Introduction
Information, it is argued, is power. When patients are misinformed about chemotherapy handling, they imagine worst case scenarios; they expect over-blown worst case scenarios. A lot of side-effects are imagined and as a consequence, anxious patients undergo loss of control over their disease-causing psycho-social effects as hopelessness (Sauer & Voss, 2012). Furthermore, acute care nurse practitioner’s role is imperative in the management of psycho-education, imparting skills and cognitive resourcefulness required by patients during the crisis period. The quality of life, which is described as the general well-being with a strong relationship to the patient’s health perceptions and ability to function, forms part of the central aim of palliative care (Gunten, 2012). It touches on physical, psychosocial and spiritual aspects of life. When there is good communication and coordination between specialists and care providers, a patient’s quality of life improves. The discussion will evaluate four issues: the role of patient education, nurse practitioner’s role, and quality of life of the patient.
Background Information
Acute Care Nurse Practitioners (ACNPs) are an important component in the life of a cancer patient. Chemo-nurses are vital to success rates of cancer survivorship, particularly when it is discovered in the initial stages. The nurses are critical in coordinating palliative care needs, assessment, planning, implementing, and evaluating interventions according to set standards. The National Consensus Project for Quality Palliative Care (2009) sees palliative care as both philosophy of care and structured systems for delivery of care. Palliative care, therefore, covers various diseases, settings, and partnerships to advance the quality of life.
WHO perceives palliative care as a model, to relieving suffering and improving the quality of life (Gunten, 2012). It concentrates on team approach when dealing with a patient undergoing palliative care. Another definition by Center to Advance Palliative Care (CAPC) dwells on specialized medical care for those patients with serious illnesses that reduce symptom manifesting as medical, emotional and psychological (Gunten, 2012). This stage in cancer management is critical to a cancer patient because it adds value to life. Each step taken in the cancer continuum from diagnosis to survivorship is embedded with nutritional challenges. About 85% of cancer patients experience weight loss and malnutrition (Sauer & Voss, 2012). Chemotherapy is vital for the patient because nurses will screen for nutritional deficiencies and manage problems as they come while they educate the patient on nutritional values (Sauer & Voss, 2012).
Notably, if not well maintained, cancer patients experience poor nutritional status, weight loss, and malnutrition results into poor patient outcomes as decreased quality of life, decreased functional status, increased complication rates and treatment disruptions. Nurse’s patient education at this stage becomes very vital. Eating well during cancer treatment results in an increase in protein and energy intake, maintenance and gain of body weight, improved quality of life, improved strength and energy levels, management of related side-effects and reduces unplanned hospital admissions (Sauer & Voss, 2012).
Another aspect of palliative care is that as the patient approaches the end of life, it becomes complex for them on whether to focus on the quality of life or cure of the disease. Palliative care for cancer patients aims at shrinking tumors enough to reduce cancer symptoms and slow down the progress of the disease and extend a patient's life by weeks or months. For instance, palliative care could prolong their life at the expense of quality life. Palliative care is an aggressive treatment that comes with side effects and risks. Research shows that 85% of patients who did not undergo chemotherapy died where they wished to while 68% who received the care died where they wanted to (Sauer & Voss, 2012). Palliative care does not aim at curing the disease, but to keep patients comfortable during the illness period. For instance, hospice volunteers give patients' relatives a break from care giving duties; listen to patients express their wishes; helps with some housework, provide patient transportation for appointments or outings and sharing with family what the patient may need. Palliative care has the potential to improve patient’s quality of life as they undergo the most difficult moments of their lives.
Patients undergoing chemotherapy may gain their enlightening moments in life by improving their social relationships with loved ones and gaining spiritual strength. Such a mental state is critical as the patient prepares to undergo; fear of recurrence, depression, chronic fatigue, persistent pain, poor body image, anxiety, financial problems, loss of employment and income, weakened social relations and physical disabilities. Palliative care ameliorates patient worries, anxiety and concerns and restores hope in the patient and eventually improves the quality of life.
Worries, Anxiety, and Adverse Effects – what nurses can do
Lester, Wesseles, and Jung (2014), second the notion held by the IOM that cancer is survivorship care. Most cancer patients exhibit a feeling of loss following the end of acute therapy like chemotherapy. This normally preceded by a physical or emotional toll of their cancer diagnosis. For that matter, the IOM encouraged health care providers to initiate cancer survivorship in their care plans and they ought to make that a routine. The efforts of IOM on this program have been embraced by cancer professional and scholars, but the challenge is that it is not implemented as expected. Because of that, cancer care for patients under acute therapy like chemotherapy is still facing the aforementioned challenges (Lester, weasels, & Jung, 2014).
Additionally, during treatment, oncology nurses educate patients about their side-effects by written handouts on chemotherapy. Patient education during chemotherapy is vital and effective in strengthening the emotional state of first-time patients. Garcia’s analysis found out that particular education topics significantly decreased anxiety through providing information on treatment, side-effects management and chemotherapy setting for the first timers. Garcia opines that when education is provided before chemotherapy, it prevents anxiety in patients. Information retention is vital which is supported by a blissful learning environment (Garcia, 2014). Psycho-education and side-effect management are recommended by the American Society of Clinical Oncology/Oncology Nursing Society as one of the best practice in the profession.
Prouse argues that palliative self-care education provides controlled patient behaviors leading to reduced chemotherapy side-effects. Research by Williams and Schreier indicated that education on chemotherapy influenced reduced anxiety among patients. Besides, through self-regulation theory while Stephenson portends that patients reduce disease prevalence either objectively (function) or subjectively (emotionally (Garcia, 2014).
When patients behave functionally, they support the involvement of their care while emotional reactions result in feelings of susceptibility. It is important during psycho-education to let the patient know symptoms that may be experienced; the chemo-environment; physical experiences and how long the chemo session would take. A mere short orientation session reduces harmful uncertainty and anxiety that patients would experience. For instance, exposing patients to the infusion area before treatment predisposed patients to positive responses that resulted in resourceful patient outcomes.
In a rejoinder, Lehto, (2013) argues that a diagnosis of suspected lung cancer may be emotionally disruptive hence requires positively strong and supportive cognitive and emotional experience. The need to adjust to new life and upcoming chemo-treatments triggers cognitive resources as directed attention necessary for endurance (Lehto, 2013). Furthermore, disseminating the correct information to patients makes them more resourceful, in control and aware of what to expect from the various stages of the diseases. When you know what to do in a crisis feels more re-assuring than when one is ignorant. Information management is, therefore, central to the health conditions of patients who are undergoing chemotherapy.
Additionally, if patients undergo surgical resection for a lesion which later turns non-malignant, exposes such a patient to monetary expenses and morbidity psychology risks. Whenever lung cancer is diagnosed in a patient, there is anxiety, stress and cognitively challenging situation. It is, therefore, vital for the patient to develop skills where they can either inhibit nonsensical information that interferes with focus and concentration rendering the cognitive function irrelevant. The patient needs skills to resolve anxiety-provoking stimuli and avoid negative arousal of emotions that lead to anxiety. Patients need to know that worry sometimes emanates from selective information processing biases (Lehto, 2013). Worry by the patient misinterprets, distorts, and negatively blows out of proportion, negative outcomes.
During the difficult chemotherapy moments, nurses can help patients manage their worries, concerns and anxiety through assessment of their perceptions of the effectiveness of their cognitive function, increased alertness on worry by monitoring the environment and seeking more information. This enables them to answer patient questions more reassuringly, answering their questions as clearly as possible and supporting the patients with worry management. Patients require a conducive physical environment full of quietness, irritating distractions, and barriers and ability discourage stress (Lehto, 2013).
Kristin (2013) adds to the debate and posits that providing palliative care for affected victims increases satisfaction for both the family and the individual. Palliative care, according to research better outcomes, satisfaction and reduces health care expenses. Many of the nurse’s roles include ambulatory care, radiation oncology, home and hospice care and acute care surroundings (Kristin, 2013). Oncology nurses have the experience of working in multi-faceted settings hence have necessary assessment skills and clinical knowledge that accommodate all palliative care patients. The nurses are now a full house that combines diagnosis and treatment, disease prevention and health endorsement and advertising.
Having said that, it is paramount for the nurse practitioner to inform the patient about whet the chemotherapy will involve, and any adjustments that the care will require. In that case, the patient should be informed on the dos and don’ts and help them prepare well for the upcoming therapy. In addition, the family members of the patients must be brought on board and be asked to assist where they can. Patient education help the patient relax.
For that matter, the nurse practitioner plays a crucial role in preparing the patient to face their therapy and improve their lives. This aspect highlights how significant nurse practitioners are in the provision of palliative care. They not only help patients ease their tensions, but also contribute to the advancement of the patients’ health. This implies that nurse practitioners dealing with cancer patients under chemotherapy should be proactive and anticipate patient challenges and plan ahead. They should plan on how to address issues that their patients are likely to face as that would improve care delivery.
Conclusion
Palliative care ameliorates physical, spiritual, psychosocial and financial anxiety and worries that the cancer patients undergo leading to improved quality of life during the most complex stage in their life. They improve their nutritional statuses which have implications for reduced morbidity and mortality. Furthermore, psycho-education by the nurses and caregivers gives the patient a chance to take charge of their lives by knowing what to do, how and when. Palliative care, is therefore, important needed in the life of a cancer patient or those undergoing chemotherapy for any other disease. Different studies have shown that palliative care preserves cognitive resources and equips the patient with essential disease-management strategies. Managing worry and anxiety, improves the quality of life significantly. First-time patients undergoing palliative care, reduce worry and anxiety when they undergo patient education. The information provided during this critical moment answers unknown questions, leading to improved psychosocial outcomes that are functionally important at this critical stage in the patient's life. Nurse practitioners dealing with such patients must have a know-how of the needs of their patients and help them address those issues as that would improve care delivery.
References
Garcia, S. (2014). The Effects of Education on Anxiety Levels in Patient Receiving Chemotherapy for the First Time: An Integrative Review. Clinical Journal of Oncology Nursing, 18 (5), 516-521.
Gunten, C. (2012). Palliative Care and Rehabilitation of Cancer Patients. Berlin: Springer.
Kristin, F. (2014). The Role of The Acute Care Nurse Practitioner in the Implementation of the Commission on Cancer’s Standards on Palliative Care. Clinical Journal of Oncology Nursing, 18(1), 39-43.
Lehto, R. (2013). Pre and Post-Operative Self-Reported Cognitive Effectiveness and Worry in Patients with Suspected Lung Malignancy. Oncology Nursing Forum 40(3), 135-141.
Sauer, A., and Voss, A. (2012). Improving Outcomes with Nutrition in Patients with Cancer. Columbus: Abbott Nutrition.
