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Demoralization in medical illness: Feasibility and acceptability of a pilot educational intervention for inpatient oncology nurses

Published online by Cambridge University Press:  09 August 2017

Benjamin W. Brewer ,
Jennifer M. Caspari ,
Jean Youngwerth ,
Leigh Nathan ,
Izaskun Ripoll  and
Alison Heru
Benjamin W. Brewer*
Affiliation:
Departmentof Medicine, University of Colorado–Denver, Anschutz Medical Campus, Aurora, Colorado Department of Psychiatry, University of Colorado–Denver, Anschutz Medical Campus, Aurora, Colorado
Jennifer M. Caspari
Affiliation:
Division of Mental Health and Clinical Neurosciences, VA Portland Health Care System, Portland, Oregon
Jean Youngwerth
Affiliation:
Departmentof Medicine, University of Colorado–Denver, Anschutz Medical Campus, Aurora, Colorado
Leigh Nathan
Affiliation:
Department of Psychiatry, University of Colorado–Denver, Anschutz Medical Campus, Aurora, Colorado
Izaskun Ripoll
Affiliation:
Department of Psychiatry, University of Colorado–Denver, Anschutz Medical Campus, Aurora, Colorado
Alison Heru
Affiliation:
Department of Psychiatry, University of Colorado–Denver, Anschutz Medical Campus, Aurora, Colorado
*
Address correspondence and reprint requests to: Benjamin W. Brewer, Mail Stop F754, Anschutz Cancer Pavilion, 1665 Aurora Court, Room 4322, Aurora, Colorado 80045. E-mail: benjamin.brewer@ucdenver.edu.
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Abstract

Objective:

Demoralization is a common problem among medical inpatients with such serious health problems as cancer. An awareness of this syndrome, a knowledge of what defines it, and a plan for how to intervene are limited among nursing teams. Nurses are uniquely poised to efficiently provide brief interventions that address demoralization in their patients. To our knowledge, there are no interventions that train nurses to distinguish and treat demoralization in their patients. The objective of the present study was to determine the acceptability, feasibility, and impact of a novel educational intervention for nurses.

Method:

An educational training video was created and delivered to staff nurses (N = 31) at oncology staff meetings to test the feasibility and acceptability of this intervention. Assessments of nurses' knowledge about demoralization and intervention methods were administered immediately before and after the training intervention and through a web-based survey 6 weeks post-intervention. McNemar's test for dependent categorical data was utilized to evaluate change in survey responses at the three timepoints.

Results:

Nurses' understanding of the concept of demoralization and appropriate interventions significantly improved by 30.3% from pre- to posttest (p ≤ 0.0001). These improvements persisted at 6 weeks post-intervention (p ≤ 0.0001). At 6-week follow-up, 74.2% of participants agreed or strongly agreed that the training had positively changed their nursing practice, 96.8% reported that this training benefited their patients, and 100% felt that this training was important for the professional development of nurses.

Significance of results:

This pilot intervention appeared feasible and acceptable to nurses and resulted in increased understanding of demoralization, improved confidence to intervene in such cases, and an enhanced sense of professional satisfaction among inpatient oncology floor nurses.

Keywords

DemoralizationDepressionNurse educationOncology
Type
Original Article
Information
Palliative & Supportive Care , Volume 16 , Issue 5 , October 2018 , pp. 503 - 510
Copyright
Copyright © Cambridge University Press 2017 

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References

REFERENCES

Akechi, T., Ishiguro, C., Okuyama, T., et al. (2010). Delirium training program for nurses. Psychosomatics, 51(2), 106–111.Google Scholar
Arman, M. (2007). Bearing witness: An existential position in caring. Contemporary Nurse, 27(1), 84–93.Google Scholar
Arora, N.K. (2003). Interacting with cancer patients: The significance of physicians' communication behavior. Social Science & Medicine, 57(5), 791–806.Google Scholar
Breitbart, W. (2002). Spirituality and meaning in supportive care: Spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Supportive Care in Cancer, 10(4), 272–280.Google Scholar
Breitbart, W. & Poppito, S.R. (2014). Individual Meaning-Centered Psychotherapy for Patients with Advanced Cancer: A Treatment Manual. New York: Oxford University Press.Google Scholar
Clarke, D.M. & Kissane, D.W. (2002). Demoralization: Its phenomenology and importance. The Australian and New Zealand Journal of Psychiatry, 36(6), 733–742.Google Scholar
de Figueiredo, J.M. (1993). Depression and demoralization: Phenomenologic differences and research perspectives. Comprehensive psychiatry, 34(5), 308–311.Google Scholar
D'Souza, R.F. & Rodrigo, A. (2004). Spiritually augmented cognitive behavioural therapy. Australasian Psychiatry, 12(2), 148–152.Google Scholar
Fallowfield, L. (1995). Can we improve the professional and personal fulfillment of doctors in cancer medicine? British Journal of Cancer, 71(6), 1132–1133.Google Scholar
Griffith, J.L. & Gaby, L. (2005). Brief psychotherapy at the bedside: Countering demoralization from medical illness. Psychosomatics, 46(2), 109–116.Google Scholar
Kearney, M.K., Weininger, R.B., Vachon, M.L., et al. (2009). Self-care of physicians caring for patients at the end of life: “Being connected … a key to my survival.” The Journal of the American Medical Association, 301(11), 1155–1164.Google Scholar
Kimmel, R.J. & Levy, M.R. (2012). Brief psychotherapy for demoralization in terminal cancer: A case report. Psychosomatics, 54(1), 84–87.Google Scholar
Kissane, D.W. (2014). Demoralization: A life-preserving diagnosis to make for the severely medically ill. Journal of Palliative Care, 30(4), 255–258.Google Scholar
Kissane, D.W., Clarke, D.M. & Street, A.F. (2001). Demoralization syndrome: A relevant psychiatric diagnosis for palliative care. Journal of Palliative Care, 17(1), 12–21.Google Scholar
Lamont, E.B. & Christakis, N.A. (2001). Prognostic disclosure to patients with cancer near the end of life. Annals of Internal Medicine, 134(12), 1096–1105.Google Scholar
Lazarus, R.S. & Folkman, S. (1984). Stress, Appraisal, and Coping. New York: Springer Publishing Company.Google Scholar
Lerman, C., Daly, M., Walsh, W.P., et al. (1993). Communication between patients with breast cancer and health care providers determinants and implications. Cancer, 72(9), 2612–2620.Google Scholar
Maguire, P., Faulkner, A., Booth, K., et al. (1996). Helping cancer patients disclose their concerns. European Journal of Cancer, 32(1), 78–81.Google Scholar
Morita, T., Murata, H., Hirai, K., et al. (2007). Meaninglessness in terminally ill cancer patients: A validation study and nurse education intervention trial. Journal of Pain and Symptom Management, 34(2), 160–170.Google Scholar
Morita, T., Tamura, K., Kusajima, E., et al. (2014). Nurse education program on meaninglessness in terminally ill cancer patients: A randomized controlled study of a novel two-day workshop. Journal of Palliative Medicine, 17(12), 1298–1305.Google Scholar
O'Laughlin, K.N., Wyatt, M.A., Kaaya, S., et al. (2012). How treatment partners help: Social analysis of an African adherence support intervention. AIDS and Behavior, 16(5), 1308–1315.Google Scholar
Razavi, D., Delvaux, N., Marchal, S., et al. (2002). Does training increase the use of more emotionally laden words by nurses when talking with cancer patients? A randomised study. British Journal of Cancer, 87(1), 1–7.Google Scholar
Robinson, S., Kissane, D.W., Brooker, J., et al. (2015). A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: A decade of research. Journal of Pain and Symptom Management, 49(3), 595–610.Google Scholar
Robinson, S., Kissane, D.W., Brooker, J., et al. (2016). A review of the construct of demoralization history, definitions, and future directions for palliative care. The American Journal of Hospice & Palliative Care, 33(1), 93–101.Google Scholar
Rotter, J.B. (1966). Generalized expectancies for internal versus external control of reinforcement. Psychological Monographs, 80(1), 1–28. Available from http://www.soc.iastate.edu/Sapp/soc512Rotter.pdf.Google Scholar
Seligman, M.E. (1972). Learned helplessness. Annual Review of Medicine, 23(1), 407–412.Google Scholar
Seligman, M.E., Abramson, L.Y., Semmel, A., et al. (1979). Depressive attributional style. Journal of Abnormal Psychology, 88(3), 242–247.Google Scholar
Slavney, P.R. (1999). Diagnosing demoralization in consultation psychiatry. Psychosomatics, 40(4), 325–329.Google Scholar
Viederman, M. (1983). The psychodynamic life narrative: A psychotherapeutic intervention useful in crisis situations. Psychiatry, 46(3), 236–246.Google Scholar