Suzanne Mellon

A family-based program of care for women with recurrent breast cancer and their family members.

PURPOSE/OBJECTIVES To evaluate the FOCUS Program (family involvement, optimistic attitude, coping effectiveness, uncertainty reduction, and symptom management), a family-based program of care for women with recurrent breast cancer and their family caregivers. DATA SOURCES Randomized clinical trial. SETTING Midwest region of the United States. DATA SYNTHESIS The family-based program of care consisted of five components: family involvement, optimistic attitude, coping effectiveness, uncertainty reduction, and symptom management. The program was delivered in three home visits and two follow-up phone calls over a five-month period of time. CONCLUSIONS Patients with recurrent breast cancer and their family members reported high satisfaction with the FOCUS Program. Although the FOCUS Program had a number of strengths, limitations of the program also were identified that need to be addressed in future family-based interventions. IMPLICATIONS FOR NURSING A need exists for family-based programs of care that enable both patients and their family members to manage the multiple demands associated with recurrent breast cancer.

Mental Health Clinical Nurse Specialist in Home Care for the 90s

The role of the mental health clinical nurse specialist (CNS) in home care is explored in light of the changing emphasis on health care reform. Home care is a field that will continue to expand in the future, and the role of the CNS takes on new definition by addressing the physical and mental health needs of the chronically mentally ill in the community as well as those of the population of clients and families dealing with psychosocial crises, where early discharge leaves them particularly vulnerable. The emphasis is seeing the CNS in home care as a key point of entry and intervention in the mental health delivery system with a focus on prevention and wellness care. Collaborative aspects of care with health care providers and consumers are discussed through case examples. Reimbursement issues are framed within current health regulations with continued changes evolving within the health care reform movement.