Journal of Advanced Nursing for Health Care - MyAssignmenthelp.com

Question: Discuss about theJournal of Advanced Nursing for Health Care. Answer: Introduction John is 65 years old electrician (Cancer Australia 2017). He does not indulge in regular exercise and do not play any sport. He is a non-vegetarian and prefers meat and sandwiches instead of fruits and vegetables. He does not have any family history of cancer. He was tested positive in a screening survey for colo-rectal cancer. The results were also positive after doing colonoscopy. He used to feel tired and occasional pain in the stomach. During colonoscopy of John, high anterior resection for a tumour was found. Histology report of John indicated ACPS B, ill distinguished adenocarcinoma penetrating the serosa. All of the 17 lymph nodes were negative and the margins were clear. The adjuvant chemotherapy was indicated along with surgery (Cancer Australia 2017). The purpose of writing this essay is to learn how individual, community, environmental and social factors influence health beliefs and practices for promoting positive health behaviours. The essay will also help in analysing models of health behaviour, health education, self-management support and partnership in health-care. The models may be applied to health promotion and wellness and rehabilitation of individuals and communities. The essay will cover Discharge plan and Self-management plan for John. The discharge plan will include recommended follow-up regime after curative treatment. It will also include signs and symptoms associated with recurrence of colorectal cancer. The self-management plan will include survivorship issues including physical, social, psychological and spiritual issues that John may experience. The section will also discuss communication strategies for effective education of patient. Lastly the essay will discuss the criteria to evaluate the success of education session with patient. Discharge Plan Discharge planning is very important component of nursing care and it should have started right from admission. A successful discharge planning requires team work and inter-professional collaboration. A poor co-ordination between professionals results in discharge problems (Atwal 2002). Nurses are best positioned to deliver patient centred care in discharge planning. Discharge planning engages different agencies including health and social care professionals. Thus it is important for nurses to know the functioning of social agencies as well (Shepperd et al, 2013). It is very important for John to adhere to follow-up regime after Curative treatment of colorectal cancer to prevent any recurrence. According to current Australian Guidelines, there was 7.7 percent incidence of recurrence of metachronous primary colorectal cancers, 4 years after surgery, and 62 percent incidence of reappearance of adenomatous polyps four years after curative surgery (Australian Cancer Network 2005). The follow-up investigations include serial CEA tests; and periodic chest, abdominal and pelvic CT scans; and periodic colonoscopic evaluation (NCCN 2014). The adjuvant chemotherapy regimen prescribed to John include Calcium folinate (Leucovorin) 50mg IV day 1, Fluorouracil 400mg/m IV Day 1, Fluorouracil 2400mg/m by IV infusion over 46 hours commencing on day. The 12 cycles of chemotherapy are prescribed and the prescribed frequency of cycles is 14 days (AIHW 2016). Fluorouracil is a fluoropyrimidine which is an important component of colon cancer treatment in adjuvant s ettings. The antineoplastic agents are given after surgical resection to minimise the risk of recurrence as they destroy microscopic metastatic tissues (Chung and Saltz 2007). However the patient should be made aware of the side-effects of Fluorouracil. The common side-effects of the drug include Nausea and vomiting, Diarrhea, Mouth sores, loss of appetite, Watery eyes, photophobia, Taste alterations, metallic taste in mouth, skin discoloration along the vein through which the medication is given, Low blood counts (white and red blood cells and platelets may decrease in the short term) (Thomas et al 2016). This can put the patient at increased risk for infection, anemia and/or bleeding. The patient should be asked for regular follow-up for the management of these side-effects. The most common symptoms of recurrence of colorectal cancer include change in bowel habits such as frequent diarrhoea or constipation; blood in stools or black stools, loss of appetite, pain in the abdomen, malaise, and unexplained weight loss (Zone and Guide 2017). Diarrhoea is also a side effect of surgery itself which can be managed by diet alone or loperamide may be given (Landers et al 2011). Patients also experience increased wind after surgery which could be incredibly painful and strong analgesics may be required to manage this (National Institute for Health and Care Excellence, UK). About one-third people after curative surgery for colorectal cancer die due to recurrence (weiser et al 2008). Therefore it is imperative to detect any recurrence at the earliest stage. Some tools have been developed for cancer recurrence monitoring. These tools are called colorectal cancer nomogram (Memorial Sloan-Kettering Cancer Center). Disease free probability nomogram can be used to predict the probability of a person to be cancer free after 5-10 years of colorectal surgery (ibid). Colon cancer nomogram can be used to know the probability of survival after five years of surgery (ibid). The tool also gives a range with 95 percent confidence interval (ibid). Social aspects of discharge planning are also very important because social diagnosis runs parallel to medical diagnosis (Lithner, 2015). Thus discharge planning should be holistic with appropriate referrals such as referral to psychologist, social worker, care-taker, legal consultant and financial consultant. The close family members of patient or close friends should also be counseled in detail regarding discharge plan including all its aspects i.e. social, emotional and psychological aspects. The pears should understand that the patient needs mental, emotional and social support during survivorship. Self-Management Plan Once diagnosed with cancer, the journey of life becomes very difficult. This is a disease where even after treatment, fear of recurrence remains inspite of maintaining healthy lifestyle during Survivorship. Thus survivorship in colorectal cancer is a great challenge and several physical, mental, emotional, psychological, social, and spiritual issues are associated with it. Survivorship may be understood by different view-points. In clinical practice, survivorship is generally referred to the period of life after getting primary treatment of cancer. Marker has defined survivorship to be the period of life after diagnosis of cancer (Marker 2015). Although the experiences of survivorship are different for different people, but the period of survivorship is generally perceived to be very difficult by almost every patient (Chapman 2015). The research has shown that colorectal cancer survivors have inferior physical and mental quality of life as compared to those without cancer (Denlinger Barsevick 2009). The physical and mental issues associated with survivorship include; lethargy, difficulty in sleeping, fear of reappearance of cancer, depression, negative body image, apprehension, gastrointestinal problems, urinary incontinence, sensory neuropathy, and sexual dysfunction (ibid). There also occur side effects of chemotherapy which may result in persistent diarrhoea, nausea, vomiting, ulcers, photophobia, and anaemia (Thomas et al 2016). These physical and mental issues make the routine life of patient very challenging. The patients also face social difficulties such as inability to fulfil work responsibilities, organisational difficulties, cognitive issues, increased dependence on others, inability to maintain intimacy, challenges to maintain self-identity, inability to fulfil personal and social expectations (Keesing et al 2015). The person may be considered medically unfit for his job and thus may lose his source of income which has serious survivorship consequences. The family may consider the patient as a burden and may become hostile to him and even abuse him. The patient may lose his self-respect, self-dignity and right to a dignified life. Thus patients life may turn to just a vegetative state where he just eat and sleep and passes his life on the mercy of others. Patients also face spiritual distress such as hopelessness (Solano et al 2016). Patients in spiritual distress are unable to find meaning in their lives. They also lose hope, love, peace, comfort, strength, and connection in life. There occurs a situation of conflict between their beliefs and what is happening in their lives (ibid). Patients are generally unprepared for the period of survivorship and they are uncertain regarding recovery and social integration back to the community (Dhillon 2015). There is also a need to prepare social communities and workplaces to help patients experience survivorship in a better way (Marker 2015). During the period of survivorship, there is a constant anxiety of cancer recurrence which is a real concern (Butow et al 2015). Thus to help patients manage survivorship issues; survivorship care plans could be very useful and beneficial. The Australian government has provided survivorship care plan toolkits and other resources (CancerCouncil, 2015; Wiley et al, 2016). Australian governments sharing health care initiative use several chronic disease self-management education programs such as; Stanford university chronic disease self-management program, stages of change model, and telephone coaching (Jordan et al 2008). The Stanford university chronic disease self-management program is a six week generic program, 2.5 hours per week, and is led by trained amateur leaders as well as health-care professionals. It has group-based format and the contents include pain management, fatigue management, proper use of medication, and managing negative emotions such as resentment, distress and frustration. Also it includes resolving health-related problems and also effective communication with health personnel (ibid). The program also utilise stages of change model which enables patients to move from pre-contemplation to contemplation to preparation to action towards self-care and self-management (Drury and Auon 2014). The health-care initiative also includes t elephone coaching which uses motivational interviewing techniques and encourages the patient to adhere to treatment (Jordan et al 2008). It also helps patients deal with negative emotions; improves self-confidence of patients; and provides consolidated social support (ibid). It is essential to communicate to patient in an effective manner to help him manage survivorship issues. Certain communication principles/ strategies need to be followed to facilitate effective communication with patient. The strategy of motivational interviewing needs to be followed. Patient may ask what he can do to optimise his health after treatment. We need to communicate discharge plan and self-management plan as prepared above. The communication ought to be effective and should be patient-centred and goal-directed. It involves collaboration with patient and respecting the patient to elicit a positive response from the patient. There should not be any ambiguity while communicating the discharge plan and self-management plan with the patient. Four general principles of motivational interviewing as described by Drury Aoun; are engaging (express empathy), guiding (develop discrepancy), evoking (role with resistance), and planning (support self-efficacy) ((Drury Aoun, 2014). Firs t of all it is essential to build rapport with patient by asking general questions such as, How do you feel now?, How are things going on?, What are you planning next?. It is better to ask open ended questions to engage the patient in conversation as much as possible. Listen to the patient, summarise what he said, reflect and then respond. Assess how the patient is passing through stages of change while health education (Drury and Auon 2014). It is important to explore the values and attitudes held by the patient. Is he religious? Does he go to Church? How active he is socially? Does he have social networks? Does he have family support? Who takes care of him during illness? All this assessment will help adding/ modifying to the survivorship plan of patient. Allow the patient to use his own arguments regarding survivorship plan. Do not argue with patient. Better understand, summarise and reflect on patients perspective. Set some SMART (Specific, Measurable, Attainable, Realistic, and time-bound) goals for the patient to be achieved slowly and one by one during survivorship (Drury and Aoun 2014). The discharge plan and survivorship plan must also be communicated to family and close friends of the patient. This is another most important and critical aspect of communication. The family and friends also need counselling regarding the care and communication with the patient. During survivorship the patient is dependent on his family or friends in one or more ways and it is their responsibility to keep the patient happy and motivated during this period. The education session will be evaluated as successful if the patient and his family or friends move from pre-contemplation (Not yet thinking to change) to contemplation (thinking for change) to preparation (planning for change) to action (adopting change/ new habits) to maintenance (continuing healthy habits), across the stages of Transtheoretical model (Drury and Aoun 2014). Another evaluation of an effective communication is happy and satisfied survivorship of John where he lives a socially and spiritually fulfilled life. Conclusion John was living a happy and comfortable life when suddenly he was diagnosed with colorectal cancer and his life turned upside down. Such moments are very challenging for the patient, his family and friends, and also their health professionals including assigned nurse. Thus a nurse requires great skills to prepare discharge plan and self-management plan for John to follow during survivorship. Even more fine skills are required to communicate these plans to John and his family. For John; after curative treatment of colorectal cancer, it becomes very important for him to adhere to the follow-up regimen. The nurse is required to prepare a discharge plan for John and communicate it to him and his family in the best possible manner. The John may also experience several physical, mental, emotional, psychological, social and spiritual survivorship issues where he needs support of his family, friends, and community. The nurse should prepare an effective self-management plan for John addressin g all these issues and should communicate effectively this plan to John and his family or friends. The goal of preparing these plans and communicating them well to patient and his family is to add life to the years of survivorship along with adding years to the life of John. 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