There are many kinds of referral plans which have been developed to obtain nursing service for the patient who is returning to his home after treatment in the hospital. Among the more useful types is the referral system which makes provision for communication between the nurse in the hospital and the public health nurse. It is very helpful if the nurse in the hospital understands and believes in the value and importance of nursing followup in the home, recognizing it as a true continuity of the nursing service rendered in the hospital. The nurse who truly believes this can often be instrumental in tactfully reminding the physician of this availability of nursing service in the community and in assisting the patient to obtain this service.

Hospital referral plans vary markedly. Not all of them are initiated by nurses. Several departments may be involved in the procedure and it is important the nurses cooperate with whatever the official plan of a particular institution may be. It is well to ask, however, that the written referral form include a specific place for the nurse to record the important things about the nursing needs of the patient.

If the public health nurse can be notified in advance of the patient's discharge she may be able to make a predischarge visit to the hospital and a home visit to prepare the family for the patient's homecoming.

The family may need time and direction to obtain or prepare special equipment that may be required for the patient. Sometimes household arrangements or schedules must be altered, and with guidance from the public health nurse and a little advance notice the family may be able to accept changes more easily with resulting benefits to the patient.

Good communication between the nurse in the hospital and the public health nurse is important. The information which the public health nurse can give the hospital nurse will help her understand the home environment-physical, social, cultural, and emotional- from which the patient comes. This will help the nurse to adapt her teaching to the needs and potential of the patient and his family.

Exchange of information between the public health nurse and the hospital nurse should also insure that the same set of instructions and demonstrations be given to the patient and his family, whether the teaching is done in the home, in the hospital or in the clinic. Patients may be very sensitive to changes of procedures and the way things are done. Even though a new way of doing the procedure may be as good or better than the way the patient was originally taught, he may resist change because of certain attitudes and feelings which are involved. The public health nurse who is familiar with what has already been done for the patient will be better able to help both the patient and his family adjust to the patient's homecoming.

Rehabilitation of Cancer Patients

Rehabilitation is not discussed as a separate entity because the patient's ultimate rehabilitation is an integral part of the medical and nursing care plan from the time the patient reports for diagnosis. The nurse contributes to rehabilitation in many ways- sometimes directly by her own skills, knowledge or encouragement, or sometimes indirectly as she selects, mobilizes, or utilizes community resources.

The thoughtful nurse will observe the patient's reactions and will plan constructive ways to be of help according to the needs of each individual. Her willingness to listen to the patient's anxieties with her mind as well as her ears, will enable her to learn much upon which a constructive rehabilitation plan can be developed. However, a free exchange of ideas is possible only when the nurse creates an atmosphere which encourages verbalization from the patient.

It should be remembered that the nurse's attitude as well as what she actually says, will affect the patient's feelings and hence his willingness to communicate.

This is not to infer that everything the nurse needs to know can be learned directly from the patient. Much can be learned from the physician, the family, referral records, and those who had contact with him in the hospital. If referral to a community resource is needed it then becomes necessary to select the one which is most appropriate to assist the patient and his family in furthering his rehabilitation.