How do Patient Navigators Contribute to Equitable, Quality and Culturally Appropriate Health Care?

How do Patient Navigators Contribute to Equitable, Quality and Culturally Appropriate Health Care?

In January 2009, the Maricopa Integrated Health System (MIHS) staged the grand opening of the Refugee Women’s Health Clinic in Phoenix, Arizona with Dr. Crista Johnson, MD, FACOG as the founding medical director. It is believed to be the only such clinic in the U.S. specializing in obstetrics and gynecology for refugee women from Africa, Asia and the Middle East.

Dr. Crista Johnson-Agbakwu.“What was striking,” said Dr. Johnson, “was the language, the cultural barriers and the stress the women experienced when they would come to the hospital.  The clinic will be an oasis to the community because there will be trained staff, knowledgeable regarding care services, resources, and specialized information who understand the patients better, and are able to facilitate a positive patient experience during their hospital contact and even in their homes.”

“These people,” Dr. Johnson continued, “are called navigators and they include nurses, public health workers, lay workers and others who would serve as a resource guiding, interpreting, communicating, facilitating and helping the refugees through the often times complicated and unfamiliar processes in obtaining satisfactory health care services.”

In the case of the refugee, who most know very little about seeing a doctor, or receiving clinical treatment, or home care of any sort and are also totally lacking in exposure to allied health services. But the engagement of navigators to improve certain service outcomes, and ultimately access to services, added a dimension that has made the service provider a key contributor to the improvement of patient satisfaction.

Duke Health in 2011 launched a robust and credible initiative using a class of employees as navigators who would serve as a resource to patients who because of cultural, economic, historical life experiences, or other reasons needed assistance in facilitating their engagement with the healthcare provider.

“The mission of the intervention,” said Dr. Angelo Moore, PhD, Assistant Director and Program Manager for Community Outreach, Engagement, and Equity (COEE) with Duke Cancer Institute, “was to be part of a highly visible community overall strategy to achieve care delivery that was equitable, culturally appropriate, and timely. The desired result would contribute to improved community health, higher performance outcomes and patient satisfaction.” The mechanism that would be employed is referred to as patient navigation. This is a concept and a process first introduced in 1990 by Dr. Harold Freeman a surgeon who saw the need for a resource for his cancer patients in Harlem Hospital, New York and who were predominantly African American women.

Patient and nurse navigator pioneer Harold Freeman. Dr. Freeman, who now oversees the operations of the Harold P. Freeman Patient Navigation Institute in New York, describes navigation as an individual intervention to help overcome barriers due to systemic reasons.  “Patient navigation is what a person does,” says Dr. Freeman. However, the type of patient navigation that is employed is based on the education, skill set, scope and who is being served. In the market-place, and since the launching of the concept, several different titles have emerged such as Nurse Navigator, Resource Navigator, Community-Facing Navigator, Clinical Navigator, Non-Clinical Navigator, Lay Navigator.  There is now an ongoing effort to harmonize these titles around a common set of descriptors common to the role and purpose of navigation.

Foundational to the role and purpose of navigation is the elimination of barriers or impediments.
What types of impediments are these? Examples of some of the frequently encountered barriers that may be eliminated through patient navigation: Financial barriers (including uninsured and under insured); communication barriers (such as lack of understanding, language and/or cultural competency), medical system barriers (fragmented medical system, missed appointments, lost results); psychological barriers (such as fear and distrust); other barriers (such as transportation and need for childcare).

Dr Freeman’s interest and desire to tackle the high percentage of African American women who were referred to him for diagnosis and treatment, was peaked when he saw that they were in the third and fourth stages of the disease of cancer. He took note that these women were also poor economically and lived very marginal lives, the circumstances that  would impact their access to care. Dr. Freeman knew from available data that white women had a lower cancer morbidity rate. He decided to conduct an investigative approach to identify, if possible, the root causes of this phenomenon.

One of the core derivatives of his work was the description assigned to the title “patient navigator.” A patient navigator is a healthcare professional who proactively guides patients through the healthcare process. They are responsible for ensuring that the healthcare provider’s system met the needs of the patient as best as possible. To that end, patient navigators spend their time communicating with patients and their families and as an interface between the patient and the provider. They engage patients by describing the relevant options, the true nature of their illness, what to expect during the treatment process, and what their recovery process will be like. They may also need to identify what are the patient’s legal rights.

It’s important that patient navigators once able to convey the specific impediments that stand in the way of effective treatment, go in pursuit of remedies to overcome the obstacles that they may encounter while pursuing treatment. This means that employees in this role need to be highly knowledgeable of healthcare systems and what can be done to ensure the patient is provided the best possible care. Attributes of compassion, positiveness, trust-building and coaching skills are key to success as a navigator.

To do well in this role, it’s critical that the employee be able to answer patients’ questions as they arise. This means that navigators must have a strong understanding of healthcare systems and how they function. They should also be a compassionate, positive individual who is capable of inspiring confidence in the patients served.

Ultimately the impact of the work of patient navigation is embedded in the social determinants of care. This addresses the social, cultural, environmental, and economic conditions in society that impact upon health. In this regard, colleagues compile and disseminate evidence on what works to address these determinants, build capacities and advocate for accelerated action.

Oncology Nursing: An Innovative and Changing Field

Oncology Nursing: An Innovative and Changing Field

Oncology nurses help patients face the uncertain territory that a cancer diagnosis brings and navigate a path through treatment.

May is Oncology Nursing Month and the time is set aside to celebrate the work oncology nurses do with patients, the advocacy they bring to their specialty, and the continual professional development they engage in.

Oncology nurses are committed to the best patient care and that means they need to stay engaged in the latest research and evidence-based practices that are always emerging. Cancer care is highly innovative as new therapies, cutting-edge drugs, and novel understandings of cancer progression are discovered. Nurses who decide to specialize in oncology nursing will match their drive for continual learning with the deep empathy for what their patients and families are coping with.

If you’re interested in becoming an oncology nurse, talking with oncology nurses is helpful to begin your research. The demand for nurses who specialize in cancer care is expected to increase over the next year as life expectancy is extended, the population ages, and more people are surviving cancer with increasingly successful targeted treatment.

The first steps are to earn an associate’s or bachelor’s degree and take the NCLEX exam to become a registered nurse. As with other nursing paths, you’ll want to gain general nursing experience where you’re likely to interact with cancer patients. Because people are surviving longer with cancer and treatments are keeping cancer either in remission or at a level where people manage the disease for years, you’re probably going to encounter people living with cancer in just about any unit you work in. You’ll begin to understand the special health needs they have, and the roadblocks they may encounter. For instance, they may have medication contradictions for other existing health conditions, or they may have to consider different approaches to new treatments they need. And they may have emotional and psychological needs to consider as you are working with them.

Cancer care, and living with cancer, is incredibly complex and touches virtually every other aspect of a patient’s life—from nutritional needs to sleep to navigating the world during a pandemic. As you begin to focus your career on oncology nursing, your experience with how all these different factors impact your patient will help you determine the best way to help and guide them while offering excellent patient care.

Connect with other oncology nurses to hear about the hot topics in the field. Organizations like the Oncology Nursing Society, the International Society for Nurses in Cancer Care, and the Oncology Nursing Foundation offer many resources for you to learn more about this career. Read up on some journals focused on oncology such as The Oncology Nurse or the Clinical Journal of Oncology Nursing.

Certification through an organization like the Oncology Nursing Certification Corporation is essential for oncology nurses because it helps you stay on top of the innovative treatments as they are implemented. Additional certifications are available as you move deeper into a specialty area of oncology nursing. The additional knowledge you’ll gain through certification will only help you provide better, more informed patient care, and your efforts will signal your commitment to being the best nurse you can be.

This field is growing and dynamic. Oncology nurses are needed in many healthcare settings, and they develop relationships with patients over the course of treatment and continued care. This nursing path is flexible, innovative, and rewarding.