ONCOLOGY Nurse Edition.
No. 4
Screening for Emotional Distress in Older Patients With Lung Cancer
By Terry Badger, PhD,
PMHCNS-BC, FAAN
Virginia T. LeBaron, MS,
ACNP-BC, AOCN, ACHPN
Ruth McCorkle, PhD,
RN, FAAN |
April 9, 2010
Terry Badger is Professor and Director, Division
of Nursing Systems, at The University
of Arizona College of Nursing, Tucson; Virginia
T. LeBaron is Clinical Associate Professor
and Acute Care Nurse Practitioner at The
University of Arizona College of Nursing;
and Ruth McCorkle is Florence S. Wald Professor
and Director, Center for Excellence
in Chronic Illness, Yale University School of
Nursing, New Haven, Connecticut.
Financial Disclosure: The authors have
no significant financial interest or other
relationship with the manufacturers of any
products or providers of any service mentioned
in this article.
Mr. Davenport reported his distress at a level 6. He related his problems to his inability to provide for his wife; worry about what would happen during the next phase of treatment, and if he should die; anger that the lung cancer was not cured; and his own physical problems of inability to sleep because of his increased pain, fatigue, depression, and stress.
The staff nurse referred Mr. Davenport to the palliative care nurse practitioner for further evaluation. He was diagnosed with unmanaged pain and with comorbid depression with some anxiety (often manifested by irritability in elderly men). He was started on oxycodone(Drug information on oxycodone) for pain and an SSRI (selective serotonin reuptake inhibitor), Celexa (citalopram), for depression. Arrangements were made for a home health aide to assist his wife with her daily care during Mr. Davenport's postsurgical recovery and his subsequent cancer treatment. A follow-up appointment was scheduled for him in the palliative care outpatient clinic.
Discussion
In summary, the nurse was able to accurately assess Mr. Davenport's psychological distress and current problems using a standardized screening tool, and appropriately refer him for a more in-depth evaluation. The palliative care nurse practitioner was able to develop a discharge plan for Mr. Davenport's complex medical needs to relieve his pain, treat his psychological distress, and obtain home health assistance for his wife during his recovery. Without nursing intervention and management, Mr. Davenport would have continued to experience unrelieved pain and psychological distress and would have been at risk for suicide.
The position statement approved by the Oncology Nursing Society Board of Directors in March 2008 recognizes that psychosocial assessment is a standard component of cancer care and that each patient's psychosocial needs must be documented with a plan for needed services.[23] Nurses can be leaders in quality cancer care by documenting a psychosocial assessment, the plan of action, and health outcomes following treatment. As members of the largest health profession and as front-line care providers, nurses are ideally situated in our health care systems to meet the newest standard in quality cancer care, addressing the psychosocial needs of cancer patients and integrating psychosocial care into routine
cancer treatment.
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