Textbook of Medical-Surgical Nursing 3e

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Chapter 11

Oncology: Nursing management in cancer care

2005). In addition, nurses and other healthcare providers often fail to ask patients about sexual concerns, and patients may be hesitant to discuss them. However, standards of oncology nursing practice include the need for nurses to assess patients’ sexuality and to help patients and their partners achieve the outcomes of importance to them (Wilmoth, 2006). Nurses who identify physiological, psychological or communication difficulties related to sexuality or sexual function are in a key position to help patients seek further specialised evaluation and intervention if necessary. Assisting in the grieving process Nurses assess the patient’s psychological and mental status as the patient and family face this life-threatening experience, unpleasant diagnostic tests and treatment modalities, and progression of disease. The nurse assesses the patient’s mood and emotional reaction to the results of diagnostic testing and prognosis and looks for evidence that the patient is progressing through the stages of grief and can talk about the diagnosis and prognosis with family members. A cancer diagnosis need not indicate a fatal outcome. Many forms of cancer are curable; others may be cured if treated early. Despite these facts, many patients and their families view cancer as a fatal disease that is inevitably accompanied by pain, suffering, debility and emaciation. Grieving is a normal response to these fears and to the losses anticipated or experienced by the patient with cancer. These may include loss of health, normal sensations, body image, social interaction, sexuality and intimacy. The patient, family and friends may grieve for the loss of quality time to spend with others, the loss of future and unfulfilled plans, and the loss of control over one’s own body and emo- tional reactions. The patient and family just informed of the cancer diagno- sis frequently respond with shock, numbness and disbelief. It is often during this stage that the patient and family are called on to make important initial decisions about treatment. They require the support of the doctor, nurse and other healthcare team members to make these decisions. An important role of the nurse is to answer any questions the patient and family have and clarify information provided by the doctors. In addition to assessing the response of the patient and family to the diagnosis and planned treatment, the nurse assists them in framing their questions and concerns, identifying resources and support people (e.g. spiritual advisor, coun- sellor), and communicating their concerns with each other. Support groups for patients and families are available through hospitals and various community organisations. These groups provide direct assistance, advice and emotional support. As the patient and family progress through the grieving process, they may express anger, frustration and depression. During this time, the nurse encourages the patient and family to verbalise their feelings in an atmosphere of trust and support. The nurse continues to assess their reactions and provides assistance and support as they confront and learn to deal with new problems. If the patient enters the terminal phase of disease, the nurse may realise that the patient and family members are at differ- ent stages of grief. In such cases, the nurse assists the patient and family to acknowledge and cope with their reactions and feelings. Nurses also assist patients and families to explore pref- erences for issues related to end-of-life care such as withdrawal

Assessment Sources of fatigue in cancer patients

CHART 11-10

Pain, pruritus Imbalanced nutrition related to anorexia, nausea, vomiting, cachexia Electrolyte imbalance related to vomiting, diarrhoea Ineffective protection related to neutropenia, thrombocytopenia, anaemia Impaired tissue integrity related to stomatitis, mucositis Impaired physical mobility related to neurological impairments, surgery, bone metastasis, pain and analgesic use Deficient knowledge related to disease process, treatment Anxiety related to fear, diagnosis, role changes, uncertainty of future Ineffective breathing patterns related to cough, shortness of breath and dyspnoea Disturbed sleep pattern related to cancer therapies, anxiety and pain.

Nurs ing Research Prof ile : Evidence -based practice Cancer-related fatigue

CHART 11-11

Summary As more women are offered and receive adjuvant

patterns and sexual dysfunction treatment can threaten the patient’s self-esteem and body image. A creative and positive approach is essential when caring for patients with altered body image. Nursing approaches for addressing issues related to body image and self-esteem are also included in the Plan of nursing care (see Chart 11-4). The nurse serves as a listener and counsellor to both the patient and the family. Possible influences of the patient’s culture and age are considered when discussing concerns and potential inter- ventions (Romanek, McCaul & Sandgren, 2006). As a result of the underlying cancer, treatments and psycho­ social responses to the experience, patients may experience a variety of sexuality-based issues. Patients who experience alterations in sexuality and sexual function are encouraged to discuss their concerns. Major barriers to addressing sexual dys- function in patients with cancer include the lack of assessment tools and evidence-based interventions (Bakewell & Volker, chemotherapy for breast cancer, recognition grows of the potential for acute and long-term symptoms and decreased quality of life (QOL) among survivors whose five-year survival rate is 97% for localised disease and 80% for regional disease. This longitudinal, descriptive design (Byar et al., 2006) aimed at identifying the differences in fatigue, other physical symptoms, and psychological symptoms and their relationship to quality of life (QOL) during chemotherapy and as long as 1 year after. Nursing implications The findings of this study demonstrate that fatigue is associated with other physical and psychological symptoms that fluctuate during and after treatment. Higher fatigue compromises QOL. Interventions targeting primary or cluster symptoms can reduce the impact of adjuvant chemotherapy on fatigue, other symptoms, and QOL. For more information on this study, see Nursing research profile 11-11 in the related ancillary file for this chapter.