Breast Health Navigator: A Paradigm Shift in Breast Health Care

In the 1990s, radical health care reforms forced many standard inpatient care procedures to an outpatient setting. Breast cancer patients, once hospitalized for days following surgery, were discharged almost immediately. Nurses no longer had time to teach patients self-care skills for recovery. A chasm in the nurse/patient relationship resulted, necessitating a paradigm shift in nursing delivery for breast cancer patients. The Breast Health Navigator-bridging the gap within the nurse/patient relationship in an outpatient setting-extends education and support throughout the continuum of illness. Because the majority of patient recovery skills required for positive outcomes are sensitive to nursing education, this new expanded role encompasses teaching physical self-care skills, psychological support and anticipatory guidance, physical and psychological assessment for triage to physicians or ancillary support systems, and psychosocial support in preparation for the challenges of survivorship. The navigator is a focal point of contact for the patient, simplifying a complex medical maze that often includes up to five physicians and coaching the patient to work as an informed partner with her health care team. Care is defragmented, productivity is increased in the physician/patient relationship, and the locus of control is returned to the patient, which is necessary for complete recovery. Based on philosophy of care delivery organization, not on equipment, the Breast Health Navigator model has proven successful for breast centers of all sizes. Lexington Medical Center serves as a case study (see pages 20). Research study of roles and responsibilities of nurses working in breast centers is included (see pages 21).