rn nurse journal registered nurse bsn rn

Bookmark the RN Journal in your Favorites File for easy reference!
 Home  Journal of Nursing  Publish  Search

 Home > Journal of Nursing > Distress and Depression Among Bone and Marrow Transplant Patients
 
<< Previous    1  [2]  3  4    Next >>


The Transactional Model of Stress and Coping is a theoretical framework for evaluating coping progression with stressful situations and events. During a stressful event, a person evaluates the level of the threat (primary appraisal) and the ability to cope with the threat as positive or negative (secondary appraisal). Primary appraisal is the person’s judgment of the event as stressful, positive, controllable, challenging, or irrelevant. Secondary appraisal follows as the person perceives and assesses their coping resources and options to address the stressful event as either positive or negative. Key examples of secondary appraisals are perceived ability to change the situation, perceived ability to manage emotional reactions to the threat, and expectations about the effectiveness on one’s coping resources. The emotional and functional effects of primary and secondary appraisals are mediated by an individual’s coping strategy. A person may be more likely to use disengaging coping strategies if the stressful event is perceived as threatening and uncontrollable. Examples of disengaging coping strategies include cognitive avoidance, behavioral avoidance, distraction, distancing, and denial. A person may be more likely to use engaging coping strategies if the stressful event is perceived as controllable and a person have favorable beliefs about self-efficiency. Examples of engaging coping strategies include active coping, information seeking, planning problem solving, and use of social support. Coping outcomes change over time and across situations (Wenzel, Glanz, & Lerman, 2002).

The National Comprehensive Caner Network (NCCN) Clinical Practice Guidelines in Oncology (2010) defines distress in cancer as: 

a multifactorial unpleasant emotional experience of a psychological, social, and/or spiritual nature that interferes with the ability to cope effectively with cancer, its physical symptoms and its treatment. It extends along a continuum, ranging from common normal feelings of vulnerability, sadness, and fears to problems that can become disabling, such as depression, anxiety, panic, social isolation, and existential and spiritual crisis. (p. DIS-2).

High distress levels has been associated with decreased adherence to chemotherapy regimens (Newell, Sanson-Fisher, & Savolainen, 2002), increased length of hospital stay (Preito et al., 2002), slower recover and increased physical limitation (Syrjala et al., 2004) decreased quality of life (Andrykowski et al., 2005; Molassiotis, Boughton, Burgoyne, & VanDen Akker, 1995), interferes with ability to perform daily activities (Molassiotis et. al., 1995), decreased life satisfaction (Sherman, Simonton, Latif, Plante, Anaissie, 2009), changes in body image, changes in personal goals, loss of independence, and decreased rates of survival (Colon, Callies, Popkin, & McGlave, 1991; Hoodin, Kalbfleisch, Thorton, & Ratanatharathorn, 2004; Rodrigue, Pearman, & Moreb, 2000). 

The mounting evidence state anxiety and depression has considerable consequences in the months and years following transplantation. Prieto et al. (2002) performed 1,062 psychiatric assessments of hospitalized stem cell transplantation patients to discover an overall psychiatric disorder prevalence rate was 44.1% and an overall prevalence rate for any mood, anxiety or adjustment disorder was 42.3%. The data indicates patients receiving stem cell transplantation have a high psychiatric morbidity and an association with longer length of stays, underscoring the need for early recognition and effective treatment. Fife et al. (2000) completed a data analysis of 101 BMT patients to reveal the period of initial hospitalization as being the most stressful and the highest degrees of anxiety, depression, anger and uncertainty. Illescas-Rico, Amaya-Ayala, Jimènez-López, Caballero-Méndez, & González-Llaven (2002) discovered allogeneic transplants verses autogeneic transplants had depression occur more frequently immediately following post-transplantation. Lee et al. (2005) found 44% post-transplant patients reported symptoms of depression, anxiety or post traumatic disorder. Sherman, Simonton, Latif, Plante, & Anaissie et al. (2009) found elevated cancer-related distress, higher level of anxiety and depression at stem cell collection and post-transplantation. The strong association between health outcomes and negative affect for the BMT patient has several important implications for healthcare professionals including psychological/psychiatric assessment prior to BMT treatment. 

Psychological distress/depression evaluation and screening leads to early recognition, which in turn improves medical management (Carlson & Bultz, 2003; NCCN, 2010). The importance to evaluate the predictors of distress, anxiety, and depression in patients undergoing a stem cell transplant has shown depression has an association with increased stem cell transplant hospitalization and mortality (Andrykowski et al., 2004; Colon et al., 1991; Hoodin et al., 2004; Frick, Motzke, Fischer, Busch, & Bumeder, 2005; Prieto et al, 2002; Rodrigue, Pearman, & Moreb, 2000) Lee et al. (2005) evaluated the feasibility of screening for psychological distress prior stem cell transplant to find elevated levels of anxiety and /or depression were detected in 55% of those providing pre-transplant assessments and were associated with compromised quality of life. The study concluded that pre-transplant distress appears to highly predict distress post transplant and is a feasible marker to target screening and intervention programs. Colon et al. (1991) findings indicated that a depressed mood before BMT may represent a negative marker for patient outcomes. NCCN reports less than 10% of oncology patients receive psychosocial therapy due to under recognition of patient’s psychological needs (Lee et al, 2005; NCCN guidelines, 2010). Patients may not report signs of distress due to fear being a burden on busy clinical staff, feel is a sign of weakness, or the belief distress cannot be helped (Lee et al., 2005) Patients at higher risk for BMT related complications were more likely to report psychological distress (Rodrique et al., 2000) Assessing and identifying individuals at high-risk before transplantation could enhance psychological interventions, resource distribution, and survival (Hoodin et al., 2004). An informal psychological distress assessment performed by a healthcare professional that indicates a high level of distress should be referred to a psychologist or psychiatrist for formal assessment (Trask et al., 2002). The psychological assessment should be a routine component of the pre-admission process. Only 50% of stem cell transplant centers implement a psychological/psychiatric assessment or monitoring program prior to BMT treatment (Lee et al., 2005). 
<< Previous    1  [2]  3  4    Next >>
 
 
 
   
   

 
 
 
 
 
 
   
 
   

 

Home Journal of Nursing News Publish State Boards About Us Search Contact Us Privacy Terms of Service Opportunities Advertise
   RN Journal of Nursing


Use of this website constitutes acceptance of our Terms of Service Information, articles, Press Releases, videos, and links are published as a convenience to our visitors. Articles are to be used only as a reference aid. They are not intended to be used as a substitute for the exercise of professional judgment. Any questions or comments about the article should be directed to the author.  We take no responsibility and give no guarantees, warranties or representations, implied or otherwise, for the content or accuracy.
2000 2011 RNJournal.com Times Publishing, LLC  All Rights Reserved