Can Nurses Provide Effective Telephone Therapy?

Mental health organizations are always looking for ways to deliver the most effective method of therapy at the lowest price. For instance, first responders who did not study psychology can still provide necessary psychological triage treatment to trauma survivors. Similarly, teachers who work with special needs children are trained to address the emotional and physical needs of those students. For individuals with chronic health problems, such as multiple sclerosis (MS), mental health needs are just as pressing as physical health needs.

Individuals with MS must come to terms with the fact that they have a progressive neurological illness that could cause significant disability. Clients may experience intermittent bouts of symptoms that cause pain, muscle weakness, and fatigue. Over time, many clients with MS may lose their mobility and ability to complete normal tasks. These realities can cause extreme distress, anxiety, and depression in many people with MS. Helping clients cope with the mental challenges resulting from the physical changes is an important element of treatment for MS. Finding an affordable and effective way to deliver this type of therapy was the focus of a recent study by Rona Moss-Morris of the Department of Psychology and the Institute of Psychiatry at King’s College in London.

Moss-Morris compared the effects of cognitive behavioral therapy (CBT) to supportive listening (SL) in a sample of 94 individuals with MS. The therapy was delivered by trained medical nurses through phone calls over 8 weeks. At the end of the treatment period, Moss-Morris found that the participants who received CBT had lower levels of functional impairment and distress than those in the SL group. Additionally, the CBT participants became much more accepting of the limitations their illness created. In sum, the study demonstrated that nurses trained to deliver CBT were able to help their clients in ways that SL did not. However, Moss-Morris also found that the gains achieved in functional impairment were not sustained at the 12-month follow-up. Although this current study provides valuable information that could help many individuals with MS and other chronic illnesses, more needs to be done. Moss-Morris added, “We also need to know more about the optimum number of sessions to maximize therapy effects and how to better maintain benefits over time.”

Moss-Morris, R., Dennison, L., Landau, S., Yardley, L., Silber, E., Chalder, T. (2012). A randomized controlled trial of cognitive behavioral therapy (CBT) for adjusting to multiple sclerosis (the saMS Trial): Does CBT work and for whom does it work?” Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0029132

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The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Gracie h

    July 6th, 2012 at 10:54 AM

    When given the right sort of training I have no doubt that a nurse or anyone with the initiative and guidance can easily help any mental health organization with providing mental health care to patients in need. I realize that the ideal situation would be to have someone actually trained and licensed in the therapy field to work with patients exclusively but in many areas this is not a possibility. Theerfore you have look for individuals who could also be capable of giving care to them and nurses would actually be a logical start for me. Many already feel like they do the bulk of care and patient follow up anyway so this is not going to be much of a stretch for many in that field. I think that you also have to have those working though who do know what their own limitations are and that they don’t try to do more than what they have been trained to do. But given the right person and the right background I think that this could definitely help with providing more services to those who need care and helping even more people with their problems than could have been possible without this program.

  • Karyn

    July 6th, 2012 at 11:25 AM

    I am a nurse and I am not sure that I would ever feel qualified to deliver CBT in a way that would actually help an MS patient come to grips with their diagnosis, nor would I have enough knowledge in this from a mental helath perspective to feel like I was really making a significant difference to them. I know that I can be a good listener and maybe even offer some sgae advice to friends every now and then but I don’t think that even as many years as I have had being a nurse could ever qualify me to be in this kind of position. I am not sure that I would benefit or that the patients assigned to me would benefit either.

  • jessica

    July 6th, 2012 at 2:58 PM

    I say that if the nurses are willing to give it a shot, then why not? I know a lot of people who are a lot more comfortable speaking with a nurse than they are with a doctor because something about the doctor intimidates them while the nurse remains a little more relatable to them. That is where this could have a huge impact for many patients, that they feel like they can talk to a nurse and not clam up like they may do with another medical professional. I think that a nurse might have a better grasp of how to talk to a person in words that they can understand and probably has a much better grasp on when they are actually getting through to the patient and making sense. You know how doctors sometimes don’t have that bedside manner. Well, I think that most nurses do and this could be a real bonus for many patients who are seeking help with answers to their questions about MS or any other disease that they could be living with.

  • cate

    July 6th, 2012 at 10:31 PM

    with instances of people with mental health problems on d rise and constant shortage of specialists it makes sense to try and implement something like this.and if the quality of the treatment does not go down then there is no reason not to implement this!

  • barb J RN

    July 7th, 2012 at 4:14 AM

    Have we given much thought to the fact that if a nurse had wanted to play therapist then this is probably what he or she would have gone to school for?
    I am an RN and dispensing therapy to patients is not what I went to school to do.
    Oh I know this would be a coice for most of us, but there might be other positions that would require their RNs to do this part of the job, and in my eyes most nurses are overworked enough already. There are other individuals with far less to do but who could be trained who could do the same job.

  • Dawn Keegan

    July 7th, 2012 at 4:37 AM

    I think the addition of a certified health coach to the medical team for a MS patient is another way to lend support. Being able to address the whole person, with changes in nutrition and lifestyle, creates an environment for success in adhering to protocol.
    I was diagnosed with MS 10 years ago, and have since become a Certified Holistic Health Coach and an Intrinsic Coach. Having the tools to address my client’s mindset is a major factor in how they progress. Another pair of “eyes” also helps in recognizing depression and cognitive impairment, which can then be relayed to the medical team.

  • Dawn Keegan

    July 7th, 2012 at 4:38 AM

    I forgot to say that I do all of my coaching by phone and Skype….which is really the point of this study. :)

  • Wendy

    July 7th, 2012 at 5:47 AM

    This is interesting. I wish more information was given on what was involved in the training of these nurses in CBT. If CBT or any other type of therapy is given and not done correctly, it could have devastating effects on the patient. Were these advanced practice nurses with a background in psychological nursing? What does trained medical nurses mean? Although I’m not 100% sure, it seems to me that this goes beyond a nurses scope of practice. Are these phone calls fielded strictly from the state in which these nurses are licensed?

    In my experience, nothing beats a highly qualified professional with years of experience in the their field. We need to examine why these professionals are not available. Patients should be demanding high quality care. I agree that we need to get creative in how we deliver care to save money, but not at the expense of experience and patient safety.

    Nursing students and first responders are minimally trained in communication techniques related to patient care. Unless these individuals are highly supervised by an expert, I would be very reluctant as a patient.

    It makes no sense to me that we’re only supporting patients cognitively with chronic illnesses for 8 weeks. Why wasn’t there a control group and patients receiving different durations of therapy for comparison? The symptoms of chronic illness can wax and wain over time. Literature would support that it takes a minimum of 3 months to learn new strategies, techniques and habits. These strategies may become ineffective over time with the progression of the disease. What then? How are the families involved? Chronic illness doesn’t just effect the patient, but the immediate family and the caregivers. Treating the patient and family wholisticly is always the best choice in my opinion. The patient should always be directly involved in their care plan as well.

    If I was the nurse or first responder, I would check with my professions standards of practice and check the laws related to my state in which I practice to see if providing this care was within my scope of practice. I would also carry some good malpractice insurance.

  • Nicole

    July 8th, 2012 at 8:37 AM

    Hey Wendy I agree with the statement about good malpractice insurance!
    In the way that so many people are looking to make a quick buck these days especially from the health care community this would be just one more way for patients to point out all the things that are being done wrong to them and a way for them to get set for life.
    Even having to think about this in this way drives me crazy but I guess it’s just the way things are.

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