Nurse navigator

(Capital Gazette) ‘It’s knowing there is someone who has their back.”

People are often overwhelmed by a breast cancer diagnosis. It’s Deb Russell’s mission to make that diagnosis less daunting.

Deb is nurse navigator at the Aiello Breast Center at Baltimore Washington Medical Center. She provides an additional layer of knowledge and support for those navigating the road to recovery.

Her first responsibility is to make sure patients understand what doctors are telling them and follow through with all procedures and recommendations.

“After diagnosis, I will sit down with the patient and have a very detailed conversation. I get answers for any questions they might have. I make sure they have a plan, and understand the plan,” says Deb, who is a certified oncology nurse in addition to being a registered nurse.

She guides them through each step, making sure doctors get the information necessary to offer the best possible treatments, and patients have the understanding needed for their best outcome.

“It’s important for people to understand … understand their symptoms, understand their treatment options, understand they have a way to get through this,” Deb says. “It’s my job to make sure they understand everything.”

The nurse navigator provides continuity during the vast array of consultations and treatments patients face.

“A breast cancer diagnosis in itself is going to be very anxiety-promoting,” Deb says. “But not knowing what is going on or how something fits in the scheme can produce even more anxiety. If people don’t get a cohesive plan, it can ruin their confidence that they can beat this cancer. We want to give people every tool available.”

There is some repetition in the questions Deb asks her patients, but she has the time to dig deeper than the doctors.

“I look at the effect of the cancer on their whole life … things that are equally as challenging as the cancer.”

Deb asks very specific questions of patients, questions about their eating and sleeping habits and how they are handling symptoms or treatments.

“With one woman, no one could understand why the side effects of the treatment were not manageable. When I took the time to ask the right questions, I found out she couldn’t afford the medicine that would help alleviate those side effects.”

She tells of another mother who kept missing her afternoon appointments — “she couldn’t afford to take the afternoon off because she only got paid if she was working.”

In these cases, Deb can augment what the rest of the team is doing “because I have the time to pull the resources together. I can help them through whatever other problems they face in addition to the cancer.”

Asking the right questions can also help relieve the stress illness can bring to the family. “I try to keep husbands and wives talking. For example, one wife said that she sometimes felt like she had let her family down because she couldn’t do all the things she used to do to care for them. The husband was totally surprised. He obviously didn’t feel that way, but he didn’t realize it was a problem for her.”

“I’m trying to heal the whole person and whole family, not just the medical issues,” Deb says.

Following the initial diagnosis, anxiety is often the overriding factor. After surgery, the focus can shift to wound healing. And with chemotherapy comes the management of symptoms, Deb says.

“And through it all, there is spiritual support for their journey,” Deb says. “I try to provide a very balanced approach, so people can be in the place they need to be so they can be confident in their treatment and recovery.”

Deb is certified in Healing Touch, a supplementary relaxation treatment. The goal of the therapy is to restore balance in the human energy system, thus creating the best environment for healing.

Benefits can range from reduced pain and improved mobility to relief of stress and an improved spiritual connection, Deb says. She calls it a self-healing technique that those who try come to appreciate. “Once they’ve had it, they want it every week.”

Patients can look to Deb for information, as well.

“Once people figure out that they really are going to get through this, they want to know ‘what I did wrong to get it.’ And they want to know how to stay healthy in the future.”

Deb makes referrals to many sources of information, from American Cancer Society dietitians to classes available locally.

The nurse navigator says she is personally aware that the doctors at BWMC “go out of their way” to give information and support to patients, but there are multiple reasons why people turn to her. “Some patients don’t want to bother the doctors. They often think the doctor will be too busy to talk with them.”

Other patients want reassurance. “They want to know that what is happening to them is normal for the situation,” she says.

Sometimes they want advice. “Patients often call to find out if something warrants a call to the doctor. They know that I am accessible, so they often check with me first.”

The nurse navigator also is available to the patient’s support team, whether it be spouse or sister or mother.

“I do a lot of caregiver conversations. They have their own issues, fears and emotions that they struggle with. It is important for them to keep their spirits up, too.”

“Most patients are used to taking care of everyone else rather than themselves,” Deb says. “For some, it’s a tough transition.”

Deb joined BWMC in 2003 when the Tate Cancer Center opened. She was among the practitioners who worked to develop the plan for the Aiello Breast Center, and has worked there since it opened in 2005. As a nurse, she has worked specifically with breast cancer since 1997.

During her years in working with breast cancer patients, Deb says “younger and younger women are showing up as breast cancer survivors. It used to be women in the 50s and 60s. Now there are many in their 30s and 40s.”

Younger people bring different needs to their recovery process. “Now, women want to see their children grown. Before, women hoped to be able to see their grandkids.”

Another change: breast cancer now is considered “more chronic rather than acute.”

“It used to be that after so many years, people would say they were cured. In reality, monitoring for breast cancer becomes a lifetime event,” Deb says. “You engage in lifestyle changes and have constant physician contact.”

This is really a new way of thinking about the disease, Deb says. “You cannot put the disease aside and be done with it.”

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