Clinical Heaematology Unit

> Taking care of a cancer patient is a way of showing that person that he or she exists in the eyes of others, and to recognise his or her dignity, and to seek a partnership, to preserve or encourage autonomy (Sauzaret, 1982).

A person with an oncological disease (the great majority of our patients) represents a challenge which no team of technicians by itself is able to resolve, respond to and counsel if one wishes to do so appropriately showing consideration for human rights. The nursing team is constituted by a group of professionals whose intervention is centred on the patient and orientated by the care which, apart from dealing with the cure (when possible), deals with the patients holistically, including subjective aspects of the situation, above all seeking a quick recovery and the patientís well-being.

The Clinical Haematology Unit comprises three sections: Hospitalisation, with 30 beds, Immuno-suppression, with 2 beds, where transplants of medulla take place, and the Day Hospital, which provides care for ambulatory patients. Care is provided by a head nurse, a specialist nurse, 22 nurses in the hospitalisation section, 6 nurses in Immuno-suppression, and 2 nurses in the Day Hospital.

The cleaning of the unit is done by a team of auxiliary staff with ten members which functions 24 hours a day. The care given in this unit concentrates on patients with oncological diseases, and is based on the quality standard provided by the administration of nursing services in Portugal and the regulations and criteria defined for this unit.

Our objectives are:

> To contribute to the maintenance of the quality standards for nursing care implemented by the administration of nursing services of Coimbra University Hospital;

> To promote improvement in the quality of nursing care provided in the unit;

> To develop an atmosphere of personal and professional satisfaction, thus encouraging the personal and professional development of the nursing staff;

> To promote the bringing up to date and acquisition of relevant knowledge and skills and their incorporation in daily practices;

> To promote personalised (centred on the patient), holistic, continuous nursing care with a guaranteed quality for the unitís patients;

> To encourage active cooperation and confidence within the unit. Bearing these objectives in mind, we understand that in the area of oncology, multidisciplinary health care teams are necessary, which share objectives, understand and accept the roles and functions of each element, and promote active cooperation and mutual confidence.

This will permit the person with an oncological disease to receive an integrated and holistic treatment, thus allowing all elements of the unit to contribute to a more authentic and humane system. Taking a person away from their surroundings certainly brings about a deep emotional crisis, worsened by the uncertainty of the future, not only his or hers, but also of his or her family. Great changes may be observed when this separation occurs, causing much anxiety in the patient. Everything is unfamiliarÖ the environment, the people, the limitations and the routines. The presence of families and/or significant others is crucial as it provides an environment for the patient and family as similar as possible to that from which the patient has been taken. The independence of the patient and the continuation of health care after discharge from the hospital is encouraged as much as possible, given that is a fundamental principle in the philosophy of the health care adopted in the Coimbra University Hospital, according to the theoretical model of Virginia Henderson.

Objectives of the Special Visitor / Partnership Care are:

> To raise the level of satisfaction on the part of patients and their families;

> To guarantee greater access to the hospitalised patients by their families;

> To promote better coordination between the nursing team and the family/patient;

> To optimise the use of resources;

> To reduce the average stay. The process begins with the reception of the patient, involving the special visitor in the health care team by means of his or her progressive involvement in his or her treatment and his or her preparation for discharge, always under the supervision of the nursing team.

In order to allow for this, the Haematology Unit has increased the visitorí timetable from originally being 12 am to 9 pm to 9 am to 8 pm, thus permitting a much greater opportunity for the special visitor to accompany and participate in the care of their family member/friend. It is intended that the special visitor is seen as an active partner in the treatment within this project, in the planning for discharge from hospital and in the ongoing health care given, as well as seeking a greater humanisation of the care given while strengthening ties with the community external to the hospital.

The setting up of the ìPatientsí Cornerî is also intended to minimise the harmful effects caused by the successive hospitalisations which our patients are subjected to, given their oncological pathology. In the ìPatientsí Cornerî, books, games, and video games, among others, are available to all. It is intended that this functions as a recreational area for hospitalised patients and also serves as a place where patients may discuss their experiences and what they have learnt. It is believed that this place may provide some opportunity to escape, however temporarily, from thinking about their clinical condition. In order to motivate the nursing team and to continuously bring it up to date with advances in the area of treatment, a ìPlace for Reflectionî was set up.

This is a place where the nursing meet every Wednesday for between half to one hour in order to reflect upon and discuss their apprehensions, fears, and anxieties, in order to develop the best health care practices and where these may be questioned whenever considered appropriate, with the objective of encouraging a greater and better involvement and effort on the part of the unit in the materialisation of new projects.