Holistic Symptom Management - Assignment Example

The principle of holism is centred on the growing idea of the interrelatedness of the mind, the body, and the environment. It has often been the custom to treat somatic symptoms in isolation, neglecting the rest of the person (Wilder, 2005). When considering a holistic assessment of a patient's needs, this should include attention to physiological, mental, emotional, and spiritual health (Cutcliffe, et al., 2001). The decision to investigate holistic symptom management comes from the authors experience as a carer; she has found wards filled with lonely patients who have no one to whom they can express their fears and concerns about their illness. They are often treated physically and left by themselves to cope psychologically with little or no social intervention. The author has also experienced constipation and intense nausea & vomiting and understands how unpleasant and distressing these problems can be. Nausea and vomiting contain a churning feeling in the stomach and of a cold sweat that washes the body just before the emetic event. Nausea and vomiting also leads to fatigue, anorexia, insomnia and immense disruption to daily living. Accompanying constipation is pain in the stomach and strain as a person attempts (and often fails) to expel the stool. Constipation can cause considerable discomfort and the individual may experience abdominal pain, a full feeling and abdominal distension. There is loss of appetite accompanied by a headache, which can lead to nausea & vomiting. This essay will explore the symptom control of constipation and nausea & vomiting from a holistic perspective, which addresses both the physical symptoms of the condition as well as the mental, psychological, and spiritual problems that might accompany them. A symptom can be defined both on the physical or psychological level (Dodd et al., 2000). It is the change in a person's condition that arises from a disorder that has made itself evident in the patient's situation. However, symptom management does not consider the symptom as merely a side effect of the disease, but understands the immensity of the impact that it might have on the patient that suffers with it. In fact, the notion of symptoms might be expanded to a three-dimensional experience, and these symptomatic experiences are comprised of psychic, physical, and social parts (Parker, et al., 2005). As a result, the management of symptoms is also comprised of more than one part. Beyond the physical, the psychic aspects contain affective, cognitive, and spiritual components (Hallenbeck 2003). The affective components have to do with the feelings the patients have while illness persists: anger, sadness, embarrassment, etc. whereas mental and cognitive symptoms occur as a means of organizing the experience into a meaningful framework (Hallenbeck 2003). The spiritual component denotes a deeper meaning attached to life and the situation-a meaning that has been triggered or otherwise influenced by the onset of the illness. During the holistic management of these symptoms the nurse engages the patient in these dimensions (Dodd et al, 2000). The diagnosis of constipation is based on symptoms, and it is often difficult to know the causes of the problem as well as how it will progress (Yates, Day & Mullany, 2004). Individuals studied have described the symptoms of constipation in terms of "bloating, cramps, excessive flatus, nausea, abdominal tightness, urges, generalized aching, and needing to be near a toilet at all times" (Koch & Hudson, 2000, p. 524). Constipation may be a delay in the passage of faeces through the colon, referred to as colonic constipation, or it may be a prolonged retention of the faeces in the rectum, which is known as rectal constipation or dyschezia. The causes of constipation are many and varied and include psychological conditions such as anxiety, depression and emotional conditions. Constipation can also result from lack of exercise, not drinking enough clear fluids, from a diet that does not include an adequate amount of fibre-rich foods or from habitual use of laxatives. Certain medications such as opioids, which are given for pain relief, can also cause constipation. In treating constipation, it is important to note that the precise meaning of the term differs among individuals (Zhan, et al., 2002). While some might use the term constipation to denote the difficult passage of stool, others might use the term to mean infrequency of bowel movement. In such cases, the nurse must become familiar with the exact nature of the problem. Kamm (2003) suggests the patient may be unaware that while it might be normal for one person to have a bowel movement every 24 hours, another might be within normality range at one bowel movement every 36 hours. A comprehensive history that includes determining the frequency and effectiveness of bowel movements is essential in treating the condition. Bowel function has been considered as having a bearing on a person's quality of life (Isenring, Bauer, & Capra, 2005), and 95% of all cases of constipation are idiopathic (Family Practice News, 2003). Constipation might result from reluctance to defecate, and reasons might range from complicated physical illnesses (Pars & Ragu et al., 2002) to something as "simple" as the occurrence of a stressful event. It may also be related to unfamiliarity with toilet areas or embarrassment. The nurse must ensure privacy is respected at all times, closing bathroom doors or ensuring that the bed is screened. The call bell should be placed within reach of the patient and the nurse will remain close by for immediate assistance when required. A nurse is in a position to converse with patients, and one way in which he or she can enhance holistic treatment of constipation is to determine reasons (if any) why a patient may display reluctance to use the toilet. Talking to the patient will assess these possible causes and contributors, and lead to a possible solution of the problem through knowledge of its truest source. Interpersonal communication skills are essential in this instance. Empathic listening assures the patient that the nurse understands how the patient feels. The use of probing questions not only accesses further information that the nurse might use to help manage symptoms, but it also reinforces the nurse's interest in and attention to the patient (Larson et al., 1999). It may be possible to achieve holistic management through the nurse helping the patient locate any psychological contributors to the symptom and aiding also in the alleviation of fears concerned. In addition to this psychological aspect of the treatment, a nurse will also be attentive to the diets of patients with constipation problems. Increases in dietary fibre, increased fluid intake and regular exercise and activity have been considered healthy ways of ameliorating the condition of constipation (Mller-Lissner et al., 2005). This attention involves taking care in gently speaking with the patient about the necessity and desirability of these types of food while administering such dietary treatment. Ambulatory considerations are also a way to improve not just the bowel function of the patient but general health. The nurse will regularly visit patients who suffer from constipation and skilfully allow them to become mobile. While attending to and minimising the pain of the ambulatory efforts the nurse will be treating the patient in a holistic manner, as this mobility addresses not just the problem of constipation, but also cardiovascular and muscular conditions. It might be the case that the nurse must perform an enema for the immediate relief of current constipation or impaction. An enema is an immediate solution to the difficulty of constipation or faecal impaction at hand. The nurse will realise, however, that it is not a long-term solution to the bowel problem and it should not be treated as such. The nurse must explain what is involved in the procedure before it is performed, including which position to assume and the length of time to retain the solution. This will include ensuring that consultation and treatment occur in an environment of enhanced privacy. It is also important that the patient be made aware that confidentiality is being upheld throughout the process. Communication is necessary between the nurse and the patient, so they are both aware of what each considers privacy (Bck & Wikblad, 1998). The nurse's encouragement and availability will be one of the best holistic treatments in cases where another condition is the source of the constipation. In this case, the patient might find it difficult or undesirable to locate and ingest foods that will alleviate constipation. If the patient has a bladder condition and associates the fullness of the bladder with pain, this might cause him or her to limit fluid intake (Gomolin et al., 2001; Al & McKay, 2001). In such cases, the nurse will provide treatment not just through the administration of the proper foods, but also through giving the patient confidence that the nurse will be available in the event that the patient needs to go to the toilet. This will be physically beneficial to the patient, but its holistic value will lie in the dual consideration of the patient's physical and psychological concerns. The patient will not have to worry (psychological) about the pain (physical) that comes with over-filling of the bladder, and relief of constipation (physical) will also occur alongside this. Holistic treatment of constipation involves the monitoring of patients who are taking laxatives and calming fears they might have about becoming dependent (Mller-Lissner et al, 2005). Again it is important that the nurse see patients as individuals who display different thresholds for the dependence on drugs. In some cases, where patients might have a small likelihood of physical dependence (Koch & Hudson, 2000), care will be taken so that the patient does not consider this the only method of treatment for the condition. The nurse will also address the emotional problems that might arise as a result of constipation, such as fear of toxicity and stress from any contributory illness that itself might be the main cause of constipation. Reversing the constipation must begin with targeting its cause. Holism is concerned with treating patients individually, taking both their symptoms and experiences into consideration and giving them what is necessary to ease both physical and mental stress. Nausea is a subjective sensation, which should be evaluated by the patient, not by the observer. The feeling is best described as the desire to vomit without the presence of expulsive muscular movements Apfel et al, (2002). Vomiting or emesis is the forceful ejection of stomach or intestinal contents through the mouth or nose or both. Volume and frequency are easily quantified, but the discomfort it causes is subjective, (Rhodes & Daniel 2002). The substance produced is often a frothy, lumpy, chime-like mixture of food and gastric juices, and the amount produced depends on the contents of the patient's stomach, (Garret et al, 2003). Nausea and vomiting accompany a number of illnesses, and of these, treatments for the disease of cancer are often the agents of the nauseating feelings that might lead to emesis (Dicato, 1997). These side effects have been identified as the most distressing of those suffered by patients in their fight against cancer (Olver, 2005). Persistent, unexplained, or recurring nausea and vomiting can be symptoms of a variety of serious illnesses. Overeating or drinking too much alcohol can cause nausea & vomiting; other causes may be due to certain medications, or illness. Nausea and vomiting may also be psychological in origin. Some people vomit under such conditions of emotional stress as family arguments, exams, travel and similar high-stress situations. In addition, some eating disorders are characterized by self-induced vomiting. Nausea and vomiting are also associated with the period following operations (Watts & Brierly, 2001). Predictors of post-operative nausea and vomiting have been shown by (Willetts, Ekangaki & Eden 2003) as including duration of surgery, history of motion sickness, obesity, gender, and history of migraine. Nurses have the ability and opportunity to take into consideration the distressing nature of nausea and vomiting as side effects of chemotherapy, surgery, and pregnancy while treating a patient with one or more of these symptoms. The nurse will be in charge of administering anti emetic drugs prescribed such as haloperidol and metoclopramide and monitor effects and side effects of the given drugs. While administering treatment, the nurse has the opportunity to allow the patient to voice concerns about the situation in which they have found themselves and gently probe to find out the patients perceptions of the symptoms they are experiencing. The nurse must also ensure adequate oral care is carried out as recurrent vomiting can result in loss of tooth enamel, tooth decay, and gum disease. After frequent exposure to gastric acid, teeth become rounded and soft, as enamel is eaten away by the gastric acid contained in vomit. Coleman (2000) advocates that mouth problems left untreated can lead to further problems such as difficulties with nutritional intake, infections, pain, and difficulty communicating, so it is vital that the nurse administers appropriate and ongoing care oral care. Research strongly suggests that cognitive treatment of patients is a part of a nurse's holistic symptom management (Brown, 2002). It is possible and helpful for nurses to let patients know as far as possible how and why their symptoms have occurred. During the initial stages of the patient's care, the nurse is able to educate the patient on the possible reasons for the post-operatic or post-chemotherapeutic nausea and help them learn behaviours that will minimise the nauseating effects of their treatments. Care should be taken by the nurse to ensure that the patient has minimal exposure to noxious stimuli such as the odour of emesis, strong perfume, the sounds of retching or gagging or the sight of unpalatable foods, etc. as these may induce the experience of nausea & vomiting (Thompson 1999). Whole patient assessment forms the basis for good symptom control. A thorough knowledge of the etiology and pathophysiology of nausea and vomiting along with an assessment of history symptom duration, frequency, and severity characteristics of vomiting episodes will assist the nurse in developing strategies to suppress or eliminate symptoms. In one case noted by the author during a recent placement, a post-operative female patient felt embarrassed when one of her bouts with nausea led to a vomiting episode that left her in a messy and odorous situation. It was important in this situation that the nurses' behaviour conveyed assurance and sympathy without disgust at such episodes that were unpleasant for both patient and nurse. This patient was averse to movement because of the increase in the violence of the nausea that motion caused. When the patient was able to perform movements, the nurse gave encouragement and praise in order to lift her spirits. This helped improve her overall mental state through the knowledge that she was getting closer to moving on with her normal life. Taking the time to talk to the patient pre-operatively allowed for probing her history and ascertaining whether such predictors of post-operative emesis existed, such as previous vomiting after operations, susceptibility to motion sickness, and/or a history of migraines. Haworth & Dluhy (2001) believe effective symptom management strategies depend on accurate assessment based on client history. In assessing the patient pre-operatively, it allowed the nurse to inform the patient of the increased risk of post-operatic nausea and vomiting. This enabled the patient to prepare herself mentally for the possibility, and this proved a helpful holistic treatment when the possibility of nausea indeed became a reality. Informing the patient about possible improvements through diet changes (Chimbira & Sweeney, 2000) and offering help in making dietary choices added to the holistic and organic treatment of the symptoms of nausea and vomiting, by giving more choices with regard to food and palate thus reducing the stress of dietary restrictions. The multiplicity of reasons why such symptoms as nausea & vomiting and constipation can occur has made it necessary that nurses be aware not just of the physical (though those are many) but also psychological causes of these conditions. Hinging on this is the fact that the management of these symptoms must go beyond just the physical level if a holistic solution is to be achieved. This research has shown that constipation, the large proportion of which is idiopathic, can be the result of factors such as fear, anxiety, and stress. Future nursing practice that addresses constipation can therefore adopt methods that locate and alleviate these psychological stresses. Nurses can talk to their patients about their fears, and also about their diets and overall lifestyle in ways that will educate them about the overall health of their whole person. A similar approach can be taken where patients with symptoms of nausea and vomiting are to be treated. The nurse can encourage dietary changes that include the benefits of foods with ingredients related to those that have been shown to reduce the effects of nausea. Such methods as massage and reflex therapy might also be included in future treatments wherever possible. In addition to these measures, a holistic approach to therapy would also include the allowance and encouragement of social and spiritual interactions and expressions by patients who might consider these as important to enhancing their quality of life. (2745) References Apfel, C. C, Roewer, N., Korttila, K. 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