Congress Abstracts 2005

142

THE NURSE AS DETECTIVE IN ASSESSING FOR PSYCHIATRIC ILLNESS AND DETERMINING THE NEED FOR REFERRAL OR CONSULTATION IN THE ONCOLOGY SETTING. Sharon Van Fleet, MS, APRN-BC, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.

Although reported rates vary, a significant number of oncology patients experience emotional distress at some point during their illness and treatment. Unfortunately fewer than 10% of cancer patients requiring psychiatric intervention receive appropriate care. While numerous factors contribute to this problem, nurses are in a key position to improve detection of problems requiring psychiatric evaluation and intervention, on account of nursing’s central involvement across the care continuum and the quality of the nurse-patient relationship.

Some nurses, however, experience discomfort in regards to performing psychosocial assessment, and many lack the knowledge required. Research has demonstrated that psychiatric illnesses are often not detected by oncology practitioners, and consequently few of those patients receive referrals. Given the pressures faced by nurses and other oncology professionals, psychiatric concerns may be devalued in the context of immediate treatment demands. Negative attitudes and misconceptions on the part of both professional and patient regarding psychiatric illness and treatment also serve as barriers to detection and optimal intervention. The purpose of this presentation is to provide oncology nurses with information needed to effectively screen for problems requiring psychiatric intervention.

General psychiatric assessment guidelines will be presented. Basic diagnostic criteria will be reviewed for psychiatric disorders most common in the oncology setting. Risk factors will also be identified. Common medical, cancer- and treatment-related factors potentially contributing to psychiatric presentations will be listed. Guidelines will be offered to aid in distinguishing non-pathologic grief from depressive disorders requiring intervention. Guidelines for assessment of suicide potential will be emphasized. Practical recommendations will be offered to assist in determining the need for staff consultation or patient referral. Suggestions for sensitively addressing psychosocial concerns will be provided. Strategies to overcome patient resistance to assessment and referral will also be given.

As a result, nurses will gain increased awareness of possible signs and symptoms warranting further evaluation and possible referral. Enhanced awareness may contribute to earlier detection and intervention, thereby limiting patient distress and other consequences of untreated psychiatric illness, as well as improving quality of life.

With enhanced knowledge regarding psychiatric assessment and referral, nurses can improve detection and facilitate appropriate, timely intervention.