Cancer of the Uterus - Nursing
Contents:
What is Nursing?
The care that nurses give to gynaecological cancer patients goes beyond the mere medical monitoring of the patient's condition. Nurses oversee the holistic care of patients. This involves coordinating the involvement of a wide range of specialists to ensure that all of the patient's needs are met. These specialists may include physiotherapists, social workers, chaplains, dieticians, etc, depending on what the patient requires.
Nurses play a vital role in the treatment and management of gynaecological cancer. They provide specialist care at all stages of the process. Areas involving this specialist care include:
 | immediate post-operative care on the ward; |
| radiation therapy nursing; |
| chemotherapy nursing; |
| home nursing; |
| palliative care nursing. |
Post-operative nursing
Post-operative nursing occurs predominantly on the hospital ward following a
patient's surgical treatment for her cancer. Here, the nurses role is essential
to the general care and well-being of a patient during her stay in hospital.
They monitor, evaluate, consult and implement changes, where necessary, to
provide quality care and services to patients. In addition, nurses are called
upon to perform many different roles and functions within the modern hospital
setting.
What Do Patients Need to Know About In-Hospital Nursing?
Admission
Admission procedures vary depending on the condition of the patient, the kind
of surgery to be performed and whether the patient has come through the public
or private health system.
Generally, public patients have been tested either by their local doctor or
in a hospital outpatient clinic, and the results have come back showing cancer
or some other abnormality. The treating doctor may then recommend either surgery
or radiation therapy followed by surgery.
Private patients are usually tested and referred to a specialist surgeon, who
may recommend either surgery or radiation therapy followed by surgery. These
patients are referred to the hospital straight from their surgeon, and admission
is arranged in advance.
These admission procedures will be bypassed if the patient is critically ill
and/or has come through the accident and emergency department.
Admission times for surgery vary. If the case is not complicated and the
patient is fit, then admission will usually be on the day of surgery. If the
patient is unwell or the case is complicated, then admission is usually 24 to 48
hours before surgery. If patients are from out of town, admission may be
arranged around flight times, etc.
Immediate post-operative care
The normal procedure after gynaecological cancer surgery is for the patient
to be out of bed and moving around as soon as possible. Patients are usually
mobilised the day after surgery for major operations. If the surgery was only
minor, the mobilisation is usually within a few hours. Patients are also
assisted with showering, etc, not just by nurses, but by a team which may
include nurses, physiotherapists, and other ward staff.
Wound Care
One of the ways in which nurses help patients is in caring for their wound
after surgery. If the surgery performed is uncomplicated and wound care is also
uncomplicated, patients may be able to be taught how to care for their wound. If
wound care is complicated, then nurses may arrange for home nursing visits after
discharge to dress and care for the wound.
Information
Back on the ward following surgery to treat her cancer, a patient is in a
very vulnerable state. She is in a completely foreign hospital environment and
is most anxious about her prognosis. One of the most important roles that
post-operative ward nurses play in patient care is to make sure that each
patient fully understands all aspects of her treatment, care and recovery
programmes. Often, during a doctor's initial visits to inform her of her
condition and prognosis, the patient may not want, or be able, to ask questions
on matters of concern. Different lifestyles, experiences and cultures affect a
patient's ability to understand and cope with these stressful situations. Here
it is the role of nurses to ensure that the patient's questions are answered;
that she is clear about the details regarding her medical condition, from her
prognosis through to the risks and benefits of further treatments; and what may
be required when she leaves hospital.
Short Term And Long Term Care
The treatment of gynaecological cancer involves two different types of care:
short term and long term. Short term care may just involve the initial surgery,
resulting in a good prognosis, and the patient returns home quickly. There may
be a need to arrange home care, and occupational therapists, etc for a short
period, and then the term of care would then end. Long term care, however, may
involve future treatments, such as chemotherapy, radiation therapy, further
surgery and possible palliative care. The nurses' role here is to inform the
patient about the details and possible requirements of her short and long term
care, and educate patients about their options as they relate to these types of
care.
Follow-up and home care
After leaving hospital, a patient may suffer only a minor, short term
disturbance to her normal life. Most patients, however, are either in immediate
need of home care, or will be in need of it in the near future. Here, it is the
nurses' role to ensure that the departing patient is aware of, and has access
to, all available services that may that she may require. This may involve
providing the names and contact details for organizations such as community
nursing, meals-on-wheels and palliative care facilities. The nurse would also
make sure that the 'care' community is aware of the patient and her possible
needs.
Standard of Care
Many women feel anxious and uncertain following the diagnosis of cancer, and
the period of recovery following surgery is often very stressful for them and
their families. Because of their close ongoing contact with women in the
post-operative phase, nursing staff are in a unique position to offer the woman
the emotional support she needs and assist her in obtaining appropriate
information. In some cases, the woman may confide concerns to nursing staff that
have not been apparent to other members of the team. In such cases, the nurse
has a vital role in ensuring that these issues are recognised and addressed by
the multi-disciplinary team.
Community health nursing plays a distinctive role in our health care system. This area of Nursing encompasses service delivery, advocacy, education and health promotion to clients in their own home or as part of a community group. This role compliments the continuum of care from the acute care (hospital) setting to the community. It involves secondary and tertiary health care using an holistic and client focused approach. Our commitment is to provide health and wellbeing to all individuals in the community. Community Health services are carried out using a multidisciplinary approach.
The aims of Community Health organisations are:
| To provide a continuum of care for clients following discharge from an acute care facility (hospital) while facilitating their return to health. |
| Promoting self -help and independence to clients in their own home and delaying permanent placement |
| Addressing the needs and health issues of the community |
| Empowering and educating our community to address contemporary health and lifestyle issues. |
For instance, the services provided by the Logan Beaudesert District Community Health Service are:
| Holistic assessment and coordination of services to meet individual client needs. |
| Multidisciplinary approach to promote health and wellbeing. |
| Counseling, support and referral. |
| Information, advocacy and support on health related issues. |
| Provision of expert knowledge to clients while utilising community health nurses individual areas of expertise. These areas include,
 | Diabetes |
| Respiratory |
| Dementia |
| Oncology |
| Nephrology |
| Arthritis |
| Continence |
| Immunisation |
| Chronic disease self management |
|
Referrals to Community Health Organisations are generally of three types:
- Self referral
- Referrals from doctors, hospital and any other agencies
- Referrals from any other person in the community with client consent.
Radiation Therapy Nursing
Radiation Therapy nursing, as the name suggests, occurs during a patient's radiation
therapy treatment. This treatment may occur before or after surgery and
before, after or during any chemotherapy
that may or may not be required. The role of the radiation therapy nurse is to
help the patient through 6 weeks (the standard duration) of radiation therapy,
usually received on an out-patient basis.
A large part of this help comes in the form of patient education. These
nurses educate patients about what they can expect from radiation therapy and
what are normal and abnormal side effects. This may involve information such as
how to examine vaginal discharges, for example whether they have increased or
decreased, whether there is any bleeding and so on.
Due to the fact that most patients are seen on an outpatient basis, radiation
therapy nurses often need to give advice and assess patients over the telephone.
For instance a patient may call to cancel therapy on a particular day because
they are unwell. The nurse must ascertain why the patient is unwell, if there is
cause for concern and whether they in fact need to come in and see a doctor or
whether a visit to their local doctor is required.
What Do Patients Need to Know About Radiation Therapy
Nursing
As detailed in the radiation therapy section, there are two types of radiation
therapy used in the treatment and management of gynaecological cancer: External
and internal. External therapy requires the use of a linear accelerator and
internal therapy requires the use of caesium
or irridium
implants. It is important to stress that patients who receive radiation therapy
are not radioactive.
The amount of information that radiation therapy nurses will need to provide
to patients will depend on whether they are receiving their radiation before or
after surgery. Patients who have already had surgery tend to be better informed
about radiation therapy and what will happen than patients who are receiving
radiation therapy at the beginning of treatment.
Sexual Factors
Radiation therapy nurses are able to talk to a patient about how radiation
therapy will affect her sex life. The radiotherapy in itself does not prevent
patients from remaining sexually active (there are no radioactive related
risks). However the patient's ability to have sex will usually be hindered
during treatment by soreness, dryness, emotional fatigue and tiredness.
Most women with gynaecological cancer are post-menopausal and many of these
women are no longer sexually active, however sexual side effects can still be of
concern. Younger women tend to become sexually active again quite early after
surgery. Women who wish to become sexually active soon after treatment are often
educated about lubricants (KY jelly) and are encouraged to take it slowly. Often
male partners need to be educated about things like not thrusting as deeply.
Radiation therapy to the pelvis usually causes the vagina to become swollen
and inflamed, which results in sexual intercourse becoming uncomfortable. There
is also an increased tendency for scar tissue to form at the top of the vagina,
which can result in narrowing and shortening of the vagina. Radiation therapy
nurses can provide patients with vaginal dilators and instructions on their use
to help overcome these problems. Vaginal dilators are met with mixed responses.
Some women are horrified at the thought of using them while others react with
humour. Some women have included their partners in the use of dilators as a way
to ease back into sexual activity and intimacy.
Dressings
Dressings are usually only required for obese ladies with a fold, or for
patients with a wound that has broken down. As most women are outpatients,
dressings need to be simple. Intrasite
adaptic and combine
dressings are usually used with stretch net pads used instead of tape to keep
the dressings in place.
What Can Carers Do?
Carers are able to help their patient and radiation therapy nurses. Often,
carers are can give the nurses information essential to the patient's care that
the patient is either unwilling or unable to provide. Patients often don't want
to complain and so don't report things that the nurse may need to know, such as
infections, diarrhoea and frequent urination. The carer may be able to provide
this information.
It is important that the carer is aware of the side effects of radiation
therapy to the pelvis and is prepared for them. These side effects are outlined
in our section on radiation therapy.
Modern health care is very successful in preventing or controlling sickness and disability. Many of us enjoy extra years of good health and function because of skilled medical treatment. But not all sickness can be cured or controlled. Sometimes it becomes evident that symptoms are getting worse, energy is failing and survival itself will be limited. It can be a very worrying time for both patients and their family and friends who are trying their best to help.
This is where Palliative Care and Palliative care nurses (and teams) can assist. You can contact a palliative care nurse through most hospitals and also in most nursing services in the community. The nurse may work as part of your treatment team or may be invited in to assist you with a range of symptom control, practical, social and spiritual issues you may have. This nurse will have a wide range of contacts within her team and with other health professionals, government and non government services who will be able to assist you and your family.
This phase of care where perhaps no active treatment is given and the future is unknown can be a lonely and anxious time. Palliative care nursing can provide the link between the hospital and the community that ensures you and your family are cared for throughout your illness, whatever happens.
Palliative Stage of Gynaecological Cancers
In palliative care the focus of care is on you as an individual (and your family) rather than your specific type of cancer. For instance, two people suffering with uterine cancer may not necessarily have the same physical, practical or social issues. A palliative care nurse (and his/her team) can help design your care needs around you and your situation.
Palliative Care Techniques
Most palliative care is provided at home by families. Palliative care nursing input can help your family quickly adjust to your changing needs. This includes anticipating changes, thus ensuring equipment and practical assistance is on hand, educating family members in basic nursing techniques and how to manage potential crises. Medication regimes can be complicated and your palliative care nurse can provide information and practical assistance in managing this. Most Palliative Care Services have a 24hr contact number that allow access to a nurse no matter what time of day or night it is.
Palliative care in the community receives government funding, therefore much of the care provided at home may be free of charge. The community also plays a role with most services using trained volunteer members of the community to provide assistance in your home to allow family members to shop, sleep or play!
The palliative stage of your illness is a time of great fear - fear of dying, or even fear of living with advanced cancer; fear of what lies beyond or fear that your family may not manage without you. These are real fears which the Palliative Care Nurse,
Counsellor or spiritual Carer can explore with you and your family. Most Palliative Care Services also provide bereavement support for family members.
Further Information
Palliative Care Queensland - ph 3832 3522;
website http://www.pallcare.org.au
Palliative Care Information Service (24 hours): 1800 772 273
If patients require nursing help at home, it is usually of a medical nature,
so nurses and trained specialists are required. Carers are most useful in home
'help'. For instance if a special diet is required, then the dietician could
inform the carer of what was needed, the carer could do the shopping, encourage
the patient to drink fluids, and prepare small frequent meals. The carer can
also assist the patient with her mobility, as is outlined in the physiotherapy
and occupational therapy sections.
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