Hannah Ross, Nursing

Abstract

This study examined nurses’ feelings as they communicated with their newly diagnosed cancer patients. Qualitative interviews with ten oncology nurses from northern and central Utah were conducted. Nursing literature demonstrated that many newly diagnosed cancer patients felt healthcare staff were not empathetic. Qualitative interviews with study participants concluded that nurses with oncology experience feel confident and competent in supporting patients. The interviews also discussed that it is important for nurses to be empathetic, compassionate, understanding, and knowledgeable to feel competent in caring for these patients.

Background

One in every three women and one in two men will develop cancer in their lifetime (American Cancer Society, 2008). A diagnosis of cancer often causes feelings of depression, fear, anxiety, and anger. Therefore when informing a person of their diagnosis of cancer, healthcare staff should be empathetic, competent in answering questions, and respectful of the patient. Studies have been done on patients’ experiences regarding their diagnosis, but there is minimal data existing on how nurses and other members of the healthcare team feel they approach patients with the diagnosis of cancer.

When faced with a diagnosis of cancer, a patient’s “greatest challenge is gaining control over an overwhelming situation” (Stephens, et al. 2008, p. 255). In fact, 90% of newly diagnosed cancer patients identified fear and anxiety as a major concern (Stephens, et al., 2008). Cancer patients also have an interest in existential and spiritual concerns because they “struggle to maintain self-identity and threats to self identity” (Henoch and Danielson, p. 1426, 2008). As a result of this struggle, patients stated that healthcare staff should pay more attention to these needs, not just treat the disease, but also treating the person (McCorkle et al., 2008). This demand by patients should not be overlooked. Of those newly diagnosed with cancer, 62.3% stated that the way they were informed of their cancer was “not so empathetic or not at all empathetic” (Spiegel et al. 2008, p. 1383).

Because cancer patients feel a torrent of emotions ranging from sadness to intense anger, it is important for healthcare professionals to seek to help patients cope with their diagnosis. Therefore, healthcare professionals need to feel competent answering questions, allow time for patients to discuss their diagnosis, and show empathy. Knowing how nurses communicate and approach their newly diagnosed cancer patients will allow nurses to recognize the areas they need to improve their therapeutic communication to give the best patient care to cancer patients. This study focuses on the level of confidence nurses feel when giving support to their newly diagnosed cancer patients. It also addresses solutions for nurses who do not feel as confident in supporting these patients

Methods

Participants
Ten nurses from the Intermountain Chapter of the Oncology Nurses Society (ICONS) volunteered their time to participate in this study. All participants were located in a western state. Volunteers were paid for their participation. Only the primary investigator had access to raw data. Tapes and transcribed material were kept in a locked cabinet. In order to maintain participant confidentiality, all information was reported as group data with no identifying information.
Materials
Interviews were conducted using a series of eight questions. These questions are as follows:
1.Tell me how you felt when you found out you had to go with the doctor to tell one of your patients they had cancer.
2. Tell me how you approached your patient after they learned of their diagnosis of cancer
3. How long did you spend talking with your patient?
4. What did you find challenging in approaching these patients with their new diagnosis?
5. What measures did you take to help the patient accept their diagnosis?
6. Do you feel confident in being able to support these patients?
7. What characteristics do you feel oncology nurses need to be supportive of their patients?
8. For nurses who don’t feel as confident, what would you suggest as ways for them to increase their confidence?

We chose these particular questions because they addressed nurses’ confidence level and communicative abilities in supporting cancer patients. Interviews were tape recorded in order to determine any similar themes between answers.

Design and Procedure
After obtaining IRB approval and formal consent, interviews were completed in one ten to twenty minute interview over the telephone. Each interview was audio-recorded and transcribed. The information collected in the initial interviews was analyzed by the primary investigator to determine any similarities. Similar themes were recorded and sent with transcriptions of the interviews. These were letters were mailed to each of the participants for correction and clarification. The corrected interviews were returned in self-addressed, stamped envelopes including no identifying information on the participants. After interviews were received, they were reread and analyzed to determine any further similarities between answers.

Results

Upon completion of this study, a number of similar themes were found from each question. Questions 1, 6, and 7 elicited a similar response. These questions addressed characteristics that were found to be essential in order to be an oncology nurse. Questions 1, 2, 3, 6, and 8 gave answers in regards to nurses’ perception of their ability to support newly diagnosed cancer patients was determined. Finally, question 5 explored challenges that oncology nurses face and how they can overcome those struggles.

Characteristics Necessary to be an Oncology Nurse
Many of the traits needed to be an oncology nurse are similar to traits that nurses in other medical areas should develop. One oncology nurse said, “ An oncology nurse needs to have a good scientific background, be assertive, have good clinical skills, and above all, compassion.” (Personal Interview, March 25, 2009) Seven out of the ten interviewed nurses agreed with these traits. However all ten agreed that traits an oncology nurse needs are empathy, have hope, good communication skills, professional mentality, positive attitude, good listening skills, sensitivity to patient needs, confidence, have a sense of humor, and have a commitment to quality care and comfort for patients. If a nurse has several of these traits he or she will be able to better support new cancer patients.

Ability to Support Patients
When asked how they approached their patients, each of the nurses interviewed had their own way of approaching patients. One nurse said, “I think a hug and an ‘I’m sorry,’ and then…you gauge whether they want emotional support or are they ready for a lot of information.” (Personal Interview, March 26, 2009) Another nurse said, “I approach them with compassion. I asked them if they had any questions and would teach them.” (Personal Interview, March 25, 2009) A third nurse said, “With empathy. And you know just trying to be sensitive to their feelings and how they are responding… just try to be sensitive and… make your reaction [similar] to theirs.” (Personal Interview, March 27, 2009) Each of these approaches was affective according to those interviewed.

Despite their differences, there were also similar ways that these nurses treated their patients. Three nurses stated that they make sure to tell each of their patients that with cancer there is a lot of hope and that they should take one day at a time. Another common theme stated by six nurses was being direct and honest to ensure that patients understand what their diagnosis meant. It was also stated by all ten nurses that the amount of time spent in the room depended on the patient’s needs. Sometimes nurses would spend five minutes in the room and other times, thirty minutes. Also, each nurse stated that patient education was part of the approach. However, before teaching, each of the interviewed nurses also stated that it was necessary to determine the patient’s readiness for knowledge about their diagnosis. A final comment that each of the nurses made was that having confidence and feeling competent helped to assist them when caring for these patients.

When asked about their confidence level, each of the nurses we interviewed stated that they felt confident in working with newly diagnosed cancer patients. When followed up with the question of why, answers varied. However, a common theme found in eight of the ten interviews was that amount of experience greatly affected their confidence level. Other responses included being educated and knowledgeable about the disease process of cancer in order to feel competent in answering questions patients have about their diagnosis. Also discussed was how newly diagnosed patients need someone to talk to who understands to certain extent what they are going through. In these instances, the nurses interviewed said that their confidence came from being able to listen and developing the ability to recognize patient cues. Finally, several of those interviewed said that although much of the time they feel confident, there are a few cases where they will feel less confident because with cancer sometimes the “…prognosis is grim and they won’t last for long. You feel like there is more that you want to do, but you know that you just can’t.” (Personal Interview, March 23, 2009) With these cases, nurses come to face many challenges that they have to learn to overcome.

Challenges Oncology Nurses Face
There are many challenges that oncology nurses face. One of these challenges stated by three nurses is how to adequately educate patients so that they understand what is happening and what their options are. Another challenge stated by three nurses is reading the verbal and nonverbal cues that patients give after they have received news of their diagnosis. Another struggle nurses face is feeling confident and competent in supporting patients through their reaction to the news. A final challenge is a nurse’s emotional ability to cope with a poor patient prognosis. These are difficult trials to face, but there are ways to overcome them.

Suggestions in how to overcome Challenges
Depending on the challenge, different approaches are used. In order to overcome the challenge of adequate patient education, the nurses interviewed stated that giving them education materials, such as pamphlets, diagrams, pictures, Internet resources, and answering patient questions directly in a way that patients can understand assist in overcoming this difficulty. To improve reading verbal and nonverbal cues of patients, eight nurses suggested that they talk with their patients and use therapeutic communication skills. They advised asking questions like, “I know this is a hard diagnosis, are you feeling overwhelmed?” In order to increase feelings of confidence and competence in supporting patients, all those interviewed suggested following a more experienced nurse and doctor to observe how they approach patients. They also suggested reviewing the disease process of cancer, the grieving process, and chemotherapeutic drugs. Finally, eight of the ten suggested for nurses who struggle coping with patients with poor prognosis to make sure that nurses take care of themselves by doing things they enjoy doing, such as exercising or reading a book. They also suggest while maintaining patient confidentiality to talk to a work colleague so that they can work through their emotions. Finally, they suggest trying to leave work at work.

Discussion

Summary

This study addressed nurses’ perception of their ability to support newly diagnosed cancer patients. We found that oncology nurses feel confident and competent in caring for these patients because of their experience level and knowledge base. It was also found that these nurses perception of patient needs were adequate. This conclusion was drawn because these nurses correctly identified patient needs that have been determined through research. For example according to Spiegel et al., patients wanted to be treated with empathy. The nurses interviewed identified empathy as one of the most important traits that an oncology nurse needs to be successful. Also, Stephens, et al. found that one of the most challenging things for patient is gaining control over a seemingly hopeless situation. These nurses identified that one of the challenges they face is knowing how to support a patient who is struggling with those feelings of hopelessness. They then identified that nurses can assist patients through this hard time by being educated about the disease process, showing compassion, and spending time with the patient. Therefore, these nurses are adequately prepared to support these patients.

Limitations
This study provides evidence that oncology nurses feel confident and competent in providing care to newly diagnosed cancer patients. However, this study did not include nurses from other medical areas, such as medical-surgical or pediatrics. Also, this study had a small sample size of ten and lack of random assignment. The participants were also all members of ICON. Finally, all participants were from northern or central Utah, which might also have created a bias.

Conclusion
The results of this study determine that oncology nurses are capable of adequately supporting newly diagnosed cancer patients. They have the experience, the knowledge base, and the characteristics that are needed to support these patients. However, there are also nurses who do not feel as confident or competent. To these nurses, we would like to say, it is not impossible to attain that level of confidence. The nurses interviewed stated that confidence and competence can be attained through seeking knowledge about cancer, shadowing nurses and doctors who are confident, and attaining personal experiences. Supporting cancer patients is not easy, but as one nurse said, “…it’s an honor to be with someone when they are struggling…” (Personal Interview, March 25, 2009)

In assisting cancer patients, it is necessary for nurses to recognize patient needs as well as their personal emotions. They need to ensure that they are capable of educating these patients as well as showing empathy and compassion. Finally, nurses caring for newly diagnosed cancer patients need to be open and honest with their patients and offer a listening ear. If nurses approach their newly diagnosed cancer patients in each of these ways, then those patients who are struggling will hopefully be able to better cope with their diagnosis of cancer.