Cancer diagnosis and treatment can be incredibly stressful and painful. When a cancer patient has an undiagnosed mental health disorder, such as posttraumatic stress disorder, it can highly affect their course of treatment and recovery. A cancer patient who has untreated PTSD is most likely to have unrestful nights, have a hard time accepting reality, have anxiety and may miss going to their follow-up appointments, and may lose hope in fighting their cancer. The key interventions for the problem are performing regular distress screening, educating the staff and patients about PTSD and symptoms, and early referrals to behavioral health.
When a patient gets admitted to the hospital, it is crucial to screen them for their distress level. An admission database includes screening where a nurse must ask the patient if they are currently experiencing a distress and their level of distress. Distress screening is intended to serve as the first stage in the more targeted evaluation of the source(s) of the patient’s distress because the word “distress” was purposefully chosen to encompass a broad idea (Smith et al., 2018). To be accredited, the American College of Surgeons’ Commission on Cancer began requiring screening for psychosocial distress in 2015 (Smith et al., 2018). The screening of distress is approved as the sixth vital sign and a standard of care that must be reached by any Canadian healthcare organization delivering cancer services that seeks accreditation (Smith et al., 2018). Similar screening criteria are in effect around the world (Smith et al., 2018). If the patient gets screened for the distress properly, it can help the nurse and other healthcare providers assess if the patient needs a behavioral health intervention, such as screening for PTSD and other mental health disorders. Comprehensive distress screening in cancer contexts ultimately aims to identify unmet biopsychosocial needs and address them (Smith et al., 2018). A study by Amonoo et al. (2021) showed that a substantial proportion of patients with acute myeloid leukemia report clinically significant PTSD symptoms one month after initiating intensive chemotherapy. They noticed that one month after an AML diagnosis, patients with and without clinically severe PTSD symptoms both reported intrusion, avoidance, and hypervigilance symptoms (Amonoo et al., 2021). These results emphasize the significance of routinely screening, assessing, and managing PTSD symptoms in all AML patients (Amonoo et al., 2021). Sadly, cancer-related PTSD is frequently misdiagnosed.
Additionally, patients, healthcare providers and families need to be educated about PTSD and behavioral support. Mental health issues in the United States are still taboo. Educating patients that there is no shame in getting mental health treatment is essential, so they can recognize it and accept referrals and treatments. High levels of sadness and anxiety are frequently perceived as “normal” reactions to cancer diagnosis and treatment; as a result, many patients are not referred to or do not accept a referral to psycho-oncology services to be assessed and treated (Leano et al., 2019). Mood, anxiety, and other psychological disorders are frequently mistaken for unexpected “manageable” sadness and preoccupation with the disease (Leano et al., 2019). In addition to highlighting the benefits of receiving specialized psychosocial oncology care, the existing literature supports the idea that many cancer patients are interested in receiving psychosocial support for the emotional and social distress they experience during diagnosis, treatment, and survivorship (Leano et al., 2019). According to a recent survey, 13% of cancer patients receiving radiotherapy said they would like psychological help (Leano et al., 2019). Numerous studies have shown that psychosocial treatment can improve cancer patients’ quality of life (Leano et al., 2019). On the other hand, patients with untreated distress have worse cancer outcomes and adhere less closely to therapy and surveillance regimens (Leano et al., 2019). Inadequate training of oncology practitioners regarding the trauma associated with a life-threatening illness and the PTSD symptoms commonly seen in cancer patients may be the root cause of underdiagnosis and a lack of PTSD screening in cancer populations (Amonoo et al., 2021). As a result, educating oncology doctors about PTSD symptoms in general and the impact of trauma on health outcomes, particularly among patients with AML, is a crucial strategy for enhancing the caliber of care for this population (Amonoo et al., 2021).
Psychological distress, mainly PTSD brought on by cancer, has been linked in numerous studies to detrimental effects on patient’s health, treatment, and quality of life. Therefore, it is imperative for healthcare providers also to emphasize mental health as a key to recovery. A holistic approach is essential in providing care for cancer patients to ensure that we are healing their minds, emotional, physical, and spiritual aspects.
References:
Amonoo, H. L., LeBlanc, T. W., Kavanaugh, A. R., Webb, J. A., Traeger, L. N., Jagielo, A. D., Vaughn, D. M., Elyze, M., Longley, R. M., Fathi, A. T., Hobbs, G. S., Brunner, A. M., O’Connor, N. R., Luger, S. M., Gustin, J. L., Bhatnagar, B., Horick, N. K., & El‐Jawahri, A. (2021). Posttraumatic stress disorder symptoms in patients with acute myeloid leukemia. Cancer, 127(14), 2500–2506. https://doi.org/10.1002/cncr.33524
Leano, A., Korman, M. B., Goldberg, L., & Ellis, J. (2019). Are we missing PTSD in our patients with cancer? Part I. Canadian oncology nursing journal = Revue canadienne de nursing oncologique, 29(2), 141–146.
Smith, S. K., Loscalzo, M., Mayer, C., & Rosenstein, D. L. (2018). Best practices in oncology distress management: Beyond the Screen. American Society of Clinical Oncology Educational Book, (38), 813–821. https://doi.org/10.1200/edbk_201307
WEEK 5 Practicum discussion.
Falls can affect the quality of life, especially for the elderly population. Falls can be prevented if the appropriate interventions are in place. For those who cannot be prevented due to patient impulsiveness, altered mental state, or eyesight problems, our goal will be that there be little or no injury. Many older adults who fall, even if not injured, fear falling. This fear may cause them to limit their everyday activities, hence causing them to be less active. This causes them to become weaker, increasing their chances of falling (wtcs.pressbook.pub, 2023).
Implementing fall interventions will help to prevent or reduce falls in our elderly and hence improve their quality of life. The first intervention is educating staff and patients about falls, what they can cause, and who may be at high risk. Patient and staff education can reduce hospital falls. Multi-factorial interventions tended to produce a positive impact (Morris et al.. 2022). Then teach every patient how to use a call bell when they need assistance and place it within reach. Teach patients and have them demonstrate how to lock their equipment, like wheelchairs, walkers, etc., during transfers, and hand ensures the handrails in room, bathrooms, and hallways are sturdy. Ensure the patient has non-slip footwear while ambulating; for non-ambulatory patients, ensure they have nonskid socks. Ensure patients’ rooms are well-lit and night lights are functional. Keeping patients’ rooms uncluttered is essential as well. Place personal belongings patients often use within reach. Check for spills and have them cleaned, and the floor is dry to avoid slips. Environmental safety precautions should be in place and monitored frequently.
The second intervention is medical and physical. If a patient is physically stable, it may be prevented. Daily patient assessments are crucial for elderly patients. It is essential to check their vitals and ensure they are not hypotensive, in pain, or dizzy. Allow the resident to sit while the gait belt is applied before they rise to a standing position. This will help avoid syncope and may prevent a fall. Ensuring patients are evaluated by physical therapy when significant changes in ROM are noted. Another cause that leads to motor instability and an increase in the percentage of falls is the decline in the strength of the diaphragm muscle. A decrease in the power and function of the diaphragm causes instability in the back area and leads to falls (Appeadu et al., 2022). Having patients participate in physical and occupational therapy and exercises will help strengthen their muscles and joints. Assessing for cognitive impairment and, if determined, enforcing fall precautions because they are high risk. Referring patients to the eye and ear doctor for screenings yearly is essential. If patients wear glasses and hearing aids, ensure they are nearby and functioning well. The use of benzodiazepines in the elderly increases the risk of night falls and hip fractures by 44%. Drugs such as antiarrhythmics, digoxin, diuretics, sedatives, and psychotropics also substantially increase the risk of falling (Appeau et al., 2022). Ensure fall precautions for patients taking these medications are enforced. Also, reassess the need for med and discuss with the provider so that if not needed can be discontinued.
Next will be nutritional interventions. Deficiencies in nutrients can result in a low body mass index, which is associated with an increased risk of falls. Vitamin D deficiency can result in muscle weakness, osteoporosis, and impaired gait patterns. Poor intake of fluids can cause dehydration, putting patients at risk for falls. Ensure staff is monitoring. Meal intakes, encouraging staff to eat and drink, assisting them if necessary to feed, cutting up food, and opening drinks. Ensure labs to check patients’ electrolytes, BMP, CBC, and CMP are done quarterly. Educate staff to be vigilant for signs of infection, UTIs, and change in status because they could also trigger falls. Prevention is always better than cure. Implementing early intervention is always a great idea.
Appeadu. M., Bordoni, B., (2022). Falls and Fall Prevention In The Elderly. Treasure Island (FL): StatPearls Publishing; 2022 Jan. https://www.ncbi.nlm.nih.gov/books/NBK560761/Links to an external site..
Morris, M., Webster, K., Jones, C., Hill, A., Haines, T., McPhail, S., Kiegaldie, D., et al., (2022). Interventions to reduce falls in hospitals: a systematic review and meta-analysis, Age and Ageing, Volume 51, Issue 5, May 2022, afac077, https://doi.org/10.1093/ageing/afac077Links to an external site.
Wisconsin Technical College system, (2023). Preventing falls. Retrieved from:
