Psychosocial assessment of a patient diagnosed with breast cancer
Introduction
About two hundred and fifty thousand women are diagnosed with breast cancer every year with more than forty thousand dying of the disease each year (US Institute of Medicine, 2008). The diagnosis of a patient with breast cancer is more often than not a life changing event because the diagnosis adversely impacts on the physical well being of the patient whilst posing a significant threat on the patient’s psychosocial well being (Schmid-Buchi et al., 2008). Patients diagnosed with breast cancer experience a wide array of emotions ranging from denial, anxiety, fear, depression, shock, amongst others that put them at risk of ineffective psychosocial coping. Notably, advances in technology have taken the management of breast cancer to a higher notch with breast conservation treatments and adjuvant therapies being available. An alarming fact however is that despite these advances, the apparent common need for psychosocial support amongst this patient population, findings from a number of studies indicate that their psychosocial needs have been largely ignored by health care providers with many patients reporting that they are normally left to their own devices (US Institute of Medicine, 2008). The aim of this paper therefore will be to describe three psychosocial needs for Irene, a patient who has been diagnosed with infiltrating ductal carcinoma, the clinical nursing interventions to be employed in meeting those needs and the evaluation of the identified interventions. The three psychosocial needs will be identified using Spade’s (2008, 2010) psychosocial assessment tool. A summary of the psychosocial needs, nursing interventions to be implemented and evaluation activities to be carried out will be provided at the end of the paper.
Psychosocial vital signs
Findings/potential issues
Interventions
Criteria for evaluation
Perceptions: What are Irene’s possible thoughts about what is happening to her and all that it involves?
Irene has a need for emotional protection because she is currently experiencing a range of emotions ranging from to anxiety fear and depression. She is fearful about:
Having breast cancer which is evidenced by her sensations of being doomed.
Possible recurrences as manifested by her thoughts about what would transpire if the doctors were unable to get the whole lump out.
Assess Irene’s personal experience with breast cancer as well as her knowledge on the disease.
Encourage Irene to verbalize her fears and concerns (Sommers et al. 2007, p.251).
Inform Irene on recent research and any new treatment modalities for breast cancer that are available as this will help to minimize her fears as well as encourage her to fully participate in the treatment plan (Mumber 2006, p.186).
Describe to Irene all the experiences that she will go through and encourage Irene to ask any questions that she might have. This is essential since it will serve to reduce Irene’s fear of the unknown which is amongst the factors contributing to her distress (Smeelter and Brunner 2009, p.1483).
Acquaint Irene with the resources that are available to facilitate her recovery.
Encourage Irene and her partner to openly discuss their thoughts/problems on how the disease might affect their sexual life (Sommers et al. 2008, p.251).
Irene will display reduced anxiety and emotional distress.
The patient verbalizes her willingness to deal with the fears and anxiety elicited by the diagnosis as well as the effects of surgery on her body image and sexuality (Smeelter and Brunner 2009, p.1483).
Irene states that the anxiety and fear she is experiencing are normal reactions in patients diagnosed with breast cancer.
Irene will exhibit knowledge of the disease process, the various treatment options available, their advantages and disadvantages (Smeelter and Brunner 2009, p.1484).
Irene’s participation in the treatment plan for example through asking appropriate questions about the best treatment options available for her will be evaluated.
Irene will respond to the information provided to her in a positive manner.
The patient would read all the literature about breast cancer and its management that had been and would continue to be provided to her (Sommers et al. 2008, p.251).
Personality style: How does Irene interact with those around her? Does she have any personality that might impact on her care?
Support: Who does Irene have in her life that she feels care and can support her? Who else might she be able to call on? What is Irene’s understanding of current illness?
Coping: How does Irene seem to be coping with this? How might she be dealing with this event? What are Irene’s normal coping patterns? Has Irene experienced any life changes or stressors?
Irene is at risk for ineffective coping because she seems overwhelmed by the diagnosis and the pace at which the events are unfolding as evidenced by her anxiety provoking thoughts and repeated crying episodes.
Assess Irene’s previous coping mechanism for example how she managed to cope with the diagnosis of arthritis which like breast cancer is a chronic illness associated with a lot of pain in the joints.
Help Irene identify the areas of her life that would be affected by the disease in a realistic and rational manner so as to dispel any myths or false beliefs that may be compounding her emotional distress.
Develop a plan that enlists the support of Irene’s loved ones so as to help her to be able to draw on coping skills and social support.
Refer Irene to support groups so that she can learn the techniques employed by other patients diagnosed with breast cancer to cope with the disease via the sharing of experiences.
Irene will name the functions and/roles that will be affected by the disease and those that will not be affected.
Irene will state the actions that she will take so as to be able to accept her situation as well as draw on social support.
Anxiety: What is Irene possibly feeling about this situation? How might it be affecting her? What concerns might she have regarding the future?
Irene is anxious and fearful about:
The physical effects of surgery and other treatment.
Her husband’s reaction to the treatment induced physical changes in her.
Possible future recurrences as evidenced by her thoughts of what would happen if the doctors were unable to remove all the cancerous cells.
What would happen after the lumpectomy.
Explore Irene’s understanding and prior experiences with breast cancer since this may be contributing to her anxiety for instance, does she know anyone who has had breast cancer and what was the outcome or prognosis of that specific person.
Encourage Irene to discuss her thoughts and fears openly with the nurse and with her partner as this will enable her to draw on their support and coping skills.
Describe the pathophysiology and the available management options for breast cancer with Irene together with their advantages and disadvantages. Additionally, provide Irene with information on current research as well as statistics on breast cancer (Smeelter and Brunner 2009, p .1483)
Describe to Irene and her husband what to expect following the treatment especially in terms changes in sensations, personality and physical characteristic. This will aid in minimizing Irene’s anxiety since she will know what to expect at every stage of her management (Rankin et al. 2008, p.56).
Explain to the patient that whatever emotions she is experiencing are normal reactions to the diagnosis of an illness.
Introduce the patient to the members of the multidisciplinary team that would be handling her case and arrange meetings with each and every one of them so that Irene gets to know them and their role in her management. These meetings will also provide Irene with the opportunity to ask any questions she might have as well as verbalize her concerns and doubts.
Teach Irene on the use of relaxation techniques like listening to music, meditation and deep breathing exercises to reduce anxiety (Ganz and Horning 2007, p.240).
Refer and/or advise the patient to join support groups comprising of members drawn from women who have been diagnosed with or those who have survived having breast cancer so that she can benefit from the therapeutic effects of such groupings for example, seeing other women who have survived breast cancer will instill hope and hence reduce her anxiety levels. Alternatively, she will be able to learn new ways of coping with her anxiety by interacting with them. (Chambre et al. 2008, p.169).
Patient states that being anxious is expected in situations whereby a person has been diagnosed with a life-threatening illness like breast cancer.
Irene describes the treatment options available and also asks questions concerning the management of her condition (Sommers et al. 2008, p.251).
Irene states that she is willing to deal with the anxiety elicited by the diagnosis of breast cancer as well as the related to the effects of treatment on her self-image and sexual functioning by employing the various anxiety relieving techniques taught to her.
Irene explains that she is aware that her husband has been counseled on her condition and on how to provide her with the necessary support.
Lifestyle information: Who does Irene live with? What is her occupation? How important is this to her? What Hobbies does Irene have?
Major issues risked by the current health event for Mike?
Spirituality/cultural issues
Does Irene have any spiritual and/or cultural issues that need to be addressed?
In conclusion therefore, Irene has three priority psychosocial needs; the need for emotional protection; relief of anxiety and finally, the need for promotion of effective coping. Various nursing interventions will be implemented in an effort to meet the three identified priority psychosocial needs. Assessment of Irene’s knowledge on breast cancer and previous coping mechanisms will elicit information that is important for the understanding and planning of interventions on how to manage Irene’s response to the diagnosis. Patient education on breast cancer and its management as well as prior emotional preparation on the perceptions and sensations that are likely to be experienced will serve to reduce Irene’s fear of the unknown which significantly contributes to her psychological distress and anxiety. More importantly, it will correct any myths about cancer known to Irene that may be contributing to her anxiety and distress and thereby help her to respond positively to treatment and nursing interventions. Reassurance, encouragement ,referral to support groups as well as counseling of Irene’s loved ones on how they can offer her social support are amongst the interventions to be instituted to provide Irene with the necessary psychosocial and emotional support so that she can cope effectively. Evaluation activities will include assessing Irene’s levels of anxiety, utilization of anxiety alleviating techniques, understanding of the disease process and its management, acceptance of her condition as well as her ability to effectively draw on her coping skills amongst others.
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