Affected Physical and Psychosocial Domain in Patient of Palliative Care (A Case Report)
Author(s): Sharafat Ali
Abstract
Palliative care is an approach that improves the quality of life of patients and their families who facing the problems associated with life-threatening illness. The approach of palliative care also provide them and their families a support system to cope with their problems associated with life changes. Along with this it make efforts to prevent their suffering, early identification of their problems through proper assessment, treatment of their problems and fulfill patient needs mainly psychosocial and spiritual need[1]. There are four domains that are physical, psychological, social and spiritual that can be affected in palliative care patient. All of these four domains were affected in my patient. But here I will only focused on two major domains which were effected in my patient that are physical and psychosocial. This case report will discuss about physical and psychosocial domains.
Introduction
Palliative care is an approach that improves the quality of life of
patients and their families who facing the problems associated
with life-threatening illness. The approach of palliative care also
provide them and their families a support system to cope with
their problems associated with life changes. Along with this it
make efforts to prevent their suffering, early identification of their
problems through proper assessment, treatment of their problems
and fulfill patient needs mainly psychosocial and spiritual need[1].
There are four domains that are physical, psychological, social
and spiritual that can be affected in palliative care patient. All of
these four domains were affected in my patient. But here I will
only focused on two major domains which were effected in my
patient that are physical and psychosocial. This case report will
discuss about physical and psychosocial domains.
History of Patient
During my palliative course clinical, I encountered a 70 year old
male patient. He was admitted with chief complain of severe pain
in tongue due to tongue Carcinoma. Patient had a history of COPD,
mild left ventricular hypertrophy and a History of Road Traffic
Accident (RTA). After RTA patient developed lower extremities
paralysis, which made him unable to walk. Lower extremities
paralysis made him completely bed bound and dependent on
others. Metastasis of cancer into lungs developed ineffective
breathing pattern. Immobility, dependency and incurable disease
developed hopelessness, low self-esteem in patient. He also
verbalized that he don’t want to live more and he is a burden on
his family. According to the patient’s son, that my father had a
small lesion on his left side of mouth which was reddish in color,
we ignored it and didn’t take care of it properly because we belongs
to a very poor family. Furthermore, he expressed that my mother
is also sick and I am the only person to earn for my family and
there is no any other family members to take care of my father,
because he is unable to do anything as he is on complete bed
rest. Sometime, my father is complaining every time and saying
that I am alone and useless and can’t do anything for you people
and even for my own self. After few days he got sever pain in
his mouth we brought him to ziauddin hospital karachi, doctor
advised for biopsy which was done in Aga khan university hospital
laboratory. Biopsy report showed poorly differentiated carcinoma
of tongue. Here in this bait-ul-sakoon hospital he has also received
few cycles of chemotherapy and now we have admitted him for
symptomatic treatment.
My feelings
After dealing with such type of patient a lot of feelings came
into my mind. Firstly, I become very anxious by listening the
financial issues of patient’s family as patient elder son verbalized
that there is no any other family member except me for earning
money. Furthermore, He also verbalized that there is no one
to take care of my father and mother. While communicating to
patient I felt that how can we help such types of patients. I listen
to their complains actively and give them psychological support. I
reassure them that there are organizations which can provide them
financial support. As according to that there are organizations
which provide treatment free of cost[2]. Secondly, the thing
which made me depressed was, patient verbalized that he is no
long worthy for his family and is only a burden on family. I felt
nervous that a person who was the active and earning person for his
family gone to a state of dependency. When I was listening patient’
these complains tears came in my eyes but I tried to tolerate it. I
felt that if same type of situation occurs in my own family what
will be my feelings in that situation. First, I was worried that how
can I handle and satisfy patient’s emotions and anxious concerns
but by the use of therapeutic communication’s skills, therapeutic
touch and active listening, I helped him a lot. I also observed that
the staff attitude toward patient and family was not professional
in that hospital. According nurses in palliative care setting should
give full support to patient, listen their needs, involved in patient
care and do efforts to improve their quality of life[3]. Throughout
the journey of palliative care, the family members, being with
the patient, are also facing their own stresses and changing roles
which may be directly or indirectly related to the patient’s illness.
Affected Domains of Palliative care in my Patient
First of all I will discuss physical domain which was effected due
to incurable disease process and other comorbid. Firstly, carcinoma
developed extra cellular growth in tongue and buccal cavity which
causes severe pain. This crushing, intolerable pain altered patient
life therefore, he can’t sleep, concentrate and unable to take rest.
Pain is the common symptom and complain in cancer patients
as literature also says that, ?Cancer pain affects about 48% of
patients with early stage cancer and between 64% and 75% of
patients with advanced disease?. There are a number of reasons
of pain in cancer patient, one of them is Chemotherapy-induced
peripheral neuropathy which is caused by side effect of several
commonly used antineoplastic agents [4]. So, I realized that pain
is not only complain of this patient but it is the common symptom
of all cancer patients. Secondly, extracellular growth of tongue
and buccal cavity narrow the oral passage way. Which lead to
difficulty in swallowing and pain during chewing. Thirdly, narrow
oral passageway, lung metastasis and COPD alter the normal
functions of lungs. Therefore he had difficulty in breathing and
use accessary muscles during respiration.
The second domain which was effected was psychosocial domain
due to disturbance in physical domain and terminal illness. There
was hopelessness, every time patient was sad and verbalized that
I am nearly to die and this is the end of my life. Patient was very
depressed and was anxious about his health status and loss of his
social role. . The family also undergoes the grief process before
and after patient’s death [5]. Every time he was asking in distress
?why did it happen to me? I didn’t hurt anybody in my life?. Who
will take care my children and family after me? Low self-esteem,
as patient said that I am unable to do anything for my own and
for my family. Every time Patient was thinking that I am burden
on family, because I am unable to take care of my family, even
to take care of own and I am also unable to earn for family[6].
Recommendations
• Give health education to family members related to patient
care
• Give more information about disease process.
• Involve family members, relatives and friends in patient care.
• Provide physical and psychological support to patient and
his family.
• Government should provide medical facilities and financial
support.
Conclusion
In conclusion, incurable diseases destroy all domains of health
and put the patient on palliative care. Palliative care not only
focus on patients but also do interventions for his family. Physical
and psychological issues are a distressing problems in a diseased
person’s life. Patient and his family life can be restored by the
demonstration of positive measures.
References
- Clinical practice guidelines for quality palliative care.
(2 Ed.). Pittsburgh, PA: National Consensus Project for
Quality Palliative Care. Retrieved from http://www.nationalconsensusproject.org/guideline.pdf
- White K R, Coyne P J, White S G (2012) Are Hospice and
Palliative Nurses Adequately Prepared for End-of-Life
Care? - See more at: http://www.nursingcenter.com/lnc/static?pageid=1333191#sthash.brjbRl2n.dpuf.JournalofHospiceandPalliative Nursing 14: 133-140. Retrieved from
http://www.nursingcenter.com/lnc/static?pageid=1333191
- Judith A Adams , Donald E Bailey, Ruth A Anderson, Sharron
L Docherty (2011) Nursing Roles and Strategies in End-of-
Life Decision Making in Acute Care: A Systematic Review of
the Literature. Nursing Research and Practice, 2011. Retrieved
from http://www.hindawi.com/journals/nrp/2011/527834/
- Seretny M, Currie G L, Sena E S, Ramnarine S, Grant R
(2014) Incidence, prevalence, and predictors of chemotherapy-
induced peripheral neuropathy: a systematic review and meta-
analysis. PAIN
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