Psychosocial care from the perspective of nurses working in oncology: A qualitative study

https://doi.org/10.1016/j.ejon.2018.03.005Get rights and content

Highlights

  • The nurses viewed cancer as fatal but they were aware of the personal and professional rewards of working in oncology.

  • The nurses had difficulties defining and setting the frame of psychosocial care, and propriety of their approach.

  • The nurses believed that other staff members also needed to take an active part in psychosocial care.

Abstract

Purpose

In cancer patients, unmet psychosocial needs are a common occurrence. The purpose of this study was to determine the views, obstacles, and needs of the nurses working with adult oncology patients with regards to psychosocial care.

Methods

A qualitative descriptive research design conducted through focus group interviews was adopted for the study. Thirty nurses providing care for cancer patients in adult oncology departments of three hospitals in Turkey with comprehensive oncology centers were involved in the interviews. The interviews were conducted via a semi-structured interview form. In analyzing the data, content analysis technique was utilized.

Results

In the study, three main themes and seven sub-themes were determined. These were as follows: “Challenge” (Sub-themes: The nature of the disease: A thin line between life and death; Lack of team/institutional support; Lack of time, staff, and knowledge; Vulnerability of the patient and their family), “reward and cost” (Sub-themes: Satisfaction; Personal growth; Exhaustion), and “essential but hard to define”.

Conclusions

This study reveal that nurses have difficulty delivering psychosocial care, which they perceive in abstract terms, in an environment where the disease is still considered fatal, the conditions of the patients change constantly, and they cannot receive the necessary support. It can be important that, as well as supportive institutional regulations, the nurses are in need of necessary assistance to help them change their own perceptions on cancer, to become emotionally stronger, and to acquire necessary knowledge and skills to give psychosocial care.

Introduction

There is a wide body of evidence supporting the importance of psychosocial care for cancer patients and their families. In the literature, it has been extensively underlined that cancer diagnosis and treatment have the potential to cause profound effects on many aspects of life and may lead to significant temporary and/or permanent psychosocial problems (Middleton, 2014). In their meta-analysis study, Mitchell et al. (2011) found that 30–40% of oncology patients were observed to have mood disorders based on psychiatric diagnosis criteria, and many other studies (Carlson et al., 2012; Zabora et al., 2001) showed that the patients suffered from psychological distress in similar ratios. Recent literature has determined that cancer patients have a high level of psychosocial needs at every stage of the disease and that unmet psychosocial needs are widespread (Carlson et al., 2012; Harrison et al., 2009; Morrison et al., 2012). Effective psychosocial care might help to eradicate or decrease the effects of these problems on daily life (Legg, 2011). The costs of unmet psychosocial problems are high for the patients, their families, society, and the healthcare system (Carlson and Bultz, 2003). For this reason, in psycho-oncology literature, there is an emphasis on the integration of the psychosocial aspect into the treatment and care of cancer patients; an examination of 'patients' distress levels and psychosocial needs, starting from diagnosis, is suggested; and consensus reports, clinical practice guidelines, and algorithms on this issues are published regularly (Holland et al., 2011; Jacobsen and Wagner, 2012).

The oncology team is a significant part of psychosocial support for both the patients and the families. In particular, the nurses are the healthcare professionals who play a key role in providing psychosocial care (Bultz, 2016; Corner, 2002). Nurses are the ones who are with the patients in both their good and bad times, from diagnosis to treatment/cure, or during palliative and end-of-life care, and thus they are the ones who most closely witness what patients go through during this process (Bultz, 2016; Legg, 2011). Therefore, they are in an ideal position to pinpoint the changes in thought or emotional patterns of the patients that might require interventions, effectively evaluate these changes in a timely manner, help the patients cope with the process, and provide significant support (Bultz, 2016; Nakaguchi et al., 2013; Sheldon et al., 2012). As attention has grown regarding psychosocial cancer care and the nurses' role in this care, important issues that influence the provision of care have been revealed.

The first issue is the consistency of psychosocial needs as determined by nurses and experienced by patients. Studies have found that the caregiving personnel were more inclined to report problems than the patients (Lampic and Sjödén, 2000), and the nurses tended to overestimate the patients' emotional problems and underestimated their coping resources and life quality (Mårtensson et al., 2008). In another study, a weak correlation was found between the needs of the patients as determined by the nurses and the perceptions of the patients (Mårtensson et al., 2010). Nakaguchi et al. (2013) reported that nurses might not be able to identify the needs and symptoms of patients receiving chemotherapy during routine care and that they felt incompetent about recognizing psychological symptoms and the need for support in particular.

Views of healthcare organizations and views of oncology nurses regarding physical and psychosocial needs was another dimension affecting care. Several studies reported that nurses are inclined to focus more on physical problems rather than psychosocial needs (Lampic and Sjödén, 2000) and that nurses view the assessment, management, and reporting of distress or other psychosocial needs as not a part of routine nursing practices (Palos et al., 2013). In another study conducted to examine how nurses defined the problems of patients based on Gordon's Functional Health Patterns, it was revealed that nurses ignored the psychosocial needs of patients while defining their biophysical needs (Griffiths, 1998).

Nurses' own perceptions related to their capability of determining and fulfilling the psychosocial needs of their patients was another issue regarding the provision of psychosocial care. One qualitative study found that the nurses were aware of the fact that the patients undergoing chemotherapy had psychological needs; however, those psychological needs were not monitored systematically because the nurses did not feel capable of managing them (Arantzamendi and Kearney, 2004). It appears that the nurses care about the psychosocial needs of their patients, yet they experience difficulties in evaluation and intervention. However, when we take into account the dissonance between the perceptions of the nurses and patients, the commonality of unmet psychosocial needs, and high levels of psychological distress, it becomes important to thoroughly understand the underlying reasons for this discrepancy. Due to the importance of nurses in the day-to-day care of oncology patients, it has become critical to prepare oncology nurses to take on a more proactive role in providing psychosocial support and to develop and apply an encouraging support system within this area (Gosselin et al., 2011; Watts et al., 2010).

The limited number of studies in this area makes it difficult to understand how to help the nurses improve their skills in psychosocial care. The quality of psychosocial support that the nurses provide is actually unknown in the Turkish healthcare system. Given these facts, it seems especially important to consider the issue from the perspective of nurses and to understand it thoroughly. There is a need to help the nurses become more sufficient in providing effective psychosocial care, but to do so, researchers need to determine their perceptions, practices, and needs in this area. Before conditions can change, the current status of nurses' understanding and actions needs to be revealed, and, in order to do this, survey studies, focus group interviews, or interviews with key people/informants need to be implemented (Schofield et al., 2006). This study intends to reveal the current status of nurses' perceptions and practices in Turkey, which can be considered as a first step in meeting the psychosocial needs of cancer patients and to determine the needs of nurses in identifying and meeting the psychosocial needs of patients. For this reason, this study aims to determine the perceptions, obstacles, and needs of the nurses working in the adult oncology field with regards to delivering psychosocial care.

Section snippets

Design

A qualitative descriptive research design was adopted with the aim of determining the perceptions, obstacles, and needs of the nurses working in the adult oncology field with regards to delivering psychosocial care. This approach was adopted because it provides rich data and enables the researchers to gain deep insights into the views of the participants. Data was collected through focus group interviews.

Participant selection and recruitment

The participants consisted of nurses who provide care for adult cancer patients receiving

Results

When the nurses' demographics were examined, it was found that the majority were females (86.7%), held a bachelor's degree (73.3%), and worked in shifts (73.3%). With an average age of 30.57 ± 6.55 years, the group had an average of 9.91 ± 9.53 years working as a nurse, an average of 5.68 ± 7.08 years working at the present institution, and an average of 5.45 ± 6.56 years working in oncology. Of the nurses involved in the study, more than half (53.3%) stated they worked in oncology/hematology

Discussion

In this study, we examined the opinions of nurses on the psychosocial care provided in the oncology field. First, nurses defined psychosocial caregiving as a challenging experience because of the nature of the disease, the vulnerability of the patients and families, a lack of knowledge/skills in psychosocial care, and organizational factors, such as a heavy workload. Regarding the nature of the disease, the nurses indicated that cancer was still not viewed like other illnesses, and it was

Conclusion

The focus group interviews in our study were conducted with nurses from one university, one state, and one private hospital from two different cities. In this way, we tried to ensure nurse representation from institutions of differing structures, yet it still might not reflect experiences in other nursing environments since each institution has its own specific organizational culture. This might be considered as a limitation of the study. The findings of this study, which sheds light on

Conflicts of interests

The authors have no conflicts of interest to disclose.

Acknowledgements

This work was supported by the Vehbi Koç Foundation Nursing Fund, in Istanbul, Turkey [grant number 2016.2-2]. The authors also thank all nurses who participated in this study for their valuable contributions.

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