Public health nurses have other responsibilities in addition to providing services to patients and families. They are expected to participate in community efforts to promote education of the public in relation to cancer. This involves helping to plan and carry out programs for organized groups-PTA, Kiwanis, women's clubs, etc. If the nurse is asked to speak she should welcome the opportunity to share her information about cancer with either organized or informal groups. She should be familiar with the variety of films, pamphlets, exhibits, and demonstration materials which are available, and should give thought to selecting those most appropriate for each specific audience.

Nurses need help in how to work effectively with groups. They need to learn how to handle anxiety in the overall group as well as how to react constructively when emotionally charged situations develop. They should anticipate that on occasion they will be approached by an anxious or fearful person who is concerned about having the symptoms which have been discussed. The importance of giving time to this person either immediately or at a future date cannot be overemphasized.

Support During Diagnosis

Many patients lack the incentive to seek medical care in the early and most curable stage of cancer because pain and discomfort may not be present.

Definitive diagnosis may involve the patient undergoing a number of examinations and tests which, to him, bear no relationship to the answer he seeks, i.e., "Do I or do I not, have cancer?" During this period the nurse may be called upon to exercise all her tact and to draw upon the patient's family and community resources in order to get the patient under medical supervision and to help keep him there until diagnosis is established and treatment instituted.

It is well to remember that people react to stress in many ways and the passive "accepting" patient may be as greatly disturbed as the overly aggressive and hostile one. More will be said about the psychological aspects in the following pages.

The public health nurse can offer a great deal of support to the potential surgical patient and his family. Also there is much she can say to the patient which will increase his confidence in the physician. This means that the nurse needs to know what is being planned for the patient as well as what the doctor has told the patient and his family. The nurse is often quite influential in persuading patients to "follow through" on whatever plan of action the doctor has recommended.

Fear of pain, disability, or mutilation may be expected reactions from most cancer patients. Often the nurse's ability to listen is the most important contribution she can make to the patient's ultimate welfare at certain periods during diagnosis, treatment, and followup. If she can understand and accept the patient's anxieties and make it possible for him to express them she will learn his needs much more readily.

Several readings related to better understanding of patient's problems may be found in appendix IV.