Integrated care. Part II: Making each moment count: building a diversional therapy program.

Patients with cancer may receive intensive therapy and be hospitalized for extended periods of time. They often are fearful and depressed, and increased levels of depression are associated with isolation (Tarzi, Kennedy, Stone, & Evans, 2001). Boredom, a less-recognized problem, may have the same causes as depression. Patients with high levels of boredom report symptoms more frequently (Sommers & Vodanovich, 2000). Severely immunocompromised patients often must remain in private rooms, behind closed doors, for prolonged time periods. This isolates them, limits their activities, decreases their opportunities to interact with other patients, and may lead to boredom. Carpenito (1997) defined diversional activity deficit as “the state in which the individual experiences, or is at risk for experiencing, an environment that is devoid of stimulation or interest” (p. 335). Nurses on one oncology unit recognized that boredom was a problem for their patients and believed that a lack of diversion was a major contributing factor. A diversional therapies committee (DTC) consisting of four oncology staff nurses was formed to create a volunteer program and develop appropriate diversional therapies (DTs). The committee solicited donations of books, video cassettes, music compact discs, games, and video cassette recorders. With other staff members, the DTC generated unique activities, such as competitions for the number of laps walked around the unit and indoor golf tournaments. Additionally, the DTC met with rehabilitation staff members to expand their role in these new interventions. Social workers, occupational therapists, and nurses initiated a discussion group for patients. This enabled patients to share experiences and learn relaxation techniques, meditation, and other activities based on their interests. Barriers to implementing this program included a lack of financial support, inadequate space, and inconsistent volunteer support. In an attempt to acquire committed volunteers, the screening process now emphasizes the important role of diversional intervention in the overall care of patients. Oncology nurses have a vital role in developing and establishing DT programs in various clinical settings.