As an oncology nurse working at a cancer specialty hospital, it is common to see patients undergoing extensive cancer treatments. While the hospital’s focus is to treat cancer, it is rare for clinicians to emphasize PTSD screening for these patients. Mental illness is one of our society’s most neglected health problems.
PTSD can develop after experiencing or witnessing a stressful event. The inability to recover from a traumatic incident is the main characteristic of posttraumatic stress disorder (PTSD) (Leano et al., 2019). It’s a frequent misperception that PTSD only manifests during war or severe physical trauma (Leano et al., 2019). Cancer can cause PTSD due to cancer-related pain, extended hospital stays or procedures, and fear of cancer recurrence. The Diagnostic Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), revised its diagnostic criteria for PTSD to include diagnosing and treating a life-threatening illness, such as cancer, as a traumatic stressor that can lead to PTSD (Leano et al., 2019). Some patients are afraid to mention “the C word” because “cancer” is so closely associated with fear, stigma, and mortality (Leano et al., 2019). Therefore, it is not unexpected that a cancer diagnosis may seem sudden, disastrous, or even life-threatening to a patient (Leano et al., 2019). A patient’s emotional and physical health might be significantly impacted by cancer-related PTSD (CR-PTSD) both during treatment and after surviving (Leano et al., 2019).
The focus of the project is to improve PTSD screening for cancer patients. The mentor for this project is a Nurse Practitioner who works at a Crisis Center who deals with a variety of crisis situations, especially people dealing with mental health disorders. The tools that clinicians can use to screen and measure the progress of PTSD are: Primary Care PTSD Screen for DSM-5, SPAN, Sprint, and Trauma Screening Questionnaire (Veterans Affairs, 2018). These are short tests that could reveal those who are more susceptible to PTSD (Veterans Affairs, 2018). The tools can also help clinicians measure the progress of PTSD by comparing the patient’s scores.
Compared to the general population, post-cancer patients are more likely to experience PTSD (Leano et al., 2019). Cancer patients with PTSD frequently suffer high levels of misery and isolation, avoid stressful reminders of their cancer diagnosis and treatment, and live in constant anxiety (Leano et al., 2019). If patients are screened early, healthcare providers can immediately provide referrals to a specialist, cognitive behavioral therapy, and evidence-based medication management. In modern medicine, clinicians should emphasize holistic care, not just treating the disease. Treating the person’s physical, mental, spiritual, and social needs are essential in their recovery.
References:
Leano, A., Korman, M. B., Goldberg, L., & Ellis, J. (2019, April 1). Are we missing PTSD in our patients with cancer? part I. Canadian oncology nursing journal = Revue canadienne de nursing oncologique. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6516338/Links to an external site.
Veterans Affairs. PTSD Screening Instruments. (2018, September 24). Retrieved from https://www.ptsd.va.gov/professional/assessment/screens/index.asp
Week 1 practicum: Falls in the elderly population.
For my practicum project, I will focus on falls in the elderly, what causes them, the injuries resulting from falling, and how to reduce or prevent them. According to the WHO, a fall is an event that results in a person coming to rest inadvertently on the ground, floor, or other lower level. Falls are the second leading cause of unintentional injury deaths worldwide. Each year, an estimated 684 000 individuals die from falls globally, of which over 80% are in low- and middle-income countries (WHO. 2021). Anyone is susceptible to falling, but the elderly population has a higher risk. Adults older than 60 suffer the most significant number of fatal falls because of age-related physical, sensory, and cognitive changes. The environment also plays a part. In the United States of America, 20–30% of older people who fall suffer moderate to severe injuries such as bruises, hips, ankles, knee fractures, or head trauma.
Working in skilled nursing for six plus years, I realized that not a single week would go by without an elderly patient falling; sometimes they have an injury, and sometimes they don’t. I have seen instant death from falls, fractures, sprains, contusions, wounds, bruising, head trauma, and other health-related issues. Each year at least 300,000 older people are hospitalized for hip fractures (CDC.gov. 2021). I remember always asking staff to maintain fall precautions on the patients, like a bed in a low position, proper floor wear, fall mats, and bed alarms. Even with all these precautions, some falls still occur. I interviewed my mentor, currently working as an RN manager at a long-term skilled rehab, about her thoughts regarding falls in the elderly population. She stated that was one of the most significant issues they face with patients, and the injuries from these falls are even worse to manage. She further mentioned how a patient could perform all their ADLs one day and then fall, fracture a hip, and mobility is limited. This brings about more anxiety and depression in patients from the inability to do what they used to and waiting for someone else to help. Some of these patients end up with other complications like a contraction, even decubiti ulcers from immobility, range of motion, and lack of frequent repositioning.
The quality of life of so many older people is affected by falls, and this problem needs to be taken seriously. The number of older adult fatal falls is projected to reach 100 000 per year by 2030, with an associated cost of $100 billion. By integrating screening for fall risk into clinical practice, reviewing and modifying medications, and recommending vitamin D supplementation, physicians can reduce future falls by nearly 25% (Hourly et al., 2016). This projection is disturbing and needs more severe interventions before things get out of control, and our elderly patients suffer and even die.
Centers of Disease for Disease Control and Prevention. ( 2021). Facts About Falls. Retrieved from:https://www.cdc.gov/falls/facts.htmlLinks to an external site..
Houry D, Florence C, Baldwin G, Stevens J, McClure R. The CDC Injury Center’s response to the growing public health problem of falls among older adults. Am J Lifestyle Med. 2016 Jan-Feb;10(1):74–7. DOI: 10.1177/1559827615600137Links to an external site..
World Health Organization, (2021). Falls. Retrieved from:https://www.who.int/news-room/factsheets/detail/falls#:~:text=A%20fall%20is%20defined%20as,though%20most%20are%20non%2Dfatal
Your post is very informative! Hospital falls are a serious issue, even though they have decreased over the past few years. The most frequent adverse events documented in hospitals are patient falls. Even with all the hospitals intervention, such as bed alarms, floor mats, non-skid socks, falls can still happen. Appropriate staffing and assigning patients to nurses by acuity will aid in preventing falls too. I read this article that says they implemented a pilot study about care zones, and it improved the fall incident in their hospital. “Care zones group patients by acuity and pair two or more nurses per zone. The shift handoff process is streamlined to one or two nurses on average, significantly decreasing incremental overtime” (Staffing: A path to fewer patient falls, 2018). Flexible care zones are another feature. Three patients may be present when the nurse begins her shift and four at the end. However, the staff knows that the staffing level is suitable and that they won’t be required to bend too far (Staffing: A path to fewer patient falls, 2018).
You picked a great topic for your project! Keep up the good work!
Karen
Reference:
Staffing: A path to fewer patient falls. AACN. (2018, July 3). Retrieved from https://www.aacn.org/nursing-excellence/nurse-stories/a-clear-path-to-fewer-patient-falls