Introduction
Quality of life and functioning relates to fulfillment of low level demands for life as outlined in Maslow’s hierarchy of basic human needs theory. It is the ability to acquire and enjoy fresh air as well as breathe efficiently. Also, it is to articulate one’s existence into self-actualization, which is the peak of successful living (Maslow, 1954 ). Therefore, in discussing this case study regarding the quality of life to be envisioned by a community health nurse for this distressed family it is imperative that strategies be designed to intervene for total well-being of all involved in Mrs. Thomas’s care.
A. Personal Perceptions
Again with reference to Maslow’s (1954) hierarchy of basic human needs theory as it relates to Mrs. Thomas’ functionality requirements, it is clear that quality of life is impaired for her personally as well as her family. Mr. Thomas is burdened with her financial upkeep and emotional support. There are relationship issues with relatives which have added to this dysfunction. According to Maslow (1954) there is a perpetual impending desire for friendship, intimacy and family in everyone (Maslow, 1954).
Personal perceptions about quality of life and health promotion that might affect my intervention for this dying patient with a lingering illness such as cancer, is the issue of denial that death is impending; the family’s need for support in caring for a dying relative and preparing Mrs. Thomas for end of life experience. These are tied into the values of love and affection induced by friendship, intimacy and family.
Carol D'Onofrio and True Ryndes (2003) speaking about the relevance of public health in improving end of life experiences emphasized that the scope is embodied in its objective that health must reflect total well-being; consistent with WHO’s definition. In applying this concept, stakeholders/ consumers perceive it to mean ‘relief from pain and suffering, maintenance of an individual's functional abilities and social relationships’ (D'Onofrio & Ryndes, 2003). Further, they stressed that these functional abilities ought to reflect meaning of life for the individual ensuring a peaceful ending offering support for grieving family members (D'Onofrio & Ryndes, 2003).
As such, when a community health nurse has to intervene in hospice services these values must be embraced. Based on this personal perception it is my belief that allowing more people like Mrs. Thomas early access to hospice is promoting functionality by improving quality in end of life activities. Often many people do not access such services at all or they receive it too late.
B.Strategies
Three strategies which are applicable to managing Mrs. Thomas’ breast cancer and Mr. Thomas’ depression relate to relieving pain, maintaining functionality and emotional support for the family in preparation for the end of life experience.
Strategy 1- Relieving Pain
An expressed concern of Mrs. Thomas as outlined in the case study is her fear of addiction. As such, she endures pain was enduing her pain. This could be very stressful on the body’s resources which are already compromised by diseased. Patients who have fear of addictions can use topical prophylactic analgesic medications that will relieve pain at the affected site. Pain management can be also therapeutic whereby she can be assigned a specialist who employs psychotherapy in relieving pain.
Strategy 11- Maintaining functionality
A major functionality challenge facing Mrs. Thomas is the use of her arms due to the mastectomy. In this case physical therapy is recommended, to make assessments regarding the level of function that can be instituted at this stage of the disease. Also, the use of alternative muscles will be evaluated to maintain function to the entire body. Mr. Thomas would have to be referred to a psychologist or coping specialist to ensure that equilibrium is maintained in conducting duties at work and caring for a terminally ill wife.
Strategy 111- Offering emotional support
Emotional support is crucial to this family. Very often people are afraid to face the evidence of death. It is impacting for Mrs. Thomas and more devastating to her children and husband. In my capacity of a community health nurse advising them to accept this as a fact or phenomenon of life can be considered inhumane. Therefore, a social worker or specialist trained in hospice intervention therapy to discuss with this family how to cope with the illness and eventually death. This is itself paining as is demonstrated in Mr. Thomas’ depress and her children’s estranged attitude.
C.Holistic Nursing Plan
The American Association of Holistic Nurses advocates that the objective of implementing a holistic Nursing Plan is ‘to foster compassion, by applying science and creativity to nursing practice as nurses unite in healing’ (Frisch, 2001). Holistic nursing intervention targets the body, soul and sprit. In the following Holistic Nursing Plan these three concepts of care will be addressed.
C.1 Functional Ability
A very useful community health nursing intervention is to allow Mrs. Thomas to be enrolled in programs that cater for end of life social, spiritual and emotional support for patients dealing with breast cancer. These interactions could be encouraging to hear how other women cope with the disease and become cancer free. She could learn through these discussions best ways to improve functionality
C. 2 Providing Care
Guidelines outlined by the National Cancer Institute that instructs community health nurses intervention include assisting patients with home care even though they are not directly delivering such care. They, however, are to intervene by collaborating with the health care team which includes the doctor, nurse, social worker. These levels of health care technicians provide information the community health nurse can use appropriately in each stage of the illness (National Cancer Institute, 2012).
Home care services are always available to terminally ill patients. A list of these agencies can be provided for the family. The community health nurse’s role is to educate the family on how to access these services and make sure that they are provided. They include medical equipment; visitations from registered nurses, in house physical therapists’ visits, as well as regular visits from social workers to assess social environment conditions (National Cancer Institute, 2012)
Non-medical services include running errands, meal preparation, personal hygiene management; and delivery of medication once Medicaid coverage is secured. Reimbursements are usually, retrieved from Medicare if the family has to pay out of pocket initially (National Cancer Institute, 2012).
D.Chronic Depression
Depression is associated with as an insidious mental disorder. Therefore, Mr. Thomas’s depression requires psychiatric intervention. In community health nursing therapeutic invention can be designed to include:-
Exclusive structured discussions of issues without Mr. Thomas’ spouse.
Inclusive structured discussion of issues with spouse
Encouragement of dialogue between husband and wife in the presence of obvious functionality impairment.
Re-enforcing love as an unchanging value in the marriage.
Specialist referral.
Conclusion
This discussion answered five specific question presented for case study analysis. Firstly, my personal impressions of the scenario were given; then three strategies for dealing with the case were suggested; thirdly, a plan for holistic care which graphically depicted soul, spirit typology of holistic management; fourthly the functional ability assessment and fifthly the scope of community nursing intervention.
References
D'Onofrio, C., & Ryndes, T (2003). The Relevance of Public Health in Improving Access to End of Life Care . Retrieved on 14th September, 2002 from
http://www.growthhouse.org/nhwg/essay5.htm
Frisch, N. (2001). Standards for Holistic Nursing Practice: A Way to Think About Our Care That Includes Complementary and Alternative Modalities. Online Journal of Issues in Nursing. , 6(2), 4.
Maslow, Abraham (1954). Motivation and Personality. New York: Harper National Cancer Institute (2012) Fact Sheet 8.9, How to Find Resources in Your Own Community if you have Cancer. Retrieved 3rd March, 2012, from
Mittelman, Willard. "Maslow's Study of Self-Actualization - A Reinterpretation". Journal of Humanistic Psychology 31 (1): 114–135.
