Care of a Dying Patient
My own perceptions about quality of life and health promotion might affect my care for a dying patient with a lingering illness such as cancer because the patient and I may have a different definition or outlook on what quality of life means. To me this would mean making the best of what little time the patient has left to live. Most importantly is to keep the patient comfortable which may include positioning the patient in bed, giving a gentle massage and administering pain medications if necessary. It is also very important to provide the patient and the family with emotional support.
It seems as Mrs. Thomas’s children are somewhat distant at her time of need because they are upset about her condition and probably in denial because they know what her outcome will be. It would play a very crucial part in improving the quality of life for Mrs. Thomas if her children and their families would come to visit her in person. I know that this will be difficult for the children to see their mother suffering but her family should play an important role in emotional support. I think a visit from her children and their families would really uplift her spirits.
Mrs. Thomas does not want take any pain medication because she does not want to become addicted to it but it should be explained to Mrs. Thomas that since she is truly in pain she will not become addicted to it. By Mrs. Thomas taking the pain medication it would not only help control her pain but it would also make Mr. Thomas feel more at ease knowing that she is comfortable and not suffering. Mr. Thomas is depressed because of Mrs. Thomas’s condition and he is not managing it very well and this is making Mrs. Thomas very sad.
I think that getting a behavioral health specialist involved and providing the family with counseling with also improve the quality of life for Mrs. Thomas. I think that it would put Mrs. Thomas’s mind at ease knowing that Mr. Thomas is dealing with his depression professionally. Talking about their feelings to a professional with also help both of them better understand and cope with Mrs. Thomas’s condition. According to American Holistic Nurses Association (AHNA), holistic nursing is an “all nursing practice that has healing the whole person as its goal. A holistic nurse will not simply attempt to treat the physical symptoms of a disease or condition, but will consider the totality of the person being treated: mental, emotional, spiritual, social, cultural, relational, contextual and environmental aspects. Treating Mrs. Thomas holistically may not only help Mrs. Thomas but Mr. Thomas as well. As the community health nurse I would allow for Mr. Thomas to assist with Mrs. Thomas’s care when he is able to. At an institution where I once worked at offered “healing touch. During this time of healing touch the room would be made rather dark for calmness and comfort and soft calming music would be played. This is what I would recommend starting with under my holistic care with Mrs. Thomas and Mr. Thomas may be present as well. During this time a light massage may also be preformed to assist with comforting Mrs. Thomas and hopefully assist with managing her pain. A way to assist Mrs. Thomas to optimize her functional ability would be to use range of motion (ROM) on her, which is when the nurse would mildly exercise her joints to minimize stiffness and Mr.
Thomas may be taught how do range of motion as well. If Mrs. Thomas is not strong enough to walk to the bathroom I can assist in getting a bedside commode delivered to her home. I can also teach her how to transfer herself safely to the commode if she is strong enough or if she is unable to transfer herself I can also teach Mr. Thomas how to safely transfer herself and I could assist as well. As the community health nurse I could assist Mrs. Thomas with everyday care such as feeding, bathing and dressing herself. I would allow Mrs.
Thomas to do as much as she can for herself. During the bed bath is a great time to apply lotion to her back and extremities and apply a gentle massage for comfort. I could also assist Mrs. Thomas with turning and positioning her in bed every 2 hours for comfort and to prevent skin breakdown. Mr. Thomas and I could assist her to complete feeding, bathing and dressing herself if she is unable to. Allowing her to perform as much tasks as she is able to will optimize her functional ability. According to Higuera, chronic depression can affect every aspect of a person’s life.
The symptoms vary, but people with chronic depression often feel intense sadness and hopelessness. They have a negative outlook on life. As the community health nurse I could assist Mr. Thomas with his chronic depression by assisting him with getting in touch with a behavioral health specialist for one on one counseling. I could also assist Mr. Thomas with coming up with a medication plan that would work for him so that he can take his depression medications on a regular basis and hopefully not forget. I could also sit with Mr. Thomas and we could do some quiet relaxing breathing exercises together.
I would also convince Mr. Thomas to take short and relaxing walks to clear his mind. I could also assist Mr. Thomas with checking with his employer to see if he could be relieved of some of his duties temporarily or take some time off from work. Although taking some time off from work may put a financial burden on their family but is may be best mentally and physically for both Mr. and Mrs. Thomas. One Mr. Thomas’s depression is managed appropriately then he can spend some quality time with Mrs. Thomas and enjoy just enjoy each other’s company.
