The nurse navigator role developed in the 1990s to support African American female oncology patients' access to services. Successful in oncology, the role has expanded to support patients with diabetes, heart failure, and chronic obstructive pulmonary disease. A unique cost-effective opportunity exists for nurse navigators to fill the gap in transitional care, between the acute care setting and home, for chronically ill and other at-risk patients who are often readmitted within 30 days for treatment of the same disease. The purpose of the project was to refine the job description of the nurse navigators in a Midwestern acute care hospital. The Rosswurm and Larrabee model for evidence-based practice change supported the work. The key research question involved identifying the tasks, knowledge areas, and skills necessary for inclusion in a hospital-wide nurse navigator job description, to promote best outcomes for chronically ill and at-risk patients. Using the Oncology Nurse Navigator Role Delineation Study as the starting point, the project applied a qualitative design in reviewing the 13 nurse navigator job descriptions. The percent of nurse navigator job descriptions containing the job expectations from the delineation study was calculated and additional expectations were identified from the hospital job descriptions and the literature to create a new standardized job description containing 3 categories of job expectations: tasks, knowledge areas, and skills. Positive social change may result from nurse navigator role clarity in the hospital by decreasing service duplication, improving care collaboration, and ensuring role accountability.

More people are likely to be diagnosed with cancer and the number of people living with cancer is expected to increase, which means that patients live longer with cancer and different treatments. All patients in Sweden should have access to a nurse navigator to facilitate the cancer trajectory. The purpose of this literature review was to delineate patients' experiences of the care given by the nurse navigator. The result is based upon twelve scientific articles included in this review. The results show that the experiences of the patients can be divided into four different categories: emotional support- being present and offering supportive talks, support for physical symptoms- counseling and relief from symptoms due to illness and treatments, educational support- receiving information and knowledge about the disease and cancer trajectory and coordination support- collaboration with other healthcare professionals involved in patients´care. The result shows that the experiences of the patients were mainly positive and they received the care that was the aim of introducing nurse navigators in Sweden. It is important to continue doing research of the care given by the nurse navigator to ensure that patients with cancer are receiving evidenced based care. / Antalet människor som drabbas av cancer och som lever med cancer förväntas öka, vilket innebär att patienter lever längre med cancersjukdom och olika behandlingar. Alla patienter med cancer skall i Sverige ha tillgång till en kontaktsjuksköterska för att underlätta för patienten genom vårdprocessen. Syftet med litteraturstudien var att beskriva patienters erfarenheter av kontaktsjuksköterskans omvårdnad inom cancervården. Tolv vetenskapliga artiklar inkluderades och ligger till grund för resultatet. Resultatet visade att patienternas erfarenheter av kontaktsjuksköterskans omvårdnad kunde delas in i fyra kategorier: emotionellt stöd - att finnas till hands och ge stödjande samtal, stöd vid fysiska besvär- råd och lindring av symptom på grund av sjukdom och behandling, kunskapsstöd - information och utbildning om sjukdom och vårdprocessen och samordningsstöd - samarbete med andra vårdgivare delaktiga i patientens vård. Resultatet visade att patienternas erfarenheter av kontaktsjuksköterskans omvårdnad i huvudsak var positiva och att de fick den omvårdnad som var syftet med införandet av kontaktsjuksköterskefunktionen i Sverige. Fortsatt forskning om kontaktsjuksköterskans omvårdnad inom cancervården ses som betydelsefullt för att säkerställa att evidensbaserad omvårdnad erbjuds patienter med cancersjukdom.

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Cancer among Indigenous Peoples (First Nations, Inuit, and Métis) is disproportionately higher than the overall Canadian population. Many Indigenous Peoples have difficulty accessing care and do not receive culturally safe care due to a longstanding history of marginalization and colonization. The role of a nurse navigator (NN) was developed to improve continuity of care and overall health outcomes for Indigenous Peoples; however, limited research exists on what a NN does or how they are perceived. Using constructivist case study methodology, this thesis explored the experiences of a NN working in a large tertiary care hospital in Ontario, Canada, and the processes the NN used to support Indigenous cancer patients in a culturally safe manner. Six in-depth semi-structured interviews were performed with health care providers and managers, and shadowing of a NN occurred over two weeks allowing direct observations of the NN that was captured in field notes and reflective journaling. Interviews were audiotaped and transcribed; all data was entered into NVIVO 12 qualitative software and coded thematically. Analysis revealed the NN to be an important complement to clinical care and key resource to navigating the health care system, providing mechanisms for building trust, and raising awareness of Indigenous historical and cultural contexts. The NN practiced non-conventional, patient-centered approaches that included engaging with the land and arts, interpreting healthcare information, advocating for and aiding autonomy over healthcare. All participants felt the NN had a positive influence on health and wellbeing. Thesis results inform healthcare delivery and nursing practice to improve quality of care and outcomes for Indigenous cancer patients.

L’annonce d’un diagnostic de cancer devrait être considérée par les professionnels de la santé, comme un processus constitué de plusieurs étapes que doit traverser la personne atteinte, plutôt que comme un évènement en soi (Tobin & Begley, 2008). Lors de la période entourant l’annonce du diagnostic, la personne peut être confrontée à des difficultés reliées à la navigation dans un système de santé complexe, en plus des sentiments négatifs engendrés par la crainte de la maladie. Pour soutenir les personnes atteintes de cancer, le programme québécois de lutte contre le cancer (PQLCC), a instauré le rôle de l’infirmière pivot en oncologie (IPO) en 2000. À l’heure actuelle, peu d’études, à notre connaissance, se sont attardées au soutien de l’IPO dans cette période. La présente étude avait pour but, d’explorer les perceptions de personnes atteintes de cancer quant au soutien offert par l’IPO, dans la période entourant l’annonce du diagnostic. L’étudiante-chercheuse s’est inspirée du Cadre de soins de soutien de Fitch (1994) pour entreprendre cette étude qualitative descriptive. Des entrevues individuelles auprès de sept personnes atteintes de différents cancers ont été réalisées. L’analyse de données a été effectuée à l’aide de la méthode de Miles et Huberman (2003), par la transcription intégrale des entrevues. Elle a permis d’identifier trois thèmes soit : le soutien formel requis pour faire face au chaos, le soutien informationnel et émotionnel à parfaire et le soutien disponible apportant sécurité et assurance. Les résultats ont mis en évidence les perceptions de personnes atteintes de cancer quant au soutien offert par l’IPO soit la nécessité de rendre accessible les soins et services de l’IPO plus tôt dans la période entourant l’annonce du diagnostic. Les personnes atteintes de cancer ont besoin d’être aidées à faire face aux difficultés rencontrées lors de cette période, notamment à l’incertitude reliée aux résultats d’examens diagnostics, à l’incompréhension des informations reçues et aux sentiments négatifs engendrés par la menace de la maladie. Les résultats évoquent le souhait des participants, à l’effet que, l’offre de soutien de l’IPO, soit axée sur leurs besoins essentiellement dans les domaines informationnel et émotionnel. Ils auraient souhaité pouvoir, partager leur expérience avec l’IPO, mieux comprendre le diagnostic de cancer et savoir davantage à quoi s’attendre lors du début des traitements. Par ailleurs, savoir que le soutien de l’IPO est disponible apporte aux personnes atteintes de cancer une assurance et une confiance en leur capacité à faire face aux traitements et leur apporte un sentiment de sécurité. / The announcement of a diagnosis of cancer should be considered by health professionals, a composed process of several steps that must pass through the person, rather than as an event in itself (Tobin & Begley, 2008). During the period surrounding the announcement of the diagnosis, the person may be faced with difficulties related to navigation in a complex health system, in addition to the negative feelings engendered by the fear of disease. To support people with cancer, the PQLC (French acronym of the Quebec Cancer Control Program) has established the oncology nurse navigator (ONN) role in 2000. At the present time, few studies, to our knowlecdge, are both in support of the ONN in this period. This study was designed, to explore the perceptions of people with cancer as regards the support offered by the ONN, in the period surrounding the announcement of the diagnosis. The student-researcher is inspired by the framework of Fitch supportive care (1994) to undertake this descriptive qualitative study. Individual interviews with seven people with different types of cancer were performed. Data analysis was performed using the method of Miles and Huberman (2003), by the full transcripts of the interviews. It has identified three themes is: formal support required to deal with the chaos, the informational and emotional to perfect and available support bringing security and insurance. The results highlighted the perceptions of people with cancer as regards the support offered by ONN or the need for accessible health care and services of the ONN earlier in the period surrounding the announcement of the diagnosis. People with cancer need to be helped to cope with the difficulties encountered during this period, including uncertainty about the results of diagnostic tests, to the bemusement of the information received and the negative feelings engendered by the threat of the disease. The results suggest the wish of the participants, to the effect that, the offer of support from the ONN, focuses on their needs mainly in both informational and emotional. They would have liked to be able to share their experience with the IPO, better understand the diagnosis of cancer and know more what to expect at the beginning of treatment. On the other hand, know that the support of the ONN is available brings to people with cancer insurance and a confidence in their ability to cope with treatment and brings them a sense of security.

Syfte: Att skapa förutsättningar för en förbättrad cancervård, genom att fördjupa kunskapen och förståelsen om behov hos huvud- och halscancerpatienter under cancerprocessen. Därutö- ver önskas ett förbättrat omhändertagande genom att implementera och utvärdera kvalitetshö- jande förbättringsinsatser. Satsningen ska resultera i en trygg och smidig resa genom vården med ett minimum av avbrott mellan olika vårdhändelser. Metod: Patientens vårdkedja studerades med en fallstudie, utifrån en aktionsforskningsansats. Behoven identifierades med patientskuggning, reflektion från observationer och semistruktu- rerade fokusgruppsintervjuer med mikrosystemet, före (referensgrupp) och efter intervention (jämförelsegrupp). Analys genomfördes med kvalitativ innehållsanalys och Kano-modell. Resultat: En fast vårdkontakt var en viktig faktor i vårdkedjan. Den fasta vårdkontakten till- mötesgick behov såsom trygghet och tillgänglighet, vilket medförde en smidigare vårdkedja. Under hela vårdförloppet fanns ett stort behov av stöd, praktiskt liksom psykosocialt, från både profession och närstående. Oberoende av position i vårdkedjan önskades individanpas- sad information och ett gott bemötande. Interventionsgruppen rapporterade bättre tillgänglig- het och stöd i förhållande till jämförelsegruppen, som inte hade tillgång till kontaktsjukskö- terska. Involvering av hela mikrosystemet vid analys med Kano-modell medför att behov och förbättringsmöjligheter identifieras och valideras. Slutsatser: En kontaktsjuksköterska kan utgöra en fast vårdkontakt som tillmötesgår och sä- kerställer cancerpatienters behov. Närstående är en viktig del av mikrosystemet och måste beredas utrymme och resurser. En förbättringsinsats genom implementering av kontaktsjuk- sköterska, utformning av nutritions- och kvalitetsregisterrutiner baserat på patientens behov bidrar till god vård och minskar risken för resursslöseri. Studien har även bidragit med fördju- pad kunskap gällande applicering av Kano-modellen i Hälso- och sjukvårdsmiljö. / Purpose: To create opportunities for an improved cancer care, by providing deeper knowledge and understanding of the needs of head and neck cancer patients during the cancer treatment process. Furthermore, to improve care for these patients by implementing and eval- uating QI efforts. This will result in a safe and smooth journey through the care with a mini- mum of disruption. Method: The cancer treatment process was examined in a case study with an action research approach. Patient needs were identified by patient-shadowing, observational reflections and focus groups-interviews with the microsystem, before (non-intervention group) and after in- tervention (intervention group). The data analysis involved qualitative content analysis in- formed by Kano’s quality model. Results: A contact nurse (CN) was an important factor. The CN provided a sense of security and accessibility, giving patients a smoother trajectory of care. Continual support was needed, regarding both, practical and psychosocial matters, from both professionals and relatives. Re- gardless of position in the continuum of care, individual information and good reception was required. Members of the intervention group reported better accessibility and support com- pared to the non-intervention group members, who were not offered a CN. Conclusion: A CN can provide a continual health care contact; meeting and ensuring that the needs of cancer patients are met. Relatives are an important part of the microsystem and should be given space and resources. An improvement effort by implementing routines for a CN, quality registry and nutrition, based on patient needs will facilitate good care and opti- mise resources. The study has also contributed to deeper knowledge of how to use the Kano model in health care.