A day in the life of a nurse working with Head and Neck Cancers

Pictured Left to Right: Lilija Sanni HCA, Pamela Brennan Staff Nurse, Lyndsey Reid CNM 1, Orlagh Duff Staff Nurse, Lorraine Leacy Staff Nurse, Nikhita Lonappan Staff Nurse

Head and Neck nursing is a very challenging but extremely rewarding career pathway in nursing especially when you see the time and effort of your working day, making a difference, for the patients attending the service.

There are multiple reasons why someone would require a tracheostomy or laryngectomy, one of these reasons is a head and neck cancer diagnosis. These patients sometimes require major surgery, on top of dealing with a potentially new cancer diagnosis and this is huge for patients to deal with.  

As most head and neck surgeries are very complex, the nurse begins preparing them for life after surgery from the first day of their admission. The preparation may include a visit from a previous patient who has gone through a similar journey and is now on the road to recovery.

As these cancers are not highlighted very much in the media, patients, in general, would not be as aware of some of the challenges ahead for them. The side effects of these surgeries can have a significant impact on a patient’s speech, their swallow and how they look. These may include that the patient may have an artificial airway in the neck and therefore may not be able to breathe through their nose and mouth as before. They may have an ICU stay direct from theatre but can potentially come back to the ward a day or two later. This is also a lot for the Patients to take in because they will be going from having a nurse at the bottom of their bed 24/7 caring just for them, to a nurse who has 8-12 other patients to care for. They will also be in a side room on the ward on their own which can increase this anxiety when initially returning to the ward. For a nurse receiving a patient from ICU a lot of time is spent initially alleviating their anxieties and building trust with the patients. The immediate post- operative period for a patient may be frightening as they could have drains in their neck, tubes in their nose and various lines and devices attached to them. They may not be able to eat or drink and they could have a very swollen face and neck. For most patients these are not permanent changes and the nursing team work very closely with other disciplines also to develop solutions for each individual patient based, on their expert knowledge in the the head and neck surgery specialty.

One of the major challenges facing some patients, post operatively is ‘communication’- the inability to speak. This is particularly difficult for someone who previously was able to speak having to rely the nurse being able to read the patients lips to understand what they need, it may require the patient to write down their request and now the team also has to factor in that the patient may not have English as their first language. Writing down what you need to say (as a patient) seems like a simple thing but after you have had major surgery you can be sore, patients could have restricted movement due to tubes and drains or perhaps the patient has positional pain in their shoulders which can hinder this and again to add complexity to an already stressful situation is the patient who cannot write. The nurse’s role here is to make the patient feel as comfortable and secure as possible, it takes time and significant work with the patient and the speech and language therapist to allay the stress of the patient and to give the patient the tools they need to be able to get their message across. This highlights the skills of adaptability of the head and neck cancer surgery nurse because no matter what obstacle is put as a barrier the nurse remains the patient advocate and has to find a way that is best for the patient to get their message across.

As the patient’s recovery progresses post operatively, their drains will begin to be removed, devices discontinued and swallow tests performed. This period requires a lot of nursing intervention. The patient will continue to have tests at different time points in their recovery –an example of this is the swallow test this is checked just before a patient starts eating and drinking, this identifies if there are any issues that need to be addressed to ensure the airway is secure. If any issues are identified, for example, a small leak the patient will have to wait a little longer to restart on food and drinks while the airway heals further.

Whilst caring for the patient the nurse is also working with them to encourage them to be as independent as possible with a view to the patient being as confident as possible on discharge from hospital. The patients do find it daunting to have to go home with perhaps a tracheostomy but this is very normal and the wider multidisciplinary team including the specialist airway nurses, speech and language therapist, occupational therapist, physiotherapist and clinical nutritionist all work together and communicate very closely with the nursing team to give the patient the tools to deal with this on discharge.

The preparation for discharge, in some cases, involves education and training family members/carers on tracheostomy care, feeding tube care and general support for someone affected post head and neck cancer surgery. The education is a long process and a patient will never be discharged until the nursing team are confident that the patient/family will be able to look after themselves day to day as well as in an emergency which could be potentially life-saving. The nurse contacts the community supports i.e. public health nurse, the patient’s local health centre well in advance of the patient discharge.

Two of the most rewarding days I find looking after head and neck patients, especially the complex cases are firstly the day they are discharged home and secondly when they come back to the ward for a visit when they are in St James’s Hospital for a clinic appointment or receiving treatment. These patients can have very long stays with us in Johns Ward and we build up such a relationship and rapport with them. This is especially true since the COVID-19 pandemic when we became, in some cases, the only people these patients saw and communicated in person with for weeks on end. Discharging the person home is such a lovely feeling and staff come from all over to say goodbye and to wish them well. Often our patients will pop back in to tell us how they are getting on and the progress they have made. It is great to see how far they have come.

Head and Neck Cancer surgery nursing requires the nurse to be able to communicate very well, to have patience, be adaptable, innovative and passionate about what they do in order to prepare the patient to return to a meaningful life after the surgery and follow up treatment.