The Aspects of Quality of Life (QOL) - Term Paper Example

Case Study The Case of Mrs. Mendez Assess aspects of the quality of life (QOL) using the model of physical, psychological, social and spiritualwell-being. How are these quality-of-life dimensions interrelated? What other information would be helpful to assess quality of life at the end of life and in planning care for Mrs. Mendez? The aspects of Quality of Life (QOL) include an understanding of how a patient is doing on a physical, psychological, social, and spiritual level. They way these are interconnected is that they depend on each other. As an example, an individual must have a strong physical basis or they may feel depressed and withdraw as Mrs. Mendez’s case. Her physical condition is deteriorating, which affects her psychologically. Her children will not let her talk about her impending death, which creates an imbalance in her psychological condition and she copes with this by withdrawing. Drake (2012) presents an adaptation model to understand how cancer patients should be taken care of as they are going through the process of living and dying. Some of the things that would be important to know, according to this scale include in this model are: why her shortness of breath is affecting her intake of fluids and food. Her physical appearance may be important to her as she lays in her bed, is better, which can affect QOL for many patients. There is no mention of church for her, though she “seems” to be religious, or at least superstitious. This should be explored. Drake (2012) states that nurses must understand early whether their patients are feeling depressed and help them receive treatment for it. Palliative care and end of life arrangements will need to be discussed. 1. Discuss how a nurse can foster hope in this scenario? When and how can the concepts of palliative care be introduced in the scenario? How can you explain the differences between Palliative care and Hospice care? Fostering hope can be difficult in a situation with the Mendez family, because they are not willing to talk about the impending death of their mother. They are also not open to helping her prepare for death. Butt (2011) states that hope is a multidimensional and it changes as the terminally ill patient continues through their illness. Butt (2011) also states that hope is a factor that creates a better quality of life for the individual. In this situation, more has to be known about the family. Mrs. Mendez seems to be losing hope because the family cannot talk about the impending death. It is important to help the patient feel hopeful, despite what is happening, because it keeps them from being depressed or feeling despair (Turco, 1998). A nurse can foster hope by maintaining a positive relationship with the patient, helping the patient see humor whenever they can, touching the patient appropriately and reassuring them, and helping them control pain (Turco, 1998). In the Mendez family, the nurse can foster hope by providing good care for Mrs. Mendez, which includes making sure that she is comfortable as her pain increases. The nurse may also need to intervene for Mrs. Mendez by contacting the primary care physician and describing the situation as it stands now. According to Tyson (2001) the Hippocratic Oath states that the individual healthcare provider will consult with others who are more expert in situations when necessary, to help their clients. In this situation, Mrs. Mendez needs help from the nurse to create the resources needed for the family to thrive, and for Mrs. Mendez to have the quality of life that she needs as she moves toward death. Palliative care was important to talk about as soon as Mrs. Mendez refused chemotherapy. She and her family must understand Mrs. Mendez’s needs as her health decreases. The family must face the inevitable and they may need to see a therapist or a priest or minister to deal with the situation. In a study done by Hermann and Looney (2011), the authors found that patients need a thorough understanding of their symptoms and what to expect as becomes more debilitating. To explain the difference between hospice and palliative care, the nurse should help the family understand and accept plight of someone who is terminally ill as their health declines. According to Evercare (2012) hospice is “specialized medical care” (para. 1) for people who have less than six months to live. Mrs. Mendez has been given an assumed diagnosis six months, because the physician has already suggested hospice to her. Although Mrs. Mendez does not want to go to hospice, many states have hospice within the home, so this may need to be researched. To explain palliative care, the nurse should explain that Mrs. Mendez needs to be made comfortable in this situation, and part of the comfort is giving the morphine as prescribed. The nurse should explain the facts in easy to understand language, and be able to answer any questions; the nurse may need to provide these instructions in Spanish. 2. Conduct a cultural assessment AND spiritual assessment to identify factors that influence care in this case [you may refer to the Resources section in Week 3: Cultural-spiritual].What culturally based beliefs and practices are evident in this case? What are the strengths and weaknesses of the care reported in this case? What are essential components of spiritual assessment that could have impacted care for this family? It is assumed that the family understands English, but there may need to be an interpreter for discussing the medical issues. The cultural aspects of this case have to do with their ethnicity. The nurse knows that they are Hispanic, and this may or may not mean that the family is Catholic. Christina seems to be more involved with religion than the rest of the family, but this would be something to check. Mrs. Mendez is also older, and many older people like to stay in their homes when they are ill, till the very end. Mrs. Mendez may not be able to stay at home as her health deteriorates, and the family needs to be prepared for this in advance. Using the Brief Cultural Assessment: The CONFHER Model (Fong, 1985), it is clear that the nurse does not know much about the orientation of the family other than they are Hispanic. A talk about nutrition would be important since Mrs. Mendez is not taking in fluids or much food because of her shortness of breath and other health problems. The nurse would need to find some nutritional liquids that provide her with the vitamins and minerals needed to sustain life as long as possible. Mrs. Mendez’s family structure is difficult. Her oldest son Josẻ has been designated as the head of the household, but he does not live with his mother and is not easily accessible. The nurse does not know all the cultural aspects of the case and other things should be asked. The family prefers herbal remedies and the services of a healer over allopathic medicine, as indicated by the presence of a healer. Using the Spiritual Assessment: Mnemonics for Interviewing Spirituality (Taylor, 2010), there are several issues that the nurse will need to address with the family. The case study says that Mrs. Mendez believes that her soul is in her breast, which indicates that she may be more superstitious than spiritual, but this is something to be investigated. The nurse needs more information about any medical issues that may be forbidden from their religion (e.g. the source of the mastectomy superstation ) because this is already impeding care. The nurse will also need to understand how their religion impacts end of life decisions need to be made. The strengths in her care include the fact that there are nurses coming to the home twice a week who are attending to her wound and to administer meds. The fact that she is at home is both a strength and a weakness. She is able to stay in her home which is the strength, but it is a weakness because out of their own fear, the family is bickering about what is happening and is in denial that she is dying. A major weakness is that the doctor is allowing her to live at home and make decisions about her care, though her health is deteriorating. Other weaknesses include, Mrs. Mendez is not receiving the necessary medication (morphine) that was prescribed by the doctors, the family is not addressing her death , and the family is listening to the oldest brother who is not present. There needs to be more information about the belief system because it would give the nurse a better idea of why Mrs. Mendez is rejecting certain types of care. It would be important to know what the family believes about death and dying. Christina is very fearful of the situation and believes that her mother will get better through prayer, but the nurse does not know the basis of this fear. Walston (2010) states that meaning, purpose, joy, belonging and connection are essential aspects of spirituality. A thorough understanding of these areas would have helped the nurses and doctors help this family at a deeper level. The QOL is also deteriorating and Mrs. Mendez may be slipping into depression and despair. 3. Discuss: (A) the ethical principle(s) that is/are at issue in this case (B) the legal consideration(s) related to the case. What patient/family issues should be addressed? What advocacy role does a nurse have in taking care of this patient? One of the first tenets of medicine is supposed to be “do no harm” (Gill, 2012). The case of Mrs. Mendez seems to ignore this tenet because the professionals do not seem to notice that Mrs. Mendez is failing under her family’s care. Although I understand that a person has the right to decide for themselves about their healthcare, in this situation, the choices have been detrimental to her health. The doctors should at some point intervene and have her in hospice at home or in another facility. Her decision to not do chemo may be one of the greatest mistakes that she made, and ethically, she should have been sent to hospice when the doctor recommended it. According to Retkin, Brandfield and Bacich (2007) there are many legal issues that someone with cancer may come up against. One of the first issues for the Mendez family is whether Mrs. Mendez has a Will. This issue would help the family understand what to do for their mother upon her death. In the study by Retkin et al. (2007), only 25% of the participants (all cancer patients) had done advanced planning. The family has not taken care of these legal issues that would also include Power of Attorney and end of life procedures. In addition, financial obligations that have not been paid should be addressed. The advocacy role of the nurse is to be the patient advocate. Wood (2010) states that ultimately, the nurse should always be aware of, and be instrumental in, insuring care and safety for the patient at all times. In this case, the nurse should be reporting to the physician the concerns about the family and their interference with the medical protocol. Although Mrs. Mendez is going to die, she should have better care and the nurses who are attending to her twice a week should be talking to the primary care physician about what they are seeing. The nurse should also be a resource person who, once he or she has done a cultural and spiritual assessment, should help the family and the patient find the necessary services they will need to cope with the fact that their mother is dying. French, Gilkey and Erp (2009) state that patient advocates work also provide the patient’s voice. This is very important in Mrs. Mendez’s case because her family is not listening. Mrs. Mendez must feel that she is being listened to by someone. The nurses can also provide understanding to the family, but they must also have “the courage… to speak up in difficult situations” (French et al., 2009, p. 2) which means they must talk to the family about subjects they do not want to address. References Butt, C. M. (2011). Hope in adults with cancer: State of the science. Oncology Nursing Forum, 38(5), E341-50. doi:10.1188/11.ONF.E341-E350 Drake, K. (2012). Quality of life for cancer patients: From diagnosis to treatment and beyond. Nursing Management, 43 (2), 20-25. DOI: 10.1097/01.NUMA.0000410865.48922.18 Evercare (2012). The difference between hospice and palliative care. Retrieved from http://www.evercarehospice.com/difference_between_hospice_and_palliativeCare.jsp Fong, C. M (1985). Ethnicity and nursing practice. Topics in Clinical Nursing, 7(3), 1-10. French, E. A., Gilkey, M. B., and Erp, J. A. L. (2009). Patient advocacy: Putting the vocabulary of patient-centered care into action. NC Medical Journal, 70(2). Retrieved from http://www.ncmedicaljournal.com/wp-content/uploads/NCMJ/Mar-Apr-09/IssueBrief.pdf Gill, N. S. (2012). Is "First Do No Harm" From the Hippocratic Oath? Myth vs Fact. About.com., Retrieved from http://ancienthistory.about.com/od/greekmedicine/f/HippocraticOath.htm Taylor, E.J. (2010). Spiritual assessment. In B. R. Ferrell, & N. Coyle (Eds.), Oxford textbook of palliative nursing (3rd ed., Chapter 33, p. 651). New York, NY: Oxford University Press. Reprinted with permission. Hermann, C. P. and Looney, S. W. (2011). Determinants of quality of life in patients near the end of life: A longitudinal perspective. Oncology Nursing Forum, 38(1), 23-31. DOI: 10.1188/11.ONF.23-31 Retkin, R., Brandfield, J. and Bacich, C. (2007). Impact of legal interventions on cancer survivors. LegalHealth. Retrieved from http://www.bc.edu/content/dam/files/schools/law_sites/library/pdf/content/tremblay_schulman/2007-01-00.Retkin%20et%20al.pdf Taylor, E.J. (2010). Spiritual assessment. In B. R. Ferrell, & N. Coyle (Eds.), Oxford textbook of palliative nursing (3rd ed., Chapter 33, p. 651). New York, NY: Oxford University Press. Reprinted with permission. Turko, S. (1998). What’s hope got to do with it? Palliativecare.com. Retrieved from http://www.palliative.org/PC/ClinicalInfo/NursesNotes/WhatsHopeGotToDoWithIt.html Tyson, P. (2001). The Hippocratic Oath today. Nova. Retrieved from http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html Walston, Jeanie (2010). Spirituality assessment. Embodiworks: Integrative Cancer Care. Retrieved form http://www.embodiworks.org/cancertretments/bodymindspirit/spirtualityassessment/ Wood, D. (2010). The nurses role as patient advocate. Nurse Zone. Retrieved from http://www.nursezone.com/nursing-news-events/more-news/The-Nurses-Role-as-Patient-Advocate_33962.aspx Read More