This chapter illustrated RBN clients were having their supportive care needs met relatively well. Also, there were important changes in RBN client’s high unmet
165 needs over the first three months of their illness. Respondents generally fit
demographic profiles in age and marriage/partner status, though their average age was younger than cancer registry data. Respondents’ medical experiences were generally consistent with standard procedure.
At one month post-diagnosis participants had almost all recently undergone surgery while one in three was receiving chemotherapy and one in five hormone treatment. Their most prevalent high unmet needs were related to the Psychological domain, namely concerns, fears, anxiety, and uncertainty, yet also included some items within the Health System and Information domains. Participants’ access to services was generally favourable. It seems likely that the recent diagnosis with a life- threatening illness left women considering many personal issues, and battling their own fears and concerns.
At three months post-diagnosis participants, respondents were generally
undergoing active treatment, most commonly chemotherapy, hormone therapy and/or radiotherapy. The most prevalent unmet needs were primarily from the Physical and Daily Living domain, while the Psychological domain items also were prevalent. Again, participant’s access to services was generally favourable, yet easy parking for cancer care was reported as a high unmet need by one in three
respondents. These findings suggest the physical impacts of cancer treatment were negatively impacting women’s daily living experiences.
The changing patterns of high unmet need between one month and three months post-diagnosis provide a clear and resounding picture of women’s experiences. While overall high unmet needs decreased over time, there were important differences in the patterns of change. The high unmet need items of greatest change coupled with the changes in the most prevalent unmet needs echo the worsening physical and daily living experiences for women, and improved
psychological position along with fewer high unmet needs for Health System and Information items. The statistically significant differences in domain changes across time reiterate these findings and further extend their validity. Furthermore, a
166 statistically significant worsening in women’s experiences around Sexuality issues was identified. Access to services was relatively consistent, yet women’s high unmet needs for easy parking increased.
Comparisons between the unmet supportive care needs profile of this sample with other samples demonstrates these women’s needs were being met relatively well. While the relatively low prevalence of high unmet needs demonstrated within this study could be due to many reasons, it seems likely that one significant contributor would have been the presence and involvement of the RBN in women’s care. These results suggest not all high unmet needs can be alleviated for all women, yet
significant improvements in meeting needs were seen in comparison to other samples. Importantly, the women in this study reported fewer high unmet needs around Health System and Information as well as Psychological domain issues. These results suggest the improved unmet needs profile is due, at least in part, to the involvement of the RBN and her care.
This chapter described the outcomes for women who consult RBNs, specifically the prevalence and patterns of high unmet supportive care needs, and the patient characteristics which contribute to needs and unmet needs. Women’s needs are expected to drive RBN actions. Thus the results presented in the upcoming chapters are better understood with the findings of this chapter in mind. These findings are useful in understanding what interventions RBNs undertake in their care with women, including their objective breast nursing practices (Chapter Six), and their subjective breast nursing practices and what influences nursing practices (Chapters Seven and Eight). The next chapter will expand on these findings by describing what happens for women within RBN consultations, demonstrating how RBNs interpret women’s needs and the interventions they undertake to alleviate, manage, and pre-empt supportive care needs.
167
Chapter Six: Quantitative
Descriptions of Rural Breast Nursing
Practices
It is useful to know how RBNs’ contribute to clients’ experiences and outcomes as a part of a wider healthcare system. Specifically, it is useful to understand how RBNs distribute their time across nursing duties, and breast nursing practices in
consultations with clients. It is then possible to highlight any discrepancies between urban and rural breast nursing care. Therefore, this chapter addresses the sub- question: What are the nursing practices of RBNs in real world settings, and how do they compare to the primarily urban NBCC SBN Demonstration Project? The
purpose of this chapter is to objectively describe rural breast nursing practices, across varying sites and summarised together27. RBN practices are then compared with the NBCC SBN Demonstration Project in order to identify similarities and differences between rural and primarily urban practice.
This chapter quantitatively describes rural breast nursing practices in terms of their overall practices, and the consultations provided to clients. RBN interventions are comprehensively described in terms of their dose, delivery and content.
Comparisons are made to urban breast nursing whenever possible. Results are drawn from the analysis of data within RBN Day Logs, Study Patient Lists, and Consultation Logs, as previously described in Chapter Four: Methods28.
27
The three RBN sites were summarised into a Summarised RBN to enable comparisons with urban breast nursing practices.
28
Also described in the Methods Chapter are the three RBN sites explored within different organisational and healthcare settings across the three regions of Tasmania, Australia. In summary, the sites included the Community RBN, Public/Private Hospital RBN (given access and freedom to work within the linked private hospital while formally placed within the public system), and Private Hospital RBN. Additionally, the
168 This chapter links with the previous results chapter by describing RBNs’ contribution - as one part of a cancer care system - to bring about the supportive care outcomes described in the previous results chapter (Chapter Five).
Results in this chapter are reported in two sections. The first section provides an overarching description of breast nursing practices through distribution of RBN time across duties, hours worked per site, and an estimate of hours worked per client. Non-uniformity of RBN services was anticipated due to the individuality of clients and their needs, diversity of RBNs and their employment arrangements, and the real world conditions under which the study was undertaken.
The second section describes RBNs’ interventions with clients in terms of their dose, delivery, and content. Comparisons are made across RBN sites, and the data are combined to describe a Summarised RBN Site. RBNs participating in this naturalistic study determined the interventions delivered within the parameters of employing organisations. Thus, consistency of RBN interventions was not expected across sites.