The Delivery of Health Services and Symptoms of Distress - Essay Example

?Running head: Distress Distress Distress Introduction Distress is one of the most natural reactions to trauma or impending trauma. Forthe most part, it can afflict any person, at any age, and for a variety of reasons. This paper shall discuss a particular case of distress, as experienced by a cancer patient. Character profile Nancy, a 45 year old female, married, with three children, is diagnosed with Stage 3 breast cancer. She is a full time mother and of Asian descent (Korea), but was born and raised in the United States. Her children are aged 11, 8, and 6 years. She first felt the lump in her breast a month prior to admission. She was advised by her GP to have a mammography and the tests revealed that she had a mass in her breast. Further laboratory testing revealed that the mass was malignant and that cancer cells have already metastasized to her liver. She was immediately scheduled for double mastectomy and subsequent chemotherapy. After the surgery, it was discovered that cancer cells also metastasized to her colon. Another surgery is being scheduled to resect the mass in her colon. She is now feeling a lot of distress, mainly because of her children and her family. She is also feeling distress because of her impending surgery and her chances of beating the disease. She fears also the chemotherapy which may or may not work. She mostly fears for the people she will leave behind, who will take care of them, and guide them as children and as young adults. She is also distressing about the pain she knows she might experience as her disease would progress. And finally, she is also distressing about whether or not the medical remedies they are using would work in managing her symptoms and in possibly prolonging her life. She is in a constant state of anxiety, at times she is tearful, and at other times she is panicking. She often wrings her fingers in an obvious state of agitation and concern for her family. She also sometimes displays anger at no one in particular. At which time, she would snap at her health care givers and even at her family members. She often immediately regrets these incidents and would cry about them. At times, she would be sad and melancholy and mostly just insist on sleeping. She would also manifest a brooding and contemplative attitude; these times often lead to moments of worry and of anxiety about herself and her family’s future. She also tries to comfort her family members and just try to be strong for them; but undeniably, there are times when she is very much agitated and anxious about her condition. During these times, she registers with elevated heart rates, breathing rates, and blood pressure rates. She has had no major medical problems. Prior to giving birth to her first child, she has had no history of hospitalization. She is slightly overweight, but not overly so. She has no history of drug and alcohol abuse. She is not a smoker, and only indulges on a glass of red wine during weekends. She tries her best to maintain a healthy diet of fruits and vegetables, but she has not been able to maintain such a diet because her children are picky eaters and they dislike vegetables. Her diet mostly consists of rice, red meat, chicken; breads; potatoes, peas, carrots, fish, legumes, and fastfoods. She was diagnosed with hyperglycemia a year prior to her current admission, but such issue was resolved within one month of taking medications. She has had normal pregnancies for her three children and has carried them all to term. Her menstrual periods have been regular since she first had them; but about a year ago, she started to miss periods. She did not have herself checked because she thought she was already going into menopause. She also experienced some tenderness in her breasts 2 months ago, but she did not feel much pain from the tenderness so she again did not go to her GP for consult. She felt dizzy and nauseated two weeks prior to admission and sought her GP for a consult. She was given medications for a stomach virus. After a day of taking the medications, the vomiting subsided. As to her family history, her maternal grandfather died of prostate cancer at the age of 67; and her maternal grandmother died of breast cancer at the age of 55; her paternal grandfather died of a heart attack; and her paternal grandmother died of natural causes (old age); her father died of a heart attack at the age of 65; her mother died of a stroke at the age of 70; her older sister was also diagnosed with breast cancer and later passed away after 5 years of battling the disease; her younger sisters are all healthy and very much alive, but are now considering early testing to rule out breast cancer. Breast cancer has a high prevalence rate among family members, especially among female family members. Distress Concept/definition Distress refers to an “aversive state in which an animal is unable to adapt completely to stressors and the resulting distress is manifested as maladaptive behavior” (National Research Council, 2000, p. 28). In facing any stressor, a person may not be able to adapt and face the stressor in terms of his physical and physiological make-up; this inability to adapt, causes distress and causes a person to manifest maladaptive behavior. In the case of Nancy, her distress is based on her inability to make the necessary adjustments in facing her current stressor – which is her Stage 3 cancer. She is thinking of different things all at once – her family issues and her disease – and in the process, she is overwhelmed by her thoughts and her concerns. Distress is often associated with stress and they are both used to describe particular states of being (Institute for Laboratory Animal Research, 2008). Once a person is unable to handle the stress, then a state of distress sets in. Nancy is actually in a state of distress because she is unable to cope with her various stressors and she is now manifesting feelings and actions which indicate her anxiety and agitation for her and her family’s future. In a more general context, distress is felt when the resources we have are overwhelmed by the resources which are demanded of us (Darling, 2010). It is a negative emotional response to stress. In Nancy’s case, her physical and emotional resources which she can potentially use during periods of stress are insufficient because the demands on her emotions and her physiology are great. She has multiple demands on her resources and these resources cannot adequately fill in her current physical and emotional demands. Hence, she is felling great distress from the different concerns she is now having with her life. Various people have a variety of social, personal, and objective tools which they can use; and the demands made in order to meet different objectives can cause distress; moreover, some stressors may require more resources as compared to others (Darling, 2010). Types of distress There are two types of distress. These are: acute and chronic distress. Acute distress manifests for short lengths of time. Chronic distress, on the other hand, manifests for a prolonged period of time. This is the more dangerous type of distress because the body is never returned to a normal state of to homeostasis (Seaward, 2010). In Nancy’s case, she is currently in a state of acute distress; however, if she would not be advised on how to deal with her stressors and on how to manage her distress, her distress may become a long-term problem. Causes of distress There are different causes of distress; and these causes are mostly borne out of stressful situations which become too overwhelming for a person to handle. Distress may be caused by: the death of a loved one; relationship difficulties; terminal illness; financial hardships; or difficulties at work (WindDown, 2011). In Nancy’s case, her distress has mainly been caused by her terminal illness and her inability to deal with the emotional and physical implications and demands of her disease. Signs and symptoms of distress There are various signs and symptoms of distress that ranges from “sadness, vulnerability, fearfulness, anger, and unhappiness to severe depression, panic, and debilitating anxiety” (Rosenbaum, 2008, p. 280). The severity of these symptoms may also range from the low to the severe, and it is the latter which needs to be monitored because they may lead to an incapacitated emotional and physical state. Some of the symptoms for distress are also unreliable because they may also be considered symptoms for other diseases; these symptoms may include nausea, insomnia, fatigue, eating disturbances, and decreased libido (Rosenbaum, 2008). These symptoms may actually also manifest among cancer patients. In Nancy’s case, she is indeed manifesting most of the symptoms for distress. She is sad, vulnerable, angry, unhappy, fearful, severely depressed, panicky, and very much anxious. She is already manifesting symptoms of nausea, fatigue, and decreased libido which were determined to be part of her cancer. Main issues The primary issue for Nancy is her distress. There is a need to address and to assist her in the management of her distress in order to avoid a chronic state of distress and in order to minimize her anxiety during the treatment of her main cancer symptoms. A crucial part in any treatment for cancer patients is the emotional state of the patients. Those who are more stressed and distressed would likely have more difficulty dealing with the primary challenges of their disease. Such concerns would set back the patient’s recovery and rehabilitation process. Enquiry-based learning (EBL) In order to establish the main issues in the case at hand, a face to face facilitated session was first carried out for the student. Face-to-face contact is an important part of learning because it facilitates a strong start to the enquiry process. It gives a more personal touch to the learning process and it makes the classroom and the learning process more dynamic and involved (Neunhauser, 2002). This serves as a good beginning for the learners. In evaluating issues in case studies, the classroom situation are good ways to start these discussions because the brainstorming and discussion process which can be carried out would be an essential part of the learning process. The next step is the student-directed self-learning. Student-directed self-learning involves students carrying out their own means of gaining knowledge. In this case, information gathering through books and journals in the libraries is a starting point for the student. It would also include internet searches and other computer-based learning and assimilation of information (The City University, 2007). The study of Agran and Wehmeyer (2000) was able to establish the important value of self and student-directed learning in the learning process and in instilling self-determination among the students. This part of enquiry-based learning is therefore important in following up the foundations laid down in the face-to-face sessions. It is important in directing the students in gathering data and in eventually meeting the goals laid out in the initial part of the learning process. Self-directed learning sets forth important tools for the learner to use in gaining crucial data about the issue being raised and to pick out the information he can use in the course of his study. Feedback, presentation, and reflection follow the data gathering and self-directed learning process. Feedback comes from the teacher. This feedback is an important follow-up to the self-directed learning because it would help gauge the student’s performance and learning process – and to establish whether or not the data gathered by the student is sufficient to resolve the issues raised. Feedback impacts on cognitive development in relation to engagement and achievement of knowledge (Butler and Winne, 1995). It helps to measure knowledge and it helps engage the student towards more self-directed knowledge and goals. The presentation process would likely involve visual aids, PowerPoint presentations, computer-simulated graphs and charts, videos, audios, and similar media. Such presentation would help establish the data on a more orderly scale. A presentation in enquiry based learning helps to highlight the main points of the learning process in order to conceptualize a general output or idea about the issue being discussed (Cleverly, 2003). Presentations are often based on the creativity of the learner; it is also based on the information gathered and how they aid in meeting the goals established at the very start of the learning and enquiry process. These presentations also give teachers an opportunity to evaluate the extent to which the student has fulfilled the goals of the enquiry and the possible changes and improvement which need to be made on the enquiry process. Filling in gaps of learning is an earlier process to carry out and it can be implemented by viewing and evaluating the presentation of the student. Finally, the reflection process is an important part of enquiry-based learning. Reflection is seen formally after the presentation of the learning and the issues to the facilitator, the teacher, and other students (The City University, 2007). Reflection is an important part of working in a team, because it helps the members reflect about the process and the results gained from the process of learning. Reflection is often conceptualized as a conversation between the student and the facilitator. It may be prudent for the student to first undergo his own reflective process before an actual evaluation can take place. Reflection on the entire EBL process can help the student understand the team working and realize how the actual learning process takes place (The City University, 2007). Reflection is also reflecting on one’s action and in determining whether or not the right direction was taken on a particular issue and if there is no other way by which such issue can be resolved. In effect, this stage helps a person become a more reflective learner (The City University, 2007). Gibbs Reflective Process 1. What happened during the EBL process? In this process, I was able to gain much needed information on the patient’s physical as well as her emotional state. She expressed her distress and anxiety about her cancer and about the implications of such disease to her and to her family. For the most part, she tried to put up a brave front for her family; however, I could see that she was really overwhelmed and distressed about her condition. Some distress is actually normal in most cases, especially in the case of parents with children and those suffering from terminal and chronic conditions. Distress is actually considered the 6th vital sign in cancer patients; it is almost always expected and has to be considered in the planning of the patient’s care (Bultz and Holland, 2006). In Nancy’s case, I was able to assess and evaluate that she was going through much stress and anxiety; and her distress, if unaddressed would likely cause significant emotional and psychological issues which would impact greatly on her cancer treatment (Institute of Medicine, 2008). 2. What were you thinking, doing, and feeling during the EBL process? I was thinking that there was a need for Nancy to really calm down and to gather enough courage to deal with the emotional and physical implications of her disease. This is a significant part of her cancer treatment. No amount of medication and intervention would address her essential physiological concerns if her psychological functioning is crippled or compromised (Holland, 2002). I tried my best to draw in the family into the patient’s life – to lend the patient emotional support and to reassure them of their own strength in facing the cancer battle with Nancy. I also tried my best to just listen to Nancy – to sit with her and allow her to talk about her concerns while also trying to plan options for her and to plan out what she can do to help herself and to help her family. Through the planning process, I know that I would be able to be more pro-active in dealing with her disease instead of fixating on her issues. This is a more helpful strategy in her case because it would distract her from depressed and distressed thought processes (Kyngas, et.al., 2001). I also felt affected by Nancy’s condition. I felt sad for her and great sympathy for what she was facing. However, I felt that with the right amount of support from her family, that she will be able to manage her distress. 3. Evaluation – what was good and less good for you about the experience? What was good about the experience was I got to see firsthand what cancer can do to a person and to her family. I got to see the emotional side of cancer and how emotionally debilitating the disease can be. What was bad about the experience was that I had a difficult time being objective about the experience. There were moments when I became too sympathetic towards the patient. I tried my best to be objective, but I found myself feeling much pain and hurt over the patient’s condition as well. I knew that I would not be an effective nurse if I sympathized too much with the patient, so I tried my best to take a less emotional stance on the patient’s condition. To this date, I am trying to achieve a safe and effective level of sympathy for my patient. 4. Analysis In terms of teamwork, I have learned that working as a team and coordinating with other health professionals in the care of a patient makes the delivery of health services more efficient and helps improve patient outcomes (Wilson, et.al., 2005). I have also learned about the signs and symptoms of distress as manifested by a patient and I have learned about the different possible risk factors for cancer. In evaluating Nancy, I was prompted to evaluate my knowledge about cancer and distress and be able to see these symptoms in Nancy. In evaluating and establishing issues with Nancy, this process was able to contribute to my clinical experience by giving me a firsthand and practical application of the theoretical and academic learning I gained from the classroom setting. I learned to be more hands-on in my approach to patient care and to manage real time patient scenarios as they manifest under pressure and with actual patients. In the process, I learned that theory is very much different from practice. And that I need to be more alert and observant of my patients in the practice. By noting their symptoms I would be able to establish patient issues which have to be addressed. I also discovered that expressing sympathy to a terminally ill patient may not always be the appropriate response. I tried to be more sympathetic to Nancy and it seems that the sympathy made her more depressed, distressed, and sad. I found out that being matter-of-fact and nonchalant about her condition can also be an effective means of drawing her out of her distress and depression. 5. Conclusion – what could you have done to make the process better/easier? To make the process better/easier, I could have been less sympathetic and more pro-active in the planning of her care. This would have made Nancy stronger and less emotionally dependent. 6. Action plan – what will you do differently/the same next time? I would have been more active in planning the patient’s care and psychological health. It would have made me more effective as a nurse-counselor and as a patient advocate. I would also have been more knowledgeable of cancer treatments and the effects of chemotherapy on a patient. I would have imparted such knowledge to Nancy to ease her worries about treatment. Works Cited Agran, M. & Wehmeyer, M. (2000). Promoting Transition Goals and Self-Determination Through Student Self-Directed Learning: The Self-Determined Learning Model of Instruction. Education and Training in Mental Retardation and Developmental Disabilities, 35(4), 351-364 American Cancer Society. (2010). Distress in People With Cancer. Retrieved 05 April 2011 from http://www.cancer.org/acs/groups/cid/documents/webcontent/002827-pdf.pdf Bultz BD, Holland JC. (2006). Emotional Distress in patients with cancer: The sixth vital sign. Community Oncology, 3; 311-314. Butler, D. & Winne, P. (1995). Feedback and Self-Regulated Learning: A Theoretical Synthesis. Review of Educational Research, 65(3), 245-281 Cleverly, D. (2003). Implementing inquiry-based learning in nursing. New York: Routledge Darling, N. (2010). Thinking About Kids: Parents, kids, and the way we live together. Psychology Today. 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