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Running Head: WIT: HEALTH CHALLENGE
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Wit: Experiencing a Health Challenge: The Effects on Clients
Sofia Fernandes
821-653-698
Friday, October 3, 2014
Paul Jeffrey
NURS 209(360): Practical Nursing Practice 3
Humber College
WIT: HEALTH CHALLENGE
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Wit: Experiencing a Health Challenge: The Effect on Clients
The movie “Wit” is about a university English Professor named Vivian Bearing and her stages of
metastatic stage IV ovarian cancer. Throughout the movie, we see the changes Vivian goes through
physically and mentally through both her cancer and also her treatment. As the story progresses, Vivian
reflects on significant events that have happened in her life. She reflects on her cancer, the cycle it
takes, her treatment and also certain aspects of the classes she taught (Nicholas, 2001). Throughout this
essay, I will be discussing health challenges, but mainly about pain and how certain interventions can be
used to manage pain and who is involved in these interventions. Finally, I will be discussing two
community resources that I believe help cancer patients by funding researches to find a cure and also
give information about cancer and what can be done to help.
Health Challenges
Vivian Bearing goes through a lot of physical and psychosocial challenges throughout her
journey with cancer. The three main physical challenges that Vivian dealt with were nausea and
vomiting, hair loss and pain. All three of these challenges are side effects of chemotherapy. Nausea and
vomiting is likely to come from a combination of drugs being taken with chemotherapy (Canadian
Cancer Society, 2014). In the movie, Vivian goes through a combination of experimental chemotherapy
drugs used to attempt to have her live longer and see if the drugs are working on the tumor. Hair loss is
a common side effect to chemotherapy as well. Vivian experiences hair loss because hair follicles are
vulnerable to chemotherapy because of how fast they grow (2014). Finally, pain is the big physical
challenge that Vivian has to endure. Pain from chemotherapy can be anywhere in the body from your
muscles to a headache (2014). Vivian also goes through a couple of psychosocial challenges. Three of the
challenges I believe she faces are loneliness, hallucinations and depression. Loneliness and depression
are intertwined. Vivian experiences loneliness because she has no family in the United States and also
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does not have many friends. This causes her to become depressed because she feels like she has no one
to support her towards the end of her treatment and life. The hallucinations could be an effect from all
the drugs she is taking to treat her cancer.
Pain
As a future nurse, I believe that pain is the number one priority in this situation. If you do not
treat the pain, a nurse cannot continue with any assessments she or he may have to do. According to
Russell K. Portenoy, patients who experience pain during cancer is one third of cancer patients and up to
90% of cancer patients with advance diseases experience pain (Russell K. Portenoy, 1992). Also, he
states that even though pain associated with cancer is usually treated with analgesics, it should not be
the only treatment of care for a patient (1992). In the movie, Vivian was offered pain medication at first,
but refused, later on she started taking them (Nicholas, 2001). Pain has two components, cognitive and
affective; the affected component is what needs attention (G.W Hanks, D.M Justins, 1992). One can
administer medication, or simply try to relieve the pain in a different way. Since pain is subjective,
nurses have to depend on what the patient says in order to continue on with the proper interventions.
Because Vivian is a terminally ill cancer patient (Nicholas, 2001), pain management, in different forms, is
the most important. We would want to make her as comfortable as possible during her treatment.
Three main interventions that I would recommend to a nurse who is treating Vivian are, an accurate
pain assessment, administering medications to prevent it from getting worse and finally relaxation
therapy.
Interventions
The first intervention and also the most important is an accurate pain assessment. According to
Lewis, Dirksen, Heitkemper, Bucher and Camera, there are two main goals in pain assessment. These
goals are to describe the patient’s sensory, affective, behavioural, cognitive and sociocultural pain
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experience for the purpose of implementing any pain management and to identify what the goals are
for therapy (Lewis, Dirksen, Heitkemper, Bucher, Camera, 2014). Doing an accurate pain assessment on
Vivian can help determine that type of pain she may be experiencing and also can help us determine
what direction she would like to take to manage the pain. While doing the assessment, you would want
to know the pattern, area, intensity and nature of the pain (2014). After doing an accurate pain
assessment, the next intervention would be to administer any pain medications also called analgesics.
Preventing the pain from getting worse is the most effective way to treat cancer pain (American Society
of Clinical Oncology, ASCO, 2013). In the movie, at first Vivian refused any analgesics and when the pain
started to get worse she accepted them (Nicholas, 2001). Usually doctors will start the patient off with a
weaker analgesic. To know how bad the pain is, usually cancer patients such as Vivian would be
prescribed non-opioids such as acetaminophen for mild to moderate pain and as the pain gets worse
she would be prescribed narcotics such as morphine for moderate to severe pain (2014). Because Vivian
is in severe pain, her physician will prescribe a narcotic to help relieve the pain or prevent the pain from
getting worse. Analgesic administration is not the only intervention that can be used. The final
intervention I would recommend to Vivian is relaxation therapy. By adding some relaxation techniques,
such as deep breathing exercises and guided imagery, it can help with pain after certain procedures and
also with side effects from chemotherapy (Canadian Association of Occupational Therapists, 2013-2014).
Two of the relaxation techniques that I would recommend to Vivian during her treatment is deep
breathing and guided imagery. Deep breathing and guided imagery can be used together. They are used
to help someone imagine themselves in a place where feelings of relaxation would be (2013-2014).
Since Vivian is in a hospital setting (Nicholas 2001), closing her eyes, deep breathing and imaging herself
in a place with no pain can potentially help her relax and also relieve her pain for a period of time.
Collaborative Care
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There are many people that can help and support a cancer patient from family to professionals.
In order to complete these interventions, I myself would consult with a doctor, a pharmacist and also an
occupational therapist. In order to get a medication order for Vivian, I would need to consult her
physician. Communicating with the physician is important because he or she can help determine the
best possible treatment to help with pain (American Society of Clinical Oncology, 2013). In order to
retrieve the order, I as the nurse treating Vivian would have describe to the physician the number on the
pain scale Vivian had given me and also the type of pain. After consulting with the doctor, I would
contact the pharmacist to dispense the medication order as soon as I had it. Hospital pharmacist are the
ones in charge of all the medications (Tanja Z, 2013). He or she would also help with determining what
the best medication would be and also explain to both myself and Vivian the side effects and any other
information about the drug (2013). Finally the last person in the collaborative care team is an
occupational therapist. I would recommend an occupational therapist to Vivian because since she does
not have any visitors, the therapist can discuss with her, her emotions and thoughts about her cancer
her life and also ways to relax (Canadian Association of Occupational Therapists, 2013-2014). They can
teach her the deep breathing technique and also help her with guided imagery so she can get away from
reality for bit.
Community Resources
There are many community resources that can help someone with cancer that range from
community centers to hospitals. Two resources that I believe are the most helpful and would have
recommended to Vivian are the Canadian Cancer Society and Wellsprings. The Canadian Cancer
Society’s mission is the eradication of cancer and the enhancement of the quality of life of people living
with cancer (Canadian Cancer Society, 2014) and their vision is to create a world where no Canadian
fears cancer (2014). While looking through the website, I found it very resourceful when it came to the
types of cancer and also the many ways to treat pain. It explains the types of pain one can get along with
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treatment options and ways of finding support. The final resource is Wellsprings. Wellsprings mission is
to create the best programs that meet the psychological, emotional and educational needs of individuals
and their family members living with cancer (Wellsprings, 2011). Speaking from experience, Wellsprings
has helped many families try to cope with cancer, especially with terminal cancer by supporting them
with mainly emotional and educational needs. It has workshops that can help both family members and
cancer patients cope with the disease and how to handle it in a healthy manner.
Conclusion
In conclusion, Wit has been an inspiring movie and has also had me really think about how I
would react when I become a licenced nurse and have to deal with a situation like Vivian’s. It has taught
me to rather than stick to medications to relieve pain or even for depression, it has helped me learn that
there are more ways than one to deal with certain situation and also think outside the box. This essay
was to determine what I would do as nurse. I would have done an accurate pain assessment because
pain is associated with cancer, given her the proper medication and also referred her to relaxation
therapy. As mentioned above, the movie is about a well-known prestigious English professor who finds
out she is terminally ill and re-evaluates significant moments in her life (Nicholas, 2001).
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References
American Society of Clinical Oncology, (February, 2013). Pain: Treating Pain with Medication. Retrieved
from http://www.cancer.net/navigating-cancer-care/side-effects/pain-treating-pain-medication
Canadian Cancer Society. (2014). Retrieved from http://www.cancer.ca
Canadian Cancer Society. (2014). Pain. Retrieved from http://www.cancer.ca/en/cancerinformation/diagnosis-and-treatment/pain/?region=on
Canadian Cancer Society. (2014). Side Effects of Chemotherapy. Retrieved from
http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/chemotherapy-andother-drug-therapies/chemotherapy/side-effects-of-chemotherapy/?region=on
Canadian Association for Occupational Therapists. (2003-2014). Relaxation Therapy/ Techniques and
Anxiety Management. Retrieved from http://www.caot.ca/default.asp?pageid=1327
Hanks, GW., Justins, DM. (1992). Science and Practice. Cancer Pain Management, 339, 1031-1032.
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Wit: Experiencing a Health Care Challenge: The Effects on Clients Outline
The movie “Wit” is about a university English professor by the name of Vivian Bearing and her stages of
metastatic Stage IV ovarian cancer. Throughout the movie, you see how Vivian changes through her
cancer and also her treatment.
Three Physical Effects
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Pain
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Nausea and vomiting
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Hair loss
Three Psychosocial Effects
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Loneliness
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Hallucinations
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Depression
Area of Priority for Holistic Nursing
I would focus on the pain because since Vivian is dying, pain management is the most important at that
very moment.
Three Nursing-specific Interventions
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Pain assessment first. Goals of this assessment is to determine the pattern, area, intensity,
nature of the pain and how it affects the patient (Lewis, Dirksen, Heitkemper, Bucher, Camera,
2014)
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Administering pain medications to prevent the pain from getting worse. Preventing pain from
getting worse is the most effective way to treat cancer-pain (American Society of Clinical
Oncology, ASCO, 2013).
-
A Relaxation Therapy. Adding some relaxation techniques like deep breathing or guided imagery
can help with pain after certain procedures and also side effects from chemotherapy or even
radiation (Canadian Association of Occupational Therapists, 2013-2014)
Three Interprofessional Collaborative Care Strategies
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Call MD about any pain medication order. Communicating with the MD is important because
he/she can help determine the best medication treatment to help with the pain ( American
Society of Clinical Oncology, ASCO, 2013)
-
Call an occupational therapist. Since Vivian does not have many visitors besides the nurse, we
can possibly call and OT for the relaxation therapy. They can discuss her emotions and thoughts
about the procedures, her life, and many more things (Canadian Association of Occupation
Therapists, 2013-2014).
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Contact pharmacist to dispense the medication order given by the doctor (Tanja Z, 2013)
Two Community Resources
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Canadian Cancer Society
55 St. Clair Ave W, Suite 500
Toronto, ON
M4V2Y7
Email: [email protected]
Telephone: (416) 961-7223
Wellspring
4 Charles St E, Suite 400
Toronto, ON
M4Y1T1