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There are several home care services available for individuals with cancer (American Cancer Society, n.d.); out of these, Julia Morales may be expected to use the services of a registered nurse who would assess the care needs of the patient and create a care plan (possibly in collaboration with physicians), as well as of a physical therapist (to help address the problems with walking, which will probably be additionally impaired due to her knee), and of an occupational therapist (to help to regain or not to lose the skills needed for daily living). Because Julia refused to continue chemotherapy and radiation treatment, her adenocarcinoma should be expected to get worse, which means she may need further services of a nurse, who would create plans for supportive care (such as pain control); as well as the services of social workers to help Julia and her partner Lucy to deal with the emotional fallout pertaining to the rapidly progressing cancer (American Cancer Society, n.d.).
On the whole, Julias condition should be expected to get worse, probably at a fast rate; therefore, the most basic nursing intervention would be aimed at providing Julia with medical care plans for supporting her organism and managing the possible adverse effects of cancer, such as pain and impaired functioning of organs into which metastases may spread. In addition, Julia should be supplied with psychological interventions aimed at creating an atmosphere of trust between the nurse and the patient, giving health education, transferring the patients focus from her adenocarcinoma, and helping Lucy to assist Julia (Cheng, Kong, Chang, & Wei, 2013). For Julias family (including Lucy), it is possible to provide psychological interventions aimed at relieving grief, as well as educational interventions to empower the family to better assist the patient and tend to her needs.
When communicating with Julia and Lucy, it may be recommended to utilize communication techniques that involve the elements of active listening; encourage the verbalization of thoughts and feelings, including such adverse emotions as grief, fear, sadness; and provide emotional support (Cheng et al., 2013; Doenges, Moorhouse, & Murr, 2014). The nurse should also supply the patient and her family with information pertaining to her diagnosis and the expected effects of the diseases further progression. The nurse might want to focus on the positive experiences and moments of the past (for instance, showing the patient that she had a good life, if possible) and the present (demonstrating to the patient that she is loved and cared about by her partner and her family). While providing interventions, the nurse should refrain from making judgments about the patients and her familys actions, as well as avoid giving the patent and her caregivers false hope; in addition, the cultural peculiarities of the patient and her family should be taken into account (Doenges et al., 2014).
There are a number of educational components and methods which may be included in Julias care plan. For instance, it might be desirable to educate the patient (and her partner, who gives her care) about the potential ways of further progression of her adenocarcinoma, and the mechanisms of coping with the adverse outcomes of these (Doenges et al., 2014). The patient and her caregivers should be taught to properly administer drugs, monitor the vital signs (HR, RR, BP, temperature, etc.) and respond to adverse changes in these (Doenges et al., 2014). The methods might include writing down the most essential information, using a medical diary for keeping track of Julias medication administration and her condition, etc. To ensure that the education has been effective, it is also possible to use the medical diary in order to monitor the responses of the patient and her care provider to the various situation which took place, as well as to check the patients/caregivers understanding of the basic principles of providing care for the patient.
References
American Cancer Society. (n.d.). What home care services are available for cancer patients?Web.
Cheng, Q. M., Kong, C.-Q., Chang, S. Y., & Wei, A.-H. (2013). Effects of psychological nursing intervention on personality characteristics and quality of life of patients with esophageal cancer. Clinics and Research in Hepatology and Gastroenterology, 37(3), 283-288.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2014). Nursing care plans: Guidelines for individualizing client care across the life span (9th ed.). Philadelphia, PA: F.A. Davis Company.
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