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Physicians, registered nurses, and mental health professionals are key agents to assess depression/distress and intervene appropriately to provide physiological, psychological, and psychosocial care for the BMT population. Several screening tools have been found to be effective in identifying distress and depression among BMT patients. The Distress Thermometer is an initial screening tool which serves as a single question to identify distress on a 1-10 scale. The distress is accompanied by 35 problem list prompting patient to identify their problems in five different categories: practical, family, emotional, spiritual/religious, and physical (NCCN, 2010). Ransom, Jacobsen, & Booth-Jones (2006) validated and found the tool useful for measuring distress in BMT patients. Scores greater than four or higher suggested a level of distress to have clinical significance. Additional tools used to assess distress and depression include the Profile of Mood Scale (POMS), Symptom Distress Scale (SDS), Beck Inventory of Depression (BID), Hospital Anxiety and Depression Scale (HADS), NCCN Distress Thermometer, Zung Depression Inventory, Psychosocial Levels System (PLS), and Center for Epidemiological Studies-Depression Scale (CES-D). Psychosocial and coping status assessment is a continuation of the integral treatment of BMT treatment. Assessment of psychological and coping status prior to BMT treatment has great importance in anticipating difficulties and preventing emotional crises. Molassiotis (1999) found 25% patients had psychological disturbances and impaired coping mechanisms during marrow transplantation. Additionally, impaired coping mechanisms identified prior to BMT treatment were denial, lack of clarity, and ambiance over treatment. The study found positive coping mechanisms during hospitalization were hope, directing attention, maintaining control over situation, and acceptance. Ineffective verses effective coping mechanisms can have important influences on psychological and physical outcomes. Previous studies have shown the importance of coping assessment with BMT patient survival and positive health status (Andrykowski et al., 2005; Meyers et al., 1994; Molassiotis, 1999; Wells, Booth-Jones, & Jacobsen, 2009). The assessment of coping styles enables professionals to obtain the optimum level of adaptation to treatment and identifying and reinforcement specific coping behaviors. The anticipation of specific psychosocial stressors may occur at various points in the treatment process and to identify factors may contribute to the exacerbation of BMT distress. (Fife et al., 2000) Coping assessment and evaluation should be performed after transplant and hospitalization as the patients emotional and physical needs change (Wells et al., 2009). Educating effective coping and behavioral strategies/programs can lower the incidence of distress and depression, improve coping, and enhance psychological and physical well-being among the BMT patient population. Psychosocial variables assessed before transplant have been shown to predict both psychosocial and physical outcomes (Goetzmann et al., 2007). Social support has been an impact on survival rates following stem cell transplant. Patients scoring a problematic social support prior to stem cell transplant showed a correspondence with poorer survival (Frick et al., 2005) Patients with a high level of perceived social support had improved survival (Colon et al, 1991) and higher quality of life (Frick et al., 2005; Rodrigue et al, 2000) The relation between social support and positive health outcomes provides the emphasizes the importance of social support assessment. NCCN has clinical practice oncology guidelines, pathways, and protocols for recognizing, evaluating, and treating psychological disturbances including distress, delirium, mood disorders, adjustment disorders, anxiety, and personality disorders. The management of distress/depression should be based on a detailed assessment of individual’s emotional, social, and psychological well-being with individualized interventions. The individualized interventions may utilize several modalities including psychosocial therapy and pharmacologic medication for symptom relief. Psychosocial therapy includes, but not limited to, supportive psychotherapy, cognitive-behavioral therapy, problem-solving techniques, and mindful-based therapy. Psychosocial therapy has been found to be effective for cancer patients by improving the overall quality of life and reducing distress (Holland & Alici, 2010; Jacobsen, 2009). Patients who received professional psychosocial therapy demonstrated significantly lower mood disturbance during BMT treatment (Molassiotis, VanDen Akker, Milligan, Goldman, & Boughton, 1996). Horton-Deutsch, Day, Haight, & Babin-Nelson (2007) conducted a pilot study to determine the acceptability and feasibility using mindfulness based approaches for patients undergoing BMT to find participants had a more positive affect after performing mindfulness interventions while experiencing an increase in symptoms, nausea, and appetite problems. Gabriel et al. (2001) conducted an art therapy program, The Creative Journey, for BMT patients to find art therapy strengthened positive thoughts, help resolve distressing emotional conflicts, deepened awareness of spiritual issues, and facilitated communication with family. Although, no additional studies were found using psychosocial interventions in the BMT patient population all recommended further research in psychosocial therapy. Bone marrow transplant patients are vulnerable to distress and depression at all stages in the process of treatment. The management of distress/depression may benefit from a pharmacologic medication (antidepressant). Williams & Dale (2006) reviewed six studies for the efficacy of antidepressant intervention and found evidence to support antidepressants are effective in the reduction depression/depressing symptom in cancer patients. The first line of depression treatment has been the usage of selective serotonin reuptake inhibitors due to their efficacious and well tolerance. Several antidepressants classes are available including tricyclics, serotonin-norephinephrine reuptake inhibitors, and norephinephrine-dopamine reuptake inhibitors. The antidepressant selected should be based on the primary symptoms, patient’s prognosis, co-morbid conditions, potential side effects and drug-drug interactions (Holland & Alici, 2010).
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Relationships among the Elderly: The Effects on One’s Health and Psychosocial Well Being
Advances in medicine are allowing many adults to live longer lives than previous generations. In fact, the elderly population is becoming one of the largest growing sectors of the present ...
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Nurse’s Legal Plight
A poem...!
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Looks Can Be Deceiving
I asked his family to step out for a moment so I could empty his JP drains. I emptied them into a basin and I noticed that they were very dark. I inspected them a little closer and I noticed it had a ...
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Culturally Competent Nursing in Homecare
Homecare nurses must be culturally aware in order to appropriately care for homecare patients. Culture plays a part in the care of all types of patients but it plays a more important role in homecare.
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The Importance of Supporting Mothers Who Breastfeed
There are many health benefits to breastfeeding children such as lower mortality rates, ideal nutritional values, and long term benefits such as healthy weights and higher intelligence later in life. ...
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Maximizing Pain Relief in Pediatric Patients
Pain management is a complex issue that has become increasingly significant in the nursing profession; so much so that the assessment of pain has become known as the fifth vital sign. This issue ...
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TO GOWN OR NOT TO GOWN?
The Center for Disease Control (CDC) states that standard precautions should be used for all patients and should be enough to prevent the spread of most MRSA cases. However, in acute-care settings ...
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Family Presence During CPR in the Emergency Department
A descriptive survey conducted in 2000 (Myers, et al 2000) investigated attitudes and beliefs of patients’ families and ER staff members about FWR. The survey reported that 98% of patients’ ...
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Keeping a Positive Outlook: My Clinical Experience as a Student Nurse
My experience in my senior year clinical preceptorship was without a doubt unique but I feel its uniqueness was in what I made of it, something every nursing student can do for themselves. If there ...
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Managing Diabetic Patients on Dialysis: The Nurse and Practitioners Role in Multidisciplinary Team Essentials
The chronic state of diabetes mellitus (DM) mainly type II, is an increasingly common cause of end stage renal disease (ESRD) in all countries, accounting for 51% of dialysis patients in the U.S. and ...
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A Solution for Solving the Nursing Shortage? Advantages and Disadvantages of Recruitment of Foreign-Trained Nurses
The Nursing shortage is not only an American dilemma but a phenomenon threatening the entire global community. Developed, as well as undeveloped, countries are experiencing an increasing number of ...
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Memories from a Haitian Cholera Treatment Center
In January and February of this year I worked in Haiti with United States NDMS DMAT and ImSurt teams providing medical and surgical care to the victims of the January 12th earthquake. What I ...
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