Community Health Nursing: Care for a Patient with a Lingering Illness - Essay Example

?COMMUNITY HEALTH Community Health Nursing Word Count 500 A. Explain how your own perceptions about quality of life and health promotion might affect your care for a dying patient with a lingering illness such as cancer. Quality of life can vary greatly when there is a problem that a patient is dealing with such as cancer. According to Yarbro, Wujcik, and Gobel (2010), “Recognizing the fact that information beyond tumor response and survival time was needed, much of the ground-breaking work in the assessment of quality of life has been accomplished in oncology” (pp. 202). Quality of life really depends upon not only what the family can do, but about what the community health nurse can impart to her patient. In the case of Mrs. Thomas, making her comfortable is going to be the nurse’s primary concern. It seems that Mrs. Thomas is on a regime that includes Vicodin, but she doesn’t seem approving of using medication for pain management. However, it is okay for the nurse to reassure Mrs. Thomas that this will help her make a smooth transition in the process in which she is going through. She is in a lot of pain, and managing the pain will definitely take a lot of pressure off of Mr. Thomas knowing that his wife feels better. Unfortunately, many times pain is undertreated by physicians in the U.S. Since Mrs. Thomas is a cancer patient, it only makes sense that she is going to feel badly with the metastasis of the cancer to her lung—and indeed, it probably is as painful as she has described to the nurse. However, not treating the pain is going to leave Mrs. Thomas without other recourse, and in the process, Mr. Thomas may become severely affected, seeing his wife in pain and feeling powerless to do much about it. Therefore, the best decision seems to be to treat the pain. This is going to be the greatest help for Mrs. Thomas as she now goes through the dying process. B. Discuss three strategies that you could use in the Thomas’s situation to improve the quality of life for Mrs. Thomas and her husband during this illness. ?? Community health nurses definitely can have a positive impact on being able to improve the quality of life for terminally ill patients such as Mrs. Thomas. According to Larsen and Lubkin (2009), “By evaluating the extent to which nursing interventions improve quality of life for clients and families, nurses are in a position to [help their clients with this]” (pp. 156). Of course, many times people may argue about what does quality of life mean. According to Sinclair (2007), “Referring to quality of life…’its definition is notoriously problematic.’ The tendency toward superficiality in measurement of quality of life in palliative care has been [criticized]” (pp. 62). Three strategies that could be used in order to improve Mrs. Thomas’s quality of life would include the following: have her listen to music; make sure she has good hygiene and grooming; and making sure Mrs. Thomas has some visitors so she can get some social interaction, perhaps with her family members who live out-of-state. Music can be a quite calming factor, especially when one is not feeling well. Something light and airy, or classical music, might be especially soothing. In addition, Mrs. Thomas should be very well-groomed and be helped to maintain good personal hygiene so that she doesn’t get any kind of infection. Third, perhaps visits from her family members from out-of-state might be a nice touch, if the nurse could get in contact with them and see if they’d like to visit her. Or, alternatively, the nurse might like to arrange a visit or two from a minister of Mrs. Thomas’s faith or a volunteer who cares for hospice patients. Volunteers who work in hospice might best serve Mrs. Thomas if at least one person came to see her on a regular basis so she could maintain some social contact with others outside her husband. C. Create a holistic nursing action plan appropriate for managing Mrs. Thomas’s care at home by doing the following: ? 1. Discuss ways to optimize Mrs. Thomas’s functional ability at this stage of her illness. Mrs. Thomas does not have very long to live. According to Fishman and Ballantyne (2009), “[T]he median survivals are 12 months for breast cancer, 6 months for prostate cancer, and 3 months for lung cancer” (pp. 645). In order to optimize Mrs. Thomas’s functionality during this time of transition in hospice, Mrs. Thomas should be allowed to do things that she can do herself, instead of having the nurse do everything for her. She may not be totally disabled at this point, and may be able to do simple things that do not require any heavy lifting or any kind of activity that would exacerbate her lung cancer. Mrs. Thomas should definitely not do any activity that would make her need to gasp for breath. Even light activity should be avoided if it is going to make Mrs. Thomas have to respirate too much. Therefore, it is advised that Mrs. Thomas conserve her energy for small tasks that she can perform while in bed—if bedridden—or tasks that she can perform that won’t cause much if any physical exertion at all. This will help her still feel functional and able to do some things, even if they are very small tasks. This will give the patient a sense of control over her situation. It is much better for the nurse to do tasks for the patient that are definitely now out of her realm of control. Meanwhile, the good community health nurse will emphasize that Mrs. Thomas do only tasks which she can handle reasonably well without assistance that, again, are minimal tasks. Nothing very ambitious should be undertaken for fear it will exacerbate Mrs. Thomas’s lung cancer. As a result, Mrs. Thomas should be encouraged to do what she can, but to not overdo it. 2. Discuss ways to provide care for Mrs. Thomas once self-care is no longer possible.???? It is very possible that Mrs. Thomas might get to the point where her husband is taxed so much that he might not be able to adequately care for her anymore without getting so stressed out and depressed where it interferes with his own ability to function. According to Forman (2003), “Residential care is provided in hospice/palliative inpatient settings for patients who require supportive care related to safety needs, weakness, or the inability to perform self-care” (pp. 50). For safety’s sake, when Mr. Thomas is working, Mrs. Thomas might need to be supervised, especially if she has difficulty walking or getting to the bathroom. Mrs. Thomas will probably need a lot of personal care as well as individualized attention, which, at this point she might only may be able to receive at a residential facility equipped to handle patients who cannot do much self-care or do not have a caregiver available for them 24/7. Since Mrs. Thomas’s grown children both live out-of-state, if they are not willing to come care for their mother in her home, they must possibly make the tough decision to put her in a residential facility so that Mr. Thomas is not too stressed out and thusly having his depression worsen. Another possibility is that Mr. Thomas might want to look into the possibility of hiring a live-in or a daytime caregiver in order to ease the burden of having to look after Mrs. Thomas all the time by himself. This way, Mrs. Thomas could stay in her home without having to be in a residential facility, and Mr. Thomas would be able to maintain his current schedule. A live-in would be more costly, but effective if Mr. Thomas could not give her 24/7 care. A daytime caregiver could take care of Mrs. Thomas while Mr. Thomas is at work. D. Explain how you, as the community health nurse, can intervene in this situation in the management of Mr. Thomas’s chronic depression. ?? Mr. Thomas could be adversely affected by his chronic depression. According to Lundy and Janes (2009), “Geriatric depression — a frequently noted condition in elders with chronic illness — is associated with lower quality of life” (pp. 555). As the community health nurse, it might be wise to suggest a multitude of things that could help Mr. Thomas cope better with the impending loss of his wife. The community health nurse might be able to ask him if he wants to get some help in caring for his wife, which is the most important aspect that the nurse should address. The next most important aspect that the nurse should address is whether he should see a psychiatrist in order to make sure he is complying with medication management and is doing well (i.e., has a good mental state). Another thing that the community health nurse might suggest is having Mr. Thomas consider seeing a therapist and/or a counselor. The counselor will probably walk him through the dying process, which includes denial—a stage that he seems that he is trying to cope with the most. The counselor will help him reach the stage of acceptance after he has resolved some of his grief issues he may be having knowing that his wife is terminally ill. The community health nurse may want to make sure that Mr. Thomas has some appropriate social outlets with his church or other community organization, and possibly some opportunities to get out of the house while perhaps a neighbor or family friend could look after Mrs. Thomas if she is still in the home receiving home care. Mr. Thomas should be evaluated as a whole person and the community nurse should take all these factors into account. Mr. Thomas will be adequately assisted. REFERENCES Fishman, S., & Ballantyne, J. (2009). Bonica’s management of pain. US: Lippincott Williams Wilkins. Forman, W.B. (2003). Hospice and palliative care: concepts and practice. US: Jones & Bartlett Learning. Larsen, P.D., & Lubkin, I.M. (2009). Chronic illness: impact and intervention. US: Jones & Bartlett Learning. Lundy, K.S., & Janes, S. (2009). Community health nursing: caring for the public’s health. US: Jones & Bartlett Learning. Sinclair, P. (2007). Rethinking palliative care: a social role valorization approach. US: The Policy Press. Yarbro, C.H., Wujcik, D., & Gobel, B.H. (2010). Cancer nursing: principles and practice. US: Jones & Bartlett Publishers. Read More