior to surgery, Wickersham explains.
“Nurses are the front line for their patients, and it’s essential to assess their symptoms along with any emotional support they require. Connecting patients to supportive resources and providing educational materials is essential,” she says. “After the physician obtains consent for a procedure, the nurse needs to go over the detailed education plan that covers what patients should expect prior to surgery through their postoperative follow-up appointment. In most cases, patients and families are anxious and will require further emotional support from the nursing team.”
Wickersham and Burke agree that nurses need to effectively multitask to address patient needs. Being detail oriented and flexible can help nurses think critically and adapt to situations as they change. Covering a wide spectrum of knowledge and educational support is crucial to caring for patients in surgical oncology.
Addressing Symptoms and Side Effects
Patients undergoing surgery will face common and unique symptoms and side effects, requiring nurses to be vigilant to manage potential adverse events.
“Strong assessment and communication skills are imperative for addressing symptoms and side effects in surgical oncology,” Wickersham says. “Based on the triage, nurses may be able to handle issues themselves, or it may warrant further communication with the physician to determine a recommended intervention. Our symptom assessment continues along the entire care trajectory from initial consultation through survivorship. If patients call into the office, the office coordinator will connect them with nurses who can triage, assess, and manage the complexity of patients’ needs or escalate to a licensed provider if necessary.”
Patients can also experience a tremendous emotional component when undergoing surgery. Oncology nurses are in a unique position to defuse distressing events and reinforce patient and family education.
“Patients often have a lot of anxiety and uncertainty prior to surgery,” Burke says. “That anxiety extends to their family members as well. Nurses must do their best to calm any concerns and answer any lingering questions, addressing the psychosocial aspect of care. Our institution routinely performs multisurgeon procedures—like a mastectomy with immediate breast reconstruction—so caring for our patients’ families and addressing their distress during that eight- to ten-hour surgery is vital.”
Overcoming Unique Challenges
Despite cutting-edge imaging technology, most surgeons won’t know exactly what a patient’s cancer looks like until the procedure is under way. Oncology nurses commonly address unexpected changes as part of their surgical oncology roles.
“When patients come in for surgery, we have an idea of what that process will entail,” Burke explains. “But as with many cancers, things can change on a dime. Once we begin a surgery, we might think it’s going to last four hours, but it could quickly turn into a ten-hour procedure. We have to work with families to manage their expectations, but we also have to address any scheduling issues if other patients are meant to go into surgery after the current patient. Ultimately, we tell patients that our team is going to spend whatever amount of time is necessary to make sure they’re getting the best care possible.”
From sustained emotional support to patient education and navigation, the varied components of care consume the finite time and resources available to nurses, Wickersham says. In a busy surgical setting, oncology nurses need to be adept at balancing individual needs while working in a time-efficient manner.
“Finding the time to address each patient’s unique needs can be tricky when you’re seeing many patients on any given day,” she notes. “Between the challenges of keeping our patients motivated and optimistic, addressing cultural nuances, and avoiding potential ethical concerns, nurses need to find the time to ensure patients and caregivers are fully informed about their treatment options and clinical prognoses.”
Collaboration Leads to Successful Outcomes
Surgical complexities and a fast-paced environment require oncology nurses to work in tandem with a wide-ranging team of care experts. Burke stresses how communication is essential for successful interprofessional collaboration.
“At our institution, we promote relationship-based care,” she says. “This involves building relationships not only with our patients and families but also with our colleagues, working alongside all different members of the care team. From surgeons to social workers, pharmacists to patient navigators, and our medical oncology nurse colleagues as well, it’s important to involve experts to address all facets of a patient’s needs.”
Wickersham encourages nurses to use the support systems available to help patients from preop to recovery and beyond.
“Nurses have a unique role and often develop relationships with patients and their support networks,” Wickersham says. “Nurses should continue to advocate for their patients, providing them with resources from an interprofessional team, including services like social work, case management, nutrition, smoking cessation, patient representatives, fertility support, and chaplaincy. Collaboration across the continuum of care is an essential component for all patients with cancer.”