Introduction
In analyzing any chronic patient’s situation, the quality of life, and health promotion will certainly dictate the kind of care to be administered to the patient. In most cases, the patient’s perspective to the quality of life may be very different from the physician’s. For instance, elderly chronically ailing people may perceive their lives to be of required quality. On the other hand, this may be the opposite when examined from the physician’s standpoint.
Nursing plan
Research indicates that the perspective of patients on the functioning of their own social, economic, emotional, and physical aspects affects their perspective on the quality of life (Janes and Lundy, 2009). Those who are in a position to manage both symptoms and negative side effects may regard their quality of life as exceptional and improved. In cases where relief from severe symptoms is not controlled with intolerable daily pathologies, the quality of life will decline drastically (Janes and Lundy, 2009).
From Mrs. Thomas’ breast cancer situation, the quality of life can therefore be termed as low mainly because, since she was given a poor prognosis for recovery, she has been wriggling in pain daily, which is a symptom of the chronic breast cancer. This has also made her unable to go and continue working which could have helped her gather financial support for more medication and hence improved health care.
Her inability to continue using the vicodin medicine that was given to her shows an increased need for health care since failure to use this medicine seems to have aggravated the cancer situation. The presence of other relatives and friends could have helped Mrs. Thomas to manage her cancer situation, but since five of them have been reported to have died earlier due to related illness, her situation requires proper care. This is also contributed by the fact that women tend to depend more on other female relatives and friends for care and support (Janes and Lundy, 2009).
The presence of Mr. Thomas alone may not therefore improve her deteriorating situation despite the fact that he is her spouse. Even if Mr. Thomas could extend help, he may not do it effectively since he is depressed, thus hindering him from carrying on with other essential daily tasks. It is at this point that caring services of a community health nurse become inevitable.
Strategies that can improve the quality of life for both Mr. and Mrs. Thomas situations
In order to improve the daily experiences and increase life expectancy, Mrs. Thomas should be guided into developing a regular program of physical exercises. This is because cancer related cases are said to be associated with fatigue, and the best way to help female patients build up normalcy and be in direct control of their physical manifestations of the disease is regular exercises (Coon and Coleman, 2004, cited in Janes and Lundy, 2009). The exercises should be planned and carried out during occasions of reduced fatigue.
Secondly, engagement related support is another way to improve the couple’s quality of life. One way of doing this is through assisting the couple access an online support group (Janes and Lundy, 2009). Most of such groups are comprised of health experts who have specialized in all health related complications, including both breast cancer and depression as in the case of Mr. and Mrs. Thomas. The patients can therefore ask relevant questions regarding their situations and ask to be given appropriate feedback. This is also necessary since the couple is not close to friends or relatives that can help provide required support. In addition to the internet, the couple should also be helped to use both telephone and postal services to facilitate engagement and being in touch (Janes and Lundy, 2009).
Phone calls provide an opportunity for perpetual sharing of information especially between the cancerous Mrs. Thomas and the depressed Mr. Thomas with the respective health specialists in these areas concerning how to manage the diseases. Letters on the other hand provide a continuous exchange of information and guard against the risk of memory loss, which is likely to be common among aging patients like in the current case (Janes and Lundy, 2009). Engagement support related instruments will help the couple in averting social isolation and loneliness since both their relatives and friends are far from them.
Thirdly, there is a self-management strategy where Mr. and Mrs. Thomas are linked to group led by trained health specialists. Here, they are helped to interpret changes in the disease and its consequences. The group sessions will also enable Mr. and Mrs. Thomas to improve the use of medication and further utilize both medical and community support, especially that of their sons, friends and other relatives (Ayers and Baum, 2007).
Ways of optimizing Mrs. Thomas’ functional ability
First, Mrs. Thomas should be advised to continue taking Vicodin (hydrocodone/paracetamol) as per the doctor’s prescriptions and drop her notion of not wanting to be addicted to drugs. This is because failing to adhere to the doctor’s prescription may deteriorate her pain hence her functional ability.
Secondly, Mrs. Thomas ought to undergo interventional palliative procedures to help her minimize pain (Kim, Fall, and Wang, 2006). According to Mrs. Thomas’ prognosis, cancer rehabilitation should be employed. This aims at helping the couple to set realistic goals that will enable the minimize dependency on others. Cancer rehabilitation is threefold: Restorative rehabilitation – aimed at returning patients to their pre-illness state. For instance, it will enable Mrs. Thomas to recover strength and full shoulder range of motion that had been lost during mastectomy. Supportive rehabilitation on the other hand will go a long way to help Mrs. Thomas cope up with permanent functional deficits caused by breast cancer.
A third cancer rehabilitation type that should be employed in Mrs. Thomas case is palliative rehabilitation. This is where various devices should be put in place to enhance support, comfort, and independence (Kim, Fall, and Wang, 2006).
Ways to provide care for Mrs. Thomas once self-care is no longer possible
Since Mrs. Thomas situation is chronic whereas its cure is not forthcoming, palliative care should be the first approach to her case. In administering palliative care, there is a model to be adopted by the community nurse (Alexander et al, 2006). This model entails first developing a rapport with the patient and her family members to establish their experience with the breast cancer disease and to be informed of their roles and coping mechanisms besides verifying what they need, what they prefer first and what they wish.
Secondly, the palliative model entails predicting symptoms that may manifest using cancer management. Thirdly, it involves the application of principals of palliative care, that include developing good management of symptoms, assisting both the patient and her family to adjust to losses and changes in the ways of living and supporting them to continue doing what they derive pleasure in engaging in (Alexander et al, 2006).
How, as the community health nurse, I can intervene in this situation, in the management of Mr. Thomas’s chronic depression
To begin with, supportive counseling and patient self-management should be the first step to intervening in Mr. Thomas’ situation. The patient should then be advised to report if the situation deteriorates. Secondly, physical activity like regular exercise should be recommended. This is because exercise does not only improve the mental ability, but also minimizes depressive symptoms (Acee, 2010).
Additionally, as his wife pre-supposes, Mr. Thomas is exhibiting suicide risk indicators that include living with poor social supports, he is an older adult male, recent loss of close relatives and separation from his sons, and hopelessness (Intermountain Healthcare, 2008, cited in Acee, 2010). In such a case, a primary care practitioner (such as a physician) and nurse manager ought to be contacted immediately. In addition, a psychiatrist’s consultation should be warranted to determine the possible safety measures and treatment (Intermountain Healthcare, 2008, cited in Acee, 2010).
Conclusion
In assessing a cancer patient’s quality of life, the social, economic, emotional, and physical aspects are essential. In Mrs. Thomas’ case, the quality of life can be said to be low. This can only be improved through proper palliative, regular physical exercises and employment engagement related support. Mr. Thomas’ depression case on the other hand requires the services of both a primary care practitioner and a psychiatrist. This is in addition to advising him to do regular exercises and seek appropriate treatment.
References
Acee, A. M. (2010). The Interactive Business Network: Detecting and managing depression in type II diabetes: PHQ-9 is the answer! CBS interactive. Web.
Alexander, M. et al. (2006). Nursing Practice: Hospital and Home: The adult. Philadelphia: Elsevier Health Sciences (p. 1096). Web.
Ayers, S. and Baum, A. (2007). Cambridge Handbook of psychology, Health and medicine. NY, Cambridge University Press. Web.
Janes, K. and Lundy, K. (2009). Community Health Nursing: Caring for the Public’s Health. Ontario: Jones & Bartlett Learning. Web.
Kim, A., Fall, P. and Wang, D. (2006). Palliative Care: Optimizing quality of life. The Journal of the American Osteopathic Association (JAOA), Vol. 105, No suppl5, pp. 9-14. American Osteopathic Association: Philadelphia. Web.