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Implementing Nurse-Based Systems to Provide American Indian Women With Breast and Cervical Cancer Screening

      Objective

      To describe the factors critical to implementation of a nurse-based system to increase access for American Indian women to breast and cervical cancer screening.

      Material and Methods

      We report the experience of 103 nurses at 40 clinics who were trained to use the nurse-based screening system. In addition, the critical elements are discussed in the context of one particularly successful site.

      Results

      Fifteen factors were identified as critical to the implementation of a nurse-based cancer screening process once a nurse had been trained to perform clinical breast examinations and collect Papanicolaou (Pap) test specimens: knowledge of benefit, skills, organization, adequate return, perceived patient demand, perceived effectiveness, legitimacy, confidence, commitment, adequate resources, a data-driven iterative approach to program implementation, an objective measure of quality, leadership, the passage of time, and a focus on delivering the service to the patient. For example, in one site that was particularly successful, the nurses, administrators, and other key health-care professionals contributed their respective resources to implement the screening program. The program was also supported by the lay community, the state board of nursing, and the state health department breast and cervical cancer control program. During the 3-year study period, the 103 nurses performed screening tests on 2,483 women, and only 18 of the Pap test specimens were unsatisfactory.

      Conclusion

      Nurse-based systems designed to collect high-quality Pap test specimens and perform detailed clinical breast examinations can be implemented if the factors that are critical to implementation are identified and addressed.
      CQI (continuous quality improvement), Pap (Papanicolaou)
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      References

      1. Valway S Cancer Mortality Among Native Americans in the United States: Regional Differences in Indian Health, 1984-88; Trends Over Time, 1968-1987. US Department of Health and Human Services, Public Health Service, Indian Health Service, Rockville (MD)1991: 39 (110)
        • Burhansstlpanov L
        • Dresser CM
        Native American Monograph No, 1: Documentation of the Cancer Research Needs of American Indians and Alaska Natives. National Cancer Institute, Bethesda (MD)1993 (Publication No. NIH 93-3603)
        • McGinnis JM
        • Lee PR
        Healthy People 2000 at mid decade.
        JAMA. 1995; 273: 1123-1129
        • Welty TK
        • Zephler N
        • Schwelgman K
        • Blake B
        • Leonardson G
        Cancer risk factors in three Sioux tribes: use of the Indian-specific health risk appraisal for data collection and analysis.
        Alaska Med. 1993; 35: 265-272
      2. The Forgotten Minority: Delivering Health Care to American Indians. Northwest Report No. 13. Northwest Area Foundation, St. Paul1993 Jan: 23-27
        • Massingberd K
        The role of nurses in a comprehensive cancer screening programme for women in Finland.
        in: Pritchard AP Cancer Nursing a Revolution in Care: Proceedings of the Fifth International Conference on Cancer Nursing: London, 4th-9th September, 1988. Springer Publishing Company, New York1989: 135-137
        • Kottke TE
        • Trapp MA
        The quality of Pap test specimens collected by nurses in a breast and cervical cancer screening clinic.
        Am J Prev Med. 1998; 14: 196-200
        • Pachciarz JA
        • Abbott Ml
        • Gorman B
        • Henneman CE
        • Kuhl M
        Continuous quality improvement of Pap smears in an ambulatory care facility.
        QRB Dual Rev Bull. 1992; 18: 229-235
        • Fletcher SW
        • O'Malley MS
        • Bunce LA
        Physicians' abilities to detect lumps in silicone breast models.
        JAMA. 1985; 253: 2224-2228
        • Rogers EM
        Diffusion of Innovations. 3rd ed. Free Press, New York1983: 163-240
        • Tornatzky LG
        • Eveland JD
        • Boylan MG
        • Hegtzner WA
        • Johnson EC
        • Roitman D
        • et al.
        The Process of Technological Innovation: Reviewing the Literature. Productivity Improvement Research Section, Division of Industrial Science and Technological Innovation, National Science Foundation, Washington (DC)1983 (Report No. NSF 83-37)
        • Fairweather GW
        • Sanders DH
        • Tornatzky LG
        • Harris Jr, RN
        Creating Change in Mentai Hearth Organizations. Pergamon Press, New York1974
        • Tornatzky LG
        • Fergus EO
        • Avellar JW
        • Fairweather GW
        • Fleischer M
        Innovation and Social Process: A National Experiment in Implementing Social Technology. Pergamon Press, New York1980
        • Pennypacker HS
        • Pilgrim CA
        Achieving competence in clinical breast examination.
        Nurse Pract Forum. 1993; 4: 85-90
        • Balestracci Jr, D
        • Barlow JL
        Quality Improvement: Practical Ap plications for Medical Group Practices. Center for Research in Ambulatory Health Care Administration, Englewood (CO)1994: 27
        • Batalden PB
        • Stoltz PK
        A framework for the continual improvement of health care: building and applying professional and improvement knowledge to test changes in daily work.
        J Comm J Q Improv. 1993; 19: 424-447
        • Berwick DM
        Continuous improvement as an ideal in health care.
        N Engl J Med. 1989; 320: 53-56
        • Glaser BG
        • Strauss AL
        The Discovery of Grounded Theory: Strategies for Qualitative Research. Aldine Publishing, Chicago1967: 21-43 (3; 61-254)
        • Kottke TE
        • Blackburn H
        • Brekke ML
        • Solberg LI
        The systematic practice of preventive cardiology.
        Am J Cardiol. 1987; 59: 690-694
        • Berne E
        The Structure and Dynamics of Organizations and Groups. Lippincott, Philadelphia1963: 105-115
        • Wangensteen OH
        • Wangensteen SD
        The Rise of Surgery. University of Minnesota Press, Minneapolis1979: 429-434
      3. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. US Government Printing Office, Washington (DC)1991: 430 (Publication No. PHS 91-50212)
        • White PD
        International cardiovascular epidemiology: introductory remarks.
        in: Keys A White PD Cardiovascular Epidemiology. Paul B Hoeber, New York1956: 3
        • Daida H
        • Kottke TE
        The epidemiology of coronary heart disease: case studies of five countries.
        Phys Med Rehabil Clin N Am. 1995 Feb; 6: 15-35
        • US Preventive Services Task Force
        Guide to Clinical Preventive Services. 2nd ed. Williams A Wilkins, Baltimore1996: 1xv (1xix)
        • Argyris C
        • Putnam R
        • Smith DM
        Action Science. Jossey-Bass, San Francisco1985: 53
        • Solberg LI
        • Kottke TE
        • Brekke ML
        • Calomenl CA
        • Conn SA
        • Davidson G
        Using continuous quality improvement to increase preventive services in clinical practice—going beyond guidelines.
        Prev Med. 1996; 25: 254-267
        • Kottke TE
        • Brekke ML
        • Solberg LI
        Making “time” for preventive services.
        Mayo Clm Proc. 1993; 68: 785-791
        • Kottke TE
        • Solberg LI
        • Brekke ML
        • Cabrera A
        • Marquez MA
        Delivery rates for preventive services in 44 midwestern clinics.
        Mayo Clin Proc. 1997; 72: 515-523
        • Glassman AM
        Rethinking organization stability as a determinant for innovation adoption and diffusion.
        NIDA Res Monogr. 1995; 155: 132-146

      Linked Article

      • New Model for Cancer Screening in American Indian Women
        Mayo Clinic ProceedingsVol. 73Issue 9
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          Breast cancer occurs with a lower frequency in southwestern American Indian women than in white non-Hispanic women.1 The lower survival rate of these women has been repeatedly described by the Surveillance, Epidemiology, and End-Results Program of the National Cancer Institute and may reflect a more advanced stage at detection of the cancer because of delay in diagnosis. Breast cancer may also be increasing in this population.2
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