End-of-life care involves holistic care where social, psychological and spiritual elements of personal care are considered (Moreitz, 2007). Cancer disease and its medication have a unique impact on a person’s life. Despite the fact that physical challenges borne by patients with cancer may be identical to those patients with non-malignant conditions, a combination of these challenges with the chronic nature of cancer, highly toxic effects of treatment, and the profound psychological effects of the ailment reveal that cancer nurses specialized knowledge and skills.
There is enhanced diversity of the role of cancer nurses and their contribution in offering seamless care throughout cancer patients’ end of life. Cancer nursing demands key skills that assist patients and their carers to cope with the reality of living with cancer while enhancing the quality of life. In this paper, I discuss the quality of life functioning, strategies of improving quality of life, and holistic care plan appropriate for terminal cancer patients, while examining a case study concerning Mrs. Thomas’s condition.
My Perception about How Quality of Life and Health Promotion Might affect Care for Mrs. Thomas
As a chronic disease, I perceive cancer as characterized by remissions, exacerbations and progressive physical changes. As a community nurse, I think caring for Mrs. Thomas as a cancer patient requires to be examined as a continuous process as it takes place in the community setting. Supporting her through her cancer journey demands the skills of community nurses and another relevant professional in conjunction with her family.
Ensuring effective communication will be very essential to optimize the care of Mrs. Thomas. Since Mrs. Thomas spends much of her life at home, much of the psychological and physical adjustments to her cancer occur at home. Therefore, community health promotions and services are set up to support her, her family, and other carers from diagnosis to terminal illness, assisting her in decision making, and attaining her optimal independence and quality of life through health promotions.
Through health promotion, emphasis will be placed on establishing a healthy environment, maintaining her health, and employing community health ideas of prevention and reduction of harm to her lifestyle (Moreitz, 2007). Health promotion in palliative health care for Mrs. Thomas will not be intended to prevent death, but rather the challenges of physical, social, psychological, and spiritual related to death and dying.
Health promotion issues will involve depression, grief, anxiety, hopelessness, and others. A community nurse can assist prevent some of these experiences and others can be targeted to reduce harm and suffering of the patient. For instance, it is not possible to prevent grief, but some of the effects of grief such as severe depression, suicide, and others can be subjected to strategic interventions of harm reduction. The social stigma and hopelessness suffered by Mrs. Thomas and her family are social and spiritual experiences amenable to prevention, but also subject to strategies of harm reduction (Jo, 1999).
Strategies to Improve the Quality of Life of Mrs. Thomas and her Husband
Mrs. Thomas’s situation will require a community nurse to partner with others to provide appropriate care to increase her adherence to optimal health behaviors. I will determine the impact of cancer on her family members before establishing appropriate strategies to be applied in her situation to improve her quality of life together with her husband. Appropriate strategies I will use that could improve Mrs. Thomas and her husband’s quality of life and functioning include: enhancing research efforts to comprehend physical, social, and psychological mechanisms and their interactions that affect Mrs. Thomas’s response to her situation; developing the use of tools to assess the quality of life of health-related issues relating to the patient and her family; and enhancing intervention to address the patient’s needs for her improved quality of life (Jo, 1999).
The first strategy will be to enhance efforts of understanding the physical, social and psychological mechanisms that affect Mrs. Thomas and her family. Enhanced comprehension of her situation will assist in helping her respond to the disease and will assist in the development of interventions to enhance the quality of life during and after her treatment. Secondly, I expand the use of tools to assess Mrs. Thomas and her family’s health-related quality of life.
This will be aimed at improving her outcomes by describing her experience of illness, and treatment. This strategy will: assess Mrs. Thomas health-related quality of life through the end of life; it will form the basis of establishing the criteria for monitoring harmful late effects of Mrs. Thomas cancer treatment; and support measures of assessing the impact of her cancer on health-related quality of life of her family members and any caregivers.
Thirdly, I will enhance intervention research to reduce her chronic cancer. Interventions will address; her cancer situation and her needs for enhanced quality of life, such as, reducing cancer symptoms of distress, pain and promoting health practices; interventions that promote her health and well being of her family members; and her personalized treatment based on her predisposition for adverse outcomes (Jo, 1999).
Ways to Provide Care for Mrs. Thomas once Self-Care is no Longer Possible
As a terminally ill cancer patient, Mrs. Thomas needs palliative care. Palliative care is associated with the end of life care. She needs active total care since her ailment is not responsive to curative treatment. The intention will be to prevent, relieve, reduce, or soothe the symptoms of cancer afflicting Mrs. Thomas. As a nurse, my major focus is on coordination and delivery of holistic care to Mrs. Thomas. This care will encompass spiritual, cultural, ethical, and legal perspectives of palliative care.
Spirituality and culture are among important aspects that may structure Mrs. Thomas’s experiences, values, behavior and her illness patterns. Understanding Mrs. Thomas’s spirituality will play a necessary role in her times of crisis and illness. Spirituality offers a sense of connection to self, nature, God, and others. It also accords a means to cope with loss, grief, and death. Mrs. Thomas’s illness is a crisis on physical, psychological, social, familial, social, and spiritual. Given her uniqueness and individuality, she may have different experiences, needs, concerns, and illness interpretations. In addition to her individuality, the nature of her cancer illness will adapt to the reality of the disease. Her spiritual and cultural worries may allow her cancer experience or may arise at any point across her trying period.
Nursing outcomes a will be focused on promoting Mrs. Thomas’s quality of life while emphasizing pain relief, suffering, and management of symptoms. For Mrs. Thomas and her family facing life-threatening disease, the focus will be on their suffering that may assume multiple relative to the mind, body, and spirit. Mrs. Thomas’s condition poses the potential for pain, changes in body image, and confrontation with the end of life, which may cause spiritual distress. It will also involve assisting Mrs. Thomas and her family to achieve personal goals, reconcile conflicts, and discover meaning from their experiences at end of life (Jo, 1999).
Mrs. Thomas’s suffering will need to be assessed adequately. As indicated in the case study, the patient is in a severe state of distress. Manifestations of her suffering are behavioural, for instance, she and her husband have withdrawn from social engagements; emotional, for instance, her distress due to lack of personal contact with her family members; spiritual, for instance, her sense of alienation from her family; or physical, for instance, she experiences moderate degree of pain after chemotherapy. These are the key concepts I will consider when Mrs. Thomas in her condition. This assessment will be performed routinely when providing care to the client.
This assessment will assist in determining appropriate nursing interventions that will alleviate Mrs. Thomas suffering. Majority of these interventions will need to be implemented by me as a nurse.
After establishing the source of Mrs. Thomas’s suffering, I will develop a holistic nursing action plan necessary to manage her condition. The implementation of these action plans will depend entirely on her needs. The nursing interventions I will need to adopt will vary according to type of distress Mrs. Thomas is experiencing.
My role as a nurse in managing Mrs. Thomas pain cannot be overemphasized. As a skilled health care professional, I will need to be competent in assessing her pain and comprehending the principles of pain management. As an advocate, I will need to collaborate with physicians and other health care professionals to create effective care plan for Mrs. Thomas. There will be need to work with both the patient and her family to determine the highest level of comfort.
Management of Mrs. Thomas’s pain will encompass her pain experiences to the end of her life. She experiences pain from her deteriorating chronic condition as one of the symptoms of her getting palatial care. However, her pain is not physiological exclusively as it involves emotional, spiritual, and psychological aspects. For instance, she is emotionally and psychological disturbed as she cannot continue with her clerical job and concerned with the state of mind of her husband; as a result of her illness.
Palliative care for Mrs. Thomas will offer her holistic care, that is, her social, spiritual, and psychological aspects will be considered in managing her deteriorating condition effectively. Palliative care will be most appropriate for Mrs Thomas since her cancer condition is life threatening and is incurable. Therefore, managing the physical symptoms of Mrs. Thomas cancer is paramount for her effective care. It will be absolutely important to incorporate the patient’s clinical treatment with broad care plans that include: psychological, supporting Mrs. Thomas’s good personal morale; social support, involving her family and her other social networks; and her spiritual and pastoral care for meaning making (Moreitz, 2007).
Health care promotion will enable Mrs. Thomas to maximize her health potential. The health promotion will be based on the assumption that from whatever stage the patient starts life; her quality of life will be enhanced and developed. One reason for emphasis on health promotion for a patient with chronic condition like Mrs. Thomas is to recommend appropriate exercise for her. The exercise program will assist improve her physical function and psychological quality of life in the programs designed around her specific condition. While this exercise will be part of her care after treatment, it will constitute an integral part of treatment or therapy for Mrs. Thomas after getting chemotherapy.
Jo, M. (1999). Community Health Nursing Advocacy for Population Health. Michigan: Appleton and Lange Publishers.
Morewitz, S. (2007). Aging and Chronic Disorders. Sydney: Wolter Kluwer Health.