Helping Patients Overcome Obstacles: Nurse Navigation Transcends Oncology When Disaster Strikes

PHILADELPHIA — Nurses have been involved in the management of natural, man-made, and disease-related disasters since the nursing profession began, said Cynthia Cantril, RN, OCN, CBCN, MPH, of Sutter Pacific Medical Foundation in Santa Rosa, California, in the lead to her presentation at the 2019 Oncology Nurse Advisor (ONA) Navigation Summit. Ms Cantril dedicated her presentation to all first responders all over the world, including nurses.

Using her own experiences as an oncology nurse navigator during the recent devastating fires in California, which were classified as a level 3 disaster, Ms Cantril highlighted the challenges of serving oncology patients during a disaster and the lessons learned by herself, her team of 10, her healthcare system, and the larger healthcare community.

The World Health Organization defines a natural disaster as “an act of nature of such magnitude as to create a catastrophic situation in which the day-to-day patterns of life are suddenly disrupted and people are plunged into helplessness and suffering, and, as a result, need food, clothing, shelter, medical and nursing care and other necessities of life, and protection against unfavorable environmental factors and conditions.”²

Ms Cantril emphasized the importance of taking into the account the psychological impact of a disaster, such as post-traumatic stress disorder (PTSD), on patients with cancer and their caregivers who may be feeling that things are already out of control. An important consideration is that oncology healthcare providers may be victims of, as well as responders to, the disaster and that provisions for mental health support should be a priority for patients, their caregivers, and responders.

Disaster planning for oncology patients should be a collective process involving many stakeholders, Ms Cantril explained. However, in the event of a disaster, personal preparedness is a critical starting point for the oncology nurse navigator, as well as alerting all team members.

“The number one thing that we needed to do was to take care of our own.” Using the analogy of the oxygen mask on a plane, she emphasized that the nurse navigator should help yourself first and then help others.

Toward that end, Ms Cantril recommended connecting with resources such as Everbridge Nixle, which provides text alerts from local police and fire departments. The Red Cross and National Public Radio offer guidance on developing personalized emergency plans. In addition, nurses should compose telephone call lists of team members.

In recounting her experiences during the California fires, Ms Cantril emphasized the critical importance of a having an offsite team at a remote incident command center to coordinate efforts. Despite circumstances and the environment changing day-by-day, her team came together quickly and was able to evacuate acute, hospitalized oncology patients within an hour.

“Getting patients out of hospital was difficult enough, but getting patients triaged who are undergoing cancer care [ie, reaching ambulatory patients in the community when infusion centers were closed for weeks and physicians and staff were displaced] was a whole new world,” she told the Navigation Summit attendees.

“Think about how you reach these patients,” she emphasized. “The power of the navigation system became clear to me when I called all the other navigators I knew and asked, ‘Can you take these patients?’”

In this context, Ms Cantril explained that her healthcare system’s use of EPIC Beacon, a healthcare IT provider, to manage chemotherapy treatments facilitated delivery in the community, but “the incident has identified a need for further integration,” she noted.

“The one thing that I think you should all take home with you is [to recognize that] those people who are able to serve you from different places in the communities are your lifelines,” Ms Cantril concluded.

References

1. Cantril C. The role of the nurse navigator in disaster planning. Oral presentation at: 2019 ONA Navigation Summit; June 13-15, 2019; Philadelphia, PA. 2. World Health Organization. Environmental health in emergencies. https://www.who.int/environmental_health_emergencies/natural_events/en/. Accessed June 14, 2019

Resources for Disaster Planning

Everbridge Nixle
Nixle keeps you up-to-date with relevant information from your local public safety departments and schools
www.nixle.com

Red Cross
Make a plan: Create and practice an emergency plan so your family will know what to do in a crisis
www.redcross.org/get-help/how-to-prepare-for-emergencies/make-a-plan.html