Julia Taylor, RN, DipNS.
Specialist Urology Nurse, Urology Unit, Hope Hospital, Salford, ManchesterThis paper looks at the findings of a postal survey that sought to identify patients' perception of, and satisfaction with, their nurse-led cystoscopy surveillance service. The patients had superficial bladder cancer or transitional cell carcinoma of the kidney.
The nurse-led cystoscopy service was developed in response to a demand for surveillance for patients with superficial bladder cancer. This arose from the findings of a regional audit undertaken in north west England in 1998, which revealed that the population served by Hope Hospital had the highest incidence of this disease in Salford.
The urology team (specifically the specialist nurse, consultant urologist and specialist registrar, with support from other members of the wider urology team) has been actively involved in evaluating the specialist nurse service by developing protocols, implementing training programmes locally for nurse endoscopists, providing training for a second nurse endoscopist and undertaking research and audit, which is an integral part of the clinical nurse specialist role (Humphris, 1994). Research had shown that experienced nurses with a special interest in urology can develop the skills for undertaking flexible cystoscopy and become competent at detecting recurrent bladder tumours (Gidlow et al, 2000). Moreover, they are able to determine an appropriate course of action based on their findings (Taylor et al, 2002).
The aims of the study were to explore the understanding of patients attending for surveillance cystoscopy at the nurse-led session. More specifically, the team wanted to:
A semi-structured postal survey was sent to the patients whose names were held on the Salford Royal Hospitals urology superficial cancer database. All of them had a diagnosis of superficial cancer and required several surveillance cystoscopies throughout the year. A total of 310 postal questionnaires were distributed, together with stamped addressed envelopes to return to the urology department, of which 187 were returned (a response rate of 60.3%). The age range of those replying was 41-92 years, with the ratio of men to women being 5:3.
Perception and understanding of the diagnosis Since the service was implemented patients have had the chance to discuss their diagnosis at any point that they felt appropriate along their cancer 'journey'. The data analysis showed that, although all patients had a histological diagnosis of superficial bladder cancer, less than one-third identified this as their diagnosis (Figure 1). More than half (53%) said they had bladder warts. This finding challenged an assumption that all the patients seen by the nurses were aware that they had superficial bladder cancer. The results also showed no differences in understanding by age and gender.
Introduction of the nurse-led service was found to provide a range of benefits for patients with superficial bladder cancer (Box 1). But it also found that it was crucial for nurses and other health-care professionals not to make assumptions about patients' knowledge and understanding.
The author would like to thank Ms E. Craddock, for data collection, Mr P. Jones for data analysis and staff in the Department of Urology, Hope Hospital, Salford, Manchester
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