As a registered nurse of only three years, I am often referred to by my peers as a “baby” nurse. However, in those short three years of practice I have learned and continue to learn many things whether medical, personal, or humanitarian. My personal nursing experience has been in surgical care services. The vast majority of the patients I have cared for are those undergoing elective procedures. They have chosen to have joint arthroplasty or some other type of procedure.
I have also had the great fortune to care for those who have been diagnosed with terminal illnesses such as cancer and leukemia. Many times I see these patients in the infancy of their disease process, but I also see them on a continue basis during treatments such as blood or platelet transfusions. The difficulties faced by patient s such as these are varied and bring with each a different set of needs to be assessed and addressed. You become not just a nurse but a caregiver, advocate, therapist, and more often than not a friend.
It is when working with these patients that the dynamics of quality versus quantity of life become central to care. In many cases family concerns, whether well meaning or not, may overshadow the patient’s wishes. Our selfish need to keep loved ones with us can blur the line as to the patient’s own wants and needs. In dealing with this you must also assess your own beliefs as to end of life decisions.
My role as a nurse must be to advocate for my patient, to develop trust in the relationship, and to follow through with their wishes. All the while promoting compassion in our interactions, In this case scenario, there are three strategies in which I would implement to address Mrs. Thomas as a patient. After assessing the patient and her situation referrals should be made for therapy modalities both physical and occupational, home health, and psychological/mental health for both Mrs.
Thomas and her spouse/caregiver.
Physical and occupational therapy could evaluate Mrs. Thomas and initiate a plan of treatment to increase stamina and range of motion to keep the patient at an optimum level of functioning. Physical improvement even in small increments can have a positive effect on the patient’s outlook. Home health could evaluate Mrs. Thomas and her need for pain control as well as her fear of dependency. Education at this juncture is imperative to patient outlook as well as outcome of treatments. With pain management in place, physical therapy could progress, thus increasing the level of patient participation. Also a mental health/psychological referral could be invaluable to both Mr. and Mrs. Thomas. Mrs. Thomas could be assisted in working through and understanding the stages of her illness, as well as her depression and sadness concerning her family relationships.
It could also help Mr. Thomas with his depression and allow them both to connect with support groups or individuals within the community with whom they can share experiences. One of the best resources for breast cancer patients is the Susan B. Komen Foundation. As a certified breast cancer educator, I have had the pleasure of working with both survivors and their families. Education is very important to all concerned in a medical diagnosis of breast cancer. Understanding of the disease process and its effects are also essential to a healthy outlook. The Komen Foundation offers support to patients, survivors, caregivers, and family members. It would be an excellent resource in which both Mr. and Mrs. Thomas could receive individualized treatment and support.
The team approach is also necessary for working with patients, families, and caregivers. As a nurse you must accept that an individual cannot meet all patient needs so you draw upon other health care professional s to accomplish the highest levels of care.
A wide variety of team members can be utilized in the care of the Thomas’. Physicians who offer direct clinical care and disease pathologies, social workers/clinical case managers who can assist in community resources as well as their knowledge of insurances, spiritual leaders to aide in dealing with final decisions and spiritual needs of the patient and family, pharmacists who assist with a wide array of pharmacological treatments for pain and symptom control, dieticians can be helpful in counseling with meals, nutrition, supplements, and hydration. Other team members may include physical and occupational therapy, psychologists, and perhaps even volunteers to assist in the home and with errands.
The needs of Mrs. Thomas and her family will continue to fluctuate as her disease progresses. It is important for the team to stay abreast of these needs and adjust plans of care accordingly. At some point hospice services may be called upon and continued through death. This can be provided at home or on an inpatient basis.
Initiating a plan of action can alleviate stress from both the Thomas’. Mr. Thomas may feel that some of the caregiver burden has been lifted and this could aid in the treatment of his depression. This in combination with medication could be the keys to initiating successful treatment. If a psychological evaluation is needed due to the possibility of suicidal ideations, then immediate intervention is warranted with a crisis facility. Especially if there is deemed eminent danger of self harm.
With pieces of the clinical puzzle in place, the Thomas’ can be assisted with as much compassion, dignity, and support as possible to meet their needs in both the short and long term.