Joumal of Advanced Nurstng, 1991,16,677-688
Factors which influence how nurses communicate with cancer patients Susie Wilkmson MSc RGN RM DANS RNT RCNT Diploma m Counselbng Macmtllan Tutor/Speaaltst Nurse, Stockport, Tamestde and Glossop College of Nurstng, Stepptng Htll Hospttal, Stockport SK2 7JE, Greater Manchester, Englartd
Accepted for publication 26 November 1990
WILKINSON S (1991) Journal of Advanced Nursing
16,677-688
Factors which influence how nurses communicate with cancer patients Communication is one of the most important aspects of cancer nursing Evidence suggests nurses expenence commumcation difi&culties and frequently block patients from divulgmg their womes or concems This paper focuses on a study which aimed to determine (a) the extent to which nurses facilitate or block patients and awareness of their verbal behaviours, (b) whether there is a relationship between nurses' verbal behaviours and levels of anxiety, soaal support, work support and athtude to death, and (c) nurses' difificulties m carmg for cancer pahents The study was conducted in a speaabst and non-speaalist hospital Fifty-four registered nurses completed three audio-taped histories (one with a new cancer patient, a patient with a recurrence and a patient for pallahve care), a self-admmistered questiormaire and a semi-structured audio-taped interview The data were analysed usmg SPSSX The findings mdicate an overall poor level of faabtahve commumcahon, with a patient's recurrence causmg most difiFicuIhes There is evidence to suggest the way nurses conunxmicate may depend on the environment created by the ward sister, the nurses' religious bebefs and athtude to death rather than speafic education m commumcahon skills
INTRODUCTION Communicahng with cancer patients has been recognized as one of the most important aspects of nursmg care (Madeod Clark 1982) Researdi evidence suggests that, m general, nurses do not communicate well and few patients are sahsfied with ttus area of care (Reynolds 1978) The time nurses spend communicahng with pahents is fil d and are lrarely minimal, conversahons tend to be superfiaal related to a diagnosis or prognosis (MacLeod Clark 1982) Most mterachons with patients occur when physical tasks are camed out (Seers 1986) and physical aspects rather than psydiobgical JBpects of care appear to dominate most nurse-^ati«it commumcahOTi (Faulkner 1985) O w « pah«its have a cancer diagnosis, nurses become more rehcent m giving them mfomiahon and have been obsenwd to ignore signs of distress by using vanous
behaviours, which prevent patients talkmg about their problems (Bond 1978, Webster 1981) Nurses themselves a^j^ut that communicahng with cancer pahents is difficult (Wilkmson 1986) but the exact problems have not been identified g^j^g authors believe that difficulhes anse because nurses do not have the verbal skills to assess how patients g^jQuj. tj,e,j tj,e,j. ,ilness (Maguire 1985) Other authors fggj g^jQuj suggest that nurses do not necessanly lack the veifcal skills, ^j^gy jj^gy jyst not be usmg them (Marshfield 1985)
Questions to be asked Thus a number of queshons need to be asked Do nurses have the skills to facilitate pahents to discuss their problems? If they do, why are they not usmg them, or are 677
S Wtlkmson 1 Study design Demograptiic variables
j
Facihtatmg verbal t>ehaviour
Work environment
Anxiety
Low
Nurse-^atient interaction
Anxiety 1/
Blocking verbal behaviour
Fear of death
1
\ High
Social support
they, as research suggests (Maginre 1985), contmually usmg blockmg verbal behaviours? And if tbs is the case, why are they? Several researchers have speculated as to why nurses use blockmg verbal behaviours Reasons have mduded, to prevent patients unleasbng shong emohons wbch they cannot handle, fear of losing composure m hont of pahents (Magmre 1985), and fear of their own death (Qumt 1972) All are anxiety-provoking situahons Does mcreased anxiety, or fear of death, mfluence how nurses commumcate with pahents or could it be lack of support or the workmg environment? Pahents who are facibtated to discuss their womes and concems appear to have greater confidence m nurses and feel more sahsfied with the care they receive (Ridgeway & Matthews 1982) It would seem imperahve that the factors wbch influence how nurses commumcate are ldenhfied
Twelve wards admithng predominantly cancer pahents were ldenhfied Six wards were chosen randomly for mclusion in the study speaalist hospital — tbee wards out of four, general hospital — tbee wards out of eight The order of data collechon was determmed by the order m wbch the random selechon was made Indusion cntena stipulated registered general or eru-olled nurses worbng on a designated ward, as a permanent member of staff, dunng the day shifts
METHODS
The study descnbed here is an analyhcal relahonal survey Data were colleded by several methods Each nurse was required to complete (a) a self-admmistered questionnaire wbch mduded demogapbc data, fear of death scale (Collett & Lester 1969), Norbeck social support queshonnaire (Norbeck et al 1981) and State Trait Anxiety mventory (%)ielberger et al 1983), (b) a tape-recorded nursing bstory with a newly diagnosed cancer pahent, a AIMS OF THE STUDY pahent admitted with a recurrence and a patient admitted for palbahve care, and (c) a semi-stnictured tape-recorded The study set mit to identify mterview on the difilkulhes m carmg for patients 1 the extent to wbch nurses use faabtatmg and blocking Field notes to obtam contextual data of the ward behaviours when commumcatmg with cancer pahents, environmoit and the nursing {wachce bemg camed out 2 if there is a relahonsbp between the extent to wduch were taken wblst working m a supemtonay ca{Kiaty on nurses usefecilitatmgand blockmg verbal behaviours each ward dunng the data collechon penod. H K design of and their levels of state and trait anxiety, athtudes the study isrepresenteddiagramahcally in Figure 1 to death, percerved levels of soaal support and work environment, A n a l y s i s (MF data 3 if nurses are aware that the verbal behaviours they use The self-admimstered queshcHinaires were coded for are blockmg or facibtahng, ccHnputahon and processed usti^ SPSSX The tape4 nurses' views and feebngs about commumcahng with recorded nursmg bstones were hanscnised x«i rated by cancer pahents one of two independent psydiolog»ts expenemsd m The study was cOTducted m two hospitals m &tgland a ratmg aujio-taped Biterviews witticamsrpat^its Further specialist cancer ho^ital and a distnd go^ral i l trainii^, however, was necessary to famdianze than with 679
Commumcation m cancer nursing Table 1 Categones of nurses' faeihtating verbal behaviours (adapted with permission of Forrest D (1983) Analysis of nurses' verbal eommumeahon with patients Nurstng Papers 15(3), MeGiU University, Montreal)
Table 2 Categones of nurses' bloeking verbal behaviours (adapted with permission of Forrest D (1983) Analysis of nurses' verbal eommumeahon with patients Nursmg Papers 15(3), MeGiU University, Montreal)
Intrcxiuetion of self Purpose of mterview Aeknowledgmg patient Open questions Eneour^emoit Piek-up of eue Refleetion danfieation Empathy Confrontahon ehaUenge Information giving Summanzing problems Patient queshons Consultation of plan of aetion
Normalizing/stereotyped eomments Premature/false reassuranee Inappropnate adviee Closed/leadmg multiple questions Tassmg the buek' Requestmg an explanation Disapproving/disagreeing Approving/agreeing Defendmg Change topie/ignonng/seleetive/attention to eue Change of foeus to relative loUymg along Personal ehit-ehat
the devised eoding system A rehabihty study to eheek their ratmg was eamed out before the study eommeneed and again dunng the study The levels of agreement reached r = 0 65 or above on all occasions as judged by Cohen Kappa coeffiaent The tape-recorded nursing histones were assessed in two ways 1
2
Each verbahzahon, defined as a complete uninterrupted utterance without pause, was assessed as either facilitative or blockmg behaviour, using the eategones adapted from Forrest (1983) (demonstrated in Tables 1 and 2) The nurses' coverage of the seven key areas of the nursing bstory is demonstrated m Table 3 Each area was assigned a score, from 0 = no coverage, I = poor eoverage, 2 = adequate eoverage, 3 = good eoverage, resulting m a mimmum seore of 0 and a maximum of 21 The ratmgs for eaeh tape reeordmg were transferred to cochng sheets for computahon
The semi-structured interviews were transenbed and checked for errors Replies to each queshon were collated and the themes to emerge were categonzed To obtam some quanhtahve as weU as quahtahve data, the categorized responses were ccxied for computation
^atistical tests As some of tht vanables were not normally distnbuted, non-fRinunetnc statishcal tests were used where appropnate For ccm^>arahve purposes, however, the means and Stanford deviahcms are presented
Table 3 Coverage of the key areas of the nursing history Patients' understanding of admission Patients' understanding of diagnosis Patients' bstory of present illness Patients' history of previous illness Physieal assessment of pahent Scxnal assessment of patient Psyehologieal assessment of patient
RESULTS Only seleeted results of the study are presented here The sample The 56 relevant staff on the randomly seleeted wards were approached All (100%) agreed to participate and 54 (98%) nurses eompleted the study one nurse did not retum from sick leave before the study finished, another transferred to mght duty before being able to complete the nursing bstones Characteristics of the sample Eighty-mne per cent of the sample were female The mean age of the sample was 28 years 5 months Thirty-seven nurses (69%) were smgle, 18 (21%) were mamed Tbrtyone nurses (57%) were Protestant, 12 (22%) Cathohc and 679
TaUe 4 Grade of StafiF by bospital Grade
Number of staff firom a ^>eaalist bospital
Number of staff from a general bospital
Sister Cbarge nurse Staff nurse ErtroUed nurse
3 — 16 7
5 2 11 10
15 4 50 31
Totals
26
28
100
11 (20%) atheist Twelve nurses {22%) attended church weekly, 26 (48%) infrequenHy and 16 (30%) never Sixteen nurses (30%) had completed an English Nahonal Board (ENB) nursmg course mne nurses (6%) the oncology course, three (2%) the cardiothoracic course, three (2%) the mtensive care course, one (1%) the death/dymg course, one (1%) the AIDS course and one (1%) the theahre course Nineteen (35%) nurses had attended a commumcation skills course of 1 to 4 days m length Distnbuhon of nursmg staff, by grade, for each hospital, is shown m Table 4
Percentage of
staff m eacb gracfe
Table 5 Tbe total coverage scores for eacb nursmg bistory* Interview A (new patient)
Interview B (recurrence)
Interview C (paUiative care)
Mean
SD
Mean
SD
Mean
SD
77
29
6-0
31
71
3-0
'For each mining history there was a minunum score of 0 •md a maxunum score of 21
Significant difiFerences in demc^aphic data Speaabst-hospital nurses (mean 5 6) had more (orelmary) O level passes than the general-hospital nurses (mean 3 4) (Mann-Wbhiey U test P=0-003) Speaabst-hospital nurses (mean 0-4) had more (advanced) A level passes than the general-hospital nurses (mean 01) (Mann-Whitney U test P = 0008) Eight speaabst-hospital nurses had completed the ENB course m oncology nursmg compared with one generalhospital nurse (Fishers exact test P=0-008) Thirteen speaalist-he>spital nurses had completed a commumcation shils course compared with six nurses from the general hospital (cb-square test 4 82577, d f = l , P=0O3) General-hospital nurses (mean 35 8) had held their present posihons longer than the speaalist nurses (mean 211) (P=004) On all other vanables the two samples were matched THE EXTENT T O W H I C H NURSES FACILITATE OR BLOCK PATIENTS WHEN U N D E R T A K I N G NURSING HISTORIES Cova'^;e aaaes for ttie iHirsing histories Table 5 gives the mean and staidard deviahon values of the total cova:^e «»res fe»- eadi nursir^ history. The coverage scenes were low m terfd and m evoy key area.
40r
30
I 20
I
10
Figure 2 Psycbological assessment scores A = interview A (new pahent), B = mterview B (recurr«ice), C = mterview C (palbahve) • = n o coverage, n = p o o r coverage, ^ = adequate coverage, H = gCKxi coverage
TTiey were particularly low m the area of psyc^olopcal assessment m companson with the physical assessment, as demonstrated m Figures 2 and 3 Few nurses a ^ d pahents how they were feelmg or if they had any womes. Observahc»i of Hie nursmg history sheets reveded that mmy mases wrote 'pahent anxious' l»t when tite relevant tape was listei^ to ami rat»i it
Commumcahon tn cancer nurstng 40 r
Figure 3 Physical assessment scores • = no coverage, D = poor coverage, 0 = adequate coverage; D = good coverage
became evtdent that psychologtcal issues had rarely been addressed Only one nurse attempted to discuss a patient's sexual concems and the problem was raised by the pahent herself This IS significant m view of the fact that the sample induded patients admitted with cancer of the cervix, ovary, breast, penis, testicle, bladder, rechim and colon, all cancers known to affect a patient's sexuabty The scores on the physical assessments were also low because they were very superfiaal Many nurses, for example, identified that the pahent was breathless or conshpated but never assessed just how much or m what way or to what extent it was affechng the patient Nurses' coverage of the key areas of the nursing bstory with patients admitted with a recurrence of their disease was sigmficantly less comprehensive than m the nursing history with new patients (P= 0 0004)
Factors which influence how nurses communicate with cancer patients Susie Wilkmson MSc RGN RM DANS RNT RCNT Diploma m Counselbng Macmtllan Tutor/Speaaltst Nurse, Stockport, Tamestde and Glossop College of Nurstng, Stepptng Htll Hospttal, Stockport SK2 7JE, Greater Manchester, Englartd
Accepted for publication 26 November 1990
WILKINSON S (1991) Journal of Advanced Nursing
16,677-688
Factors which influence how nurses communicate with cancer patients Communication is one of the most important aspects of cancer nursing Evidence suggests nurses expenence commumcation difi&culties and frequently block patients from divulgmg their womes or concems This paper focuses on a study which aimed to determine (a) the extent to which nurses facilitate or block patients and awareness of their verbal behaviours, (b) whether there is a relationship between nurses' verbal behaviours and levels of anxiety, soaal support, work support and athtude to death, and (c) nurses' difificulties m carmg for cancer pahents The study was conducted in a speaabst and non-speaalist hospital Fifty-four registered nurses completed three audio-taped histories (one with a new cancer patient, a patient with a recurrence and a patient for pallahve care), a self-admmistered questiormaire and a semi-structured audio-taped interview The data were analysed usmg SPSSX The findings mdicate an overall poor level of faabtahve commumcahon, with a patient's recurrence causmg most difiFicuIhes There is evidence to suggest the way nurses conunxmicate may depend on the environment created by the ward sister, the nurses' religious bebefs and athtude to death rather than speafic education m commumcahon skills
INTRODUCTION Communicahng with cancer patients has been recognized as one of the most important aspects of nursmg care (Madeod Clark 1982) Researdi evidence suggests that, m general, nurses do not communicate well and few patients are sahsfied with ttus area of care (Reynolds 1978) The time nurses spend communicahng with pahents is fil d and are lrarely minimal, conversahons tend to be superfiaal related to a diagnosis or prognosis (MacLeod Clark 1982) Most mterachons with patients occur when physical tasks are camed out (Seers 1986) and physical aspects rather than psydiobgical JBpects of care appear to dominate most nurse-^ati«it commumcahOTi (Faulkner 1985) O w « pah«its have a cancer diagnosis, nurses become more rehcent m giving them mfomiahon and have been obsenwd to ignore signs of distress by using vanous
behaviours, which prevent patients talkmg about their problems (Bond 1978, Webster 1981) Nurses themselves a^j^ut that communicahng with cancer pahents is difficult (Wilkmson 1986) but the exact problems have not been identified g^j^g authors believe that difficulhes anse because nurses do not have the verbal skills to assess how patients g^jQuj. tj,e,j tj,e,j. ,ilness (Maguire 1985) Other authors fggj g^jQuj suggest that nurses do not necessanly lack the veifcal skills, ^j^gy jj^gy jyst not be usmg them (Marshfield 1985)
Questions to be asked Thus a number of queshons need to be asked Do nurses have the skills to facilitate pahents to discuss their problems? If they do, why are they not usmg them, or are 677
S Wtlkmson 1 Study design Demograptiic variables
j
Facihtatmg verbal t>ehaviour
Work environment
Anxiety
Low
Nurse-^atient interaction
Anxiety 1/
Blocking verbal behaviour
Fear of death
1
\ High
Social support
they, as research suggests (Maginre 1985), contmually usmg blockmg verbal behaviours? And if tbs is the case, why are they? Several researchers have speculated as to why nurses use blockmg verbal behaviours Reasons have mduded, to prevent patients unleasbng shong emohons wbch they cannot handle, fear of losing composure m hont of pahents (Magmre 1985), and fear of their own death (Qumt 1972) All are anxiety-provoking situahons Does mcreased anxiety, or fear of death, mfluence how nurses commumcate with pahents or could it be lack of support or the workmg environment? Pahents who are facibtated to discuss their womes and concems appear to have greater confidence m nurses and feel more sahsfied with the care they receive (Ridgeway & Matthews 1982) It would seem imperahve that the factors wbch influence how nurses commumcate are ldenhfied
Twelve wards admithng predominantly cancer pahents were ldenhfied Six wards were chosen randomly for mclusion in the study speaalist hospital — tbee wards out of four, general hospital — tbee wards out of eight The order of data collechon was determmed by the order m wbch the random selechon was made Indusion cntena stipulated registered general or eru-olled nurses worbng on a designated ward, as a permanent member of staff, dunng the day shifts
METHODS
The study descnbed here is an analyhcal relahonal survey Data were colleded by several methods Each nurse was required to complete (a) a self-admmistered questionnaire wbch mduded demogapbc data, fear of death scale (Collett & Lester 1969), Norbeck social support queshonnaire (Norbeck et al 1981) and State Trait Anxiety mventory (%)ielberger et al 1983), (b) a tape-recorded nursing bstory with a newly diagnosed cancer pahent, a AIMS OF THE STUDY pahent admitted with a recurrence and a patient admitted for palbahve care, and (c) a semi-stnictured tape-recorded The study set mit to identify mterview on the difilkulhes m carmg for patients 1 the extent to wbch nurses use faabtatmg and blocking Field notes to obtam contextual data of the ward behaviours when commumcatmg with cancer pahents, environmoit and the nursing {wachce bemg camed out 2 if there is a relahonsbp between the extent to wduch were taken wblst working m a supemtonay ca{Kiaty on nurses usefecilitatmgand blockmg verbal behaviours each ward dunng the data collechon penod. H K design of and their levels of state and trait anxiety, athtudes the study isrepresenteddiagramahcally in Figure 1 to death, percerved levels of soaal support and work environment, A n a l y s i s (MF data 3 if nurses are aware that the verbal behaviours they use The self-admimstered queshcHinaires were coded for are blockmg or facibtahng, ccHnputahon and processed usti^ SPSSX The tape4 nurses' views and feebngs about commumcahng with recorded nursmg bstones were hanscnised x«i rated by cancer pahents one of two independent psydiolog»ts expenemsd m The study was cOTducted m two hospitals m &tgland a ratmg aujio-taped Biterviews witticamsrpat^its Further specialist cancer ho^ital and a distnd go^ral i l trainii^, however, was necessary to famdianze than with 679
Commumcation m cancer nursing Table 1 Categones of nurses' faeihtating verbal behaviours (adapted with permission of Forrest D (1983) Analysis of nurses' verbal eommumeahon with patients Nurstng Papers 15(3), MeGiU University, Montreal)
Table 2 Categones of nurses' bloeking verbal behaviours (adapted with permission of Forrest D (1983) Analysis of nurses' verbal eommumeahon with patients Nursmg Papers 15(3), MeGiU University, Montreal)
Intrcxiuetion of self Purpose of mterview Aeknowledgmg patient Open questions Eneour^emoit Piek-up of eue Refleetion danfieation Empathy Confrontahon ehaUenge Information giving Summanzing problems Patient queshons Consultation of plan of aetion
Normalizing/stereotyped eomments Premature/false reassuranee Inappropnate adviee Closed/leadmg multiple questions Tassmg the buek' Requestmg an explanation Disapproving/disagreeing Approving/agreeing Defendmg Change topie/ignonng/seleetive/attention to eue Change of foeus to relative loUymg along Personal ehit-ehat
the devised eoding system A rehabihty study to eheek their ratmg was eamed out before the study eommeneed and again dunng the study The levels of agreement reached r = 0 65 or above on all occasions as judged by Cohen Kappa coeffiaent The tape-recorded nursing histones were assessed in two ways 1
2
Each verbahzahon, defined as a complete uninterrupted utterance without pause, was assessed as either facilitative or blockmg behaviour, using the eategones adapted from Forrest (1983) (demonstrated in Tables 1 and 2) The nurses' coverage of the seven key areas of the nursing bstory is demonstrated m Table 3 Each area was assigned a score, from 0 = no coverage, I = poor eoverage, 2 = adequate eoverage, 3 = good eoverage, resulting m a mimmum seore of 0 and a maximum of 21 The ratmgs for eaeh tape reeordmg were transferred to cochng sheets for computahon
The semi-structured interviews were transenbed and checked for errors Replies to each queshon were collated and the themes to emerge were categonzed To obtam some quanhtahve as weU as quahtahve data, the categorized responses were ccxied for computation
^atistical tests As some of tht vanables were not normally distnbuted, non-fRinunetnc statishcal tests were used where appropnate For ccm^>arahve purposes, however, the means and Stanford deviahcms are presented
Table 3 Coverage of the key areas of the nursing history Patients' understanding of admission Patients' understanding of diagnosis Patients' bstory of present illness Patients' history of previous illness Physieal assessment of pahent Scxnal assessment of patient Psyehologieal assessment of patient
RESULTS Only seleeted results of the study are presented here The sample The 56 relevant staff on the randomly seleeted wards were approached All (100%) agreed to participate and 54 (98%) nurses eompleted the study one nurse did not retum from sick leave before the study finished, another transferred to mght duty before being able to complete the nursing bstones Characteristics of the sample Eighty-mne per cent of the sample were female The mean age of the sample was 28 years 5 months Thirty-seven nurses (69%) were smgle, 18 (21%) were mamed Tbrtyone nurses (57%) were Protestant, 12 (22%) Cathohc and 679
TaUe 4 Grade of StafiF by bospital Grade
Number of staff firom a ^>eaalist bospital
Number of staff from a general bospital
Sister Cbarge nurse Staff nurse ErtroUed nurse
3 — 16 7
5 2 11 10
15 4 50 31
Totals
26
28
100
11 (20%) atheist Twelve nurses {22%) attended church weekly, 26 (48%) infrequenHy and 16 (30%) never Sixteen nurses (30%) had completed an English Nahonal Board (ENB) nursmg course mne nurses (6%) the oncology course, three (2%) the cardiothoracic course, three (2%) the mtensive care course, one (1%) the death/dymg course, one (1%) the AIDS course and one (1%) the theahre course Nineteen (35%) nurses had attended a commumcation skills course of 1 to 4 days m length Distnbuhon of nursmg staff, by grade, for each hospital, is shown m Table 4
Percentage of
staff m eacb gracfe
Table 5 Tbe total coverage scores for eacb nursmg bistory* Interview A (new patient)
Interview B (recurrence)
Interview C (paUiative care)
Mean
SD
Mean
SD
Mean
SD
77
29
6-0
31
71
3-0
'For each mining history there was a minunum score of 0 •md a maxunum score of 21
Significant difiFerences in demc^aphic data Speaabst-hospital nurses (mean 5 6) had more (orelmary) O level passes than the general-hospital nurses (mean 3 4) (Mann-Wbhiey U test P=0-003) Speaabst-hospital nurses (mean 0-4) had more (advanced) A level passes than the general-hospital nurses (mean 01) (Mann-Whitney U test P = 0008) Eight speaabst-hospital nurses had completed the ENB course m oncology nursmg compared with one generalhospital nurse (Fishers exact test P=0-008) Thirteen speaalist-he>spital nurses had completed a commumcation shils course compared with six nurses from the general hospital (cb-square test 4 82577, d f = l , P=0O3) General-hospital nurses (mean 35 8) had held their present posihons longer than the speaalist nurses (mean 211) (P=004) On all other vanables the two samples were matched THE EXTENT T O W H I C H NURSES FACILITATE OR BLOCK PATIENTS WHEN U N D E R T A K I N G NURSING HISTORIES Cova'^;e aaaes for ttie iHirsing histories Table 5 gives the mean and staidard deviahon values of the total cova:^e «»res fe»- eadi nursir^ history. The coverage scenes were low m terfd and m evoy key area.
40r
30
I 20
I
10
Figure 2 Psycbological assessment scores A = interview A (new pahent), B = mterview B (recurr«ice), C = mterview C (palbahve) • = n o coverage, n = p o o r coverage, ^ = adequate coverage, H = gCKxi coverage
TTiey were particularly low m the area of psyc^olopcal assessment m companson with the physical assessment, as demonstrated m Figures 2 and 3 Few nurses a ^ d pahents how they were feelmg or if they had any womes. Observahc»i of Hie nursmg history sheets reveded that mmy mases wrote 'pahent anxious' l»t when tite relevant tape was listei^ to ami rat»i it
Commumcahon tn cancer nurstng 40 r
Figure 3 Physical assessment scores • = no coverage, D = poor coverage, 0 = adequate coverage; D = good coverage
became evtdent that psychologtcal issues had rarely been addressed Only one nurse attempted to discuss a patient's sexual concems and the problem was raised by the pahent herself This IS significant m view of the fact that the sample induded patients admitted with cancer of the cervix, ovary, breast, penis, testicle, bladder, rechim and colon, all cancers known to affect a patient's sexuabty The scores on the physical assessments were also low because they were very superfiaal Many nurses, for example, identified that the pahent was breathless or conshpated but never assessed just how much or m what way or to what extent it was affechng the patient Nurses' coverage of the key areas of the nursing bstory with patients admitted with a recurrence of their disease was sigmficantly less comprehensive than m the nursing history with new patients (P= 0 0004)
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