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Power of the pen

Wednesday April 16, 2014
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Receiving a cancer diagnosis and experiencing the ups and downs of illness and treatment is often a traumatic experience, said Melissa Craft, APRN, PhD, CNS, AOCN, an expert oncology nurse who has worked extensively with high-risk breast cancer patients. Helping the patient work through that trauma can be as feasible and easily implemented as a brief expressive writing intervention. “People are afraid to say the word cancer,” she said. “And it’s just like Harry Potter and Voldemort, not saying it gives the word too much power. If we talk about it, when we communicate about the things that scare us, we actually find strength.”

Craft defines expressive writing as an exercise in which an individual writes for a brief period of time, between 10 and 20 minutes, over the course of three to four writing intervals. The writing can cover a range of topics from a traumatic event to something more simple and specific, such as how an individual has been sleeping. She led a study, published in the Journal of Advanced Nursing in April 2012, in which she found a statistically significant improvement in quality of life indicators among early breast cancer survivors who participated in a structured expressive writing intervention. Craft shares some tips for using expressive writing in the clinical setting.

Assess for readiness.

Having someone write when he or she is too near the trauma may be harmful. Craft advises using expressive writing with patients who’ve had some distance from the traumatic event. They’ll have more energy to write about the event and the exercise is more likely to yield therapeutic benefits.

Keep sessions short.

A relatively brief 10-to-20-minute session is ideal, but if a patient doesn’t have the energy for that, or feels overwhelmed by that length, try three minutes. Often the time goes much faster than is initially anticipated.

Focus on storytelling.

A story has a beginning, middle and end. Many people, even those who associate writing with schoolwork or as something they’re just not good at, can relate to storytelling. The writing doesn’t need to make sense and often the story will emerge on its own. “Pre-lingual thoughts and feelings are more likely to cause rumination, the individual may start out not knowing what the end of the story is going to be, but when you write those thoughts down and put it into words, you’ll likely find meaning in it.”

Assure privacy.

Reassure patients that whatever is written is private and will remain private. Still, in Craft’s experience, patients often have a need for someone to hear their story. Remain open to that if the patient offers.

Use writing prompts.

Writing prompts and a loose structure can help focus the patient. Encourage your patient to write about what’s bothering them, rather than what you think is bothering them. Pay attention to themes that keep resurfacing and suggest one for a writing springboard, for example, “It sounds like you’ve been doing a lot of worrying at night when trying to sleep. What are some of the things that are keeping you from sleeping?”

To see what else is trending in cancer care, visit www.Nurse.com/Cancer.

Expressive writing can work for anyone

Melissa Craft became interested in expressive writing after experiencing trauma first-hand related to caring for victims immediately after the Oklahoma City bombing in 1995. She says it transformed her
outlook on the situation.
I wrote a story about the patients that I took care of that day and I thought, ‘Oh my gosh, in the middle of that turmoil, in the chaos, there is hope.”
Craft encourages other nurses to use expressive writing as a
therapeutic tool for themselves.

For patient’s, writing for therapy can lead to creative ways to help the healing process. For instance, one of Craft’s patients wrote a letter to her uterus before her prophylactic hysterectomy (she was at high risk for uterine cancer). Craft said,

It sounds kind of hokey, but it helped [the patient] start the conversation and start grieving.”



Meaghan O’Keeffe, RN, BSN, is a freelance writer. Check out her blog at www.ScrubbedIn.Nurse.com. Post a comment below or email specialty@nurse.com.