Breast Cancer Pain Treatment and Life Quality Improvement

Perception about Quality of Life and Health Promotion

According to the American Chronic Pain Association (2009), quality of life can be measured using the ‘Quality of Life scale’ which measures the ability to function normally for people with pain. About this scale, Mrs. Thomas falls under scale 1; she stays in bed for at least half a day and does not have contact with the outside world. My perception of quality of life is based on this concept as it looks at one’s ability to function but not only pain and therefore enables community health nurses to assess the impact of pain on activities of daily living. The chronic pain secondary to the breast cancer being experienced by Mrs. Thomas has affected her ability to perform her daily tasks and even a greater part of activities of daily living. The type and quality of care that I will give to Mrs. Thomas will therefore be geared towards assisting her to regain her functional ability. This will include helping her with those activities of daily living that she can not perform such as oral care, bathing, dressing, feeding, and any other that may come up during assessment.

Health Promotion (HP) according to the World Health Organization as explained in the Ottawa Charter is defined as “the process of enabling people to increase control over, and to improve, their health” (WHO, 1986). The phases of health promotion according to the Ottawa Charter are: the first phase is that which determines the background/determinants, the second phase which sets the objective (to lead an active productive life), and finally, the activity which means enabling process. Based on this concept, the care that I will provide to Mrs. Thomas will be towards achieving the phases of HP according to the Ottawa Charter. This will ensure that Mrs. Thomas receives quality care in that all factors involved in her current condition will be assessed and evaluated to assist her to lead a healthy life. From the above, my perception about the quality of life and public health is geared towards improving the health of any person who is sick and needs nursing care. Any dying person suffering from a chronic illness such as breast cancer normally has their ability to take part in certain activities highly compromised. They need to be assessed so that their deficits can be supplemented. The concept of quality of life in a dying patient encompasses the idea of spirituality which is part of holistic nursing care. This, therefore, means that the patient’s spiritual needs must be taken into consideration as lit will help the patient to have peace of mind and subsequently a peaceful death. Taking into consideration the spiritual needs will therefore greatly improve the quality of care given. Health Promotion does not only view an individual but the community at large. This means that all people who are affected by the dying patient’s illness will be part and parcel of the caring in that they will also be receiving care; their health needs will be considered and if their health improves, then there are chances that the improvement on their health will be reflected on the dying person health as they will be able to help in the care of the dying patient. They will be a symbol of hope to the patient. This will improve the quality of care provided to the dying patient. Health promotion also takes into consideration external factors involved in the disease process such as environmental factors hence, all these when considered will help in providing quality care that is appropriate and effective. The quality of life concept views human beings as bio-psycho-social-spiritual beings meaning that all aspects of one’s life are critically assessed to determine how best to care for a patient. This means that the patient’s needs will be ‘wholly’ catered for and therefore improve the quality of care.

Strategies to Improve Quality of Life

Mrs. Thomas and her husband will need a variety of nursing interventions if their quality of life is to improve. These interventions must be evidenced-based (Evidence-Based Practice-EBP) with scientific rationale. If Mrs. Was in a health institution, the care provided to her would have been different in that the multidisciplinary team would be involved but in this case, the nurse will have to come up with strategies that will help improve the quality of life of Mrs. and Mr. Thomas. The strategies to be used are; Psychosocial well-being, Physical well-being, and social support and support services.

Thomas. The first strategy will be to ensure the psychosocial well-being of both Mrs. and Mr. Thomas. From the history given about the progression of the disease and the subsequent psychosocial trauma being experienced by Mr. and Mrs., Thomas, it is evidenced that both are having a difficult time adapting to the changes in their lives. Both are depressed and will therefore need counseling. Mr. Thomas has shown signs of depression which if not controlled may lead to major depression characterized by suicidal tendencies. Antidepressants may be used in addition to other therapies such as psychotherapy. The nurse will also have to involve their sons whereby they will be counseled and taught on what their parents are undergoing and the importance of them being present and giving them social support during this difficult time. They will be made to realize that phoning alone is not enough and therefore they need to visit their parents. This strategy will also be aimed at improving relationships between Mrs. and Mrs. Thomas and their neighbors, colleagues at work, and significant others.

The second strategy will be to ensure the physical well-being where the nurse will ensure that both Mr. and Mrs. Thomas’s physical health improves and does not deteriorate further. To ensure that Mrs. Thomas’s activities of daily living (ADL) are met, her needs will be assessed; assessment is the first action to be taken just as in the nursing process so that her physical needs can be determined. Based on Orem’s Self Care Model, the nurse will have to help her with all those activities that she is not able to perform until that time that she will be able to perform them. From the history given, it is evident that the two have self-care deficits, the nurse will therefore assist them with their ADLs. Mrs. Thomas is experiencing chronic pain and this has impacted negatively on her health. This has to be addressed for her quality of life has to be improved. Some of the interventions to be put in place for chronic pain management are non-pharmacologic and pharmacologic pain management. Non-pharmacologic interventions will include alleviating anxiety through allowing her to express her feelings freely and communicating empathy and willingness to listen; distraction or diversion which involves occupational therapy, conversation, and reading, watching television, meditation, self-hypnosis, biofeedback, and autosuggestion (Loese, & Butter, 2001); and provision of physical care which is directed at reducing mechanical, chemical and thermal stressors that lower pain tolerance. This includes protecting her from local irritations or inflammations such as infection or thrombosis, muscle spasm or muscle strain, interference with local blood supply and venous and lymphatic drainage, distension of hollow visceral organs such as the bowel and bladder, and further damage to traumatized tissue (Loese, & Butter, 2001). Pharmacologic interventions will involve the use of the analgesic ladder to provide the most appropriate analgesic that will effectively control the pain. The third strategy will be to provide social support and other support services. Because Mr. and Mrs. Thomas are both ill and their ability to take part in activities that are income generating or even home care is highly compromised, it will be upon the nurse to ensure he/she helps them with performing some of these functions and duties.

Holistic Nursing Action Plan

According to American Holistic Nurses Association (2008), Holistic nursing practice is about healing the whole person, explicitly recognizing and addressing the interconnectedness of body, mind, emotion, spirit, society/culture, relationships, context, and environment. Holistic nursing practice helps patients to find much-needed peace, comfort, harmony, balance, and well-being. It looks at an individual as a bio-psycho-social being and therefore every aspect of one’s life is considered during the provision of nursing care. The holistic nursing action plan will be based on the above aspect of holistic nursing practice. The first step will involve a holistic assessment of Mrs. Thomas to identify her needs and come up with accurate and proper nursing diagnoses. This will involve an assessment of her dietary, physical, psychological, spiritual, and socioeconomic needs. Some of the diagnoses that will be made are activity intolerance, impaired adjustment, ineffective individual and family coping, noncompliance to drug regime, impaired social interaction, pain, and altered nutrition less than body requirement. The second step in the action plan will be to write a plan of care as per the nursing diagnoses made during the assessment. These will include assisting with activities of daily living, nutritional support, physical exercise, pain management, health education and promotion on the disease process and compliance to drug regime, psychotherapy, and counseling for both the parents and their sons. The third step will involve the execution of the above plan of care (intervention). The nurse and other people who may be involved in her care will assist Mrs. Thomas with her ADLs such as personal hygiene, oral care, dressing, feeding, and bathing. To improve her ambulation and mobility, she will be engaged in light exercises such as a dance movement program which may involve arm movements, walking around her compound, slow and regular limb movements, and touch and body therapy. Touch and massage have been shown to improve blood circulation, body image, and physical well-being. The failure of her sons to visit her is causing Mrs. Thomas a lot of distress and therefore the sons will be counseled and educated on how their isolation is causing their parents a lot of harm with aim of making them change towards visiting their parents regularly. The nurse will also engage the services of social workers who will assist with the provision of social support. The fourth step will involve the evaluation of the interventions. This is a continuous process that helps the nurse to know the effectiveness and shortcomings of the interventions made. If the objectives or goals of care are not met, the steps start again from step one. This ensures that quality care is provided at all times.

Community Health Nurse Interventions

The community health nurse can intervene in many ways in the management of Mr. Thomas. The first intervention will be the assessment and monitoring of his needs and the level of her depression. Since he is likely to progress to major depression which is as mentioned earlier is characterized by suicidal tendencies, the nurse will therefore ensure that the house where he lives is free from any equipment and or tool or any other thing that he may use to harm himself and that of others. The nurse can also offer counseling services to Mr. Thomas. Communication is one of the effective ways in dealing with depression and just being there to talk to and listen to Mr. Thomas will help a great deal in allaying his anxiety and allowing him to express his feelings and thoughts. The community health nurse is also well placed to offer psychosocial support and health education. Health education is a powerful tool in empowering a patient with relevant knowledge that opens his/her mind to many aspects of life that are not known well to him/her some of which may be the cause of the depression. Another important intervention by the community health nurse will offer medication and ensure that Mr. Thomas adheres to the treatment regime.

Conclusion

Breast cancer, chronic pain secondary to breast cancer or any other cancer, and depression can lead to adverse effects and even death. The nurses must always keep an eye on any changes in health or behavior that may be harmful to the patient. In most cases, the nurse alone may not be able to manage these conditions alone and needs the support of the multidisciplinary team at the community level and may include, social workers, chaplains, nurses, counselors, support staff, and physicians. Quality of life and function should be assessed and evaluated continuously so that quality care is maintained throughout.

References

  1. American Chronic Pain Association. (2009). Quality Of Life Scale: A Measure of Function for People with Pain.
  2. American Holistic Nurses Association (2008).Holistic nursing: Scope and Standards of Practice ISBN-13: 9781558102484. Pub#: 9781558102484.
  3. Loese, J. D., & Butter, S. H., (2001). Management of Pain. Philadelphia, PA: Lippincott.
  4. World Health Organization. (1986). Ottawa charter for health promotion, Journal of Health Promotion, (1):1-4.