Counseling Skills in Palliative Care - Essay Example

? Nursing Essay Introduction Colorectal cancer (CRC) is a common and dangerous disease. It is estimated that approximately 143,460 new cases of rectal cancer will be realized in the United States in 2012 (Siegel, Naishadham and Jemal, 2012) including about 103,000 colon and 40,000 rectal cancers. Approximately 51,690 of the American natives are predicted to die of large bowel cancer in the near future. Although CRC mortality rate has been steadily declining, it still occurs as the second most prevalent cause of cancer death in the US. Due to this, the patients are becoming a distress to most families today as well as to the experts such as health care professionals and policy makers, particularly in the nursing profession. Nowadays, caring for cancer patients is becoming more complicated requiring the work of a health professional. This article explains the sickness connected to cancer and the nursing activities done to reduce and prevent the effect of such sicknesses in a 34 year old woman, Frankie, who is suffering from rectal cancer. Issue Identification (Noticing) Typically, oncology related ailments go with persistent health issues. Such illnesses usually have multiple symptoms as were diagnosed in Frankie; she was anxious, and was suffering from further progressive disease in her lung liver and peritoneum. Other ailments found in her were, abdominal distension, leg edema and uncontrolled rectal pain. When such sicknesses are combined, they amplify the care complexity of cancer patients. Nevertheless, early detection of these conditions and their effective management can enable the cancer individuals to become comfortable and responsive to treatment. A formal capacity assessment on admission demonstrated that Frankie was competent according to the Mental Capacity Act (2005) and she has remained competent. Frankie’s husband is unaware of his wives’ expectations and as much as he may need her to stay in a hospital facility and get the necessary care, his wife has different wishes which she would also want her husband to be kept out of it. Frankie says that her husband is ‘already dealing with enough.’ Chronic condition managers of cancer patients direct that they have to live on more than a single medication that has been regularly prescribed. For example, Frankie's drug therapy includes Capecitabine a chemotherapy drug used to treat the rectal cancer, Oxycodone (subcutaneous) and Fentanyl (patch) used to treat the pain, Midazolam to treat Frankie's insomnia and Escitalopram a selective serotonin uptake inhibitor used to manage Frankie's anxiety. In Frankie’s case, the individuals providing for her health care away from the hospital, i.e. her husband and children, are not health care experts specialized in handling her conditions; as an alternative, they are just alimentary health care providers. It is even probable that these health care providers have no specialized skills in such areas as oncology. Her health care providers are also either older or younger than she is; this is a regular incident in health care for the terminally ill. Nevertheless, Frankie’s elder health care provider, her husband, is given a chance to learn. Formulation Development The formulation of the disease was data based. The information collected together with the assessment of the patient’s health was sufficient for diagnosis. It relies on set up questions as well as processes (Drescher, Jotzo, Goelz, Meyer, Bacher & Poets, 2008); Patient’s Identity – it is a female who is tall and slender. Patient’s name is Frankie. She is now in her mid life years and he appears weak. Diagnosis – Frankie is ailing and was diagnosed as suffering from advanced rectal cancer with liver, lung and Para aortic metastasis. Since then Frankie has received palliative chemotherapy, a partial lung resection, palliative radiotherapy to her pelvis, a right hepatectomy, radiofrequency ablation of her liver, and further liver resections for metastasis r4(Funnell, Koutoukidis & Lawrence, 2009). Precipitating factors – Frankie was very anxious and was suffering from further progressive disease in her lung liver and peritoneum. She is suffering from abdominal distension, leg oedema and uncontrolled rectal pain. They enhance the patients’ condition to a level that is clinically identifiable. The causes are however different. Predisposing factors- pre disposing factors are the factors which enhances the patient’s susceptibility towards a particular diseases. Family as well as peer pressures are also predisposing factors which lead to persistent conditions. But in this case, Frankie seems to have a supportive family. Perpetuating factor – No perpetuating factors are outstanding as at now but her lack of faith in a hospice may make the situation worse. The lack of proper care for a case like this will make the person deteriorate in her illness. All the above factors are important in making Frankie’s proper records that can be used in all her treatment sessions. Interpreting In Frankie’s scenario, it is essential for her care providers to understand their ability to change her attitude towards cancer to reduce prevalence of more complications such as depression. Positive beliefs can be useful in sustaining a balanced and healthy diet resulting to fewer cancer sicknesses (Levy et al., 2009). Since cancer is contributed by poor diet, the old individuals are required to always have micronutrients rich food since they are the highly hit by deficiencies. Therefore Frankie needs an encouragement on taking food full of vitamins all the time. Additionally, her condition can be boosted by encouraging her to maintain a social life that is positive since being socially active results to an improved lifestyle for the old (Lachman and Agrigoroaei, 2010). The vascular adjustments in her can involve a decrease or an increase in the normal heart rate where cardiac output can be minimized. In this scenario, regular exercise is required together with a fat diet (Huether & McCance, 2008). Renal changes cause the swelling of her lower legs because waste excretion is taking place properly in her body. These too can be eradicated or reduced by employing healthy dietary behaviors. Critical Analysis (Reflection) According to Blazer (2003), one to five percent of cancer patients undergo depression. Even though majority of them ignore this, depression caused by the deaths of our loved ones can lead to serious health associated problems. Constant depression has been proved to interfere with an individual’s ability to live a very healthy life style (Blazer, 2003). As mentioned earlier, Frankie was recommended for counseling whilst in hospital, which she agreed to, in order to address her anxiety about her future and that if she finds the therapy useful that she sees a counselor after her discharge home earlier next week. This is one step in alleviation of depression in patients suffering from terminal ailments. As I assisted Frankie with her hygiene needs, Frankie shared with me some of her own personal thoughts, to show that terminally ill patients consider adverse decisions for the sake of their condition and they can also do this because they wish not to be a burden either for the family of for the society. Frankie confided in me and said that she "planned to end her life on her own terms", that she "did not want to die slowly whilst unconscious in bed in hospital or hospice” that she "intended to end her life before it gets to that"… "In her own bed, in her own home". Frankie explained that she has accumulated a stock of Oxycodone, Fentanyl and Midazolam at home and that she believes that she knows how much to take. She has looked it up on the Internet. Frankie told me that she has not told anyone else about her plans and that she does not want her husband to be told of her intentions. She explains, "He has enough to cope with at present ". This is a depression phase. This leads to greatest supposition for Frankie’s sickness and such issues like counseling should be encouraged in her therapy (Bayliss, 2008). The terminally ill individuals need counseling on how to deal with the hard phase of their lives. Frankie should therefore be made to come to terms with the fact that there is life after death (Boog and Tester, 2008). These healing techniques connected to depression and stress after illnesses should be employed to help her minimize stress and depression. Thus cancer patients should be assisted to enjoy life by professionals (Bayliss, 2008). Reflection is also used to describe the type of reflection utilized by nurses to assist them in identifying areas of their practice which may need improvement (Kofoed, 2011). In order to achieve this I employed the use of a reflective framework which will provide a guided and structured approach to reflection while asking thought provoking questions. The framework selected for this exercise is the Gibbs Reflective Cycle, a seminal theory on reflective practice first indentified by G. Gibbs in 1988. To this day it is instrumental in the educational teaching of linking theory and practice for reflection within many healthcare disciplines (Burzotta & Noble, 2011). The significance of Gibbs Reflective Cycle is that it allows its user to take a holistic approach to learning, by taking a step back to analyze a situation through six stags or questions. Firstly, a description, what happened? Feelings, what were you thinking and feeling about the situation? Evaluations, what was good and bad about the experience? Analysis, what sense can you make of the situation? The conclusion, what else could you have done? And finally, the action plan, if it arose again what would you do? (Burzotta & Noble, 2011). This format will be followed to reflect on my experience. When 34 year old Frankie was checked into the Oncology ward I was on duty and within minutes of the arrival I was able to put her in a much comfortable position despite all her protests that came about as a result of pain especially in the fetal position by displaying signs of significant pain by groaning, unable to lie on back and unable to transfer from QAS trolley to ED bed in oncology section. I quickly introduced myself and assured the patient that everything was going to be fine and that she as now in safe hands. I could rate her pain as “10/10”. I helped her to put on a hospital gown which she could not manage on her own as she was unable to lift her arms up. I pulled the curtain and assisted her to remove clothing and apply the gown as the RN was collecting the IV trolley. Within 10 minutes the doctor had arrived to the bedside to assess the patient and prescribe analgesia. History taking was done immediately to ascertain proper records and it was found that In May 2009 Frankie was diagnosed as suffering from advanced rectal cancer with liver, lung and Para aortic metastasis. Since then Frankie has received palliative chemotherapy, a partial lung resection, palliative radiotherapy to her pelvis, a right hepatectomy, radiofrequency ablation of her liver, and further liver resections for metastasis. On admission to the ward Frankie was very anxious and was suffering from further progressive disease in her lung liver and peritoneum. She is suffering from abdominal distension, leg edema and uncontrolled rectal pain. A formal capacity assessment on admission demonstrated that Frankie was competent according to the Mental Capacity Act (2005) and she has remained competent. Evaluating the good and the bad of the situation was obvious to me at this point. The good was the assistance I provided the patient to transfer to the bed and aid in changing into a gown. Also I was able to quickly assess the patient’s vital observation, perform an ECG and identify her pain. I provided as much privacy as possible in an emergency department by pulling the curtains. The good aspects of the multidisciplinary team were the swift diagnosis from the doctor, administration of initial analgesia by the RN. Unfortunately the bad or not so desirable aspects were that the patient’s pain was not adequately under control, non-invasive and invasive ultrasounds were not explained to the standard I would have expected causing further pain. Upon concluding my reflection I have been able to identify areas in which I personally could have done more to help this patient by advocating for her in the midst of the chaos of the emergency department. Firstly I feel my focus could have been on discussing with the RN about further pain relief for the patient because it was obvious to me that she was suffering. Secondly as research and best practice has identified, to provide holistic care a greater emphasis must be placed on the emotional and psychological wellbeing of patients (Warner, Saxton, Indig, Fahy & Horvat, 2012). With this being said I would have involved the social worker asking them to phone the patients husband so he too could be advised of the situation. Another way of helping cancer individuals is to teach them on how to cope with these adjustments in familiar environments, self esteem, loss of independence, social networks, control over lifestyles and life spans. This is seen in Frankie’s case where she insists on her familiar environment but still on a negative attitude of wanting to die ‘peacefully’. This shows that even social arrangements have changed together with change in self esteem and independence. Frankie’s caregivers need to help her in conquering these abrupt changes (Boog & Tester, 2008). Conclusion In conclusion, it is the responsibility of the health care providers to take care of the terminally ill in the best achievable way. Though, oncology individuals as well need to cooperate with these care providers for them to get greatest benefits. But in reality it is known that prevention is far much better than cure and individuals should be encouraged through learning to avoid old age chronic illnesses (Burzotta & Noble, 2011). Reference Burzotta, L, & Noble, H, 2011, “The dimensions of inter-professional practice” British Journal of Nursing, 20(5), 310-315 Siegel R, Naishadham D, Jemal A, “Cancer statistics,” 2012. CA Cancer J Clin 2012; 62:10 Lasater, K, 2007, “Clinical Judgment Development: Using Simulation to Create an Assessment Rubric.” Journal of Nursing Education, 46(11), 496-503. 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