This paper with be focusing on case scenario 3. The patient in this scenario is Jennifer Vaughan, 34. She lives with her partner William, has no children yet. They have two pet dogs. Her parents live an hour drive away and see her father once a week. Her parents have no history of cancer. Jennifer presented to hospital with abdomen pain and fullness. After laparotomy, it was found that Jennifer has carcinoma of right ovary which was followed by right oophorectomy. Three months after her early treatment, she was diagnosed with lymph node metastases on her right groin which means her disease has spread and cannot be cured.
Jennifer will now be in palliative care setting, where the main aim is symptom management and deliver quality life. This concept includes many subjective elements such as physical, emotional and social function, cultural, attitudes to illness, patient’s daily living activities including communication with the family. However, in the following paragraphs, issues relating to Jennifer’s situation such as physiological, psychological, social and spiritual will be discussed briefly.
The issues mentioned above will also demonstrate the complication of Jennifer’s experience and how the Registered Nurse (RN) is effectively able to care holistically while making sure that all care provided is of high ethical standard. Firstly, from the case scenario, the physiological issue of Jennifer include symptoms such as nausea, vomiting, abdominal pain, fatigue, anorexia, weight loss, constipation and difficulty in ambulating. According to Farrell and Dempsey (2011) the symptoms of ovarian cancer include increasing abdominal pain, pelvic pressure, bloating, indigestion, flatulence, gastrointestinal symptoms.
The assessment and management of pain in the palliative care setting is the most significant role of RN in order to provide comfort and ease the death of the person, at the same time maintaining the dignity of the person who is dying. Pharmacological intervention to manage pain at the end of life can include use of appropriate dose of opioids and other co- analgesics depending on the intensity of the pain that can be determined by use of pain management tool (Ferrell, Levy, and Paice, 2008). Side effects of opioids can include conditions such as constipation, nausea, and sedation.
Prevention and management of such side effects can also often improve the quality of life of the person. Intervention to manage nausea and vomiting which is the consequence of malignant bowel obstruction in advanced cancer can be treated by use of antiemetic medications and also by use of venting gastrostomy tube instead of nasogastric tube as suggested by Lynch and Sarazine (2006). The advantage of this type of tube is that it helps to decrease the episodes of vomiting in the patient, decrease compression on other organ and also provides some comfort to drink and eat liquid at the end stage of life (Lynch and Sarazine, 2006).
The nurses need to educate and advocate the patient and patient’s family member about frequent oral hygiene, because of the advanced bowel obstruction nutrition and hydration can bring more complication, eventually decreasing the level of comfort in the patient. In such cases, the nurse can provide support, grieving the loss of interacting with the patient in association with food that symbolises the sign of life (Lynch and Sarazine, 2006). This can help both the patient and family to calm down psychologically and cope accordingly.
Non pharmacological interventions include repositioning to prevent pressure ulcer which may relieve the discomfort or pain (Searle & McInerney, 2008). Quality of life at the end stage of life is highly correlated with the number of physical symptoms experienced following psychological distress argues Lockwood-Rayermann (2006). Therefore management of physiological symptoms along with psychological, spiritual and social needs can meet the holistic approach in order to provide optimum comfort.
Relieving the distressing symptom can also provide support to the family being their perception of ‘good death’ or ‘bad death’ influences their grief reaction (Searle & McInerney, 2008). Secondly, psychological issues in Jennifer’s case include aspects such as the non curative disease like ovarian cancer can become very stressful. At the same time, absence of parents and increase level dependency can create feelings such as being burden, and infertility leading to depression, anxiety, fear, hopelessness and confusion.
Changes in her life as well as the family daily life and altered sexuality can also have impact on psychology (Lockwood-Rayermann, 2006). In order to manage psychological issue, the physical symptom should be managed, nurses be able to from the therapeutic relationship (communication, active listening, attentive, being there with patient, reassurance, developing trust) between the patient and with patient family, supporting the patient in the homely environment (Craven, 2000).
Management of the psychological and emotional issue of Jennifer is very important in terms to provide comfort and quality of life till the end of her life. Emotional distress can alter the way of thinking, feeling and behaviour in response to diagnoses, prognosis, treatment and relationship with family members (Legg, 2011). Every human being has a sexual need and even patients with advanced cancer. Anxiety, depression, despair, feelings of social isolation, lowered self-esteem, fear of rejection, loss of control over bodily functions, and so on may also affect one’s expression of sexuality.
To help manage these kinds of symptoms and provide quality of life, assessment and good communication skills are important to formulate therapeutic relationships, thus allowing patients to feel easy and open to share their feelings. As well as nurses need to possess appropriate knowledge, skill and high level of sensitivity in dealing with patient’s sexual health needs. According to the research, positive behaviour by the nurses or care givers is associated with psychological wellbeing and positive health outcomes in patients with cancer (Legg, 2011).
Health care professionals that use empathy, understanding, and reassurance contribute to positive psychological outcomes for patients eventually the Patients feel supported in a holistic approach that focuses on their quality of life, relationships, and social situation. Thirdly, the social needs of the patient are also co-related to provision of holistic care to the patient in end stage of life. Social aspect of cure in case of Jennifer can include relationship with her partner, her parents, employment and finance. Cancer is not a disease of an individual but disrupt the family system as well.
Significant changes in relationship with family and friends and weak relationship with health care teams can result in feeling of isolation or loneliness (Lockwood-Rayermann, 2006). Intervention to social aspect can include open. The nurses can help the family member that the emotional stress and behavioural change is not uncommon during illness and these problems can be overcome by support and patience. It is certain, that the social support can help people to cope with psychological effect of cancer and help to promote physical recovery.
The nurses should give emphasis in communication between the patient and family and the support they received is with respect to their treatment choice (Mystakidou, Parpa, Tsilika, Kalaidopoulou, & Vlahos, 2002). Finally, various aspects of spirituality play a significant difference in improving the quality of life in end life. Spiritual wellbeing is especially awakened at the end of life as patients seek purpose and meaning (Legg, 2011). In case of Jennifer, as she is not being able to cope with her present condition, she can feel loss of self identify, regret, guilt, suffering and death, of whether her life has made a difference.
These are related to suffering or spiritual distress leading to isolation and seeking meaning of life. Nurse can help Jennifer to cope spiritually by performing spiritual assessment and identifying her spiritual needs. Management of spiritual distress by nurses can include the companionship and support in the journey of search of meaning inclusive active listening and connecting which is the valuable part of the human journey to wholeness and peace at the end of life (Campion, 2010).
In conclusion, taking care of the patient as end stage of life by nurses can play a very critical and challenging part of career in order to provide holistic care to the patient. Although, if we are not able to completely manage all the symptoms of the patient with end stage of cancer, several strategies can be applied to promote patients quality of life till death of life arrives. The above mentioned paragraphs has clearly demonstrated the interconnection between all the issues and nursing intervention that can have great positive influence on the patient’s end stage of life and also to patient family member.
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