Community Health Nursing:
Quality of Life and Functioning

A. Personal Perceptions After reviewing the case of Mrs. Thomas and her situation, there are many feelings I have about the final outcome. As nurses, we always have to take our feelings into account and rationalize what we feel about the health and well being of our patients. After a BRAC analysis was performed, significant results were indicated. I feel empathy for Mrs. Thomas because this technology showed what her odds were for future recurrence of breast cancer. I’m disappointed that a radical mastectomy was not suggested to be performed with Mrs. Thomas’ first surgery to help avoid a further decline. It appears almost obvious that this should have been encouraged by her medical team. I do, however, understand that it is easier to look back on this than to look forward with what options remain. What is most important is Mrs. Thomas’ quality of life for the duration of what time she has left. I define quality of life as the ability to be as emotionally, physically and mentally fulfilled as possible. Quality of life is finding all the moments that matter and cherishing them on a daily basis. There will be better days than others, but what is key is to understand the big picture. The major challenge is promoting the best quality of life when the big picture ultimately has a poor outcome. Health promotion is crucial to increase Mrs. Thomas’ quality of life. Interventions will be initiated in all areas that require improvement to promote health. This will involve effective implementations of these interventions to maintain and promote Mrs. Thomas’ quality of life.
B. Strategies After identifying the areas that require the most assistance, several strategies should be implemented to promote Mrs. Thomas’ quality of life. It is important to acknowledge that strategies will change over the course of time as Mrs. Thomas’ condition changes. Mrs. Thomas will require a multidisciplinary team method for the duration of her care. The first strategy is to coordinate care for the physical aspect of Mrs. Thomas’ quality of life and make sure proper communication within the team will happen. This team involves the physician, a home care nurse, physical and occupational therapy and a home health aide. Mrs. Thomas will need the assistance from each member of this team during each stage of her illness to promote each facet of the quality of her life as she declines. The use of the multidisciplinary team will also help to address Mrs. Thomas’ concerns as she feels uncomfortable and a burden when utilizing friends or coworkers for assistance with her medical condition. Secondly, this process has to be funded somehow. Working with insurance companies, Medicare and cancer assistance foundations to help the Thomas’ pay for this care is a hardship that they shouldn’t have to endure alone. While Mrs. Thomas still has the ability to work, contacting her former employer to try to coordinate a part-time position to help the Thomas’ with the bills will also help with Mrs. Thomas’ self-esteem and self-worth. The early assistance with an occupational therapist will help to provide assurance to Mrs. Thomas’ employer that she is able to do the work she did prior to her diagnosis. The Thomas’ financial needs will change during the course of the rest of Mrs. Thomas’ life. New strategies for financial assistance will have to be created when new challenges come. The third strategy is for Mrs. Thomas’ mental and emotional quality of life. Mrs. Thomas will be given information and referrals to support groups. It is very easy to feel alone when one is terminally ill. Putting Mrs. Thomas in touch with others who are facing the same issues may assist in Mrs. Thomas’ mental well being. This will also help her ability to communicate certain feelings that she may feel she cannot express to her family, helping her emotional and mental well being. I would also be available to listen to Mrs. Thomas and provide support should she require it. Another strategy focusing on Mrs. Thomas’ emotional well being is reconnecting her with her family and friends. Something that concerns me is the lack of communication between the Thomas’ and their sons. The feelings the sons have are valid, but educating them on what they can do to help their mother, I believe, will result in them feeling less helpless. Initiating a dialog between the parents and children is the first step to help relieve extra stress on Mr. and Mrs. Thomas. The best way to do so is to call a family meeting. As a family, they can discuss their fears and concerns and with my help, implement new strategies to decrease the collective stress each family member has. By identifying key issues, they can tackle them together as a family.
C, C1&C2. Holistic Nursing Action Plan, Functional Ability & Providing Care
Before any approach is taken, it is important just to talk to Mrs. Thomas to understand what her beliefs are and what she wants. Empowering Mrs. Thomas when she feels so helpless can assist in her overall well being. Florence Nightingale believed in care that focused on “unity, wellness, and the interrelationship of human beings and their environment” (ANHA, 2013). For the effective management of Mrs. Thomas’ care, a thoughtfully developed holistic action plan is required. Holistic nursing may not necessarily be what is done, but how it is executed. As Mrs. Thomas’ condition progresses, her ability to physically function will become increasingly difficult to maintain. Because of this, she will begin to be less able to perform her activities of daily living independently. The care required throughout each stage of decline will become increasingly more challenging. While Mrs. Thomas can still function, her plan of home care would first involve a home health care nurse that remains with this case and makes reliable and constant visits for the duration of Mrs. Thomas’ life. This nurse will guarantee that all members of the multidisciplinary team are effectively communicating with not only each other, but with the family as well. The nurse will also assist in the development of new health promoting strategies as Mrs. Thomas’ illness progresses as well as to plan for new issues that have yet to be discovered. There will also be an occupational therapist and a physical therapist to aide Mrs. Thomas as well as a home health aide. All three of these rolls will also change throughout the duration of Mrs. Thomas’ life. A holistic approach also offers alternatives to Western medicine as enhancements. Enrolling Mrs. Thomas in yoga classes is one way to promote well being. Non-pharmacologic pain management is another alternative. Other Eastern therapies such as meditation, acupuncture and acupressure are non-pharmacologic means of pain management. If it is legal in her state, cannabis therapy, should Mrs. Thomas agree, can assist in Mrs. Thomas’ pain as well as promote an appetite. The anticipated result will be the maintenance of Mrs. Thomas’ independence for the longest time using the safest means possible throughout the progression of her cancer. It is of upmost importance that she is treated with dignity during this time. The quality of her care will abound from the first plan execution into the phases of grief for her family members. Once self care is no longer possible, the strategy changes. There will be a 24 hour home health aide that assists in Mrs. Thomas’ activities of daily living. Mrs. Thomas will also be in a great deal of pain. The home care nurse will make more frequent visits ensuring that the physician as prescribed appropriate PRN orders for pain management. Physical therapy will assist in the slowing down of muscle wasting during this illness. When the time is appropriate, Mrs. Thomas will then be placed in hospice care. Mrs. Thomas’ functional abilities are becoming more challenging during this current stage of illness. A physical therapist involved in her case can assist in optimizing her ability to maintain physical functioning of her body by assessing weaknesses in different areas of the body and recommending teaching ways to decrease the weaknesses or at least slow its progression. As previously stated, the occupational therapist assigned to Mrs. Thomas can assist her in not only her activities of daily living, but also perhaps with her part time job. This would in turn, potentially help the family financially as well as increase Mrs. Thomas’ feelings of self worth. It is important to acknowledge, however, that returning to her part time job would be temporary and the hours would have to be less. Yet if Mrs. Thomas’ part time employer is willing to keep her on, this could be beneficial for Mrs. Thomas’ quality of life. Pain is a catalyst for limiting the progression of healthful feeling. The nurse should make sure that PRN orders for pain medication from the physician are obtained in the event that Mrs. Thomas’ pain hinders her ability to function daily. Lastly, home health aides will assist Mrs. Thomas with her lesser activities that may create energy loss that should be reserved for the recommended exercises assigned by the physical therapist.
D. Chronic Depression
Mr. Thomas is also displaying symptoms of depression. As this is common for caregivers of the chronically ill, it is important that Mr. Thomas understands he, too, is not alone. Many people like Mr. Thomas suffer from caregiver role strain. Mr. Thomas can be given information on caregiver/spouse support groups and encouraged to attend. Providing referrals, education and support to Mr. Thomas will help address the symptoms of his depression. The first thing I would do is to help Mr. Thomas understand that he is not alone in his feelings as his wife’s primary caregiver. I would also listen to his concerns and provide support. I would also put him in contact with groups such as the American Cancer Society and other support groups where he can meet with other people who are living with family members with cancer (ACS, 2013).
E. Sources
American Cancer Society. (2013). Available from http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/mindbodyandspirit/support-groups-cam

American Holistic Nursing Association. (2013). Available from http://www.ahna.org/About-Us/What-is-Holistic-Nursing