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Running Head: WIT: HEALTH CHALLENGE 1 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 2 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 WIT: HEALTH CHALLENGE 3 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 WIT: HEALTH CHALLENGE 4 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 WIT: HEALTH CHALLENGE 5 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 WIT: HEALTH CHALLENGE 6 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). WIT: HEALTH CHALLENGE 7 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. Retrieved from http://media.proquest.com.rap.ocls.ca/media/pq/classic/doc/1695111/fmt/pi/rep/NONE?hl=& cit%3Aauth=Hanks%2C+G+W%3BJustins%2C+D+M&cit%3Atitle=Cancer+Pain%3A+Management &cit%3Apub=The+Lancet&cit%3Avol=339&cit%3Aiss=8800&cit%3Apg=1031&cit%3Adate=Apr+2 5%2C+1992&ic=true&cit%3Aprod=ProQuest&_a=ChgyMDE0MTEyMDIzMzcwMzUzNzoyNTkwN DESBjEwMzMxMxoKT05FX1NFQVJDSCIOMjA0LjIyNS4xMDcuNDcqBTQwMjQ2MgkxOTkwMjYzNz M6DURvY3VtZW50SW1hZ2VCATBSBk9ubGluZVoCRlRiA1BGVGoKMTk5Mi8wNC8yNXIKMTk5Mi8 wNC8yNXoAggEoUC0xMDA3MTA3LTg2MTEtQ1VTVE9NRVItMTAwMDAwMjAtMTA2NDM0NZIB Bk9ubGluZcoBbU1vemlsbGEvNS4wIChXaW5kb3dzIE5UIDYuMTsgV09XNjQpIEFwcGxlV2ViS2l0Lz WIT: HEALTH CHALLENGE 8 UzNy4zNiAoS0hUTUwsIGxpa2UgR2Vja28pIENocm9tZS8zOC4wLjIxMjUuMTExIFNhZmFyaS81Mzc uMzbSARJTY2hvbGFybHkgSm91cm5hbHOaAgdQcmVQYWlkqgIoT1M6RU1TLVBkZkRvY1ZpZXdCY XNlLWdldE1lZGlhVXJsRm9ySXRlbcoCB0FydGljbGXSAgFZ4gIBTuoCBnN1bW1vbvICAA%3D%3D&_s =8CilYTJLS1n5ltF9EPdPBYtU5uU%3D Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., Bucher, L., Camera, I.M. (2014). Medical-Surgical Nursing in Canada (3rd Edition). Elsevier Canada Portenoy, R. (1992). Science and Practice. Cancer Pain: Pathophysiology and Syndromes, 339, 1026. Retrieved from http://media.proquest.com.rap.ocls.ca/media/pq/classic/doc/1695110/fmt/pi/rep/NONE?hl=& cit%3Aauth=Portenoy%2C+Russell+K&cit%3Atitle=Cancer+Pain%3A+Pathophysiology+and+Synd romes&cit%3Apub=The+Lancet&cit%3Avol=339&cit%3Aiss=8800&cit%3Apg=1026&cit%3Adate =Apr+25%2C+1992&ic=true&cit%3Aprod=ProQuest&_a=ChgyMDE0MTEyMTAxMDY1MzI5MTo3 OTY1NDUSBjEwMzMxMxoKT05FX1NFQVJDSCIOMjA0LjIyNS4xMDcuNDcqBTQwMjQ2MgkxOTkw MTI5ODE6DURvY3VtZW50SW1hZ2VCATBSBk9ubGluZVoCRlRiA1BGVGoKMTk5Mi8wNC8yNXIKM Tk5Mi8wNC8yNXoAggEoUC0xMDA3MTA3LTg2MTEtQ1VTVE9NRVItMTAwMDAwMjAtMTA2ND M0NZIBBk9ubGluZcoBbU1vemlsbGEvNS4wIChXaW5kb3dzIE5UIDYuMTsgV09XNjQpIEFwcGxlV2V iS2l0LzUzNy4zNiAoS0hUTUwsIGxpa2UgR2Vja28pIENocm9tZS8zOC4wLjIxMjUuMTExIFNhZmFyaS 81MzcuMzbSARJTY2hvbGFybHkgSm91cm5hbHOaAgdQcmVQYWlkqgIoT1M6RU1TLVBkZkRvY1Z pZXdCYXNlLWdldE1lZGlhVXJsRm9ySXRlbcoCB0FydGljbGXSAgFZ4gIBTuoCBnN1bW1vbvICAA%3D %3D&_s=Eg7Vz82uQyWB1BImS68tmGLb%2BVU%3D Tanja A. (2013). Pharmacist Job Description. Retrieved from http://www.healthcaresalaryworld.com/pharmacist-job-description/ WIT: HEALTH CHALLENGE Wellspring. (2011). Retrieved from http://www.wellspring.ca/ 9 WIT: HEALTH CHALLENGE 10 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 - Pain - Nausea and vomiting - Hair loss Three Psychosocial Effects - Loneliness - Hallucinations - 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 - 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) WIT: HEALTH CHALLENGE - 11 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 - 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). - Contact pharmacist to dispense the medication order given by the doctor (Tanja Z, 2013) Two Community Resources - - 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