Community Health Nursing and End-of-Life Care

Personal Perception

Upon visiting Mrs. Thomas, I realized that facing a terminally ill patient was a fearful and traumatic experience that affected her and her husband, Mr. Thomas. I noted that my own perception would also affect the quality of care that Mrs. Thomas would receive. Mrs. Thomas has lingering cancer. However, she has unmet needs, such as emotional support, pain and symptoms management, and loneliness.

One major perception I will have to face as a care provider is that, despite the best quality of care and effort I would provide to Mrs. Thomas, she would eventually die from lingering cancer and other related complications. This was a perception I realized would affect the quality of care for Mrs. Thomas, but I had to overcome it somehow. I also knew that my feelings must remain hidden from the patient and her family, and I must treat my emotions as analogous in this situation (Mccallum and Mcconigley, 2013). Generally, I must control my emotional pain for Mrs. Thomas when I provide care to her (Varcoe, Pauly, Storch, Newton and Makaroff, 2012).

Moreover, Mrs. Thomas’ condition affected me emotionally, but I would not distance myself from her situation (Popejoy, Brandt, Beck and Antal, 2009). I knew that the treatment would not be beneficial to Mrs. Thomas, but I had to care for her all the same. This led me to feel morally distressed. However, I would have to continue with the treatment that is personally difficult until the physicians decide otherwise.

I realized that it would be sensible to embrace Mrs. Thomas and Mr. Thomas and other family members despite the difficulty. I knew that the patient and her family would have several unresolved questions, and they would turn to me for responses. I would practice sensitive disclosure. My roles would involve offering quality care and comfort for Mrs. Thomas and her family through effective communication.

Strategies for improving the quality of life for Mrs. Thomas and her husband

Mrs. Thomas would require various strategies to enhance her quality of life because of her terminal illness. The approach would involve palliative care for emotional support, pain and symptoms management, and eliminating loneliness (Wayne, 2013). Mrs. Thomas requires constant care because of her deteriorating medical conditions. This is hospice care with extensive palliative care to allow Mrs. Thomas to live her last days with dignity and the highest quality of life. At home, Mrs. Thomas would receive additional care and services, including physical therapy, bathing, and any other personal care she may require.

Emotional support

Emotional support for Mrs. Thomas and Mr. Thomas would improve their quality of life. However, these needs differ between Mrs. Thomas and her husband. While Mrs. Thomas has stress from worrying about her children and husband, Mr. Thomas experiences depression because of his wife. Mrs. Thomas does not want to be a burden to her husband. The following are emotional support suggestions for Mrs. Thomas and her husband.

  • Mrs. Thomas requires a company of her husband, children, and the nurse
  • The nurse will avoid burdening Mrs. Thomas with her cases of emotional and moral distress
  • Mrs. Thomas would be free to express her fears of death to come to terms with her condition
  • The quality of care shall allow Mrs. Thomas to reminisce to gain a perspective of her life
  • Strategy for emotional support should honor the wishes of Mrs. Thomas, and she would take part in discussions and decision-making.
  • The nurse will respect the privacy and preserve the dignity of Mrs. Thomas

Pain and symptoms management

Pain and symptoms management would also improve the quality of care for Mrs. Thomas. Mrs. Thomas has complained of discomfort and pain. The quality of care would manage pain and other related symptoms to tolerable levels. This would be a daily monitoring process and reassessment of other possible indicators of immense pain. Any further changes in behaviors would indicate unmet needs in pain and symptoms management. The strategy would include a log of pain and pain status of Mrs. Thomas. It is important for Mr. Thomas to understand the pain his wife experiences so that he can understand her status.

Managing loneliness

Mrs. Thomas is lonely. She has no relatives and her children are away. Moreover, Mrs. Thomas’ condition has affected her husband too. This has contributed to her loneliness. Managing loneliness would extend even if Mrs. Thomas would not be able to speak because she needs companionship in her last days. Mrs. Thomas would be able to get comfort from the touch and companionship of her husband.

  • Communication, calmness, and soothing atmosphere would be able to reassure Mrs. Thomas of companionship
  • Mrs. Thomas would require all items, including pictures that would alleviate her loneliness

At the same time, the strategy would ensure that Mrs. Thomas maintains her dignity in order to be comfortable and calm. She still has the capacity to experience love, loneliness, fear, and sadness. Hence, the ultimate aim of managing loneliness is to ease all sources of discomfort and allow Mrs. Thomas to connect with her husband and children. This would eliminate stress from Mrs. Thomas.

A holistic nursing action plan for managing Mrs. Thomas’ care at home

Optimizing Mrs. Thomas’s functional ability

Usually, the treatment of cancer affects the functional ability of a patient. Hence, it is necessary to help Mrs. Thomas to optimize her functional abilities. Mrs. Thomas would experience challenges related to nausea, pain, infections, fatigue, drowsiness, loss of appetite, and vomiting. These conditions affect the functional abilities of terminally ill cancer patients.

Mrs. Thomas would require effective pain and symptoms management approaches in order to enhance her functional abilities. Constant pain creates discomfort to the patient. Although one cannot completely eradicate Mrs. Thomas’ pain, it would be important to manage it to acceptable levels. This should be a daily monitoring process.

Mrs. Thomas must eat healthy diets. Healthy balanced diet should consist of foods that are easy to digest. A good diet would allow Mrs. Thomas to have enough energy for her body, which would allow her to conduct daily living activities. The diet would improve Mrs. Thomas’ physical well-being, and it would ensure that she avoids opportunistic diseases because of improved immunity. It is important to note that Mrs. Thomas may require less food as her body shuts down naturally. She would experience a loss of appetite together with declining abilities to utilize food and fluids in the body effectively. Mrs. Thomas would be free to choose her diet and appropriate time to eat. The nurse may also advise that Mrs. Thomas should consume foods in small amounts but frequently. Mrs. Thomas’ diet should consist of fluids and foods that are easy to digest. Mrs. Thomas does not have any challenge in swallowing foods, and she can still chew food. However, the diet should change as soon as she starts to display discomfort in chewing and swallowing of food. Mrs. Thomas’ diet should not consist of any harmful foods or drinks like alcohol.

Mrs. Thomas requires a regular exercise to keep her body fit. Patients with terminal cancer require effective physical therapies and other forms of exercise. Regular exercise would result in increased body immunity and make Mrs. Thomas strong. She should take physical exercise by walking. Mrs. Thomas would remain fit and improve her functional abilities through regular exercise.

Mrs. Thomas also needs emotional support from her husband and family. She needs love and affection from the family. Emotional supports would enhance psychological abilities of Mrs. Thomas.

Providing care for Mrs. Thomas once self-care is no longer possible

Mrs. Thomas will require a different care quality as her condition deteriorates because she no longer be able to engage in self-care.

Practical care and assistance

This would be the most difficult time for Mrs. Thomas and her husband. Mrs. Thomas would not be able to sit, walk, eat, talk, or even smile. Moreover, she may also fail to make any sense of the word. Normal daily activities, such as bathing, eating, toileting, moving, dressing may be impossible. Hence, Mrs. Thomas would require complete physical support and physical energy from the nurse or the care provider. Mrs. Thomas will require a personal assistant, nurse, or a team from a hospice throughout her last days.

Grief support

Grief can result into several feelings in a family. Hence, Mrs. Thomas would require grief support through effective communication. Grief support would extend to Mr. Thomas too because of his depression even though the loss has not occurred. The nurse will be responsible for providing comfort to Mr. Thomas and his family through effective communication. This may also require a spiritual intervention to prepare the family for imminent death.

Comfort and dignity

Although Mrs. Thomas may have poor cognitive and memory functions, she would retain her abilities to feel lonely, love, fear, peace, secure, and sad. Interventions for comfort and dignity for Mrs. Thomas should ensure that she gets consequential connections with her husband and children.

Intervention for Mr. Thomas’s chronic depression

It is important for Mr. Thomas to seek medical assistance for his chronic condition. This would allow Mr. Thomas to understand the status of the chronic depression.

The two most effective interventions for the patient are “use antidepressant medications and psychotherapy” (Gelenberg, Kocsis, McCullough Jr., Ninan and Thase, 2006). Mr. Thomas may even use a combination of different classes of antidepressant medications. A psychotherapy intervention may involve traditional cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) (Gelenberg et al., 2006).

Mr. Thomas may also seek help from other support groups, which deal with cases of depression. Social engagement with others would improve Mr. Thomas’ chronic depression. Mr. Thomas must also watch his diet and exercise regularly. He must avoid alcohol to manage the chronic disorder.

A collaborative care intervention is the most effective intervention for Mr. Thomas because a combination of various strategies would enhance outcomes and improve his quality of life (Gelenberg et al., 2006).

References

Gelenberg, A., Kocsis, J., McCullough Jr., J., Ninan, P., and Thase, M. (2006). The State of Knowledge of Chronic Depression. Prim Care Companion J Clin Psychiatry, 8(2), 60–65.

Mccallum, A., and Mcconigley, R. (2013). Nurses’ perceptions of caring for dying patients in an open critical care unit: a descriptive exploratory study. International Journal of Palliative Nursing, 19(1), 25-30.

Popejoy, L., Brandt, L., Beck, M., and Antal, L. (2009). Intensive Care Unit Nurse Perceptions of Caring for the Dying. Journal of Hospice and Palliative Nursing, 11(3), 179-186.

Varcoe, C., Pauly, B., Storch, J., Newton, L., and Makaroff, K. (2012). Nurses’ perceptions of and responses to morally distressing situations. Nursing Ethics, 19(4), 488.

Wayne, M. (2013). Late Stage and End-of-Life Care. Web.