Textbook of Medical-Surgical Nursing 3e

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Unit 3   Applying concepts from the nursing process

Plan of Nurs ing Care Care of patient with cancer ( continued )

CHART 11-4

Expected outcomes • The patient and family identify resources available to aid coping strategies during grieving. • The patient and family use resources and supports appropriately. • The patient and family discuss the future openly with each other. • The patient and family discuss concerns and feelings openly with each other. • The patient and family use non-verbal expressions of concern for each other.

Nursing interventions 3. Encourage active participation of patient or family in care and treatment decisions. 4. Visit family frequently to establish and maintain relationships and physical closeness. 5. Encourage ventilation of negative feelings, including projected anger and hostility, within acceptable limits. 6. Allow for periods of crying and expression of sadness. 7. Involve pastoral care as desired by the patient and family. 8. Advise professional counselling as indicated for patient or family to alleviate pathological grieving. 9. Allow for progression through the grieving process at the individual pace of the patient and family. Nursing interventions 1. Assess patient’s feelings about body image and level of self-esteem. 2. Identify potential threats to patient’s self-esteem (e.g. altered appearance, decreased sexual function, hair loss, decreased energy, role changes). Validate concerns with patient. 3. Encourage continued participation in activities and decision making. 4. Encourage patient to verbalise concerns. 5. Individualise care for the patient. 6. Assist patient in self-care when fatigue, lethargy, nausea, vomiting and other symptoms prevent independence. 7. Assist patient in selecting and using cosmetics, scarves, hair pieces and clothing that increase their sense of attractiveness. 8. Encourage patient and partner to share concerns about altered sexuality and sexual function and to explore alternatives to their usual sexual expression. 9. Refer to collaborative specialist as needed.

Rationale 3. Active participation maintains patient independence and control. 4. Frequent contacts promote trust and security and reduce feelings of fear and isolation. 5. This allows for emotional expression without loss of self-esteem. 6. These feelings are necessary for separation and detachment to occur. 7. This facilitates the grief process and spiritual care. 8. This facilitates the grief process. 9. Grief work is variable. Not every person uses every phase of the grief process and the time spent in dealing with each phase varies with every person. To complete grief work, this variability must be allowed.

Nursing problem: Disturbed body image and situational low self-esteem related to changes in appearance, function and roles Goal: Improved body image and self-esteem

Rationale 1. Provides baseline assessment for evaluating changes and assessing effectiveness of interventions. 2. Anticipates changes and permits

Expected outcomes • Identifies concerns of importance. • Takes active role in activities. • Maintains previous role in decision making. • Verbalises feelings and reactions to losses or threatened losses. • Participates in self-care activities. • Permits others to assist in care when the patient is unable to be independent. • Exhibits interest in appearance and uses aids (cosmetics, scarves, etc.) appropriately. • Participates with others in conversations and social events and ­activities. • Verbalises concern about sexual partner and/or significant others. • Explores alternative ways of expressing concern and affection.

patient to identify importance of these areas.

3. Encourages and permits continued control of events and self. 4. Identifying concerns is an important step in coping with them. 5. Prevents or reduces depersonalisation and emphasises patient’s self-worth. 6. Physical well-being improves self-esteem.

7. Promotes positive body image.

8. Provides opportunity for expressing concern, affection and acceptance.

9. Interdisciplinary collaboration essential in meeting patient needs.