Connecting is one of the most important themes in establishing an effective nurse-patient relationship (Johnston & Smith, 2006).
This connection with the patient gives them someone to talk to, someone to listen to them, someone that wants to know them as a person and someone that doesn’t avoid them. These things are often difficult for family and friends to do during the end of life stages because of their own grief and lack of knowledge of supportive measures. The author’s decision to return to school and become a nurse was the result of having a wonderful nurse that did just this.
The author’s 8 year old niece was diagnosed with leukemia and only lived 6 months after the diagnosis. There was nothing that could have changed the final outcome of her niece but the connection that her nurse had with the family changed the way that they dealt with everything. This is something that the author will never forget and inspired her to “pass this forward”. When a nurse has gone through a tragic situation like this, they can remember those large and small things that were done for their loved one and the impact it had.
Being able to bring this life experience to the situation allows a nurse to connect on a deeper level. This connection assists with enhancing the quality of life and will ultimately influence the course of the illness in a positive manner. Keeping the patient as free from pain as possible not only is beneficial for the patient, but is comforting to the family members when they don’t have to watch their loved one suffer as much. This was one of the things that the nurse of the author’s niece monitored closely. She educated the family on appropriate pain management and comfort measures to be used when they brought her home to die.
Peplau (1952) observed the nurse as a fundamental tool for change whilst explaining how powerful the nurse-patient relationship is. The nurse approaches the relationship with understanding and experience obtained personally through their lives but also through their training and work. Generally, it is considered the more training and work experience a nurse has, the more therapeutically effective ...
If the parents had not felt comfortable in their knowledge of how to do this, they would not have been able to bring her home to be with her family in her last days. This education and advocacy for what was best for the family was driven completely by this nurse. The author relates back to this often and because of this insight, strives to deliver this same compassionate care. Regardless of whether the patient wants to die at home or in a hospital setting, the author keeps them as comfortable as possible and advocates for the patient making as many decisions about their care as possible.
Once decisions are made, education and support are the greatest gifts the nurse can give. The nurse needs to help the patient and family understand that there is no right or wrong answer and support them when a decision is made. If a nurse were simply caring for a patient from a clinical standpoint, the patient, family and nurse would miss the opportunity for some very special moments. Strategies There are several things that a nurse can do to improve the quality of life for Mrs. Thomas. There should be a conversation between Mr. and Mrs. Thomas and the nurse on their expectations and wishes for this final stage.
Baohui Zhang had a team of researchers in a Coping with Cancer study that determined patients who were more worried at the beginning had a worse quality of life in the final weeks (Nordqvist, 2012).
To effectively assist them with the choices, the nurse must learn about things that were important to the couple prior to the illness. The goal is to try to redesign the processes of the treatment when needed to allow the couple to independently participate in these as long as possible. Understanding the history and wishes of Mr. and Mrs. Thomas will be of assistance as the nurse develops the care plan for Mrs.
Patient education is best when viewed as a personal way of conducting interpersonal communication between two people: the teacher and the learner. The learning process follows a method that should be apt per case and per person, centering more on the side of the learner and the attached circumstances, context, and environment. For clinical teaching that is bound by dynamic interrelationships and ...
Thomas. Education can begin when the nurse understands the scenarios they have chosen for the final days and why. A second strategy that should be initiated is appropriate pain management. The nurse should determine the baseline pain level of Mrs. Thomas so there will be a reference point as the disease progresses. Education should be provided to Mrs. Thomas related to the fear of addiction to the pain medications. If Mrs. Thomas remains adamant about not taking the pain medication, the nurse should assist her with alternative methods of pain management.
Some alternative treatments are nerve blocks, acupuncture, massage therapy, implanted pain pumps and relaxation techniques with guided imagery (“Pain management,” n. d. ).
A third strategy that could improve the quality of life for Mrs. Thomas is for the nurse to assess and augment the support system for the couple. In addition to struggling with their own illnesses, each of them is worried about the other. Although the sons are not in the same city, arrangements could be made for visual with auditory communication through modern technology such as Skype or Facetime. Seeing Mr. and Mrs.
Thomas could emphasize the seriousness of the situation to the sons as well as comfort Mrs. Thomas. The nurse could also educate them on local support groups and make the initial contact for the couple. Holistic Nursing Action Plan A holistic nursing plan for Mrs. Thomas would begin with an assessment of the physical, spiritual, psychological and social wellbeing of her and her family. After the assessment, the nurse would develop a plan to implement and evaluate interventions in each of these areas. The physical plan would concentrate on pain management, her ability to perform ADLs, and remaining nutritionally sound.
There is no information given about the religious or spiritual preferences of Mrs. Thomas but the nurse should have gathered this information in the initial assessment. Numerous studies have shown that patients seeking spiritual and religious support were associated with less anxiety, hostility, discomfort and social isolation (“Spirituality benefits,” 2012).
The nurse would encourage Mr. and Mrs. Thomas to reach out to members of their church, contact a community spiritual resource or supply reading material for them.
My Personal Support Group Honors English 11 August 31, 1999 I am often sorry that my parents did not take it upon themselves to enroll me in any recreational activities in my preadolescent years. I believe that sports are an integral part of growing up. They provide an opportunity to meet and interact with peers. Numerous occasions I can recall feeling excluded from the group because of my lack of ...
Psychosocial distress is seen in varying degrees among cancer patients and the nurse must be able to determine if these periodic episodes are characteristic of normal adjustment or a more serious disorder. Prompt management of anxiety by supplying thorough education and access to support groups usually decreases the associated symptoms (“Anxiety,” 2012).
Behavioral coping strategies, relaxation training, group social support and cancer educational session produce positive benefits between 57% and 65% of the time (“Anxiety,” 2012).
A patient’s functional ability usually worsens as the disease progresses and measures need to be initiated as early in this process as possible. Stressing the importance of remaining active will benefit Mrs. Thomas emotionally as well as physically throughout the end of life. Because Mrs. Thomas’ pain has worsened, pain management needs to be addressed quickly. Uncontrolled pain is one of the most common reasons that people become immobile. This lack of mobility contributes to further physical deterioration and increased depression. The longer Mrs. Thomas can stay active, the more independent she can be.
This independence fosters a feeling of being in control which would also help her emotionally. Mrs. Thomas may benefit from a referral to a physical therapist to help her develop a basic conditioning and strengthening program. Establishing this relationship early on would also be beneficial because the therapist would have a baseline functional status to compare to as the disease progresses. This therapist would be able to assist Mrs. Thomas in obtaining durable medical equipment (DME) like a walker for the time when she is unable to ambulate without assistance.
The nurse should also assist Mr. and Mrs. Thomas in connecting with various support groups. This would be beneficial to Mrs. Thomas since she does not have anyone that she is comfortable calling on for support. This would help her prepare for the progression of the disease as well as introduce her to a new group of people to interact with. Mr. Thomas would benefit from support groups to deal with his depression as well as how to support Mrs. Thomas. Whether they chose individual sessions, group sessions or a combination of both, Mr. and Mrs.
Effective reflection on relationships that develop in care work Mary is an 82 year old female resident who came to live in our nursing home five years ago she has a mild cognitive impairment and is totally independent she wears an incontinence pad and requires minimum assistance. Mary loves to sing and listen to music especially Irish traditional music and popular ballads. She remains in close ...
Thomas would become less isolated and possibly develop new friendships as a result of this. Changes in nutritional status usually begin shortly after diagnosis as psychosocial issues affect the patient’s desire to eat. When the patient begins chemotherapy, this worsens due to chemo associated nausea, vomiting, and changes in taste and smell. A nutritionist should be introduced to Mrs. Thomas to assist her with developing a meal plan to maintain adequate nutrient and calorie intake. The nutritionist is also able to facilitate outside resources such as Meals on Wheels that can bring Mr. and Mrs.
Thomas daily meals when they are unable to prepare them themselves. Early assessment and recognition of malnutrition risks are invaluable and should be reassessed continually throughout treatment. Providing Care As the end approaches for Mrs. Thomas and she can no longer care for herself, it is time to refer back to the initial assessments where the nurse discussed the long term plans with Mr. and Mrs. Thomas. Some people prefer to stay at home as long as possible with the help of outside providers and others prefer to be in a facility where their family is not responsible for their hourly care. If Mrs.
Thomas wanted to remain at home, the nurse could make the recommendation to contact Home Hospice. Mrs. Thomas would have a team available to her 24 hours a day. This team is typically comprised of a physician, nurse, social worker, chaplain, home health aide and a volunteer. The nurse would make scheduled visits to keep Mrs. Thomas’ pain and symptoms controlled and would communicate back to the physicians. The home health aide helps with personal care such as bathing and feeding. The social worker assists with emotional support and counseling and provides assistance with financial and practical concerns.
They will identify other support services and facilitate communication between Mr. and Mrs. Thomas and the community agencies. Chaplains provide the spiritual support and can assist with the funeral arrangements if needed. It requires a lot of mental and physical strength to care for a loved one that is terminally ill while dealing with their own pain of an impending loss. It is an enormous undertaking when you have several people to help with all that is required, much less when someone tries to do this alone. Since Mr.
The Essay on Principles for implementing duty of care in health, social care or children’s and young people’s setting
1.2 All practitioners have a duty of care all the children the setting, this also includes the staff. A duty of care is where a practitioner has to take care of them and not let them get harmed in any way. This will involve the children attention, watching out for hazards and preventing mistakes or accidents. If a practitioner has not met the duty of care required then they can be held accountable ...
Thomas is the only relative in the area and is still trying to work full time while struggling with his depression, it would be close to impossible for him to care for Mrs. Thomas by himself. Unless Mr. and Mrs. Thomas are adamant that this would not be too difficult to care for Mrs. Thomas at home, there are several hospice facilities that Mrs. Thomas could be transferred to. Inpatient hospice would allow Mrs. Thomas to receive around the clock care and free Mr. Thomas up to sit with Mrs. Thomas in the role of a husband and friend and not be burdened with the responsibility of providing medical care.
Because he is the only person that she is comfortable being around, this arrangement would allow them to have more quality time together and build final memories for him to cherish. Chronic Depression Depression is a debilitating disease and if left untreated, can be life threatening. Mr. Thomas is under a great deal of stress because of his occupation and this stress is exacerbated by of his wife’s deteriorating condition. Either one of the situations alone could cause Mr. Thomas’ depression to worsen but the combination of these two events is very serious.
Any concern about suicidal thoughts should be investigated immediately. If the community health nurse is not comfortable making this assessment, she should contact someone from social services for support. Chronically depressed people, like Mr. Thomas, usually require long term medication and therapy or newer treatments like Transcrannial Magnetic Stimulation to function on a daily basis. Under stressful situations like Mr. Thomas is in, it is imperative that he adhere to the prescribed regimen. Depressed people often get caught up in a vicious cycle.
The extra stress causes the depression to worsen and their ability to function decreases. When they are not functioning optimally, they either forget to take their medication or feel that it is not helping and simply stop taking it. Consequently, the depression worsens and their functioning decreases more and feelings of hopelessness consume them. Once it is determined that Mr. Thomas is not suicidal, the next thing that should be done is to assist him in establishing a routine to take his medication. The nurse could obtain a daily pill box and organize his medication for him.
Evaluation of Treatment for Ovarian Cancer-Induced Depression Research Brief The research study, Depression Treatment and Screening in Ovarian Cancer Patients, (M.D. Anderson Cancer Center website, 2007) was conducted by the M.D.Anderson Cancer Center in collaboration with the Lance Armstrong Foundation and the National Cancer Institute (NCI) on a group of women who were diagnosed with ovarian ...
Making this process as easy as possible for him and putting it in an accessible area will increase the likelihood that he will take it consistently. If Mr. Thomas agrees, the nurse should contact his previous therapist or arrange for him to talk with one if he is not currently established with anyone. He will need someone specifically trained in behavioral health to help him process all that he is dealing with. Most anti-depressants take approximately 30 days to reach therapeutic levels so Mr. Thomas should be monitored very closely during this time. The nurse should also discuss Mrs. Thomas’ concerns and Mr.
Thomas’ situation with the members of Mrs. Thomas’ interdisciplinary team. Extra time can be allocated to both of them as they work through the grief counseling and other supportive interactions. Cancer is a terrible disease that impacts the physical, psychological and social of the patient as well as their family and friends. The community health nurse should take great care in assessing the needs in each of these areas and implementing appropriate actions for all those involved. Although technology is better than it has ever been, it can often be the small things that have the biggest impact in times like these.
The right pillow, the gentle touch, continual reassurance or simply sitting quietly with them may be what really counts. Look into their eyes and their heart and connect with each of them on some level and you will have helped them experience a dignified death. References Anxiety disorders: description and etiology. (2012).
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Nurses’ and patients’ perceptions of expert palliative nursing care. Journal of Advanced Nursing, 54, 700-709. ttp://dx. doi. org/tp://dx. doi. org. wguproxy. egloballibrary. com/10. 1111/j. 1365-2648. 2006. 03857. x Nordqvist, C. (2012).
What improves quality of life for dying cancer patients? Retrieved from http://www. medicalnewstoday. com/articles/247602. php Pain management for breast cancer. (n. d. ).
Retrieved from http://ww2. cancercenter. com/breast-cancer/pain-management Relation of religion and spirituality to adjustment, quality of life and health indices. (2012).
Retrieved May 26, 2013, from http://www. cancer. gov/cancertopics