Kanser Hastalarına Sunulan Psikososyal Hizmetler ve Hemşirelerin Psikososyal Değerlendirme ve Müdahalede Yaşadığı Zorluklar: Ülke Çapında Bir Araştırma

Yıl 2024, , 101 - 110, 25.06.2024

Nazmiye Yıldırım , Perihan Güner , Figen İnci

https://doi.org/10.17049/jnursology.1425828

Öz

Amaç: Bu çalışma temelde kanser hastalarına sunulan psikososyal hizmetlerin mevcut durumunu ve hemşirelerin hastaların psikososyal gereksinimlerini karşılama yollarına ilişkin görüşlerini belirlemeyi amaçlamaktadır. Ayrıca hastaların psikososyal gereksinimlerinin karşılanmasının önündeki engellerin değerlendirilmesini ve hemşirelerin psikososyal tanılama ve müdahale uygulamalarında zorluk düzeylerinin ölçülmesini amaçlanmaktadır.

Yöntemler: Türkiye'nin 12 coğrafi bölgesinden seçilen 32 hastanede, erişkin kanser hastalarına doğrudan bakım veren 1189 hemşirenin yer aldığı çok merkezli, kesitsel bir çalışmadır. Veriler, araştırmanın amacına uygun olarak hazırlanan anket aracılığıyla toplanmıştır.

Bulgular: Katılımcıların dörtte üçü hastanelerinde psikososyal destek hizmeti sağlandığını ve %67,7'si bu hizmetin psikiyatri konsültasyonu ile verildiğini bildirmiştir. Yaklaşık yarısı (%49) tüm sağlık çalışanlarının hastaların psikososyal gereksinimlerini karşılamakla yükümlü olduğunu, özellikle hemşirelik görevlerinin ayrılmaz bir parçası olduğunu belirtmiştir. Ancak organizasyonel koşulların (%48,2-%30,7), hastaların psikososyal gereksinimlerinin karşılanmasında en önemli engel olduğu bildirilmiştir. Katılımcıların en çok "cinsel sorunlar" ve "tedaviyi reddetme", en az da "hastaların hastalığa tepkileri" konusunda hastaların psikososyal gereksinimlerini değerlendirmede ve müdahale etmede zorluk yaşadığı ortaya çıkmıştır. Ayrıca katılımcıların 19 psikososyal boyuttan yedisini değerlendirmede ve beşine müdahale etmede daha fazla zorluk yaşadıkları belirlenmiştir (P<,05).

Sonuç: Bu çalışma Türkiye'de psikososyal hizmetlerin daha iyi yapılandırılmasına katkı sağlayabilir. Aynı zamanda psikososyal bakım eğitiminin planlanmasına da rehberlik edebilir. Hemşire-hasta oranı başta olmak üzere kurumsal engellerin aşılması ve hemşirelerin psikososyal bakım kapasitesinin geliştirilmesi gerekmektedir.

Anahtar Kelimeler

Kanser, Hemşirelik, Psikososyal Onkoloji, Anket

Etik Beyan

The study was initiated after approval from Koç University’s Ethics Committee (Protocol number: 2016.162 IRB 3.092) and after written permission from participating institutions and informed consent of participants were obtained.

Destekleyen Kurum

This work was supported by the Vehbi Koç Foundation Nursing Fund, in Istanbul, Turkey [grant number 2016.2-2].

Proje Numarası

VKV-2016-2.2.

Teşekkür

The authors also would like to thank to all participant nurses and unit managers for their support during conduction of this study.

Psychosocial Services Provided to Cancer Patients and Nurses' Difficulties in Psychosocial Assessment and Intervention: A Nationwide Study

Öz

Objective: The study mainly aims to determine the current state of psychosocial services offered to cancer patients and the views of nurses regarding the ways to meet patients’ psychosocial needs. Other aims to evaluate barriers to meeting patients’ psychosocial needs and measure nurses' difficulty level of psychosocial assessment and intervention practices.

Methods: This multicenter, cross-sectional study was conducted with 1189 nurses providing direct care to adult cancer patients in 32 hospitals in 12 geographical regions of Türkiye. The data were collected by a survey prepared in accordance with the aims of the study.

Results: Three-quarters of the participants reported that their hospital has psychosocial support services while 67.7% stated that this service was provided by psychiatry consultation. Nearly half (49%) stated that all healthcare professionals are responsible for meeting patients’ psychosocial needs, especially it is an integral part of their nursing duties. However, organizational conditions (48.2%-30.7%) are the most important barriers to meeting the psychosocial needs of the patients. Participants have difficulty mostly in assessing and intervening in psychosocial needs of patients mostly in "sexual problems" and "rejection of treatment", and least in "patients’ reactions to illness". Also, the participants have more difficulty in assessing seven of the 19 psychosocial dimensions and intervening in five (P<.05).

Conclusion: This study may be contributed to better structuring of psychosocial services in Türkiye. It can also guide the planning of psychosocial care training. Institutional barriers need to be overcome, especially the nurse-patient ratio, and the psychosocial care capacity of nurses should be improved.

Anahtar Kelimeler

Cancer, Nursing, Psychosocial Oncology, Survey

Proje Numarası

VKV-2016-2.2.

Kaynakça

• 1. Miller KD, Nogueira L, Devasia T. et al. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin. 2022;72(5):409-436. doi:10.3322/caac.21731
• 2. Wang T, Molassiotis A, Chung BPM, Tan JY. Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliat Care. 2018;17(1):96. doi:10.1186/s12904-018-0346-9
• 3. Adler NE, Page AEK. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. National Institute of Medicine Committee on Psychosocial Services to Cancer Patients/Families in a Community Setting. Washington, DC: National Academies Press; 2008.
• 4. Holland J, Watson M, Dunn J. The IPOS new International Standard of Quality Cancer Care: integrating the psychosocial domain into routine care. Psychooncology. 2011;20(7):677-680. doi:10.1002/pon.1978
• 5. Singer S, Kojima E, Deppisch L. et al. What is the best time for psychosocial counselling from the perspective of cancer patients and their relatives? A multi-centre qualitative study. Couns Psychother Res. 2022;22:558-568. DOI: 10.1002/capr.12488
• 6. Grassi L, Fujisawa D, Odyio P. et al. Disparities in psychosocial cancer care: a report from the International Federation of Psycho-oncology Societies. Psychooncology. 2016;25(10):1127-1136. doi:10.1002/pon.4228
• 7. Grassi L, Watson M; IPOS Federation of Psycho-Oncology Societies' co-authors. Psychosocial care in cancer: an overview of psychosocial programmes and national cancer plans of countries within the International Federation of Psycho-Oncology Societies. Psychooncology. 2012;21(10):1027-1033. doi:10.1002/pon.3154
• 8. Daem M, Verbrugghe M, Schrauwen W, Leroux S, Van Hecke A, Grypdonck M. How interdisciplinary teamwork contributes to psychosocial cancer support. Cancer Nurs. 2019;42(3):E11-E20. doi:10.1097/NCC.0000000000000588
• 9. Bultz BD. Cancer care and the role of psychosocial oncology: Where are we and where are we going? Asia Pac J Oncol Nurs. 2016;3(2):118-120. doi:10.4103/2347-5625.182929
• 10. Banerjee SC, Manna R, Coyle N, et al. Oncology nurses' communication challenges with patients and families: A qualitative study. Nurse Educ Pract. 2016;16(1):193-201. doi:10.1016/j.nepr.2015.07.007
• 11. Haavisto E, Soikkeli-Jalonen A, Tonteri M, Hupli M. Nurses' required end-of-life care competence in health centres inpatient ward - a qualitative descriptive study. Scand J Caring Sci. 2021;35(2):577-585. doi:10.1111/scs.12874
• 12. Uwayezu MG, Nikuze B, Maree JE, Buswell L, Fitch MI. Competencies for nurses regarding psychosocial care of patients with cancer in Africa: An imperative for action. JCO Glob Oncol. 2022;8:e2100240. doi:10.1200/GO.21.00240
• 13. Taş B. Adaptation Process to The European Union for Turkey’s New Region Concept: The Nomenclature of Territorial Units for Statistics (NUTS). The Journal of Social Sciences. 2006; 8(2):186-198.
• 14. Laffan AJ, Daniels J, Osborn M. Profiling the psychological training and support needs of oncology staff and evaluating the effectiveness of a level 2 psychological support training program workshop. J Psychosoc Oncol. 2015;33(6):686-702. doi:10.1080/07347332.2015.1082170
• 15. National Institute for Health and Clinical Excellence. Improving Supportive and Palliative Care for Adults with Cancer. London: NICE, 2004.
• 16. National Cancer Action Team, National Cancer Programme. The Manual for Cancer Services: Psychological Support Measures. Version 1.0. London: National Cancer Programme, 2011.
• 17. Kocaman Yıldırım N, Terakye G. Future and present of psychiatric consultation liaison nursing. Türkiye Klinikleri J Psychiatr Nurs (Special Topics). 2017;3(1):1-6.
• 18. Uitterhoeve R, Duijnhouwer E, Ambaum B, van Achterberg T. Turning toward the psychosocial domain of oncology nursing: A main problem analysis in the Netherlands. Cancer Nurs. 2003;26(1):18-27. doi:10.1097/00002820-200302000-00003
• 19. Gosselin TK, Crane-Okada R, Irwin M, Tringali C, Wenzel J. Measuring oncology nurses' psychosocial care practices and needs: Results of an Oncology Nursing Society psychosocial survey. Oncol Nurs Forum. 2011;38(6):729-737. doi:10.1188/11.ONF.729-737
• 20. Iheanacho PN, Opara HC, Ifezulumba JC, Omotola N, Ingwu JA, Anarado AN. Nurses' perceived challenges in the management of hospitalized cancer patients in a Comprehensive Cancer Center in Southeastern Nigeria. Asian Pac J Cancer Prev. 2022;23(10):3587-3593. doi:10.31557/APJCP.2022.23.10.3587
• 21. Dilworth S, Higgins I, Parker V, Kelly B, Turner J. Patient and health professional's perceived barriers to the delivery of psychosocial care to adults with cancer: A systematic review. Psychooncology. 2014;23(6):601-612. doi:10.1002/pon.3474
• 22. Kenny A, Endacott R, Botti M, Watts R. Emotional toil: Psychosocial care in rural settings for patients with cancer. J Adv Nurs. 2007;60(6):663-762. doi:10.1111/j.1365-2648.2007.04453.x
• 23. Papadopoulou C, Sime C, Rooney K, Kotronoulas G. Sexual health care provision in cancer nursing care: A systematic review on the state of evidence and deriving international competencies chart for cancer nurses. Int J Nurs Stud. 2019;100:103405. doi:10.1016/j.ijnurstu.2019.103405
• 24. Fennell R, Grant B. Discussing sexuality in health care: A systematic review. J Clin Nurs. 2019;28(17-18):3065-3076. doi:10.1111/jocn.14900
• 25. Depke JL, Onitilo AA. Sexual health assessment and counseling: Oncology nurses' perceptions, practices, and perceived barriers. J Community Support Oncol. 2015;13(12):442-443. doi:10.12788/jcso.0174
• 26. Faller H, Koch U, Brähler E, et al. Satisfaction with information and unmet information needs in men and women with cancer. J Cancer Surviv. 2016;10(1):62-70. doi:10.1007/s11764-015-0451-1
• 27. Kendall S. Being asked not to tell: Nurses' experiences of caring for cancer patients not told their diagnosis. J Clin Nurs. 2006;15(9):1149-1157. doi:10.1111/j.1365-2702.2006.01460.x
• 28. Dunniece U, Slevin E. Nurses' experiences of being present with a patient receiving a diagnosis of cancer. J Adv Nurs. 2000;32(3):611-8. doi:10.1046/j.1365-2648.2000.01518.x
• 29. Usta YY. Importance of social support in cancer patients. Asian Pac J Cancer Prev. 2012;13(8):3569-3572. doi:10.7314/apjcp.2012.13.8.3569
• 30. Richardson EM, Schüz N, Sanderson K, Scott JL, Schüz B. Illness representations, coping, and illness outcomes in people with cancer: A systematic review and meta-analysis. Psychooncology. 2017;26(6):724-737. doi:10.1002/pon.4213
• 31. Kaneko M, Ryu S, Nishida H, Tamasato K, Shimodaira Y, Nishimura K, Kume M. Nurses' recognition of the mental state of cancer patients and their own stress management - a study of Japanese cancer-care nurses. Psychooncology. 2013;22(7):1624-1629. doi:10.1002/pon.3191
• 32. Kvåle K. Do cancer patients always want to talk about difficult emotions? A qualitative study of cancer inpatients communication needs. Eur J Oncol Nurs. 2007;11(4):320-327. doi:10.1016/j.ejon.2007.01.002
• 33. Chan EA, Wong F, Cheung MY, Lam W. Patients' perceptions of their experiences with nurse-patient communication in oncology settings: A focused ethnographic study. PLoS One. 2018;13(6):e0199183. doi:10.1371/journal.pone.0199183
• 34. Zheng RS, Guo QH, Dong FQ, Owens RG. Chinese oncology nurses' experience on caring for dying patients who are on their final days: a qualitative study. Int J Nurs Stud. 2015;52(1):288-296. doi:10.1016/j.ijnurstu.2014.09.009
• 35. Boyle DK, Miller PA, Forbes-Thompson SA. Communication and end-of-life care in the intensive care unit: Patient, family, and clinician outcomes. Crit Care Nurs Q. 2005;28(4):302-316. doi:10.1097/00002727-200510000-00002