Wie erleben und beurteilen Pflegende das Screening von stationären onkologischen Patient_innen mit dem Belastungsthermometer?

How do nurses experience and interpret the screening of hospitalised cancer patients by means of the distress thermometer? - A qualitative study Abstract. Background: People with cancer experience distress and may need professional support. In 2012, the University Hospital Zurich introduced its distress thermometer (DT) screening, whereby all inpatients were to be screened to gauge their support need. However, after five years, the screening rate was 40 % and the referral rate to psycho oncology was 7.9 %, surprisingly low. Aim: The aim of this qualitative study was to describe how nurses experience the screening and how they interpret the screening and referral rate. Methods: The evaluation of three focus group interviews with 14 nurses followed the principles of qualitative content analysis according to Mayring. Results: The analysis revealed four main categories. The first category "Trying to perform useful screening in a complex daily routine" comprises three subcategories: "Using the benefits of screening for comprehensive care", "The best way to recognize the individuality of the counterpart" and "Failing due to structural and personal barriers". Three further main categories addressing nurses' personal attitudes complete the screening experience: "Experiencing fewer difficulties due to competence and experience", "Being careful due to hesitations", and "Reflecting one's responsibility". Conclusions: Nurses want to use the DT. However, they need more practical and scientific support to usefully integrate screening into their everyday life.

Evaluation of the adherence of distress screening with the distress thermometer in cancer patients 4 years after implementation.

PURPOSE: Identifying and assessing psychosocial distress with an appropriate screening instrument is essential when caring for cancer patients. Since 2012, the distress thermometer (DT) has been used by nurses for all cancer inpatients at the Comprehensive Cancer Center Zurich. We wanted to identify nurses' adherence to the screening protocol, differences between screened and not screened patients and the relationship between screening rate and productivity. METHODS: This retrospective descriptive study used screening and referral data as well as socioeconomic and disease-related data of inpatients at the Comprehensive Cancer Center Zurich. This was collected from the electronic patient documentation system. Additionally, data showing the productivity of all wards was used. All data were analyzed descriptive. RESULTS: Since 2012, 40.6% (4541) of the 11,184 patients have been screened. The screening rate was initially significantly lower but settled at 40% after 2 years. There was a higher screening rate among Swiss, married, male, and emergency patients and patients with hematology diseases, brain tumors, or head and neck cancer (p < 0.001). Every fourth patient with a moderate to severe distress level requested referral to a psychosocial service. Significantly more screened patients were referred to the social service (44.7%) than to the psycho-oncology service (9.4%). Only 22.9% of all referrals were made on the day of screening or a day later. There were only two wards of 15 with a significant relationship between productivity and screening rate. CONCLUSIONS: Screening is useful in recognizing distress among patients, but screening practice needs to be reconsidered.

The Distress Thermometer: Cutoff Points and Clinical Use

Purpose/Objectives: To establish an optimal cutoff point for the National Comprehensive Cancer Network's Distress Thermometer (DT) as a screening measure to identify and address psychological distress in individuals with cancer, and to examine whether distress as measured by the DT significantly changes across the treatment trajectory. Design: Secondary analyses of baseline data from a longitudinal parent study examining a computerized psychosocial assessment. Setting: Three diverse comprehensive cancer centers across the United States. Sample: 836 patients with a current or past diagnosis of cancer. Methods: Study participants were selected from a randomized clinical trial. Patients during any stage of the cancer treatment trajectory were recruited during a chemotherapy infusion or routine oncology appointment. Main Research Variables: The Behavioral Health Status Index and the DT were administered and compared using receiver operating characteristic analyses. Findings: Results support a cutoff score of 3 on the DT to indicate patients with clinically elevated levels of distress. In addition, patients who received a diagnosis within the 1­4 weeks prior to the assessment indicated the highest levels of distress. Conclusions: Providers may wish to use a cutoff point of 3 to most efficiently identify distress in a large, diverse population of patients with cancer. In addition, results indicate that patients may experience a heightened state of distress within 1­4 weeks postdiagnosis compared to other stages of coping with cancer. Implications for Nursing: Using a brief measure of distress can help streamline the process of screening for psychosocial distress.

Promoting quality breast cancer care: psychosocial distress screening.

OBJECTIVE: To evaluate the feasibility of implementing psychosocial distress screening in a breast center of a comprehensive cancer center, using a model of structure (personnel, resources), process (screening), and outcome (number of patients screened, number referred). METHODS: The first step in the project was to establish administrative support, educate and engage breast center staff, identify stakeholders and persons with expertise in the conduct of evidence based initiatives. A two-phase implementation approach was agreed upon with Phase I being screening of new patients in surgical oncology and Phase II being screening women in medical oncology. RESULTS: A total of 173 patients were screened. The new patients screened in surgical oncology reported higher average distress scores compared to patients in medical oncology (5.7 vs. 4.0). However, a greater number of patients in medical oncology reported scores >4 compared to the new patients screened in surgery (54% vs. 35%). Psychological distress was the most commonly reported distress for patients in surgery. In contrast, 60% of scores >4 in medical oncology were symptom related, managed by the nurse or physician. SIGNIFICANCE OF RESULTS: Nurse led implementation of psychosocial distress screening is feasible, addressing this important quality indicator of patient-centered care.

Internet confessions of postpartum depression.

Women with postpartum depression may suffer in silence due to the stigma of depression and failed motherhood. It is important to consider how mothers are able to talk about postpartum depression and what strategies they use. Foucault's idea that confession is a widespread technique for producing truth in Western societies was tested through discourse analysis of posts on an Internet forum for women with postpartum depression. The Internet forum showed women's use of confessionary language and self-judgments as well as their sense of disconnected mothering, shame, and disembodiment. Discourses of depression included the good mother, biomedical illness, and social dysfunction. Findings have implications for creating safe spaces for helping mothers with postpartum depression.

Sociocultural differences and colorectal cancer screening among African American men and women.

PURPOSE/OBJECTIVES: To examine sociocultural factors that influence an informed decision about colorectal cancer (CRC) screening among African American men and women. DESIGN: Descriptive, cross-sectional. SETTING: A medical center, a National Cancer Institute-designated comprehensive cancer center, and various social organizations and barbershops in a midwestern city of the United States. SAMPLE: A purposive sample of African American women (n = 65) and African American men (n = 64) aged 50 years and older. METHODS: Participants completed a self-administered survey. MAIN RESEARCH VARIABLES: Cultural identity, CRC beliefs, family support, and informed decision. FINDINGS: Family support was positively related to CRC beliefs among participants, and CRC beliefs were positively related to an informed decision. However, among men, family support positively related to an informed decision about CRC screening. In addition, t-test results indicated that the men and women were significantly different. Family support predicted CRC beliefs among men (p < 0.01) and women (p < 0.01). CRC beliefs predicted CRC screening informed decisions among men (p < 0.01) and women (p < 0.05). However, the accounted variance was dissimilar, suggesting a difference in the impact of the predictors among the men and women. CONCLUSIONS: Family support has a significant impact on CRC beliefs about CRC screening among African Americans. However, how men and women relate to the variables differs. IMPLICATIONS FOR NURSING: To improve CRC screening rates, informed decision-making interventions for African Americans should differ for men and women and address family support, CRC beliefs, and elements of cultural identity.

Evaluation of effectiveness and satisfaction outcomes of a mental health screening and referral clinical pathway for community nursing care.

The study aimed to explore the effectiveness of a mental health screening and referral clinical pathway for generalist community nursing care of war veterans and war widow(er)s in Australia on outcomes of client self-reported mental health, quality of life, and client and carer satisfaction. The pathway was developed by literature review and consultation, then trialled and evaluated. Validated screening tools were embedded within the pathway to support generalist nurses' mental health decision making. Pre- and post-measures were applied. Clients on whom the pathway was trialled were invited to complete an evaluation survey questionnaire, as were their informal carers. Most clients and carers who responded to these questionnaires were highly satisfied or satisfied with care provided through application of the pathway. This study adds understanding about one way that community nurses might identify people with mental health difficulties. The trialled pathway, which was modified and refined following the study, is now available on the Internet as an evidence-based resource for community nurses in Australia to guide practice and maximize holistic care for war veterans and war widow(er)s where that care is funded by Department of Veterans' Affairs.

The problem of distress in patients with cancer: more effective assessment.

This article provides oncology nurses with an overview of the incidence, diagnosis, and treatment of emotional distress in patients with cancer. Oncology nurses tend to focus more on the physical symptoms of their patients, and the assessment and treatment of distress in patients with cancer often are overlooked. A brief discussion of the National Comprehensive Cancer Network practice guidelines for distress management and signs and symptoms of distress are included, especially in the context of somatic symptoms. Barriers to nursing assessment of distress are included. Signs and symptoms are considered, especially in the context of patients' somatic symptoms.

Screening instruments for use in a complete geriatric assessment.

The rapid population growth of individuals 65 years and older in the United States is predicted to continue through 2050. As people age, the complexity of their healthcare needs increase and can be attributed to the normal aging process as well as an increased frequency of chronic illness with associated morbidity. There are many geriatric assessment instruments that can be used to evaluate the complex health needs of the older adult, but there is a need for a geriatric screening assessment process that can address the domains of the aging individual in a practical, holistic, and cost-effective manner. There are multiple quality-of-life instruments that can be used for this screening of health needs in the aging population, and 3 will be discussed, the LEIPAD instrument, the Medical Short Form-36, and the WHOQOL-BREF. The rationale for introducing a screening assessment into the clinical practice of the clinical nurse specialist for positive patient outcomes will be examined.

Assessing and managing women with depression: a midwifery perspective.

Women are at disproportionate risk for depression. Depression often goes untreated because of lack of recognition by providers. The Institute of Medicine maintains that primary care providers are essential in the management of mental health disorders. The assessment and management of depression in women are sensitive topics and may require advanced training and skills.

Intimate partner violence screening practices of certified nurse-midwives.

It is estimated that 324,000 pregnant women are abused by their partners in the United States each year. The purpose of this qualitative study was to explore the intimate partner violence-screening practices of certified nurse-midwives (CNMs). In-depth interviews were conducted with a sample (n = 8) of CNMs, and the data were analyzed by using with-case and across-case methods. The findings demonstrate that the midwives were inconsistent in their intimate partner violence-screening practice during pregnancy and increase or decrease screening in response to a woman's cultural background. Screening in a culturally competent manner is expected of all clinicians, but the demands of an increasingly complex, culturally diverse practice environment make it difficult. Consistent intimate partner abuse screening in a culturally competent manner is a challenge for all primary care providers.

Listen to them draw: screening children in primary care through the use of human figure drawings.

This literature review focuses on the Human Figure Drawing (HFD) methods put forth by Elizabeth Koppitz as a screening instrument. Children's drawings have potential as a mental health screening aide for health care practitioners in the primary care setting. This paper focuses on self-portrait drawings as a screening technique for emotional well-being, anxiety, and depression in school-aged children (6-12 years old). Using Koppitz's emotional indicators checklist for mental health, practitioners can use the child's HFD as a quick screening tool. Although the HFD is not diagnostic and can not be used as the sole indicator for anxiety or depression, two or more emotional indicators may signal to the clinician that further psychiatric assessment and referral is needed.

Mothers, midwives, and HIV/AIDS in Sub-Saharan Africa.

This article reviews clinical and program issues in the prevention of mother to child transmission (PMTCT) of HIV in sub-Saharan Africa. Topics include prevention of infection, voluntary counseling and testing, prenatal care, labor and birth, postpartum, family planning, infant feeding, and the role of traditional birth attendants. Programs providing short-course antiretroviral therapy to prevent infant infection are contrasted with comprehensive programs offering antiretroviral therapy and medical care to mothers, children, and families. Feminization of the epidemic is related to gender inequalities that facilitate the spread of HIV and make pregnant women an especially vulnerable group. Nurses and midwives are the primary health care providers for most of the population in sub-Saharan Africa. They are the backbone of the new PMTCT programs and will be the largest group of health workers available to diagnose and treat opportunistic infections and dispense antiretroviral therapy. But they have received little training and support to provide AIDS care and treatment and are rarely consulted when plans are made about workforce issues and capacity development in the health sector. Clinical training, leadership skills, salary support, expansion of the nursing workforce, and development of expanded roles for nurses and midwives in AIDS care are needed to help them turn the tide of the epidemic.