Quality of Life and Functioning - Essay Example

?A. As the caregiver for a terminally ill patient, my perceptions about the quality of life and health promotion would strongly affect my care for the patient. According to Bahrami, Parker, and Blackman (2008), the nurse must have a similar perception for quality of life for the nurse to adjust the care to fit the patient’s unique needs. The difference in the perceptions for quality of life is important. For example, if the nurse has a lesser perception of the quality of life compared to the patient and the patient’s significant other, the nurse would be content to care for the patient as ordered without taking the initiative to resolve the emotional issues that afflict both the patient and her family. On the other hand, if I had a similar perception of quality of life with her family, we could discuss their problems, giving me a chance to help them get through with the ordeal. It becomes easier to empathize with the patient while she accepts the fact that she is dying, and it allows me to help ease the journey for her and her family. B. Palliative care is all about improving the quality of life for patients undergoing a terminal illness and are expecting death. Researchers from the Dana-Farber Cancer Institute in Boston published a report which identified factors that greatly affected patient’s quality of life at the end of their lives. Two of the most powerful determinants of poor patient quality of life were dying in a hospital or being admitted to the ICU during the last week of life. No patient wants that, and considering how the patient does not have much in the way of money, additional hospital costs would severely stress the family. A good strategy would be to prevent these by keeping the patient home while assessing him regularly for complications which should be promptly treated before the patient would need to go to the hospital. Another thing that impacts the quality of life would be the patient's level of worry at the beginning of care. As a nurse, we must dispel the patient’s worries and fears by providing them with information and offering to them your help as a nurse. Try to forge a therapeutic alliance with the patient to make them feel like they are being taken care of holistically. Lastly, religion plays a large role in many people’s lives, and during the end of life, many people would like to talk with a religious figure such as a priest or pastor before they pass away. Bringing in a pastor at the request of the patient could help ease the feeling of dying with the thought of her God watching over her and her remaining family. Religion could also help the family cope with the situation (Nordqvist, 2012) C. Pain and fatigue from the treatment and the stresses of her illness cause Mrs. Thomas to lose the ability to care for herself, and this problem can only get worse over the course of her illness. She needs to find ways to make taking care of herself easier, and find other ways to do help her husband and family do it for her once she reaches the point wherein she can no longer do it herself. Pain is a major deterrent to the patient’s ability to perform her activities of daily life. This pain caused her to lose her job, and her insistence on not taking the pain relief medication leaves her crying in the daytime. Reducing the pain nonpharmacologically would really help in increasing Mrs. Thomas’s functionality. There are many nonpharmacological pain methods that could be done by Mrs. Thomas or with the help of Mr. Thomas. Massage and backrubs are can be very effective when done correctly. Teaching this to Mr. Thomas would allow him to care for his wife when she needs help with the pain. Since Mr. Thomas has to work, there would be times wherein Mrs. Thomas would be left alone. To handle the pain during these times, she can apply warm and cold compresses to the painful areas, and if she has trouble sleeping because of the pain, she can try to reposition herself to find a comfortable position. Diversional activities can also help, especially if they are done in combination with other treatments such as massage. These diversional activities can be soft music, television, meditation, aromatherapy, and whatever entertains the patient. These methods reduce pain by promoting relaxation and helping to refocus the attention of the patient on more pleasant things. For severe pain that cannot be affected by nonpharmacological means, to appease the concern of the patient regarding addiction, the nurse can suggest to her to ask her doctor for a non-opioid pain reliever such as aspirin, or some other NSAID. The problem with these is that they can affect only mild to moderate pain. If she really needs a stronger pain reliever, the patient must be taught on the pros and cons of her opioid analgesic, so she can make a better informed decision regarding her usage of it to relieve pain (Berman, Snyder, Kozier, & Erb, 2008; Deglin & Vallerand, 2008; Doenges, Moorhouse, & Murr, 2008). Fatigue can also severely limit the patient’s ability to care for herself, though most fatigue would be caused by pain, when the pain goes away, the fatigue would usually go too, but in case there would be other causes of fatigue for the patient, the nurse could help the patient plan her activities to allow for rest periods, while involving the patient and her family in the planning; the nurse can also help the patient change the environment to make activities easier for her such as using a urinal at bedside as opposed to going to the toilet, or keeping the bed low, or adjusting the lighting in the room to help her sleep more, etc. By involving the patient’s family in the care of the patient, the patient will not lack for care even when she reaches the point when she can’t care for herself (Doenges, Moorhouse, & Murr, 2008). Once Mrs. Smith can no longer care for herself even with the adjustments to make everything easier, it is unavoidable that there should be someone to take care of her at all times. A system wherein the whole family helps take care of her would be best. A shifting schedule, adjusting to the availability of the family members would ensure that there is someone at the bedside at all times; the nurse can offer to train the rest of the family members in giving care to the patient such as serving a urinal, giving sponge baths, changing clothes, feeding, etc. If the patient requires special equipment such as a suction machine, or other such devices, there should be trained personnel to operate it, but the older family members can be trained on the basics, but it is more reliable to make sure they have the contact information of professionals who can operate medical equipment, in case of problems. Medication instructions have to be given clearly and must be written down so that no one will forget. Aside from the personnel for the equipment, the family must also have the numbers of the patient’s physician, the community nurse’s and emergency services, in case there are problems. D. Mr. Thomas’s depression at his wife’s predicament is clearly a case of interrupted family process r/t his wife’s condition augmented by the modification in the families’ finances. There is a great amount of stress for him to provide for his dying wife while he is also stressed by the fact that he is going to lose her soon. This stress also stresses Mrs. Thomas, which makes her condition that less bearable. Helping Mr. Thomas with his depression can benefit both of them. As the community health nurse, we can encourage the couple to maintain continuous open dialogue to facilitate in the problem solving of how they can cope with the situation; during these discussions, the nurse can also put in valuable information to help them reach informed decisions as to what they should do at this point of their lives. Aside from open communication, the family must also be encouraged to make contact with each other regularly to make them feel warm and closer to each other (This advice should also be applied to their children, if possible). During these open talks, there might be strong emotions involved such as anger. Encourage them to express their anger since this indicates them moving forward with the grieving process. If the anger is directed toward the nurse, do not take it personally to maintain the distance between nurse and patient. Most importantly, involve Mr. Thomas in the care of Mrs. Thomas. This teaches him to take care of his own wife, and the frequent contact will keep them closer together and will help make sure the plan of care will be followed (Doenges, Moorhouse, & Murr, 2008). References Bahrami, M., Parker, S., & Blackman, I. (2008). Patient’s quality of life: A comparison of patient and nurse perceptions. Contemporary Nursing, 29(1), pp. 67-79. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18844544 Berman, A., Snyder, S., Kozier, B., & Erb, G. (2008). Kozier & Erb’s fundamentals of nursing: Concepts, process and practice (8th ed.). Upper Saddle River, NJ: Pearson Education, Inc. Deglin, J., & Vallerand, A. (2008). Davis’s drug guide for nurses. Philadelphia, PA: F. A. Davis Company. Doenges, M., Moorhouse, M., & Murr, A. (2008). Nursing diagnosis manual. Philadelphia, PA: F. A. Davis Company. Nordqvist, C. (2012, July 9). What improves quality of life for dying cancer patients? Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/247602.php Read More