Clare is a lung cancer patient who has just been referred to a community palliative care services. This is a support strategy aimed at helping her to get adequate care for her condition. Palliative care is given to a patient suffering from a terminal disease. Its aim is not to cure but to treat the side effects and symptoms associated with the fatal disease. According to Twycross, (2003) “palliative care is the active total care of patients with life-limiting diseases and their families by multi-professional team, when the disease is no longer responsive to curative or life longing treatment.” Based on the fact that Clare’s condition is fatal, it is important that she be given adequate spiritual, physical, psychological and social support.
Palliative care is given alongside other treatments. The patient continues with the treatment but also attends palliative care in order to deal with the side effects of the disease. Through palliative services, nurse will be able to holistically care for Clare and her family. According to Pereira, (1998) holistic nursing care is a health aspect which aims at healing an individual through combining spirit, mind, emotion, body, and environment. holistic nursing care will ensure that Clare and her family maintain the right attitude and perception of life. Community palliative care is commonly referred to as hospice care (Twycross, 2003).
Clare says that she does not have enough strategies to deal with her Disease. This paper covers three areas. First, it explains how Clare can benefit from palliative care. Secondly, it shows how Clare’s family and friends can help and support Clare during these trying moments of her life. Thirdly, it enlightens the nurses and medical team on the various strategies that they can use to manage Clare’s symptoms.
Case management is a strategy used by nurses to care for outpatients suffering from a particular disease. According to Twycross, (2003) “Nursing case management is a nursing care delivery system that supports cost-effective, patient outcome oriented care.” In this strategy, nurses set patient outcomes that are the expected results on a patient undergoing care therapy. According to the New York health department (2006),” Case management includes the following processes intake, assessment of needs, service planning, service plan implementation, service coordination, monitoring and follow-up, reassessment, case conferencing, crisis intervention, and case closure”.
Even though most nurses do not put into practice the recommended strategies needed to attend to lung cancer patients, Twycross (2003) strategies can be very helpful to the nurse dealing with Clare’s case. It will help the nurse to carefully study Clare’s condition and collect all the information required in setting realistic goals (Cherry & Jacob, 2005). It will also help the nurse plan her activities and services to be offered to Clare in her treatment process. Through case management, the nurse will be able to establish the options available in dealing with Clare’s situation. The nurse will also be able to evaluate if these services or activities are cost-effective and affordable to Clare.
This is very vital considering the fact that both Clare and Andrew are not working. Setting goals that require affordable financial resources will enhance the continuity of palliative care. However, if the nurse sets patient outcomes that require financial resources that are too costly, Clare may not afford the palliative care services. This may lead to termination of the palliative care (Elaine and Cesta, 2005).
Palliative care is one of the major aspects which give physical support to any patient suffering from any fatal disease including lung cancer. Clare is expressing breathlessness, cough and fatigue. She also finds it difficult to sleep at night which contributes to her occasional sleep during the day. The research conducted by Pereira (1998), indicates that lung cancer patients need to be given adequate support in order to attain strong personal anxiety. In this regard, it is fundamental that the nurse provides physiological and physical needs in order to eliminate the worrying condition which only deteriorates Clare health condition. As mentioned earlier, Clare has breathing problems and fatigue.
These are some of side effects and symptoms associated with lung cancer condition. Clare says that she does not know how she can deal with these symptoms. The nurse may undertake different strategies to treat these physical symptoms of lung cancer. These strategies include symptoms relief, oxygen therapy, pharmacological therapies, non-Pharmacological therapies and pain management (Rossi, 2003).
Symptoms relief is one the support strategy used to deal with the physical symptoms of lung cancer patient. Clare is experiencing cough, fatigue and breathlessness. She also explains that she does not know how to deal with these symptoms. Nurse dealing with Clare’s condition should be able to come up with strategies that would suppress these symptoms. Based on the research by Dudgeon et al, (2001) symptoms relief strategies relive pain, discomfort and tiredness from a patient.
By treating these symptoms, Clare will be able to do engage in her daily activities. The nurse may recommend Clare to avoid practices such as smoking which may make her condition worse. If these symptoms are dealt with, Clare will be able to engage in activities that will bring meaning to her life. This will ultimately improve her economic condition, social life as well as her health situation (Peter and Beglinger, 2007).
In addition, oxygen therapy is found to be an important strategy for relieving the symptoms. Clare suffers breathlessness, a prevalent symptom in most lung cancer patients. Breathlessness may lead to sensational feelings to the patient. Palliative care nurse dealing with Clare condition should come up with strategies that will help reduce these sensations. Oxygen therapy can be a helpful breathing control technique. The nurse could recommend Clare to use oxygen delivery systems. According to Robert and Pearson, (2002) “there are various oxygen delivery systems used by lung cancer patients” some of them include concentrators, tanks or cylinders and liquid tanks. The selected oxygen delivery system depends on patients’ ability to move and its affordability. Concentrators are the least expensive but require use of electricity.
They can be comfortably be used at home. Tanks or cylinders oxygen are available in different sizes. Portable tanks cylinders can provide oxygen for up to five hours. Tanks of liquid oxygen are very expensive but very portable (Williams, 1987). Oxygen intake is given to patient with the help of a nasal cannula or facemask. In this regard, in order for the nurse to effectively manage the Clare case, nasal cannula can be used since it is very convenient in that it does not deter a patient from movement or talking. However, nasal cannula may lead to dryness around the nasal cavity. Facemask on the other hand cannot be used while the patient is eating or talking (Sun et al, 2007).
Palliative care nurse dealing with Clare’s case should be able to establish the best oxygen delivery systems for her. If Clare cannot afford liquid oxygen, the nurse should recommend tanks or cylinder oxygen. This option could help Clare while she is traveling from one place to another. At home, the nurse may recommend Clare to use concentrators which are very cheap. Oxygen delivery systems are highly inflammable. It is therefore advisable for the nurse to find out whether Clare is a smoker (Proctor, 2004). If Clare is a smoker, the nurse should be able to convince her to stop smoking. This is because smoking will not only deteriorate her condition, but will also be very dangerous while using oxygen delivery systems (Wang et al, 2007).
Pharmacological therapies are one of the physical supports that are given to lung cancer patients. According to Proctor, 2004 Pharmacologic therapy entails use of medications either alone or in combination with other types of therapy to treat lung cancer patients. Pharmacological therapies aim at reducing anxiety and fear in lung cancer patients. One of the medications that can be used to reduce anxiety in lung cancer patients is benzodiazepine. Benzodiazepine is a major form of pharmacological therapy that relieves breathing problems in lung cancer patients. The nurse attending Clare can prescribe short term use of Benzodiazepine tablets to reduce anxiety. Suppression of anxiety, panic or fear would control the breathing process of Clare and therefore reduce breathlessness (Foyle and Hostad, 2007).
Non-pharmacological therapies can be given to a lung cancer in order to reduce the problem of breathlessness. According to Schwartzstein (1987),” facial cooling in the areas around cranial nerve can reduce breathlessness”. One of the non-pharmacological therapies that can be used for a lung cancer patient is the use of fans in rooms (Cheung et al, 2007). Fans improve air circulation in rooms. Palliative care nurse dealing with Clare‘s case can encourage her to use fans at home especially in her room. This would help her reduce breathlessness and improve air circulation in the room where she stays.
Another strategy that involves non-pharmacological therapies includes pursed-lip breathing. Pursed- lip breathing is a strategy that is used to reduce breathlessness. It is performed while a person is for instance moving up staircase or walking on a steep place. It involves taking in a long normal breath while the mouth is closed and exhaling through pursed lips. According to Thun (2006), “pursed-lip breathing improves walking endurance and oxygen saturation during walking in patients”. Palliative care nurse dealing with Clare‘s case should encourage her to practice pursed-lip breathing. This will improve Clare’s breathing problem.
Acupuncture could also be used to reduce breathlessness in patients. According to Becker, (2009) “Acupuncture is a method of inserting needles into certain points in the body in order to promote natural healing and improve body function”. It is alternative method that could be useful to Clare to reduce tension and stress which can lead to breathlessness. The nurse dealing with Clare case can prescribe acupuncture since it will relieve her breathlessness. This medication is therefore useful but only for short period. This does not make it very applicable strategy which the nurse dealing with Clare’s case can emulate (Filshie et al, 1996).
Pain management in cancer patients is very vital. Palliative care ensures that a lung cancer patient is given proper medication to help control pain. It also gives emotional support to lung cancer patients (Roger, 2004). This is based on the fact that a cancer patient may have fear that the medications given by their nurses may not effectively control their pain. The patient may also be concerned that pain medication may lead to adverse side effects, addictions or it may be too costly. This fear may lead to disrupted sleep, eating and exercise habits. In advanced cases it could lead to depression. Clare has trouble sleeping at night and is frequently sleepy during the day. This could be due to fear.
One of the strategies that could be used to manage pain is medication. This medication is commonly referred to as opiods. According to the health studies done by Becker (2009), there are different varieties of opiods. Some of the most common opiods include Morphine, fontanel, hydromorphone and oxycodone. Palliative care nurse who is responsible for managing Clare health condition should be able to determine the best opiods to use on Clare and any other alternative in case the opiods does not work. This will improve Clare’s condition since it will reduce her pain.
Lung cancer patients undergo psychological change in their life. Palliative care ensures that a patient and his family are given psychological support during this trying time. This enables the patient and his family to adapt to their condition (Bond & Bond, 1994). There are different ways in which palliative care will help Clare to get psychological support. These include psychotherapy, behavioral–cognitive therapies, and educational therapies (Wenzlaff, 2005).
This is one of the psychological supports that can be given to Clare. It helps patient deal with feelings of depression and anxiety.” Clare appears to be anxious. Her anxiety is clearly reflected by her inability to sleep at night. Palliative care is aimed at helping lung cancer patients and their families cope with any form of change that would psychologically affect their lives. Psychotherapy is aimed at helping patients and their families adapt to these changes. Through counseling the nurse will be able to help Clare and Andrew overcome anxiety and depression. Psychotherapy will help the family confront their implications positively Strang, (2004).
Cognitive care therapy is a psychological support strategy aimed at helping lung cancer patients and their family to overcome anxiety and depression. According to Zerwekh (2006),” CBT (Cognitive Behavioral Therapy) is a psychological intervention which aims to help the patient recognize, prioritize and link thoughts, feelings, behaviours and physical symptoms”. Cognitive Behavioral therapy is aimed at changing a patient’s thoughts that could be influencing his behaviour.
Behaviours such as depression in patients are as a result of negative thoughts. Through cognitive behavioral therapy, a nurse should be able to encourage positive thoughts in depressed patient. This would help eliminate depression. Clare is experiencing insomnia which could be as a result of negative thoughts such as self pity. The nurse dealing with her case should help Clare avoid negative thoughts that could be causing her sleepless nights. Through this therapy, the nurse should be able to encourage both Clare and Andrew practice positive thinking.
One of the cognitive behavioral therapy that the nurse could recommend is keeping a record of daily thoughts and feelings.This record will help them monitor the number of positive and negative feelings and show the out come of their behaviours. Positive thoughts will record good behaviors while negative thoughts will record negative behaviours. This will encourage both Andrew and Clare to encourage positive thoughts that would help Clare to avoid insonmia.
Palliative care gives educational support to lung cancer patient, his family and friends. Andrew would like to know how he can be of help to Clare. The nurse dealing with Clare’s case should ensure Clare and Andrew are adequately informed on Clare’s condition. Information such as how Clare health situation is progressing will help both Andrew and Clare know what to expect. According to Corner et al,(1996) multi-centre breathlessness management study is an integrated course in palliative care. It is a course educate lung cancer patient to take control of their breathing and also manage anxiety which is linked to their breathlessness.
The nurse should educate Clare and Andrew on home care skills that could be useful for Clare’s condition. Some of skills that the nurse could train both Andrew and Clare may include relaxation techniques such as meditation, muscle relaxation therapy. This could greatly reduce fatigue and breathlessness. Practices such as encouraging Clare to use the bed only when sleeping would increase her desire to sleep.
Palliative care gives social support to any patient suffering from a certain fatal disease.There are two ways that palliative care can enhance social support to lung cancer patient. This includes family support and community support.
Family support is another important aspect which a lung cancer patient should be provided with. Based on the fact that Clare misses her children and wishes to see them physically, her only hope and interest in life is positive personal relationships. Andrew on the other hand is withdrawn and always avoids communication when performing home chores. This is his way of dealing with grief and disappointment. According to Sun et al, (2007) “Patient perception of family’s or friends’ worry may affirm presence of support or may drive personal anxiety.” The nurse attending Clare should ensure that Clare have positive perception towards her family. This way she will be able to freely share her feelings with her family.
Community support is an important strategy that helps to eliminate anxiety in lung cancer patients. Clare is surprised by the number of people who have suddenly started to visit her at home. She does not understand why so many people are interested in her. This shows that her community is giving her emotional support. According to Cindy (2006), “sharing feelings with trusted and supportive people can improve emotional and cognitive processing of disease. Lack of positive support may adversely affect this process”. Since lung cancer is a smoking related disease, it is possible that Clare may be feeling guilty about her actions.
This may make her feel uncomfortable or anxious to share her feelings with community support group. The nurse should ensure that Clare can freely share with her friends who come to visit. The social groups which provide psychological support to patients with fatal diseases such as lung cancer are also significant in provision of support to Clare.
Andrew retired from his work two years ago so that he could take care of Clare. There is a possibility that they were facing financial crisis at home. The nurse attending Clare case should also find out whether Clare needs any financial support at home or for her medication. She should also find out whether there are any nearby community groups that give financial support patient suffering from fatal disease. This would greatly help her feel appreciated and reduce stress which she is currently experiencing.
Spiritual support is very vital for any patient suffering from terminal disease. Spirituality is anything that gives a person meaningful life. According to Thun (2006), “spirituality is important during all phases of one’s health and disease, but spiritual and religious factors plan an especially prominent role in a patient’s experience with terminal disease, the dying process and death”. Spiritual support given in palliative care addresses three main areas. These areas include meaning of relationship, love and religious practices (Hallak, 2003).
Meaning of Relationship
According to Clare, personal relationships seem more important to her now than before. She says that she misses seeing her children even though she constantly communicates with them through phone calls. This clearly shows that Clare values relationships. Seeing her children physically will give her life more meaning. Through dialogue a nurse is able to establish what gives meaning to a lung cancer patient (Fernando, 2005).In this way, the nurses are able to encourage the patient engage in activities that will bring hope and purpose to her life. These would greatly motivate her to live longer.
Every patient suffering from a terminal disease needs affection from loved ones. Palliative care ensures that lung cancer patient gets affection from the family, friends and relatives. This is because any affection given to the patient would positively influence his health outcome. Clare longs for her children affection. She constantly communicates with them through telephone but she would prefer physically meeting them. Facial expression such as a smile from her children would add new meaning to her life. Andrew on the other hand, is withdrawn and prefers to work than talk. The palliative care nurse attending Clare’s case should encourage Andrew to talk with her wife more often. In this way, Clare will feel loved and appreciated by her husband. Her attention will be deviated from her children.
The nurse also plays a significant role in ensuring that Clare feels appreciated and loved. Her actions influences patients’ attitude towards life and palliative care. According to Strang (2004),” a large part of message is conveyed to a patient through non-verbal communication. This non-verbal communication includes facial expression, eye contact, peach or pace of voice, touch and posture”. Positive non-verbal communication will help Clare feel appreciated by the nurse. This will not only improve her perspective to life but will also encourage her to constantly attend palliative care services.
A patient’s religion may influence her perceptive of life either positively or negatively. Religion may negatively affect a patient’s condition if he thinks that his condition may be as a result of punishment from God. Hence, the patient may feel rejected, or condemned by God. He may also have fear that God will judge Him accordingly after death. Nurse attending such a patient should ensure that the patient is discouraged from such thoughts (Sykes et al, 2004).
This is because such thoughts would deteriorate patient’s condition. However, the nurse should show respect to patient’s belief. Religion may also positively affect lung cancer patient. If a lung cancer patient has a strong belief in her or his religion positively, she might engage in religious practices more than before. For example, Clare can adopt more activities which are propagated by the religion such as giving offerings to his creator, assisting the orphans and giving guidance and canceling services to the sick. These practices will give a lung cancer patient purpose to live or hope.
Through dialogue, the nurse attending Clare case should find out her beliefs. The nurse should find out whether Clare is positively or negatively influenced by her religion. If Clare is positively influenced by her religion, the nurse should motivate Clare to continuing practicing her religious activities (Mueller et al, 2001). Some of the activities that a nurse could encourage Clare to practice is to pray and attended social gatherings.
In this way, Clare would feel motivated to live and this would improve her quality of life. If the nurse realizes that religion is negatively affecting Clare condition, she may try to discourage Clare from negative thinking. For instances she can convince Clare that her ailment is not a punishment from God (Puchalski, 2002). As a result, Clare would not feel condemned or discouraged.
Palliative care services can be very useful to Clare and her family. This is because these services will give spiritual, physical, psychological and social support to Clare and her family. The nurse dealing with Clare’s condition should be able to educate Clare on the various changes she should expect in her health. However, the nurse should be able to come up with strategies that will help reduce Clare’s physical symptoms.
These will help Clare be able to engage in daily activities such as cooking, shopping. These will also help Clare in control of her life thus adding meaning into her life Becker, (2009). This could also help Andrew take a part-time job that would help them get financial resources to cater for their needs. The nurse should also be able to positively influence and encourage Andrew and Clare engages in positive thinking.
Negative thinking results in psychological problems such as self-pity, anxiety, insomnia and fear. Clare and Andrew are facing psychological problems such as anxiety and insomnia. One of the most important roles of the nurse is to offer counseling services to enable Andrew and Clare confront their fears and anxiety (MacLellan, 2006). This will help them view life them positively. Clare will be able to sleep at night and do some domestic chores during the day.
The nurse should be able to help Clare understand the need for social support. Clare does not understand why people have suddenly become interested in her. The nurse attending her should encourage Clare to take this action positively. This is based on the fact that sharing with friends will comfort her and make her feel more appreciated (O’Connor & Aranda, 2003). Clare values her family and wishes to see her children. She also values personal relationships. The nurse should be able to encourage Clare to convince her children to see her whenever possible. She should also emphasis the importance of spirituality every time she attends the health care centers for medical check up.
This will give her spiritual support and help her cope with her disease. Palliative care services will ensure that Clare and her family will live normal lives (Phelps, 2002). In my opinion, it is imperative that government should initiate more health care centers which give cheap but quality medical services to the lung cancer patents. Likewise, effective legal strategies should be initiated in order to provide insurance health facilities which will cater for each patient regardless of the kind of disease.
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