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Discussion

The patient in the mentioned case study was a 37-year-old single mother who was referred to the palliative care outreach team with the case of metastatic cancer. The patient was fully diagnosed with cancer almost 10 years ago due to the development of breast cancer. Presently, the patient was presented in the hospital with the symptom of pain, vomiting and nausea. The present medication includes- MS contin, morphine. The patient also reported that she feels bloated and experienced diarrhea and vomiting. The patient needs proper management of symptoms which can be done by clinical reasoning cycle and caritas processes. The caritas framework consists of various factors which helps inn determining the patient’s perspective such as determining the positive and negative feelings, determination of spiritual factors, understanding the basic human needs, determining the sensitivity feelings towards others, determination of hope, faith, implementing of proper protective environment and developing a proper trust between the nurse and the patient (Medeiros et al., 2016). It is also essential to provide the patient with proper short and long-term intervention for supporting the patient’s condition. It is also essential to determine the patient’s vital signs for interpreting the data and recommending strategies. The following paper will discuss about the patient issue, clinical reasoning cycle and its relation with caritas process.

Identification of the key aspects

The patient in this case was found to be suffering from both physical and psychological distress due to cancer. The patient in this case needs proper care for disease management which includes- development of metastatic cancer, increased pain, vomiting and nausea. The patient was facing issues in managing diet. The most common issue which needs proper management includes pain management as it is one of the main issues faced by the cancer patient (Money & Garber, 2018). The short-term goals include- immediate pain management, restoration of food and lowering distress or fatigueness due to excessive pain. The long-term goal which needs proper care and family support includes- the long-term goal includes implementing positive dying experience, addressing the spiritual need along with cultural, implementing supportive environment and developing relationship with one and other (Cleeland, 2021).

The incidence of pain among the cancer patient is found to be higher due prolonged treatment process and adverse effect of medication. It is stated that the development of cancer and enhancement of the tumor destroys the nearby tissues which subpresses the organ, nerves and bones (Delgado-Guay et al., 2016). ALTUN & SONKAYA (2018) stated that the side effects of the chemotherapy develop due to the side effects of chemotherapy which creates almost an unobserved clinical obstacle in the cancer management. The prolonged development of side effects influences the protraction of the further treatment which negatively impacts the patient’s quality of life. The researcher in this case stated conducted a survey which highlighted that the issues are mostly related to urological tract, digestive tract and gynecological tract. The most common signs which is common among the cancer patient includes- vomiting, nausea and fatigue (Krishnaswamy & Nair, 2016). The other issues include decreased appetite among the patient, loss of hair, changes in the taste and development of allergic reaction. Gonzalez et al., (2019) performed the study for determining the relationship between the development of fatigue and diarrhea and its relationship with the cancer-related symptom. The result of the study stated that the development of diarrhea is common and the symptom of fatigueness and diarrhea impacts the cancer patient and hence, proper intervention for supporting the cancer patient is essential in this case. The patient in this case was found to refuse to eat which resulted in distress and it lowered the quality of life. Cotogni et al., (2021) stated that providing the patient with proper nutritional support is essential for the cancer patient. The study stated that a proper guideline must be provided to the patient which will help in supporting the patient and prevent the chance of developing malnutrition which one of the most common issues among the cancer patient (Planas et al., 2016). The study highlighted about other nutritional intervention which includes supplemental nutrition or feasible nutritional solution will be effective for improving the quality of life and it needs to be implemented within the comprehensive early palliative care approach (Grace et al., 2018).

Identification of the key aspects

Caritas Processes and its relation with the reasoning cycle

The patient’s condition can be analyzed by considering the clinical reasoning cycle which will help in predicting the patient’s condition through proper interpretation of the patient’s both objective and the subjective issues (Akturk & Erci, 2018).

Consider the patient

The patient in the mentioned case study was found to be suffering from cancer for prolonged 10 years which impacted that quality of life and presently needs palliative healthcare. The key issues which are highlighted in this case includes- excessive pain, development of lump, vomiting, nausea and diarrhea (Wang et al., 2016). The patient refused to eat as she was feeling bloated and it is highly essential to recommend the patient with comfort for improving the present state.

Collecting cues/ Information

In this case, the patient’s condition is found to be deteriorated and the patient’s family was aware of it. In this case, it is highly essential to the maintain a proper therapeutic relationship with the patient and it helps in providing an important influence on the understanding of carers in the fatal phase of their loved one’s life. The patient’s information which needs to be collected in this case includes- patient’s age, relationship with the patient’s family and ability of the patient to deal with other grief reactions (Treml et al., 2021).

The information about the terminal phase needs to be analysed and the main focus is to determine the palliative symptoms of the patient for implementing symptom management strategy. It is the responsibility of the patient is to provide with care by accessing the patient’s situation such as indication of the patient’s dying sign such as lack of proper bowel movement with increased pain, fatigue, thirst and increased pain. It is highly essential to implement proper care for improving the patient’s symptoms and the involvement of family is also essential in this case. The caregivers in this case must assist the patient’s family by encouraging them to take rest by practicing relaxation therapy (Tsai et al., 2020).

It is also essential to recall the knowledge of the patient’s psychological, physical and spiritual care as it is essential in the terminal phase of the patient. In this case, the recommending the patient with proper complimentary therapy is also essential which helps in providing contemplation and hence, it is essential to determine the patient’s spiritual, physical and psychological need. The main physical issue which needs to be addressed in this case includes- excessive pain, nausea, diarrhoea and vomiting (Wen et al., 2020). The psychological issue which needs to be addressed in this case includes- anxiety, depression, distress. The patient’s spiritual assessment must be done in this case which will help in determining the spiritual and religious belief and it will help in long-term management and coping up with the cancer and its cancer symptoms. It is determined that one of the major concerns which is faced by the patient is lack of proper social support and hence recommending complementary therapy is essential (Breuer et al., 2017).

Caritas Processes and its relation with the reasoning cycle

Process information

It is essential to determine the patient’s temperature, blood pressure and pulse rate as the patient was found to be suffering from excessive pain and distress. It is also essential to determine the bowel function, temperature and blood pressure. Assessment will determine the fact that the patient’s respiratory rate will be around 30, the blood pressure will be 140/95 and the pulse rate is 120 due to excessive pain (Merluzzi et al., 2016).

Hence, the most relevant condition which is appropriate to the patient’s condition includes- nausea, vomiting and pain which can also be determined from the vital signs of blood pressure, pulse and respiratory rate.

Issues

The main issues which are identified in this case include- pain due to side effect of the drugs, nausea, vomiting. The other issue includes- communication between the patient and the caregiver, developing therapeutic skills, developing spiritual care and implementing pain management strategies. The issue of constipation is also common in this case which includes opioid use and it resulted in reduced oral intake, limited mobility and the condition is accompanied by vomiting, pain and nausea. The development of abdominal discomfort is also common in this patient (Henson et al., 2020).

Establishing goal

The proper short-term intervention which needs to be provided in this case includes- providing medication or therapy for lowering the pain, vomiting and nausea. To improve the patient’s condition by resuming the normal diet, reducing the issue of constipation and referring to nearby hospice. The other issues which need to be analysed in this case includes- involving the patient’s family in the care process, arranging alternative accommodation for the patient family and referring the patient to the social worker for possible accommodation (Zebrack et al., 2016).

Take action

The nursing care plan which needs to be implemented in this case includes-

  • To encourage the fluid and nutrition intake.
  • Educate the patient related to mobility, adequate fluids.
  • Implementing pain reduction therapies for managing the situation.
  • To clear the faecal impaction.
  • To provide the patient with proper anxiety and depression reduction therapy such as- relaxation, mediation and even spiritual therapy.
  • Family education and recommendation of advance directive for the patient.

Evaluation

It is determined that the recommendation of the aroma therapy helps in managing the patient’s condition by lowering the pain sensation. The patient and his family must be provided with relaxation therapy such as music which will help in long-term challenges.

Reflection

I believe that the palliative care patient needs proper care for managing the emotional and stressful situation due to fear of dying and hence, proper support needs top be provided based upon the key priorities.

The CRC will be used for the implementing proper support to the patient including her family. The Caritas process elements which will be addressing in this case includes- implementing proper spiritual care, implementing supportive environment as the patient had limited knowledge and social support. The social support can be referral to proper palliative care service. It is also essential to provide the patient with proper faith and hope which will help in improving the self-confidence and maintaining a proper trust, care and relationship. The patient in this case must be provided with proper empathy and spiritual care which will help in improving the quality of life and preparing the patient for palliative care.  The patient in this case was found to be suffering from excessive pain which developed from cancer along with the condition of nausea and vomiting.  The prolonged impact upon the patient due to the development of cancer and sudden deterioration might impact the patient and the family by increasing distress and triggering the development of depression and anxiety. Laranjeira et al., (2022) stated that hope is one of the most effective factors which plays an important role in coping up with the long-term stressful events, for example cancer and it helps in supporting the patient including the family specially in the palliative ward. It is determined that the stressful situation among the patient and the family impacts the daily life and the primary reason which increases the distress includes poor communication and helplessness.  The study highlighted that proper hope and empathy must be provided to the patient and the family which helps in providing a supportive environment and the sense of compassion. Hence in this case, the patient must be provided and encouraged with realistic hopes and the family will be prepared for the advanced stage of cancer or the care that needs to be provided to the patient during the end-of-life care. The hope and empathy will help in providing social support to the patient as well and increasing the chance of long-term adherence towards the treatment process.

Consider the patient

The teaching-learning process will help in providing education to the patient and the patient’s family and advising them to understand the sign and symptom of deterioration. The patient must be provided with supportive environment such as empowering the patient to determine their own activity. It is also essential to provide the patient with faith and hope by spiritual care which will support the patient in the challenging situation. The care can be provided through proper problem solving such as guided imagery therapy which will help in solving issue such as empowering the patient to consume diet and fluid (Tonin et al., 2017). The Caritas process emphasises upon providing the patient with supportive care, social support and referral which will help in lowering the long-term pain, reduce the issue of refusal to eat. Ratshikana-Moloko et al., (2020) stated that implementation of spiritual care helps in lowering pain and improves the end-of-life experience for the cancer patient. The spiritual therapy also helps in lowering family worries and improving the patient care.

Conclusion

The above paper discussed about clinical reasoning cycle and caritas. The patient in this case needs proper care for disease management which includes- development of metastatic cancer, increased pain, vomiting and nausea. The patient was facing issues in managing diet. The short-term goals include- immediate pain management, restoration of food and lowering distress or fatigueness due to excessive pain. The long-term goal which needs proper care and family support includes- the long-term goal includes implementing positive dying experience. Lastly, the study highlighted about caritas process.

References

Altun, I., & Sonkaya, A. (2018). The most common side effects experienced by patients were receiving first cycle of chemotherapy. Iranian journal of public health, 47(8), 1218-1219. PMID: 30186799

Breuer, N., Sender, A., Daneck, L., Mentschke, L., Leuteritz, K., Friedrich, M., ... & Geue, K. (2017). How do young adults with cancer perceive social support? A qualitative study. Journal of Psychosocial Oncology, 35(3), 292-308. https://doi.org/10.1080/07347332.2017.1289290

Cleeland, C. S. (2021). Pain assessment in cancer. In Effect of cancer on quality of life (pp. 293-305). CRC Press.

Cotogni, P., Stragliotto, S., Ossola, M., Collo, A., Riso, S., & Intersociety Italian Working Group for Nutritional Support in Cancer. (2021). The role of nutritional support for cancer patients in palliative care. Nutrients, 13(2), 306. doi: 10.3390/nu13020306

Delgado-Guay, M. O., Chisholm, G., Williams, J., Frisbee-Hume, S., Ferguson, A. O., & Bruera, E. (2016). Frequency, intensity, and correlates of spiritual pain in advanced cancer patients assessed in a supportive/palliative care clinic. Palliative & Supportive Care, 14(4), 341-348. DOI: https://doi.org/10.1017/S147895151500108X

Collecting cues/ Information

Gonzalez, V. J., Beckstead, J., Groer, M., McMillan, S., Ortiz, D., Marrero, S., & Saligan, L. N. (2019). Exploring the relationship between diarrhea and fatigue that can occur during cancer treatment: using structural equation modeling. Puerto Rico health sciences journal, 38(2), 81. PMID: 31260550

Grace, E. M., Shaw, C., Lalji, A., Mohammed, K., Andreyev, H. J. N., & Whelan, K. (2018). Nutritional status, the development and persistence of malnutrition and dietary intake in oesophago?gastric cancer: a longitudinal cohort study. Journal of Human Nutrition and Dietetics, 31(6), 785-792. https://doi.org/10.1111/jhn.12588

Henson, L. A., Maddocks, M., Evans, C., Davidson, M., Hicks, S., & Higginson, I. J. (2020). Palliative care and the management of common distressing symptoms in advanced cancer: pain, breathlessness, nausea and vomiting, and fatigue. Journal of clinical oncology, 38(9), 905. doi: 10.1200/JCO.19.00470

Laranjeira, C., Dixe, M. A., Semeão, I., Rijo, S., Faria, C., & Querido, A. (2022). "Keeping the Light On": A Qualitative Study on Hope Perceptions at the End of Life in Portuguese Family Dyads. International journal of environmental research and public health, 19(3), 1561. https://doi.org/10.3390/ijerph19031561

Medeiros, F. D. A. L., Félix, L. G., & Nóbrega, M. M. L. D. (2016). Clinical Caritas Processes in workshops for caregivers of institutionalized elderly people. Revista brasileira de enfermagem, 69, 1059-1066. https://doi.org/10.1590/0034-7167-2016-0359 

Merluzzi, T. V., Philip, E. J., Yang, M., & Heitzmann, C. A. (2016). Matching of received social support with need for support in adjusting to cancer and cancer survivorship. Psycho?oncology, 25(6), 684-690. https://doi.org/10.1002/pon.3896

Money, S., & Garber, B. (2018). Management of cancer pain. Current Emergency and Hospital Medicine Reports, 6(4), 141-146. https://doi.org/10.1007/s40138-018-0170-9

Planas, M., Álvarez-Hernández, J., León-Sanz, M., Celaya-Pérez, S., Araujo, K., & García de Lorenzo, A. (2016). Prevalence of hospital malnutrition in cancer patients: a sub-analysis of the PREDyCES® study. Supportive Care in Cancer, 24(1), 429-435. https://doi.org/10.1007/s00520-015-2813-7

Ratshikana-Moloko, M., Ayeni, O., Tsitsi, J. M., Wong, M. L., Jacobson, J. S., Neugut, A. I., Sobekwa, M., Joffe, M., Mmoledi, K., Blanchard, C. L., Mapanga, W., Ruff, P., Cubasch, H., O'Neil, D. S., Balboni, T. A., & Prigerson, H. G. (2020). Spiritual Care, Pain Reduction, and Preferred Place of Death Among Advanced Cancer Patients in Soweto, South Africa. Journal of pain and symptom management, 60(1), 37–47. https://doi.org/10.1016/j.jpainsymman.2020.01.019

Tonin, L., Nascimento, J. D. D., Lacerda, M. R., Favero, L., Gomes, I. M., & Denipote, A. G. M. (2017). Guide to deliver the elements of the Clinical Caritas Process. Escola Anna Nery, 21.  https://doi.org/10.1590/2177-9465-EAN-2017-0034

Treml, J., Schmidt, V., Nagl, M., & Kersting, A. (2021). Pre-loss grief and preparedness for death among caregivers of terminally ill cancer patients: A systematic review. Social Science & Medicine, 284, 114240. https://doi.org/10.1016/j.socscimed.2021.114240

Tsai, W. I., Wen, F. H., Kuo, S. C., Prigerson, H. G., Chou, W. C., Shen, W. C., & Tang, S. T. (2020). Symptoms of prolonged grief and major depressive disorders: Distinctiveness and temporal relationship in the first 2 years of bereavement for family caregivers of terminally ill cancer patients. Psycho?Oncology, 29(4), 751-758. https://doi.org/10.1002/pon.5333

Wang, Y. H., Yao, N., Wei, K. K., Jiang, L., Hanif, S., Wang, Z. X., & Pei, C. X. (2016). The efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer: a systematic review and meta-analysis. European Journal of Clinical Nutrition, 70(11), 1246-1253. https://doi.org/10.1038/ejcn.2016.102

Wen, F. H., Chou, W. C., Shen, W. C., & Tang, S. T. (2020). Distinctiveness of prolonged?grief?disorder?and depressive?symptom trajectories in the first 2 years of bereavement for family caregivers of terminally ill cancer patients. Psycho?Oncology, 29(10), 1524-1532. https://doi.org/10.1002/pon.5441

Zebrack, B., Kayser, K., Padgett, L., Sundstrom, L., Jobin, C., Nelson, K., & Fineberg, I. C. (2016). Institutional capacity to provide psychosocial oncology support services: a report from the Association of Oncology Social Work. Cancer, 122(12), 1937-1945. https://doi.org/10.1002/cncr.30016

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