Congress Abstracts 2005

8

A COLLABORATIVE APPROACH TO CARE OF THE PATIENT AFTER TRAM FLAP SURGERY: IN THE HOSPITAL AND BEYOND. Carolyn Weaver, RN, MSN, AOCN^®, and Deena Dell, RN, MSN, AOCN^®, BC, Fox Chase Cancer Center, Philadelphia, PA.

For many women who have a mastectomy, breast reconstruction makes a huge impact on their quality of life. There has been an increase in the number of free transverse rectus abdominis muscle (TRAM) flaps as well as deep inferior epigastric artery (DIEP) flaps at this Comprehensive Cancer Center. The Breast Cancer Clinical Nurse Specialists (BCCNSs) identified the need for a collaborative approach to care of these patients and subsequently established the interdisciplinary program.

The purpose of this program is to improve patient outcomes and satisfaction after TRAM flap breast reconstruction. The literature contains information about how to care for these patients immediately after surgery but little attention has been given to psychological preparation before or symptom management after hospitalization.

At the initial visit, a BCCNS along with the breast cancer social worker provides patients and support persons with information about available resources and an overview of treatments, including breast reconstruction. A plastic surgeon on the team provided in-services for the healthcare staff (including preadmission testing) on the types of TRAM surgeries and standard post op care. A standard of care and monitoring checklist were developed. The social worker created a database of women who had TRAM surgery and who were willing to share their experiences. The nursing and physical rehabilitation staff collaborated with the surgeon to devise a patient information sheet that explained activity restrictions and abdominal and postural exercises. The BCCNSs wrote several articles (one along with the physical therapist) to help educate nursing and physical rehabilitation colleagues.

Current evaluation of the program is based on anecdotal evidence and subjective evaluations. Therefore we, in collaboration with physical therapy, have instituted a research study to objectively identify the post op recovery with special attention to the area of pain assessment, pain control, return to prior activities, and patient satisfaction with our interventions.

A collaborative approach to care of the TRAM patient helps to ensure that satisfactory patient care outcomes are achieved. This interdisciplinary process can easily be utilized by other oncology nurse to improve nursing practice.