Introduction
Complex illnesses can bring serious suffering and massive use of resources in reducing their severity or in an attempt to seek cure them. Patients with such fatal illnesses need close care and attention so as to minimize their suffering and prolong their life span (palliative care). This means providing any form of medical attention or treatments that aim at reducing the intensity of the disease symptoms or reducing the disease progression in general.
Personal relationships are very important as far as cancer patient assistance and other patient assistance are concerned. Sometimes the patients see their future as hopeless and feel so, because their situations cannot heal. Thus, personal relationships serve to restore hope and confidence in them. As mentioned, palliative care also aims to provide psychological and spiritual care to patients with fatal health complications to see them live a more active life. This could mean through guidance and counselling, where necessary.
Lung cancer exhibits such symptoms as breathing difficulty, continual fatigue and intensive cough. As it progresses, the disease passes to the terminal stage exhibiting severe conditions which lead to a patient’s death. The treatment depends on the type of cancer cells, the extent of its spread, and the intensity of the progress of the disease. When undergoing a course of treatment, a patient may feel distressed, lose the interest to the course of his/her life; his/her eating habits and social life may be also affected. Palliative care services help a patient and his/her family cope with the treatment process from the moment the disease has been diagnosed to its advanced stages.
Palliative care is applied to clients who are not responding to medical treatment. it gives them opportunity to life their life with dignity and comfort at that stage when the disease is threatening their lives (Doyle, Hanks, & MacDonald, 1998). It provides guidance for both a client and the family in making decisions regarding optional pain management and treatment that may be inconsistent with their will and wishes before the clients’ end of life (Lynch, 2003; Buckley, 2008).
Case Management
This paper is devoted to study of the case of a 65 year old woman with lung cancer. Clare lives with her husband in their home and has two grown children who are married. The disease exhibits such symptoms as breathlessness, cough and fatigue: Clare gets distressed by her inability to breathe, and as she sometimes has trouble sleeping at night; she is often sleepy during the day. Clare feels her powerlessness in managing the symptoms of the disease and considers that her condition challenges fulfilling her usual activities. Besides, she lacks close communication with her children: despite being in constant touch with her children by the phone, she misses them very much.
Clare feels uncomfortable about a big number of people who come to visit her. Her husband, Andrew, retired two years ago and helps her with shopping, cooking, and other household tasks.
He still feels that he would be more helpful if he could do more and seeks help in this regard. Palliative care services provide support for the family and the patient during the illness and treatment procedure, which includes social, spiritual and emotional support. Since the disease is life threatening, both the patient and the family need exceptional help in dealing with the ailment.
Clare’s condition is one of those that need palliative care. That is,, lung cancer is a chronic condition that worsens with time and needs appropriate palliative care so that Clare lives a better life with minimized suffering from the condition. The nurse has to provide all the support for Clare’s coping to ensure that she lives with the hope of a better future. Clare’s wish for personal relationships with the people around her has to be taken care of in addition to medical and other health support for her condition. The nurse has to see that Clare’s lack of strategies to manage her life-threatening illness is complemented and that numerous alternatives and strategies are provided.
Though Clare’s disease is a big sorrow for her family, their task is to support her and provide psychologically comfortable environment. At this stage, health education which is the part of palliative care is crucial for Clare and the family members: it is the source of emotional, spiritual and physical support for them. The family needs to go through counselling to get the holistic notion of care they should provide to Clare, not the issues of pharmacological management only.
It is multiple style behaviour to adopt more than one mechanism of treating patients as described, and it can be beneficial, according to Byers (2002) (cited in Pierce, et al., 2007).
Physical support
Physical support is evidenced to have benefit to patients with cancer, for instance, sleeping well, relaxing, and maintaining a weight that is reasonable as has been featured in Pierce et al. (2007) and Chlebowski et al. (2006) (cited in Rutledge & Robinson, 2009). It is possible to advise patients to join a professional program aimed at improving their health. These health-related programs are available after organizations have lobbied the government for their development. The nurse has to provide physical support to the client such physical exercises, which can be done by preparing an exercise program that combines a range of activities that Clare will have to perform each day.
The physical exercise will be of great importance, especially in reducing fatigue and promoting her general physical performance and well-being. The exercise will also be useful in relieving other symptoms such as lack of breath and coughing, since they will enhance air circulation within the lungs and throughout the other body parts. Physical therapy will also be vital in case Clare has to undergo surgery as this will help her to regain physical vigour (movements) as soon as possible.
Other physical support in terms of occupational therapy is also vital. The nurse can help Clare in what she does like dressing, showering and other major daily tasks. Some studies have linked survival after breast cancer with physical activity level and dietary patterns, as can be supported by Rock et al. (2005), Zhang, et al. (1995), Holmes, et al. (2005), Bastarrachea, et al. (1994) and Obermair, et al. (2002) (cited in Pierce, et al., 2007) while others have not supported the idea e.g. Rohan, Fu, & Hiller et al. (1994), and Kroenke, et al. (2005) (cited in Pierce, et al., 2007). These relate to diets that are linked with hormones, featured also in discussions by Rock & Demark-Wahnefried (2002) and Broocks et al. (1990) (cited in Pierce, et al., 2007), as well as other diets such as food vegetables (Pierce, et al., 2002, cited in Pierce, et al., 2007).
This means that the nurse may at times have to administer oxygen to Clare’s respiratory system when she cannot breathe normally to increase this supply to the lungs and thereby enhance its availability to the body tissues. Oxygen therapy results in more comfort and this can help Clare sleep at night and be more attentive during the day.
Depending on the effect of drugs, the nurse can choose the best combination to be administered at different times. When Clare is experiencing pain, regular massage will give her a great deal of relief. Other non-pharmacological therapies that will be important in Clare’s case are music, laughter, good aromas and regular happiness.
Psychological Support
According to literature, the distress level of the patient needs to be addressed effectively. Trained professionals can be assigned to people if they are experiencing high levels of stress and anxiety according to Thomas & Bultz (2008) (cited in Rutledge & Robinson, 2009). Otherwise, there are “psych-educational support groups” which can be helpful in supporting those with less psychological stress (Rutledge & Robinson, 2009).
It is possible to implement self-help skills to patients so as to help them cope with their psychological problems. Many medical systems have programs which help patients in this manner, although some are dogged with poor financing according to McMurtry & Bultz (2005) (cited in Rutledge & Robinson, 2009). Usually, the level of stress will increase with the extent of the illness, and a chronic cancer patient will experience high level of stress due to their suffering and because they are worried about how they will get well (and how long this will take). Psychological support involves guidance and counselling, advice and other related care, which means an interpersonal relationship with trained personnel (psychotherapy).
The nurse needs to be in constant communication with Clare as this will provide her with a personal relationship and company that she requires most. Those newly diagnosed patients need to be taken care of so as to impart emotional experience in them. A care for cancer, which is completely therapeutic, can be facilitated where people find a purpose for engaging in the cancer experience. Trained volunteer programs have been proven to be helpful and successful through practical experience, hence it would be expected that Clare would experience positive outcomes according to the Centre for Behavioural Research and Program Evaluation (n.d.) (cited in Rutledge & Robinson, 2009).
Because patients suffering from the illness may experience stressful and isolating feelings, they would be more appreciative if they have someone to discuss their personal experience with, and therapeutic effects may be achieved by listening to the patients as well as their family members, according to Maguire (1999) (cited in Rutledge & Robinson, 2009)
The nurse can also organize other visitors to ensure that Clare is not lonely and bored, because she likes company and is surprised by the number of people who have come to visit her. Therefore, the nurse should not restrict such people from seeing Clare, but organize appropriate times for them to do so.
The nurse should let Clare’s husband be close as this makes her more motivated in life. It may be possible to ease anxiety, improve the quality her interaction with the medical practitioners and the system, as well as assist her to prepare for meeting medical professionals whenever psychological help is offered to make her understand what is happening as can be seen in Mayer et al. (2007) (cited in Rutledge & Robinson, 2009). Nevertheless, where many people pay attention to treatment and neglect the relational aspects of patients, they are doing harm, because illness affects the emotions.
This can be done by setting goal-oriented systematic procedures to be practised regularly in minimizing the symptoms and other effects of the illness. The nurse will need to provide Clare with necessary information to better her state and provide ways that will boost her understanding and learning, especially in matters related to her condition. Intensive interaction and active engagement of the brain will be useful in administering this therapy. There are programs which are offered through telephone numbers and which avail opportunities for the cancer patients to get support and healing according to Canadian Cancer Society (2008) (cited in Rutledge & Robinson, 2009).
Social Support
Palliative care seeks to help the family of the patient with information about the needs of the patients. Using a team approach to provide support for both the patient and family helps to deal with the life-threatening ailment in a positive way and understand the progress the disease takes. This is a further course of therapy for the patient other than the medication given for treatment as the patient may also be dealing with depression: the fear of losing his/her social position, job prestige, income and role in the family aggravated by insomnia affects his/her psychological condition and makes him/her feel dispirited; hence, medicine alone cannot help them instantly in their illnesses. Sometimes, the patient is depressed due to feeling like a burden to the family, the pain they are going through and the deterioration of their health.
Their social support will ensure that she gets various therapies and other requirements. The support will also ensure that Clare’s change of condition is noticed so that necessary action can be taken in time. Clare should also be given time to interact with other community members, as this will make her have a sense of belonging and attachment. Clare’s husband, Andrew, wishes to be more helpful during her illness. He is helping with the jobs around the house, cooking and shopping which is a step forward in caring for the patient. However, it would be important for him to understand that care is needed to help Clare deal with her physical and psychological suffering.
The family, as Clare’s closest unit of interaction, is better placed to provide this care. Andrew would provide support by attending the treatment together with his wife so that he can understand more about Clare’s condition and progress and thus be of better help. Palliative care centres seek to provide health education to the family as well as counselling since they also go through some trauma. Clare appreciates relations with her children and needs their psychological support; phone contact is not enough for her to satisfy her needs in communicating with children.
Being affected by a disease, many people are isolated from the day-to-day activities that they took part in before the illness due to their physical condition, and sometimes isolated from conversations or the responsibilities they handled.
This isolation and the thought that they will not be in a position they had before may cause their stress. As Clare goes through treatment, she needs emotional support and the opportunity to be listened to in order to accept her condition and feel appreciated. Open discussion of the changes that are happening in her life may help her to accept the situation; Andrew’s task is to listen to Clare’s concerns and support her psychologically. As Clare does not have opportunity to manage her symptoms, Andrew should be more attentive to her and get ready to provide the necessary help.
Patients suffering from lung cancer are required to follow the fat-free diet. It is highly recommended to increase the intake of fruits and vegetables, as well as taking foods and drinks containing minerals, vitamins, proteins, and carbohydrates; lack of sufficient nutrients can cause a patient’s exhaustion and the inability to fight infection. Thus, providing a balanced diet for Clare during this time is vital for her health.
She and her husband need to learn nutritional requirements that assist in fighting infections and rebuilding tissues; to create opportunity for Clare to follow the healthy diet, Andrew should take the responsibility of providing her with the necessary health foods.
Palliative care centres provide support groups where cancer patients share their experiences. These activity may become an encouragement factor for Clare: at the moment, she is dispirited by impact the illness is having on her; hearing other people’s experiences can help her identify with her symptoms. Attending social events together with Andrew will also become a significant factor of support for Clare.
Spiritual Support
Illnesses and diseases touch and affect emotions; hence, the importance of emotional support for the patient cannot be ignored for wholesome healing. The spiritual care includes emotional support from families, friends and society (Jeffrey, 2003). The families of patients with life threatening diseases find great solace in this, too. However, this area is less addressed by many physicians.
Since the essence of palliative care is to provide holistic care for the family and the patient, their spiritual well-being is an aspect not to be ignored. One of the most burning questions is how and when it is appropriate to bring up the topic of spirituality to the patient; in many cases, this concern is raised later in the illness when the patient is on the advanced stages.
Being aware of Clare’s religious background, Andrew may provide valuable support to his wife by praying with her or reading scriptures together with her: it is a good way to give Clare opportunity to feel their psychological unity.
Study of Townsend, Kladder and Ayele, et al. (2002), showed that religious practice such as prayer improved health outcomes. This idea can be a source of inspiration and hope for Clare: it may reduce her concerns and encourage resisting to the disease. Being psychologically close with his wife, Andrew may find an appropriate moment to touch upon this idea in the conversation with her and make her interested in it. Besides, love and support of Clare’s family may give her energy to live her life with psychological comfort and accept death as a natural process.
Spiritual support will enable Clare to be connected to a transcendental force according to her belief system and this may as well provide support, protection, guidance, hope and general well-being. The relationship between Clare and the spiritual powers she believes in should be promoted. The nurse can also be part of her spiritual support by joining Clare in spiritual practices such as prayers, meditation, or singing. In this way, Clare’s spirituality will be expanded by increased hope, peace and faith. With this spiritual support, the importance of love will also be manifested. Furthermore, experiencing love from spiritual leaders will also do Clare a great deal of good.
Conclusion
In this paper, the case of a 65 old woman suffering from lung cancer has been discussed. Palliative care is the kind of treatment given to patients ailing from terminal diseases such as cancer, and the aim is to reduce the severity of the disease rather than stop the disease. Moreover, palliative care helps to care for social, emotional, spiritual and physical needs as the patients go through the treatment regimen.
Clare gets distressed by her inability to breath, and she sometimes has trouble sleeping at night and is often sleepy during the day. She feels unable to manage the symptoms of the disease and considers her disease an obstacle on the way to living her usual life. Furthermore, Clare suffers from insufficient psychological contact with her children and misses them, though she is in constant communication with them by phone.
Palliative care is important, because it aims at providing a support system for the family so that they can understand how well to handle the patient during this time of the illness. Since the disease is life threatening, the patient is taken through a process where they can view death as a natural process rather than only considering the outcome of the disease. A palliative care for Clare in enduring this life-threatening illness will help reduce her suffering and improve her quality of life. Palliative care will also be important in choosing and administering various therapies and treatments for this fatal condition.
The care will also help in Clare’s communication and determine her welfare by disclosing factors leading to the progress or deterioration of her condition. Palliative care is a commendable approach in caring for people with a life-threatening condition, and the nurse plays a major role to play in this care as they know when and how various therapies, treatments and other requirements of palliative care have to be administered. The family, friends and the community have also a role to play in the care as they make the world complete for such patients with chronic and fatal conditions like lung cancer.
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