. Author manuscript; available in PMC: 2015 Sep 1.

Published in final edited form as: J Cancer Educ. 2014 Sep;29(3):449–457. doi: 10.1007/s13187-014-0640-z

Table 3.

Case Examples for Acuity Levels

Case Example: Level 1: Low Acuity Navigation Actions	Case Example: Level IV - High Acuity Navigation Actions
Ms. A. is a 76 year old Caucasian with a high school diploma. She was able to understand written documents with minimal assistance at times. She had worked in the school system her whole life as a teacher’s aide. Although widowed a few years before, her daughter who was an RN was very involved in her mother’s health care. Ms. A had her own transportation, and drove herself to her appointments. Her daughter accompanied her to most clinic visits, and they consulted with the doctors directly about Ms. A.’s need for a breast biopsy and discussed her options in English. She had Medicare and a supplemental health insurance to cover her health care. The patient navigator served to make the initial linkages to a clinic for a breast biopsy and supported the family in their navigation of the health system. The patient was well versed on breast biopsy procedure and was accompanied by her daughter. The breast biopsy outcome was negative.	Ms. G, a 50 year old immigrant from Mexico residing in the USA for 5 years. Ms. G states that she has three years of schooling in Mexico. Her limited literacy was noted by her not being able sign her own name (used an X) – she did not understand the words in most documents that were given to her, even in her native language, Spanish. Yet, she was very dedicated to field work and to being a housewife living in a rural area of our county and was open to learning. She was married with several adult children but could not depend on them for support. Her husband did not get involved in her health matters and her adult children were not involved, either by choice or because they did not know of her health situation. She had low understanding of the severity of her diagnosis at first, and was unable to seek resources for treatment on her own as she was unfamiliar with the health system. She was uninsured and undocumented in the USA. She was very quiet and inhibited. The bilingual patient navigator was a significant resource in linking Ms G. to the nurse for education on her cancer diagnosis and needed treatment. Also, the navigator was able to link Ms G. to a social worker for processing of the charity application for care at the cancer center. The navigator accompanied Ms. G. to her appointments, explained processes, and arranged local transportation through the local community health center van. Most importantly, the navigator was able to establish a strong relationship with Ms. G whereby she trusted the navigator enough to follow through with her treatments of chemotherapy and subsequently breast surgery, a mastectomy which saved her life. Due to the complexity of the situation, the nurse supervisor also assisted in navigation and education.

Case Example: Level 1: Low Acuity Navigation Actions

Case Example: Level IV - High Acuity Navigation Actions

Ms. A. is a 76 year old Caucasian with a high school diploma. She was able to understand written documents with minimal assistance at times. She had worked in the school system her whole life as a teacher’s aide. Although widowed a few years before, her daughter who was an RN was very involved in her mother’s health care. Ms. A had her own transportation, and drove herself to her appointments. Her daughter accompanied her to most clinic visits, and they consulted with the doctors directly about Ms. A.’s need for a breast biopsy and discussed her options in English. She had Medicare and a supplemental health insurance to cover her health care.
The patient navigator served to make the initial linkages to a clinic for a breast biopsy and supported the family in their navigation of the health system. The patient was well versed on breast biopsy procedure and was accompanied by her daughter. The breast biopsy outcome was negative.

Ms. G, a 50 year old immigrant from Mexico residing in the USA for 5 years. Ms. G states that she has three years of schooling in Mexico. Her limited literacy was noted by her not being able sign her own name (used an X) – she did not understand the words in most documents that were given to her, even in her native language, Spanish. Yet, she was very dedicated to field work and to being a housewife living in a rural area of our county and was open to learning. She was married with several adult children but could not depend on them for support. Her husband did not get involved in her health matters and her adult children were not involved, either by choice or because they did not know of her health situation. She had low understanding of the severity of her diagnosis at first, and was unable to seek resources for treatment on her own as she was unfamiliar with the health system. She was uninsured and undocumented in the USA. She was very quiet and inhibited.
The bilingual patient navigator was a significant resource in linking Ms G. to the nurse for education on her cancer diagnosis and needed treatment. Also, the navigator was able to link Ms G. to a social worker for processing of the charity application for care at the cancer center. The navigator accompanied Ms. G. to her appointments, explained processes, and arranged local transportation through the local community health center van. Most importantly, the navigator was able to establish a strong relationship with Ms. G whereby she trusted the navigator enough to follow through with her treatments of chemotherapy and subsequently breast surgery, a mastectomy which saved her life. Due to the complexity of the situation, the nurse supervisor also assisted in navigation and education.