Published works

Psychotherapeutic supportive oncologic patients. TRAINING OF HEALTH WORKERS AND RISK PREVENTION TEAM WORK

Apostar a la Vida Foundation

Author: Dr. Silvia Garsd

Where there is life there is struggle for life

FUNDAMENTALS

The basis of the creation of APOSTAR A LA VIDA Foundation is to make the patient from the disease, which has become an obstacle to the normal development of his life from an active position, not resignation to regain its balance, its ability decision and make behavioral changes that are detrimental in affecting their health staff.

The effect of these actions results in a cancer patient willing to fight for their quality of life and contribute to their attitude to achieve the best results of treatments applied.

Therefore, a committed and active patient becomes a "mirror of life" for others who are living the disease at different times. About 200 members and recovered fourteen years working with the Foundation to assist the recovery of the sick soul, working in the organization, dissemination and participation in scientific events to promote health. We also note the work capacity of Bet to Life Foundation in conjunction with other public, private and NGOs.

Fourteen years ago generated a volunteer patients have become health agents which contain, reflect, inform and train their peers. The patient knows their rights, restores their ability to fight and becomes the protagonist of his story.

OBJECTIVES

* With respect to the patient:

Initially, the main purpose is to rescue the state of initial unease over the diagnosis, emotional content and providing tools to make it active protagonist of his recovery.

In a second step, get the patient to learn to defend their rights, to develop changes in their thinking as they relate to family environment, work, social, to arrive at a better quality of life.

In a third stage, transforming the patient into a life model for other patients.

* With respect to society:

Promote prevention, early diagnosis help, bring about a better quality of life, to spread the model of the Foundation's work at the regional and international levels.

Promote Teamwork between the psycho-oncology and medical treatment for best results.

WORKING MODEL. HUMAN RESOURCES.

The working model of Bet to Life Foundation has three parts: containing, reflection and change. The model is based on teamwork and group participation.

Faced with the diagnosis of cancer patients entering a state of helplessness mental, moral, fear of death and anguish. It works with the emergency as the patient arrives with the certainty of death and goes with life chances.

Patients are greeted by the staff that consists of the following human resources:

• A psychologist and two coordinators of the group.

• Patients in various stages of the disease.

The two coordinators are patients with a good emotional balance. Its function is active, are the authority in the group, organized the debate, serving as moderators of the dynamics of work and know the philosophy of Bet to Life

The coordinator enforces the rules of the group to call on in need (speaking at the time that is given the word, not to interrupt or replicate), being a moderator. When the coordinator is a low mood should "run" function to coordinate and integrate the group.

Coordinator and psychologist make up the backbone, have an assigned role. The members involved peripherals without specific function, when they see the need (and who are also health workers).

The psychologist does not have the experience of the disease, which does have a coordinator who is heard from the place of the experience. The latter message arrives with more speed and is best understood as speaking from the point of having experienced this state of mind.

The psychologist has specialized training in cancer patients. Its function is to contain, make a deeper psychological reading of what is involved, ie the manifest and latent in each patient. With simple words and appropriate considering the speaker's internal time, leads to the conscious level the conflict is about to emerge and must be put into words. This will mark a turning point in group discourse. They let the "concrete answers to the problem" and moves to the terms of the emerging conflict (which was previously agreed by the participants), leading to a radical change in the action that raised the issue-problem.

We exemplify a case of patient X is 54 years old, is a lawyer with relapsed breast cancer is the third cycle of chemotherapy. It relates that is dealing with a great aunt that no one wanted, confined in a nursing home. His father was interned with hemiplegia. This patient was very low with the defenses. The group's response was felt. They gave "solutions". Each of these had already been considered by the patient, however, despite the state it was, felt the need to participate in the care of family members listed regardless of the stress it caused him.

The psychologist, knowing the previous history perceives that the underlying problem is the "fault", which impedes access to tables where responses should not be involved. Patient X was seeking to redress what he said not being able to do for his mother, who had died months ago when she was prostrated by chemotherapy. He blamed himself for having abandoned his mother. After the intervention of the psychologist, the patient reacts crying insight ago, completely changed his attitude and accept the solutions given by the group.

With the psychologist's intervention changed the tone of all the participants as if it were just a self help group (without intervention of a professional) would only solutions to the manifest. The patient, not feeling understood not accept any solution found for him boost his own thinking, as a result the group is tired and / or the person quit the therapy.

Patients do not have the powers peripheral or obligations of the coordinator and psychologist but have an active role. They are role models and mirrors of life These trainees are part of the observer team and participate on demand, ie, they answer according to the situation that arises. Their responses are consistent with situations that arise, their interventions are associated with containment work, reflection and amendment have a character, while introducing a variable that leads people to think and change their own beliefs. Faced with an approach that assumes a risk, will soon be feeling the response of any member of the group without having a set role or function does modify his speech with the reasoning, beliefs, negative thinking, everyday situations dangerous (stressful behavior, abandonment of treatment, fear of operation, fatigue, exhaustion, etc.).. When this comes the realization of what we call a salvage therapy. This is to assist these patients who are given containment, are removed from that state and also assists those who come first. It shows them the expertise they have already gone through the same situation, producing the phenomenon of the mirror. People are reflected in the other and you can identify beneficial and hopeful abriéndosele different angle. They leave the "syndrome of the tile" that is increasingly turning to small to get to rotate on its axis, getting caught in the dimensions of a tile. Just repeating "do not want to die" or the counterpart: "I want to live." The two options create a play-action where the individual does not see or understand that out of death is the living ends. They remain stationed in this state with consequent emotional responses (panic, anxiety, crying).

Rescue therapy also works in various situations such as relapse, discontinuation distress at the physical losses that determine the behavior of their relational life (sense of mutilation, isolation, shame), fears associated with treatment, surgeries, etc..

We wish that when there is injurious to health - which is expressed in behaviors, habits, eg smoking and others - are working on this habit to quit even if the desire remains in force.

It is necessary to modify links, toxic relationships, avoid the submission, the delays and promote actions for the subject to become protagonists of their life. (learning from others)

The essence of the work methodology are the active roles of both the psychologist, coordination and the remaining patients (health workers, mirrors of life).

TRAINING OF HEALTH WORKERS AND CONTINUING EDUCATION

For eight years the course is made in psycho-oncology assistant issued by the Foundation. The role of the course is to train patients and psychologists in practice theoretical way from start promoting teamwork. The purpose of training is to replicate the model of work that raises the mental health project Gambling Foundation to Life.

It is a requirement for registration to have full primary level instruction for patients. Both psychologists and patients are evaluated by a team of professionals to measure aptitude, vocation, commitment, intelligence, dedication to the task and motivation of applicants.

The course attendance must be regular, not accepting more than 15% of absences.

The course module consists of a physician, a psychological form, general psychology and theory and techniques of group dynamics.

After the course is a condition of approval:

a) For the theoretical part, the presentation of a paper to defend and exams after each module.

b) For the participants must practice driving for two weeks to coordinate a group supervised by an expert and psychologists should act their roles for four or five meetings with supervision of a staff psychologist.

The practical part consists of continuous observation in different groups (Ramos Mejía Hospital and other affiliates) once or twice a week. In the first classes of students role is to observe the group to soak the working atmosphere, then allowed to take notes of what is observed (this will be assessed) and finally the observers operate directly with the approval of the group.

The course consists of seven modules conducted by professionals hematologists, immunologists, physicians, oncologists, in which themes are developed as pain therapy, group dynamics (to replicate the model), care during treatment, reactions to drugs specific to the treatment signs, symptoms, side effects. These tools will avoid confusion with psychological states themselves some signs of disease or treatment effects (side effects) that bring both organic and psychological disorders and mood.

At the same time within the groups are working steadily continuing education participants achieving the involvement to address the situation of illness, allowing you to take control of your life, be an author and actor of treatment and get through the appropriate channels medication prescribed by doctors. It is essential that the patient remove the risk factors, mandates, roles and made defendants in the family and produce, through self-knowledge, attitude changes that will benefit him and keep them in time.

Also, courses for training of psychologists who work with symptoms, signs, the latent and the manifest and other meanings. Apart from this training is required assistance to groups with a trained professional.

In addition to this course Gambling Foundation to Life made the "National meeting between the oncology patient and professional" open to the community, which spreads through testimonies of patients, that change is possible and where there is life there is struggle for life. In turn, the medical team poses new advances in treatments.

It makes the training of health team knowledge of recent advances in cancer treatment. To this end, the Foundation's days with a panel doctor who participated in the World Congress of Oncology (ASCO) in the U.S., which is held annually in order to inform patients of global developments on the treatments.

Another form of training is through the delivery free of charge to all cancer patients dissemination of the book "Cancer, sharing feelings," a joint project of the Gutenberg Foundation, students of 4th, 5th and 6th year and the Gambling Foundation life.

The Bet to Life Foundation in conjunction with the Argentina Chamber of Hygiene and Toiletry, created the program "Look Good, Feel Better" sessions organized by the makeup of women with cancer from 1998 to date.

The Foundation has two programs on AM radios themselves "Growing up with life" and "Bet to Life" on prevention, issues of general interest when responding to socio-cultural patterns of consumerism, etc.. constitute risk factors for mental and physical health.

CONSEQUENCES OR HAZARDS OF WORK

1. Coordinator

The group coordinator can show problems if untreated can become a saboteur attitude of the task, namely:

Denial of what happens (not daring to raise their own problems) by the defendant and assumed the role to be invested with a behavior "model" where there is no room or tolerance for both sides to the error or to have conflicts ( invulnerability).

Proceedings rebellious anxiety generated by a massed.

Identification with the proposals or interventions, especially when the other has the same pathology and relapse occurs.

Hypertrophy of the role of coordinator, generating aggressive responses, omnipotent, arrogant, harmful to the group work.

Interventions not relevant, long and tedious without giving rise to the word of others.

Fears: not being able to place limits on interventions that exceed the time or who have speech reiteratorio, aggressive, morbid or violent.

Psychophysical exhaustion.

Competitive relationship with the psychologist.

1.2. Regulatory and remedial action of these hazards-consequences.

The psychologist is active at the time he perceives that there is recurrence in these behaviors. Subsequently, post-group meetings emerging situations arise and in the fortnightly meetings where the coordinator presents the psychologist problems and monitors whether the subject is able to continue with the coordinating role or should depart.

2. 1. The psychologist.

The multiplicity of tasks (see the group dynamics, roles, functions, saboteur leader, leader, pop group, scapegoat, etc., let the subjects express, which are dominated by grief and anguish at the same time that contain observations the reaction of the rest of the group and act accordingly and other group phenomena). can lead to loss of professional care, physical and mental exhaustion resulting from the handling of large groups (15 to 25 people).

Another characteristic that is highly demanding oncology patient. The psychologist must be very careful patient problems, listening to the speech latency, the premorbid personality of it, because cancer and unites or separates, opens: conflicts, values, beliefs, fears, commands, etc.. This work is stressful and professionally.

The practitioner should also pay attention to the behavior of coordinators.

2.2. Regulatory and remedial action of these hazards-consequences.

The problems that arise from working with cancer patients are monitored in team meetings with other professionals.

Being a high risk group is that psychologists receive in addition to working on other issues than health care (to give courses, organization of conferences, etc..) In order to give continuity to the task of assisting with the commitment it deserves .

Also new trained professionals in the philosophy of the Life Bet alternate on the task of coordinating groups to prevent wear by producing this work in quantity and quality.

Work Life Gambling on the patient tends to achieve a good quality of life. The extension of that helps the patient reach the new scientific discoveries.

This is achieved through group work that emphasizes changes in the tranquility, balance, self awareness so that the tendency to relapse into harmful behavior patterns can be perceived and modified.

CONCLUSION

Teamwork (patient, doctor and psychologist) contributes to the positive interaction occurs flattering generating feedback from the psycho-physical recovery of the cancer patient.