carCaring for Mrs. Thomas
HAT Task 2
Caring for patients who are dying presents a unique challenge for nurses. Common to all nursing is the necessity for self reflection and assessment of personal biases that can influence care delivery. In the case of the terminal patient, especially one with as many ancillary problems as Mrs. Thomas, the North American tendency towards individualism and denial of death complicates the nurse’s role. Nurses must examine their attitudes towards death and dying, and confront personal losses as well as fears in order to be present for the terminal patient. Further, having a “good death” can be subject to interpretation and determining what a patient wants needs to be the guiding principle in culturally competent end of life healthcare. What a nurse believes constitutes appropriate care or behavior of the dying patient is less important than what the patient wants, so awareness of personal feelings and biases is crucial to being of real support to the dying client. The community health nurse who is unable to speak to the issues faced by patients and families because of unresolved or unrecognized personal fears and issues, will not be able to intervene and help Mrs. Thomas and her family to confront and successfully cope with the reality of her situation. This tertiary level of healthcare promotion should provide “All measures available to reduce or limit impairment and disabilities, minimize suffering caused by existing departures from good health and to promote the patient's adjustment to irremediable conditions” (Allendar and Spradley, 2001). Most people have at least a vague idea, or opinion, of how they would act or behave under certain circumstances. However, when actually confronted with the circumstance, people often surprise themselves with their first-hand reaction to the anticipated scenario. In the same fashion, given that death remains such an emotionally laden, but unexplored and largely taboo topic in mainstream western culture, when we contemplate death, it is easy to postulate how we would manage the situation. Our feelings and the actuality of our responses is often quite different. Many families have not confronted how they would deal with a terminal, lingering illness until it is upon them. Even then, denial remains a powerful defense mechanism that can impede successful coping with the event. For example, when Mrs. Thomas identifies that she does not take her Vicodin because she does ‘not want to become addicted’ she is indicating that she is possibly still not able to grasp the reality of her situation, and consequently, to manage it successfully. This is an especially opportune time for a community health nurse to be able to positively impact a patient and their family’s dying experience. One of the most powerfully positive aspects of community nursing is that in assisting the Thomas family with Mrs. Thomas’s death and Mr. Thomas’s depression, the entire family receives benefits from successful nursing interventions, and the ripple effect of that health promotion permeates the community. The public health nursing role can also positively impact the future of many potential clients by advocating for dialogue about end of life and terminal disease management in primary prevention practice. Strategies to Improve the Thomas’s Quality of Life
Strategies to improve the Thomas’s quality of life are determined by assessing what constitutes quality of life to the couple. What determines quality in one’s life is often a very personal perception. Freedom, creativity, learning, and harmony in everything we do—these are the real factors that produce a high quality of life (Oleshkevych, 2012). Researchers at the University of Toronto's Quality of Life Research Unit define quality of life as "The degree to which a person enjoys the important possibilities of his or her life" (University of Toronto, 2009). Their “Quality of Life”...
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