Psychosocial Issues

 Laurl at ONS 

Welcome to the Hot Topic chats. Today's expert is Molly Loney, talking to us about psychosocial issues.

 mloney 

Welcome to the chat on Psychosocial Issues. Do you have any challenging patient care issues you would like to discuss?

 mloney 

It would be helpful to know where you are from & what your work setting is.

 chale 

Hi

 chale 

!

 rak2404 

Have not done this before. Hi.

 espalm 

How do you find time in a busy clinic to address these kinds of issues without a social worker or counselor on staff?

 chale 

From Bristol TN, not good typist - kind on slow side so bear with me.

 rak2404 

That is our problem too. There is never enough time to address emotional issues during clinic.

 lisa 

I work at a comprehensive cancer center and would like to know more about some best practices to help patients having emotional distress in both the inpatient and outpatient settings

 mloney 

Good question that we all face. Most of the time it's based on what the hot issues is at hand. It's important to use your co-workers to discuss challenging patient situations & problem-solve, but time is always a concern.

 mloney 

NCCN has a great set of guidelines on distress management using a distress screening thermometer. Have you seen these yet?

 rak2404 

I have, but I haven't looked closely enough at it to see how I can integrate it into our clinic.

 espalm 

I have not seen these. These are available on the NCCN website?

 lisa 

I'm aware of them but haven't studied them in detail yet-I'll definitely do that.

 mloney 

They are - & the guidelines are user friendly & can be adopted in any setting.

 mloney 

If you type in the main site, & search for distress thermometer, you should be able to access the guidelines as well.

 rak2404 

I'll get a better look at them soon and try to work with staff to use this and help screen patients. Does that help with averting an 'emotional break down' we sometimes have in the middle of a busy clinic?

 chale 

Since we are always busy and usually short handed, it is getting harder and harder to spend that time that we need to give the time to those issues. I am usually the one who does but sometimes the other girls get frustrated that I’m being too slow. We don't have a social worker on staff and the docs don't want to hire one for our private office.

 rak2404 

Same at our clinic, Chale.

 mloney 

Taking care of ourselves is important - you may find the caregiver burden transcripts from a past chat helpful.

 mloney 

I also wanted to let you know ONS has a 2nd ed of Psychosocial Issues in Oncology Nursing due soon for publication.

 espalm 

How do we access the previous chats?

 chale 

Yeah I keep up with those, try to make sure the others read and understand which they say they do but also say that we are here to make money and take care of the patient without overtime. I tell them this IS taking care of the patient!

 Laurl at ONS 

Hi, the past chats are all located in the www.ons.org/CNE Central pages. Go to the CNE Central tab, then index, then chats. The Hot Topic mini web site is there. There is a tab called "past dates and transcripts"- the series was called Caregiver Burden.

 espalm 

Sounds good, thanks.

 mloney 

Chale, we are all focusing on some many tasks that we forget about the patient experience. Since that is a big initiative with Joint Commission, maybe you could use that to advocate for taking time during the tasks with our patients.

 mloney 

We also are so focused on our agendas that we forget about how important it is to stop & take into consideration the patient's agenda. You should like a great advocate for that in your setting.

 chale 

I just had to take medical leave for the 2nd time in a year for back problems - don't think I’ll get far. hey you guys need help by computer?

 mloney 

Sounds like you have lots on your agenda!

 mloney 

Do you have any challenging patient encounters you would like to share & discuss?

 lisa 

It sounds like we're all struggling to manage our desire to advocate for our patients in the way we'd like and still keep the day running on schedule.

 mloney 

I give you a lot of credit - it's all about prioritizing - knowing when to stop & focus on our patients is what nursing is all about.

 rak2404 

Dealing with a patient right now and her family that are very unrealistic about her prognosis and want to do 'everything' possible to keep her alive. We know they will be so 'angry' when she dies, don't know how to help them see she won't get any better no matter what we do for her.

 mloney 

That's tough - asking what they have heard from the MD may help them talk through the facts as well as talk about what goals they have. We can only start where our patients' perspectives are - even if we know possible outcomes.

 lisa 

I can think of a number of examples of when you can just see that a patient or their family member is so anxious-sometimes they can't grasp what you're saying because they're so afraid of what will happen next- I try to make a lot of eye contact and speak calmly and unhurriedly even when I know I'll have to make up for that time somewhere else

 mloney 

It is so important to first connect by being present & letting the patient/family know you care. That speaks louder than words.

 Laurl at ONS 

I just happened to be in the ED with my son last night ( all is ok now) and the pt in front of us was a newborn and parents with potential life threatening cardiac condition. The nurse impressed me so much - she slowed down physically, listened to the baby's heart, and told the parents "Right now, she is okay. Right now, you can feel safe". It was wonderful. She knew exactly what to do to calm them.

 chale 

If you don’t stop and truly listen to what they are saying, then you get half the story - by that I mean the little things they are afraid to tell the practitioners or docs because their tx could but should be held for safety's sake. In this old warhorse's opinion, if I didn't keep my ears and eye's open in every way, I’d miss out on a LOT ie infection, or signs of other serious complications

 rak2404 

True, sometimes just sitting and listening for even 5 min, patients and families feel so much better

 mloney 

Great point - your experience has given you great insight & almost an intuitive knowing about what is happening with your patients. It's important to trust that "gut feeling".

 mloney 

Unfortunately not all disciplines are trained in how to connect & respond with patients - so nursing gets the brunt of patients & families' psychosocial needs.

 rak2404 

Have to sometimes listen to what they aren't saying - because they are afraid to say it. Several patients have told me that they prefer seeing me for their follow ups because I explain it in terms that they understand - not medical terms.

 mloney 

I learned a lot from a lung cancer patient who took on the challenge of teaching his MD what he needed him to say & how he needed him to respond.

 rak2404 

Then they are less afraid.

 mloney 

It is important to realize while demanding how you each make a difference by being present & connecting with your patients.

 mloney 

Have you ever had a patient who was so distraught that he/she lost control?

 rak2404 

I had a patient who was so angry when he was first diagnosed that none of the staff wanted to take care of him. By the time I finished his 4th treatment and took time with him, everyone loved him. He was just angry and scared and didn't know how to act.

 chale 

When my mom died in Jan, this year my family looked to me to explain about her diagnosis of pancreatic cancer, what was going on , what this meant, what that meant, etc. And it different with others. my mother in law doesn't believe a word I say - maybe that's not so bad!

 mloney 

Cale, it's strange how our families don't see us in the same way as our patients at times. that must be challenging. Rak2404, how did you help the angry patient & staff? Sounds like a powerful success story.

 rak2404 

I mainly listened and tried to explain why certain things were being done a certain way and how he could adapted the treatment and his life to fit together. Wasn't easy at first, but I didn't let him get me angry. Have to go, it has been informative. Have a patient to see.

 mloney 

Thanks for joining us & your thoughtful comments.

 mloney 

One of the most difficult parts of responding to someone who is angry is not getting pulled into the anger or becoming defensive.

 mloney 

Any other types of patient encounters that challenge you?

 chale 

Our chemo room is one large "living room" style room >1500sq ft in size with 11 recliners and then11 family chairs one beside each recliner. If we have an emergency occur, we pull shades around to give privacy, one nurse records, one gets the docs, sets up the O2, whatever. the one doing the recording was usually the one explaining to the family what's happening and had to do that remaining calm - that was my job because of my back

 mloney 

Nice set up & team effort. Does this include psychosocial outbursts as well?

 lisa 

We have a similar set up-it's challenging!

 mloney 

The more we can anticipate possible distress & have a plan at least the more prepared we fell = & the more coordinated the team can respond.

 lisa 

I'll sign off now-thanks for the NCCN info!

 chale 

Yes. if there is a problem, one of us will try to maintain things going on with the other patients (pumps alarming etc) while one goes for help. That leaves 1 or two to manage the "irritated" person(s) until we can get someone in to assist usually the provider.

 mloney 

Support among each of the team is as important as what is planned.

 chale 

We used to have to worry about having "CODE CLUE " Drills every so often but there for a while it was happening about once every two months so we just started listing them in our book and blacking out the name. JCAH said that would work.

 mloney 

Sounds like you have a supportive work environment. How do you plan out ahead of time responding to a psychosocial crisis or patient death?

 chale 

You can't work as closely together as we do if you don't work together as a team. If we feel or know there is a problem among us we try to get it out in the open and work on it together because if we don't it falls apart and we all go down together.

 mloney 

Sounds like you have a group that has worked through a lot of issues very successfully. Have you ever thought about sharing your team process in supporting cancer patients through any kind of emergency - as an ONS congress poster or CJON article?

 chale 

psychosocial - whoever has the patient stays with the patient, one runs one stays, one records (& quietly calls admin). Thankfully, I have worked with this office since 1997 and not ever had a patient die in the chemo room - knock on wood! & PRAISE THE LORD!!!!

 mloney 

Another testimony to your teamwork -

 mloney 

Since we have 5 minutes left, is there anything else you would like to address?

 chale 

thanks, mloney! If the Lord is with me, I have just sent an article to journal of hospice and palliative nursing (About my mom) wish me luck!

 Laurl at ONS 

Good luck with that potential publication!

 mloney 

Good luck. It sounds like your faith is an important support.

 chale 

Couldn't do without HIM!

 chale 

Thanks! You all have a blessed day!!

 mloney 

Sounds like we are about out of time. Thanks for sharing your insights & helpful comments.

 Laurl at ONS 

Thank you so much for your participation today! Please be sure to check out the next topic - in a couple of weeks- on Prevention of Medication Errors.