Please Help First Clinical Rotation in Oncology

[Regulas]

Hello All,

My first clinical rotation starts next week and it's on an oncology floor of a local hospital. My instructor says we are going to be placed with patients who have just been diagnosed with cancer. I have a background as a CNA so I am familiar in taking care of those who are at the end of their lives, but I have no clue how to act around people who have just received a very serious diagnosis! I understand emotional support is going to be a must, but I don't I even know how to start a conversation with such patients? Any help you can offer me would be greatly appreciated.

[KelRN215, BSN, RN]

It's unlikely that the entire floor will be filled with newly diagnosed patients. You will have patients with a wide range of experiences in the cancer world... some newly diagnosed, some in the midst of treatment admitted for chemotherapy or for complications, some who've had cancer several times for some years. If you introduce yourself as a nursing student, the patients will know your role is limited. The ones who've been around the block know the roles of everyone and what to expect. Many patients won't expect you to say anything profound- let them guide the conversation.

[brithoover]

They are still people who want to be treated normal. Just act like you would with any other patient

[AgentBeast, MSN, RN]

Google "therapeutic communication" and learn it.

[swansonplace]

I agree learn the therapeutic communication cycle. Refresh IV skills.

[DalekRN]

You wont be giving the diagnosis or anything so it won't be as big a deal as it seems like. Nursing profs make everything seem like a big deal.

[LoveNeverDies]

I just lost someone whom I was very close to, so these will be a mixture of what witnessed and what I have done in clinicals.

1. Understand that everyone is going to react to this diagnosis different. Your patients will all be at different stages in the grief process.(In regards to the 5 stages of death) Remember that this model is a framework, some people skip steps and revert back often to previous steps.

2. Therapeutic communication is very helpful to the patient and family if they WANT to talk to you. If you keep getting short answers, or the person keeps bursting in to tears, please stop badgering them.

3. Review the disease processes, for instance, someone with cancer receiving treatment can have very dry skin, not have an appetite, be very nauseous, etc. Apply lotion unless contraindicated, apply Vaseline or chapstick to lips, if needed. For heavens sake, please do not try to force feed your patient. We had a nurse try to feed my friend's mother while she was half asleep and medicated because "she keeps refusing when I ask" Of course she began coughing on it and was very stressed. I almost came close to an assault charge on that one. If your patient refuses food kindly leave it available for a while, and maybe prompt one or two more times before taking it away. Document and report to your nurse so dietary and the Dr. are aware.

4. If your patient is taking pain medication, please be aware of when it can be given. It is completely agonizing to watch someone moaning/crying/screaming because the nurse cannot be found. (Went off the floor on a break. Covering nurse was MIA. Charge nurse ended up medicating.)

5.If your patient is having problems sleeping, when they finally do fall asleep please leave them be unless you MUST wake them. Again heart breaking to see someone restless and exhausted for 20 hours to finally fall asleep comfortably only to be awaken by dietary or a student coming to do therapeutic communication. (I find a great time to do communication is during assessment. Two birds with one stone, especially for someone who tires easily.)

6. Lastly, if you have lost someone and you can relate, feel free to share that with the family. If you have not, PLEASE do not tell them about how you understand. This happened many times, two i will share. "Oh I know exactly how you feel, my husband's mother died of cancer a few years before I met him, when he told me i was so heartbroken." Obviously this does not compare to someone losing someone they have known their entire life. That was from a nurse, another from a family friend. My friend's dear mother was in pain and was trying to sit quietly but asked a few of us to find the nurse for meds (she was a little disoriented so she would ask someone then a minute later ask again) "Oh you want to talk about pain, I had pneumonia a few weeks ago and you would not believe how painful that was! Be glad you don't have to deal with that." Of course, be glad she doesn't have pneumonia when she has terminal cancer metastasized to 6 places. Some people right?

[Jenngirl34RN]

My husband was diagnosed with cancer last year, and I can tell you from our experience that emotions will be all over the place. Mostly, you just treat them as you would any patient. Some days will be better than others. Just try to be understanding of the fact that they, and their families, are going through a rough time, and try to help them through it. That holds true for people newly diagnosed and for people who have been fighting their disease for a long time. Don't pretend to understand if you don't, and don't give meaningless advice like "it will get easier to deal with" or "everything happens for a reason." Just be sympathetic and take the time to listen or answer question if they need you to, and be sincere. Nothing is worse than people saying a bunch of things they don't really mean because they are the "appropriate" things to say in such a situation. I am sure you will be just fine.