Nurse Navigator: development of a program for Brazil

Pautasso, Fernanda Felipe; Lobo, Thafarel Camargo; Flores, Cecília Dias; Caregnato, Rita Catalina Aquino

doi:10.1590/1518-8345.3258.3275

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 28 • 2020 • https://doi.org/10.1590/1518-8345.3258.3275 copy

Nurse Navigator: development of a program for Brazil^* * Paper extracted from master´s thesis “Desenvolvimento de um programa de navegação em um centro de alta complexidade”, presented to Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to develop a Navigation Program for cancer patients, based on the model proposed by The GW Cancer Institute at George Washington University, adapted to the reality of a Brazilian High Complexity Center in Oncology.

Method:

a convergent care research applied in the development of a patient navigation care process, based on the model proposed by George Washington University, adapted for a High Complexity Center in Oncology in Brazil. Phases of the Convergent Assistance Research: conception, instrumentation, scrutiny, analysis and interpretation. These were correlated with the stages of the Program Development Cycle. Scale designed to categorize patients into navigation levels, validated by the Delphi Technique, with 12 specialists.

Results:

in the diagnosis, patients with head and neck cancer were defined for inclusion in the Navigation Program. Planning and implementation took place simultaneously, allowing the basic formatting of the program and its processes to be designed. Navigation Needs Assessment Scale designed to select the patient to join the Program and determine the recommended support. The scale validation had a consensus index of 96.42%. Evaluation of the stages of the cycle occurred through the adapted Plan/Do/Check/Act cycle.

Conclusion:

a Navigation Program was developed adapted to the Brazilian reality, and attributions of the navigators were created.

Descriptors:
Patient Navigation; Nursing; Oncology; Nurses; Patient-Centered Care; Neoplasms

Navigation needs assessmen scale (Escala de avaliação de necessidades de navegação, EANN*)
Category	key questionto the patients		Criteria		Score
Patient's understanding regarding the diagnosis	What did your doctor tell you about your health problem?		Uderstands your diagnosis		1
	If yes, what did he/she tell you?		Partly understands the diagnosis		2
	From all that said, what did you understand?		The patient did not understand an anything or whats was said about his/her diagnosis		3
Communication ability	Observe the patient's ability to communicate during the ir responses to the questions:		No communication difficulties		1
	Is there any physical barrier that makes it impossible?		Has some communication difficulty		2
	Are there language, cognitive or cultural barriers that partially or completely hinder their ability to communicate?		Cannot communicate		3
Understanding the treatment trajectory	Did your doctor tell you about how your treatment will be? If so, what did he tell you?		Understands the treatment trajectory well		1
	Did you undertand what you were told? If so, what did you undertand?		Partially understands the treatment trajectory		2
	Do you know what the stages of your treatment will be and how they will be carried out?		Does not understand the treatment trajectory		3
Organizational ability to perform the treatment	Do you have any difficulties to come for the appointments, treatments, and/or perform exams? If so, which?		The patient is able to organize himself to attend to appoiments, treatments and/or to carry out necessary exams		1
Organizational ability to perform the treatment	Would you like to receive help from someone to organize your appointment, treatment and exam schedules? If so, how could this person help?		The patient has difficulty organizing himself to attend to appointments, treatments and/or to carry out necessary exams and needs help to do so		2
Access to health services/system (transport conditions, commuting between services necessary for treatment within and outside the health institution)	Do you have any difficulty going to the hospital and/or another location (outpatient clinics, diagnostic imaging centers, laboratories, other hospitals) to carry out your treatment? If so, which one(s)?		It is easy to access the service by means of transport (public or private) and knows how to locate the place (hospital or other service) of your treatment		1
	Do you know where the hospital is and the sectors where you do your treatment? If so, where?				1
	Do you use any transport (public or private) to come to the hospital? If so, Which onde?		It is easy to access the transport (public or private) to go to the health service and difficulty in locating the hospital/service of your treatment (other reasons)		2
	Do you have the means to go the hospital and/or other places to caarry out your treatment? If so, how do you get there?		Difficulty in accessing a transport (public or private) to go to the hospital/service for tratment and difficulty to go the place (hospital/sector) for treatment		3
Family sypport	Are you accompanied by a family member and/or caregiver when you come to consultations and/or carry out your treatment? If so, who?		There is full support and monitoring: the family/caregiver participates in decisions and care and accompanies the patient always of treatment		1
	Do you have any family, friend and/or caregiver support you during the treatment? If so, who?		There is partial support and monitoring: the family/caregiver participates in decisions and care and accompanies the patient in some moments of treatment		2
	Who do you talk to, besiders hospital/service professionals, about your health problem, treatment and the changes that are occurring?		Absence of support: the patient has no family member/caregiver who participates and monitors their treatment		3

Total Score:___________________________________
Navigation Level 1: Navigation performed by an academic navigator and a professional navigator most of the time, with support from the nurse navigator.		Key MINIMUM SCORE: 6 POINTS MAXIMUM SCORE: 17 POINTS		6 TO 9 POINTS: NO NAVIGATION NEEDED
				10 TO 12 POINTS: NAVIGATION NEED LEVEL 1
Navigation Level 2: Navigation performed by the nurse navigator, mainly with other navigators.				13 TO 12 POINTS: NAVIGATION NEED LEVEL 2

List of Assignments
Help patients to identify and overcome challenges to obtain quality health care.
Help patients to access care and navigate the health system.
Assist patients to mitigate and overcome barriers to obtain care.
Assess the main barriers to care, involving patients and family members/caregivers in the definition of solutions to overcome them.
Identify the necessary resources to meet the needs of patients (biopsychosocial and spiritual), considering social, cultural and cognitive conditions, making the necessary referrals with the multidisciplinary team.
Educate patients and caregivers about cancer treatment, the roles of multidisciplinary team members and what to expect from the health system and service.
Contribute to the development, implementation and evaluation of the patient navigation program.
Encourage communication between patients, family members/caregivers and professionals responsible for health care to favor and optimize results.

Dimension	Assignments
Care Coordination	Assess patients for their need for navigation from the EANN^* * EANN = Navigation Needs Assessment Scale; .
	Develop and implement the navigation plan for patients included in the NP^† † NP = Navigation Program .
	Identify possible barriers to obtaining care and facilitate access to the services and resources needed to mitigate them.
	Promote and implement a consistent and comprehensive navigation plan, using appropriate tools and methods for assessment, based on the best scientific evidence.
	Participate in defining the care plan with the multidisciplinary team and patient.
	Coordinate the care plan with the team, accompanying the patient during their treatment and providing support through guidance, health education.
	Facilitate the promotion of individualized care considering the physical, cultural, biopsychosocial and spiritual needs for patients and family members/caregivers.
	Assist patients to overcome barriers related to treatment goals, palliative care and end of life concerns through an ethical and humanized approach.
	Know health systems and the impact of their processes for treatment in a timely manner, providing support to patients and favoring safe decision-making in conjunction with the multidisciplinary team.
	Provide support to patients for the organization of appointments, exams and other procedures necessary for their treatment, aiming to promote their adherence and participation in planning.
	Assist and make it possible for patients to attend consultations and other tests and procedures necessary for treatment.
	Coordinate the operation of the NP^† † NP = Navigation Program and performance of the navigator team.
Leadership	Supervise the execution of navigation processes.
	Evaluate the results and outcomes related to the NP^† † NP = Navigation Program .
	Implement improvements and/or new processes to improve the quality of the NP^† † NP = Navigation Program .
	Develop tools to optimize NP results^† † NP = Navigation Program .
	Act as a link between patients, their families/caregivers and the care team, favoring the strengthening of the bond between them.
Communication	Promote effective communication between the multidisciplinary team and patients.
	Work with the multidisciplinary team to promote patient-centered care that includes shared decision-making, setting goals related to treatment and evaluating outcomes.
	Favor and direct access to psychological and/or social support according to the needs of patients and family members/caregivers throughout the treatment trajectory.
	Ensure that communication is culturally appropriate for the level of understanding and cognition of patients and family members.
	Empower patients through the development of a personalized educational plan, aimed at promoting patients' autonomy in relation to their treatment.
Health education	Develop an educational plan for patients and family members/caregivers considering possible and existing barriers to care.
	Promote health education for patients, families and caregivers on diagnosis, treatment, management of side effects and other care to prevent the occurrence of complications.
	Provide health education and personalized support, favoring patients' autonomy in decision making regarding their treatment.
	Give to patients and family members/caregivers information based on the best scientific evidence to answer questions about treatment and potential expected results.
	Provide information aimed at promoting quality of life during treatment, guiding you on the importance of maintaining a healthy and self-care lifestyle.
	Promote and favor adherence of the patients to treatment through health education.
	Guide and inform patients and families/caregivers about the health system, access to available resources and services, about the roles of members of the multidisciplinary team.
Guidance and Information	Guide and inform patients about times of procedures, consultations, exams and necessary accompaniments for their treatment.
	Guide patients on care and management of possible complications related to their treatment.
	Provide access to information on the assistance needed according to the needs of patients.
	Inform patients about their rights and duties in relation to their treatment and diagnosis.
	Direct patients to the necessary services for the proper progress and continuity of their treatment.

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[1] Corresponding author: Fernanda Felipe Pautasso E-mail: enfermeirafpautasso@hotmail.com https://orcid.org/0000-0001-8791-9308

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Nurse Navigator: development of a program for Brazil* * Paper extracted from master´s thesis “Desenvolvimento de um programa de navegação em um centro de alta complexidade”, presented to Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.

Objective:

Method:

Results:

Conclusion:

Nurse Navigator: development of a program for Brazil^* * Paper extracted from master´s thesis “Desenvolvimento de um programa de navegação em um centro de alta complexidade”, presented to Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.