I have recently been involved in the care of Mrs. XY who initially presented at accident and emergency (A & E) complaining of pain and weight loss. She was referred by the hospital doctor for an ultrasound, which suggested that Mrs. XY had cancer. According to Joanna Briggs Institute (2008), health professionals are consumers of research aside from the individuals who use the health care system. Indeed, as medical nurses, we are exposed to a huge amount of evidences and information on a regular basis. This requires the need to understand the value of these evidences and apply them accordingly. Rather than simply taking evidence on the basis of “face value,” healthcare providers are obliged to process the evidences, practice them and arrive at pertinent nursing decisions which will affect both the quality of nursing task as well as the quality of life of the patient. In this way, nurses are required to contribute to better patient outcomes. As such, the very last thing that a nursing practitioner could do is to commit a mistake which may have consequences not just for him/her but also to the patient.
Evidence-based health is crucial. It is critical for medical nurses to acquire evidence-based practice skills and to continually improve these skills in order to keep pace with the changing medical environment. Furthermore, these skills are significant in dealing with cancer patients, as the aim is to sustain the quality of health of patients despite their conditions. In this essay I will use the reflective model: a concept of reflective practice that is becoming more popular among practicing nurses due to the interplay between internal and external aspects of medical nursing (Johns, 2000). Johns (1996) notes that using reflection in practice underpins a framework guide for nurses. Reflective assessments will be based on the case of Mrs. XY.
Inherent for nursing intervention strategies is the necessity to improve the quality of life of the patient (Rustoen et al., 1998). Personally, I felt like it is high time for changing the mindset of nurses when dealing with cancer patients. Although I am always trying to be objective about my work and the environment I had to deal with everyday, there are instances that I deceive myself. It is hard to work with cancer patients especially in dealing with those who are in the diagnostic phase, seeing all the rollercoaster of emotions that confront them and their families. Nonetheless, I learned that these emotions could work at the advantage of the families of cancer patients. But with maladaptive reactions, these could work against the patient herself. In the case of nurses, there could be also adaptive and maladaptive reactions but there must be a balance in between these reactions. Mrs. XY who, unfortunately, embraced the exact opposite of fatalistic beliefs, denying the disease that confronts her. She believes that nurses have a great deal of influence and power over whom we care for, despite the intricacy that a patient could be influenced. The sad part is that she has her own decisions to against medical advices.
Treatments were not forced upon her instead the doctors, with the support of families and friends, adviced that she should undergo a psychotherapy treatment first. One thing that I have learned during my clinical placement is that healthcare professionals must have evidences that will support the course of treatment. Evidence-based health functions as the process of adhering to the best practices means to integrate individual clinical expertise with the best available external clinical evidence from systematic research. Simply, medicine values evidences over opinion should be prioritised (Pearson, Field and Jordan, 2007). As for me, as a part of a multidisciplinary team approach that provides the most appropriate care to cancer patients, I came to know that there are two repertoires of skills to learn: ability to examine evidence related to the propose course of treatment and ability to apply evidence in practice.
One of the basic concerns of the Mrs. XY is her employment. Mrs. XY is an employed, single mother with two sons. Mrs. XY already acquired special anxieties upon learning about the cancer, with concerns centering on her abilities to function adequately after the treatment. LeMura and Von Duvillard (2004) relate that cancer and its treatments often result in significant reductions in quality of life. Expressively, the decline in the physical function is due to the cancer itself and these declines in physical functioning may, in part, also underlie some of the psychologic and emotional dilemmas of the cancer experience. I proceeded to explain to Mrs. XY that although her healing process was going to be slow, her decisions would lead to significant developments. Mrs. XY, the doctors and the nursing staff agreed to offer her a variety of conservative treatments and decide which would be the most appropriate for her condition. I would like to believe that gradually she is accepting her fate, as evidenced by her changing attitude toward the situation. Based on my observations, she starts to abandon the depressive emotions and anger with regards to her situation. Ethically, I realize that I cannot force my views and beliefs of health behavior on to Mrs. XY. As she has the right to decide for herself the course of action she want to take as long as she has all the information and facts that will help her make informed decision.
I now came to understand that nurses play a gatekeeper role when dealing with cancer patients. This is because nurses serve as instruments of mediation between doctors and the patient while also being the confidante of the patient when doctors are away. Nurses are place in order for the patients to better understand and accept their illnesses and diseases as they can urge patients and their family members to consider the possible effects that cancer and its treatment may have prior to implementing treatments. Yarbro, Goodman and Frogge (2005) are correct when they said that cancer nursing is a physically, emotionally and mentally demanding job. According to them, nurses are often asked to anticipate changes that patients and families may need to take in their lives in response to the cancer experience. Further, nurses are encouraged to help patients and families prepare for treatment and anticipate what work-related adaptations might be needed.
By the time that Mrs XY acknowledged that she needs help, I offered her informations to make her aware of the potential difficulties and to aid her to think about the possible solutions and plans ahead. I informed her and her family regarding the interventions that we can provide her the type of cancer treatment and coping strategies, and also the intervention for strategies that she will need and might need in the future. In order that the care alliances will gain her confidence, I also disclose to her the pain management methods that we could implement. All these things I presented to the patient and her family is part of the process to prompt the family to discuss and consider options that could possibly maintain the family status and prevent financial vulnerabilities. Yarbro, Goodman and Frogge (2005), also made mentioned that the cancer patients and family members should be encouraged to consider who has health insurance benefits and how the treatment, both short and long-term might affect employment Yarbro, Goodman and Frogge (2005).
Based on my readings, I have learned that there are specific practice principles that medical nurses should engage into when dealing with cancer patients. I followed the advice of Suinn (1998) of acknowledging the sentiments of people with cancer. Coupled with closely adhering to the protocols of the hospital, I provide emotional support to address fears and anxieties about cancer and provide education for Mrs. XY to obtain and know how to actively request for factual information about cancer and treatment both for the patient and the family members. This is their first time to actually go through a process of cancer experience although there are other relatives who are also cancer survivor. In addition to this, I and my mentor, offered coping strategies for stress management and general adjustments although I don’t know if what I am doing are effective enough at least for this case. Of course, I am not dealing with this aspects without the consent of the doctors and the patient herself. Next, I implicitly joined in their decision-making while also providing the patient with meaningful general psychotherapy goals. Lastly, I had the opportunity to enable the family members to receive similar opportunities for their own adjustment so that they can relate with Mrs. XY.
Such actions were done so that Mrs. XY and her family are provided with the best alternative that would not leave them physically, emotionally and financially exhausted. The cancer experience itself is already a toxicating event for the patient and the family and so a more proactive approach intended for dealing with inevitable changes should be considered. Further, there is yet another stuff of the cancer experience I know that I could contribute effectively, about the ‘legal aspect’ of cancer. It is essential for us as a nurse to be aware of the protections and provide patients and families with the information about their rights and legal protections. As such, as the allocated nurse, I helped Mrs. XY with planning the time she needs to be away from her job in order to maximise the benefits of health policies. While these things are ongoing, with permission from the physician and her psychotherapist, I have decided to document the patient’s illness for her employer.
While interfacing with Mrs. XY and the family, I learned that Mrs. XY has private health insurance policy, with Bupa Health Insurance Company and could help in covering the costs of Mrs. XY temporary unemployment whilst in the hospital care. So, I helped her understand what the policy covers for her and reviewed the actual contract. The documents, I figured, could be sent to Mrs. XY’s healthcare insurance provider including informations about the benefits and medical appropriateness. With what I did, I also figured that it is unavoidable for a nurse to take a leadership role in assessing the needs of not just the patient but also the family and offering the best possible solutions onward long-term medical requirements. Nurses also need to recognise the needs of the family thereby help them prepare for the immediate and ongoing requirements of care giving (Yarbro, Goodman and Frogge, 2005).
Handling the case of Mrs. XY strikes me as something both rewarding and disappointing. Rewarding because I was able to sustain the needs of the family of the patient simply by means of providing them information on how they are going to cope with the cancer experience as a family, with the mother of Mrs. XY, her aunt and her two sons, and to make the most informed decision that they can. Letting them realise the necessity to stick together and providing Mrs. XY with the understanding of the long-term effects of cancer. Disappointing, on the other hand, because I don’t want to give them false hopes and there are times I think I am guilty of this. Currently, Mrs. XY is undergoing the treatment phase, and in this state that I notice that although she is complying with treatments and medicines, she exhibits certain noncompliance with health-protective behaviours especially when it comes to eating.
With this case as the reference, Corner and Bailey (2008), assert that the complex needs of patients with cancer and their families could be addressed by situating cancer care in the context of society’s attitudes toward the disease and the everyday needs of patients and caregivers. A critical view of cancer care and treatment in lieu with the extended roles of nurses shall put in perspective the cancer nursing ideology. What nurses should understand is that cancer is a disease with many manifestations that occur in the different time and impacting different people surrounding the cancer patient. Likewise, nurses should also understand that the adjustment to cancer depends on the personal meaning of cancer and the perceived threat of death.
Treatment could be particularly difficult for the person directly and indirectly involved in the cancer experience because this may produce unacceptable transition. As a life-changing experience, cancer impacts the family in many ways. Cancer is disturbing that it is even harder to recognise or know how to support. Experience of cancer families, communication within, living with it, interaction with healthcare professionals and approaches to caring for families is deemed a priority. With these said, medical nurses who are working directly with the cancer patients and their families shall understand that the work requires more than just performing a task. If the nurses are determined in sustaining the quality of life of the patients, their families and friend, passion for caring would be most appropriate.
Reference:
Corner, J and Bailey, C (2008), Cancer Nursing: Care in Context, Blackwell Publishing, Oxford, UK.
Joanna Briggs Institute (2008). What is Evidenced Based Health Information?, Adelaide, South Australia, retrieved on 12 December (2008), from http://www.joannabriggs.edu.au/consumer/ci_intro_evidence_based.pdf.
Johns, C (1996). The benefits of a reflective model of nursing, Nursing Times, vol. 92, no. 27, pp. 39-41.
Johns, C, (2000) Becoming a reflective practitioner: a reflective and holistic approach to clinical nursing, practice development and clinical supervision, Blackwell Science Publishing, Oxford.
LeMura, L M and Von Duvillard, S P (2004). Clinical Exercise Physiology: Application and Physiological Principles, Lippincott Williams and Wilkins.
Pearson, A, Field, J and Jordan, Z (2007). Evidence-based Clinical Practice in Nursing and Health Care: Assimilating Research, Experience and Expertise, Blackwell Publishing, Oxford.
Rustoen, T, Wiklund, I, Hanested, B R and Mourne, T (1998) .Nursing intervention to increase hope and quality of life in newly diagnosed cancer patients, Cancer Nursing: An International Journal for Cancer Care, vol. 21, no. 14, pp. 235-245.
Suinn, D (1998). Working with Cancer Patients: Expanding Your Practice, Pioneer Development Resources, Inc.
Yarbro, C H, Goodman, M and Frogge, M H (2005). Cancer Nursing: Principles and Practice, Jones and Bartlett Publishers.
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