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Published byHadi Salim Modified over 6 years ago
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Psychosocial aspects of nursing in caring a patient with a cancer
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Relevant statistic Cancer pts are three times more likely to suffer from anxiety or depression than the general population, twice as likely as other medical pts. Between a quarter and a third of cancer pts experience significant psychological distress
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Factors related to severity of psychosocial problems
Disease Environment Individual
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Stages triggering distress
Initial investigation Diagnosis Treatments End of treatment Recurrence Palliative care Bereavement
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Impact on sense of identity
Personality changes Ability to work/function normality Role in family Body image Sexuality Fertility
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Mediating factors Stage in life cycle Social support Cultural issues
Beliefs about illness Personality factors- life event, history of psychological difficulties
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Adaptation to cancer Stimulus for coping: cancer
Primary appraisal: how threatening? Secondary appraisal: options? Coping response Primary coping efficacy: demand met? Secondary efficacy: impact on the mental and physical health?
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Factors promoting well-being
Able to view demand as challenge rather than treat or loss Belief in own ability to do something about situation Ability to define priorities, set goals and solve problems
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Issues of uncertainty Questions: Guidelines: Can I be treated?
Can it be cured? What are the side effects? Will it come back? Acknowledge, uncertainty, empathy Be honest about what can’t be answered Be aware of distancing techniques Discuss what would help them deal with the uncertainty
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The dreaded questions......... Is it cancer? Am I dying?
How long have I got? How will I die? What happens after I die? How do I tell......? How will they cope without me?
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Fears Fear of being blamed Fear of the unknown/ untaught
Fear of unleashing a reaction Fear of expressing emotion Fear of not knowing the answer Fear of illness of death
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others Desire to shield/protect the patient Personal issues triggers
Complex family dynamics Insufficient time
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Distancing techniques
Avoiding the patient Not asking about the emotions Ignoring clues Premature reassurances Giving advice Focusing only on the positive aspects of treatment Playing down side effects Giving false hope
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Importance of answering difficult questions
Maintain trust Reduce uncertainty Prevent inappropriate hope Allow appropriate adjustment Prevent conspiracy
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Responding to questions
Check why the pt / relative is asking this particular question Explore what they already know Check whether they want further information Encourage expression of feeling and concern/worries Acknowledge difficulty of living with uncertainty
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If you don’t know the answer......
Be honest Help pt decide how they could get the desired information If feasible, offer to liaise with relevant professionals to obtain answers With extensional or highly emotive questions, help pts to find their own answers
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Denial Recognise importance of denial as a coping mechanism
Only challenge denial if it create serious problems for patient or relatives
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communication Elicit core issues for the pt, their fears and worries
Elicit beliefs about illness- based on pt’s knowledge and predictions Provide information on clinical challenges faced Explore strategies and options
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Communication cont....... Focus on what can change
Help establish clear goals Help pts access the informational, practical , social and emotional support they need
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