Teamwork has been fundamental to the program. "Successful
partnership requires strong coaching," she said. Paraphrasing the words
of the legendary Wisconsin Green Bay Packers coach Vince Lombardi, Ms. Plank
explained, "You don’t just tell them what to do, you show them the
Back in 1999, nurses at St. Joseph Medical Center who attended an
oncology congress heard a talk about how nurses underestimate the depression of their clients, and they decided
to do something about it.
"It became a performance improvement project," said Mary C.
Thompson RN, BSN, patient care coordinator at St. Joseph, a 460-bed
community hospital. "Identifying these symptoms is a very common first
step for most nurses," she said. "However, it can be very
difficult to separate the symptoms of depression from disease symptoms or
even treatment side effects."
For instance, she said, sleep problems can stem from dexamethasone
therapy, or impaired concentration can result from pain control medication.
The nurses’ response to this need was to look at ways to assess the
depression quickly and accurately. "Our first goal was not to set
ourselves up for something so complicated to follow through on that neither
the staff nor the patients would continue to do it," Ms. Thompson said.
They chose to use the Zung Self-Rating Depression Scale, a 20-item
questionnaire. The nurses report the results to medical oncology and provide
referrals. Patients scoring greater than 50 are referred to a psychiatric
liaison nurse or supportive care nurseknown in some hospitals as a
palliative care nurse.
Even with a normal Zung score, Ms. Thompson said, nurses may still make
referrals based on their observations or on patient or family requests.