Introduction
The sole purpose of any nursing activity during any given kind of illness and end-of-life stage is to maximize the quality of life and functioning for individuals, families, and the community at large. Nursing activity is also intended to promote wellness principles and programs for individuals, families, and communities and reflects on how personal benefits or perceptions about the quality of life and health promotion impact approaches or decisions made in nursing care (Morewitz, 2007). Many patients with a chronic, terminal illness (like Mrs. Thomas) are cared for in the home. The community nurse is a key resource to these patients both in providing a link to healthcare and in promoting quality of life. This paper is a case study that is aimed at elucidating this perception of nursing activity where it is intended to realize this by the way of citing a nursing condition case study of Mrs. Thomas and discussing it on topical capacity on different strategies that can be used for the condition’s treatment and management.
Personal Perception
End-of-life care involves holistic care where social, psychological, and spiritual elements of personal care are considered (Moreitz, 2007). Cancer disease and its medication have a unique impact on a person’s life. Despite the fact that physical challenges borne by patients with cancer may be identical to those patients with non-malignant conditions, a combination of these challenges with the chronic nature of cancer, highly toxic effects of treatment, and the profound psychological effects of the ailment reveal that cancer nurses need specialized knowledge and skills. There is enhanced diversity of the role of cancer nurses and their contribution in offering seamless care throughout cancer patients’ end of life. Cancer nursing demands key skills that assist patients and their carers to cope with the reality of living with cancer while enhancing the quality of life. In this paper, I discuss the quality of life functioning, strategies of improving quality of life, and holistic care plan appropriate for terminal cancer patients, while examining a case study concerning Mrs. Thomas’s condition.
Strategies
For the kind of illness described by Thomas’ condition, there are a number of intervention strategies that can be used for the treatment and management of her condition. These strategies are discussed below under three broad categories which the nurse will need to address the cluster of symptoms that accompany Mrs. Thomas’s cancer experience. These interventions are:
- Symptom management intervention strategies
- Cognitive-behavioral strategies
- Social support intervention strategies.
Symptom Management Intervention Strategies
Symptom Management Intervention strategy has one main objective that is concerned with trying as much as possible to alleviate the distress experienced by the patient. There are a number of ways that this can be achieved. For instance, the nurse needs to enhance activity management with Mrs. Thomas through exercise or energy conservation to benefit her burden of fatigue. This strategy will assist Mrs. Thomas to improve her mood, fatigue, and quality of life. To minimize her physiological symptoms, the nurse can apply sensory-stimulating strategies to correct her cognitive dysfunction (Morewitz, 2007). The intervention may entail some hours of weekly exposure of the patient to an aesthetically pleasing environment such as observing a sunset or gardening. Since Mrs. Thomas undergoes chemotherapy, the nurse will need sensory stimulation interventions to help her cope with distress associated with chemotherapy. This intervention will integrate her visual, auditory, and other sensory stimuli according to her own preferences. The nurse should repeat these sessions as many time times as the patient desires this intervention will be aimed at improving Mrs. Thomas’s physical symptoms and reducing her negative mood states. The nurse may also apply massage therapy as an appropriate intervention for Mrs. Thomas’s symptoms relief. This may be of short-term benefit in improving Mrs. Thomas’s perceptions of well being including reducing pain and fatigue (Jo, 1999).
Cognitive Behavioural Intervention Strategies
Cognitive Behavioural Intervention Strategies will mainly be aimed at dealing with the disturbing effects of Mrs. Thomas’ psychological distress where they will focus on her problem or emotional coping strategies. The use of cognitive-behavioral therapy would be more appropriate to both Mr. and Mrs. Thomas to assist them to cope with depression and anxiety caused by her illness. The depression is manifest in the patient’s husband who has even undergone medication for chronic depression due to his wife’s illness. This condition has also caused him difficulties at work due to chronic stress and this, in turn, places the patient in even more distress (Moreitz, 2007). To assist the couple to regulate their experiences of psychological distress, the nurse focus on emotional coping strategies to manage the situation. The couple needs to be guided to a level where they perceive that they have high control over their situation (Jo, 1999).
Social Support Intervention Strategies
Social support intervention strategies are aimed at ensuring Mrs. Thomas and her husband receive interventions that provide a supportive environment. This supportive environment should be focused on the provision of a safe, neutral context for the patient and her husband to express their emotions as a strategy to alleviate their distress. Most common, the nurse may recommend the use of support groups for patients with cancer as an intervention strategy. The provision of a supportive environment to the patient as a safe, neutral context takes many forms. Relaxation and counseling for instance may assist Mrs. Thomas and her husband relieve their psychological distress symptoms in a group of patients with cancer. In addition, the provision of aromatherapy by the nurse will assist the couple to relieve the stress associated with the illness. Aromatherapy sessions provide patients with a safe space where they could discuss their concerns and feelings without burdening their families or bothering their physicians (Moreitz, 2007).
Holistic Nursing Plan for Mrs. Thomas
The overall holistic nursing plan for Mrs. Thomas in her condition will entail the provision of symptom control through psychotherapy, education, and communication. The nurse should recommend Mrs. Thomas to undergo effective psychotherapy due to the pain she endures during and after treatment of her illness. The aim of this psychotherapy with pain is to offer the patient support, knowledge, and skills. Psychotherapy will assist focus on the crisis created by the patient’s medical illness where the patient will be provided with emotional support, continuity, information, and assisted with adaptation (Jo, 1999).
Psychotherapy puts emphasis on past strengths, supporting previous successful strategies of coping and teaching new coping skills such as relaxation, cognitive coping, utilization of analgesics, self-observation, documentation, assertiveness, and communication skills. Communication skills are of paramount importance for both patient and family, particularly in regard to pain and analgesics issues. Mrs. Thomas and her family are the unit of concern and need a more general, long term supportive relationship within the healthcare system in addition to specific psychological strategies dealing with pain and dying, that a nurse, psychiatrist, clergy, social worker, or psychologist can provide (Moreitz, 2007).
The holistic action plan for Mrs. Thomas is designed in such a way that it incorporates all the strategies discussed above and has a level of simplicity such that it can be used by other practitioners that may attend to the patient. In dealing with the strategies, the holistic action plan in effecting the Cognitive Behavioural Intervention Strategy for Mrs. Thomas’s cancer management should be simple since this simplicity for the Cognitive Behavioural Intervention Strategy approach can be a useful adjunct in cancer management. This will involve subjecting Mrs. Thomas to passive relaxation combined with mental imagery, music therapy, hypnosis, and others (Moreitz, 2007). The aim of this treatment will be to guide Mrs. Thomas in a way that she better controls her pain. Some of the techniques adopted will be primarily cognitive emphasizing the patient’s perceptual and thought processes. Others will be directed at modifying her patterns of behavior that assist her cope with pain. The behavioral intervention for her pain control will seek to modify her physiological pain reaction, pain behavior, and her operant pain behaviors. Cognitive strategies for coping with her pain on the other hand would be aimed at reducing the intensity of her distress that is part of her pain experience. This will involve modification of the patient’s thoughts about pain and psychological distress, the introduction of adaptive coping strategies, and instruction in relaxation techniques (Jo, 1999).
Functional Ability
The impact of breast cancer on the quality of life Mrs. Thomas has been manifest in her distress and anxiety right from when she was diagnosed with breast cancer. The high distress and anxiety have also extended to members of Mrs. Thomas’s immediate family, particularly her husband and children. In other words, Mrs. Thomas and her family are in psychological distress and thus their functions have been impaired physically. Thus, relief for the affected can come from psychological counseling and support and improvement in their physical symptoms. As a woman who has experienced fatigue, Mrs. Thomas lost the ability to enjoy life, engage in normal relationship activities, and maintain her job as a clerk. Increased family stress arose from the husband’s distress due to his wife’s condition. This immensely affects his functional ability at his job as a police officer. In addition, the couple is unable to attend social functions. The problem of financing her medication has affected her quality of life.
There are intervention approaches that nursing activity can take to improve optimize Mrs. Thomas’ and her family’s condition. The key areas to note for urgent address are the depression condition that her husband is slowly sinking deeper into; the distress that her son and daughter are experiencing at the thought of the suffering their mother is going through to the extent that they do not want to pay her regular visits to see how she is fairing on; and the frustration, anxiety, and disturbance that Mrs. Thomas herself is experiencing from the excruciating pain, struggle and discomfort that is dilapidating her health condition by day due to her cancer condition. After identification of these key concerns, nursing activities can best be steered towards specifically addressing them so that the program is relevant and beneficial in optimizing Mrs. Thomas’ functional ability at this stage of her condition. First, there is a relentless need for urgent and vigorous counseling for the entire family members beginning with Mr. Thomas since he is the one that is in constant contact with Mrs. Thomas and therefore poses a greater danger if his attitude to her condition is characterized by pity and hopelessness. Enthusiasm and hope from him coupled with constant encouragement to his wife are attitudes that are imperative for Mrs. Thomas’ condition and ones that uplift her spirit thereby optimizing her functionality through her condition.
Providing Care
As a terminally ill cancer patient, Mrs. Thomas needs palliative care. Palliative care is associated with the end of life care. She needs to be provided comprehensive care as she approaches her end of life. The intention will be to prevent, relieve, reduce, or soothe the symptoms of cancer afflicting Mrs. Thomas. As a nurse, my major focus will be on the coordination and delivery of holistic care to Mrs. Thomas. This care will encompass spiritual, cultural, ethical, and legal perspectives of palliative care. The greatest nursing function will continue to be that of patient advocate. In the care of Mrs. Thomas as a dying patient, this involves that commitment to never abandon the patient. This could include the nurse initiating communication between Mrs. Thomas, her family, caregivers, staff (from her former employer), and physicians. This will center on the promotion of dignified death. The good or dignified death is interpreted as death that encompasses awareness, acceptance, and preparation for death by all concerned. It is also important in assisting Mrs. Thomas find meaning in her suffering experiences.
In addition to having professional counseling sessions prescribed for the rest of Mrs. Thomas’ family members to help improve their attitude towards her condition and in the process be more supportive, some resources such as the use of supplements that boost her body’s immunity can be used. For instance, recent research (Morewitz, 2007) has shown that supplements containing aloe Vera are rich in nutrients that boost the body’s immunity against a host of diseases. These supplements would be instrumental for Mrs. Thomas since the last thing she would need is any form of additional illness to stress her system. This is particularly when self-care for Mrs. Thomas is no longer tenable. The supplements are also important since they are not medicinal and therefore would not have any foreseeable effect on her body from her previous inception of chemicals in form of therapeutic drugs.
Chronic Depression
Chronic depression can be described as a type of depression that has been persistent over a long time. It is the depression that lingers for a considerably lengthened period of time. In the case of Mr. Thomas, there is a need for combined efforts both from the nursing activity and the immediate family members to nurse and care for his chronic depression condition. The chronic depression is a result of stress from his work as well as the health condition of his wife. All these situations have affected him. He does not adhere to the drug prescriptions and decides to stay indoors. Religious intervention is among the strongest concepts that deeply soothe patients with chronic depression as it equips them with a clearer hopeful attitude of life which alleviates their self-denial and helps them brace themselves with reality. Family members could play a vital role here in praying for him and sharing with him the Good News of redemption that ushers in ‘New Life’ of acceptance of pain and suffering. Once Mr. Thomas is made to realize what is happening and accept God’s will, then it will be easy to apply management techniques for his condition.
When self-care is no longer possible, it will be imperative for the nursing activity to mainly major on ways to alleviate pain, despair, and further frustration while at the same time preparing him for the eminent reality of demise. This period will depend extensively on encouragement, soothing through emotional, psychological, physical, and even financial support. In times like this, the easiest way to reach such patients is through their relations and confidants. It will be highly recommended for there to be an investment of time for his family, relatives, and friends to come and spend time with him in his home as a gesture of solidarity in his difficult moments. In addition to medical intervention to help him bear with the pain and other discomforts associated with chronic depression, it will be necessary for there to be constant attention given to all his other needs such as food and other financial support to facilitate his family. The psychological responses of Mr. Thomas and his family can be difficult to be dealt with by the nurse. However, communication remains the most effective tool the nurse will use to support him and his family. The nurse has an obligation of doing everything possible to enhance Mr. Thomas’ quality of life and to assist him to accept his condition, his wife’s condition, and start living a new life under treatment.
Mr. Thomas’ chronic depression can be managed in three major ways. The first one is by use of psychotherapy. Psychotherapy will help to address the social and personal issues that are contributing to his illness. It will help address the issues concerning his work and his wife’s health condition. The second means of management is by application of drug therapy. The drugs are called antidepressants and they address any chemical imbalances that the brain might have suffered during the depression. The drugs may also address the sadness symptoms resulting from his wife’s condition. If the two methods fail to work, electroconvulsive therapy can be applied. This involves the use of charged electrodes to induce a seizure in the brain. This is used when the patient is severely suicidal. A combination of the first and second methods will work well for Mr. Thomas.
Conclusion
In sum, the significance of alleviating Mrs. Thomas’s physical and psychological symptoms is underscored by the fact that; the burden of her physical symptoms is significantly correlated with the desire for a hastened death in active treatment and when receiving palliative care. Nursing interventions are more effective when multidisciplinary teams work together and involve patients with their families. Nurses play important roles in symptom control, education, and communication since they have more time and develop closer relationships with patients than other professionals.
The roles of other professionals such as; psychiatrists, clergy, oncologists, and the others such as social workers and psychologists are equally important. This is because they have unique disciplinary expertise with counseling, education, psychotherapy, pastoral care, and when indicated medication.
References
Jo, M. (1999). Community health nursing advocacy for population health. Michigan: Appleton and Lange.
Morewitz, S. (2007). Aging and chronic disorders. Sydney: Wolter Kluwer Health.