As members of The Oncology Nursing Society project team for “Putting Evidence into Practice” concerning anxiety, the authors embarked on a mixed methods research essentially to inform colleagues what empirical research had to say about what works for managing inpatient anxiety. The research program of Sheldon, Swanson, Dolce, Marsh, and Summers (2008) involved reviewing meta-analyses done by others, embarking on one themselves, and interviewing authorities in the field.
The first two insights one draws from the meta-analysis is that psychoeducational and psychosocial interventions provide a tangible benefit for patients understandably anxious about their mortality and end-of-life conditions. The former class of interventions counts many programs that may be taken for granted because institutionalized quite a while back: information sessions about the facility and the surgical procedure, for example. As in cardiac surgery, oncology patients derive distinct benefits from being briefed thoroughly and in a timely fashion about their diagnoses, treatments, prospects of remission/survival, self-care, and self-management of pain and other symptoms. The second type of psychoeducational intervention covers training patients in relaxation techniques and furnishing printed or video materials about nutritional and physical activity regimens that might mitigate side effects when the time comes that oncology patients must be released to a hospice or managed-care facility.
Psychosocial interventions attack anxiety, post-traumatic stress disorders and related syndromes more directly. Outstandingly effective examples, as shown by pre-and-post measures of anxiety, include cognitive-behavioral (CBT) or behavioral therapy,
stimulating family “engagement” and support groups, and counseling. RN’s may not be able to carry these off themselves but individual counseling, group therapy and even one-on-one videoconferencing have not only soothed patient anxiety but even ameliorated physical symptoms. Finally, the third lesson is that pharmacotherapy and massage must have value but more rigorous research is needed to validate these interventions.
The article was written for the oncology service. However, every nurse who already has exposure in practice and remembers her Psychiatry lectures that anxiety syndromes span a wide range understands that the lessons of this article apply to many other classes of patients. Cases of leukemia may fall within the purview of the Pediatric service but it is no less anxiety-inducing for having such a low treatment success rate. The same may be said of those on the ropes from AIDS-induced opportunistic infections. Survival rates may be much better in the surgical and OB-Gyn services but patients and their families are certainly concerned about the chances of a mishap and accordingly suffer at least free-floating anxiety.
RN’s must take the analyses by Sheldon et al. to heart because they are in a position to fill service and care gaps. By and large, the sheer numbers of aging “Baby Boomers” means the shortage of therapists and physicians will persist into the foreseeable future. Thus, RN’s need to be more discerning about diagnosing anxiety syndromes at the screening stage and during long confinements. As well, they can take the initiative to embark on psychoeducational and psychosocial interventions in clinical practice when Consultants are too busy to see about organizing such interventions themselves. As to the uncertain benefit of massage, RN’s can certainly see to regular therapist sessions while not forgetting the power of attentiveness and soothing touch in reaching out and assuaging anxiety and frank depression. In so doing, the profession can prove that it truly manages the holistic needs of the patient in physical decline and emotional distress.
Sheldon, L. K. Swanson, S., Dolce, A., Marsh, K. & Summers, J. (2008). Putting evidence into practice: Evidence-based interventions for anxiety. Clinical Journal of Oncology Nursing, 12 (5): 789-97.