INTRODUCTION “Your mammogram is suspicious for breast cancer” “Your biopsy was positive for breast cancer. ” These are among the most terrifying words a woman can hear from her doctor. Breast cancer elicits so many fears, including those relating to surgery, death, loss of body image and loss of sexuality. Managing these fears can be facilitated by information and knowledge so that each woman can make the best decisions concerning her care. Optimally, these issues are best discussed with the patient’s doctor on an individual basis.
What follows is a review of information on breast cancer intended to aid patients and their families in their navigation through the vast ocean of breast cancer issues. Breast cancer is the most common cause of cancer in women and the second most common cause of cancer death in women in the U. S and other countries. While the majority of new breast cancers are diagnosed as a result of an abnormality seen on a mammogram, a lump or change in consistency of the breast tissue can also be a warning sign of the disease.
Heightened awareness of breast cancer risk in the past decades has led to an increase in the number of women undergoing mammography for screening, leading to detection of cancers in earlier stages and a resultant improvement in survival rates. Still, breast cancer is the most common cause of death in women between the ages of 45 and 55. (Stoppler, 2009) RATIONALE Breast cancer is a preventable disease but can be very chronic if it appears in a woman’s body, especially if it metastasizes to other parts.
When a woman has breast cancer, it is sometimes very hard for them to accept the fact that they have cancer. According to an article by Gina Shaw, 2005 entitled,” Metastatic Breast Cancer as a Chronic Condition”, the hardest part, for most women, is the uncertainty. The uncertainty as to when they will stop suffering from this disease and when they will ever get rid of it has always been the problem that breast cancer patients are facing. Faye Glenn Abdellah conducted research to identify ways to promote patient-centered comprehensive nursing care.
As a result of the first three of these studies, 21 basic nursing problems were identified. Abdellah’s 21 problems are actually a model describing the “arenas” or concerns of nursing, rather than a theory describing relationships among phenomena. In this way, the theory distinguished the practice of nursing, with a focus on the 21 nursing problems, from the practice of medicine, with a focus on disease and cure. The problems may be overt or covert, and problem solving is to used by the nurse. The nursing process as a problem-solving process is compatible with this approach. Copyright © 1995-2008, Pearson Education, Inc. , publishing as Pearson Prentice Hall) SYNOPISIS OF THEORY Abdellah spoke of the patient-centered approach, she wrote of nurses identifying and solving specific problems. This identification and classification of problems was called the typology of 21 nursing problems. Abdellah’s typology was divided into three areas: (1) the physical, sociological, and emotional needs of the patient; (2) the types of interpersonal relationships between the nurse and the patient; and (3) the common elements of patient care.
Abdellah and her colleagues thought the typology would provide a method to evaluate a student’s experiences and also a method to evaluate a nurse’s competency based on outcome measures. (Tomey & Alligood, Nursing theorists and their work 4th ed. , p. 115, 2002) Abdellah’s 21 problems are actually a model describing the “arenas” or concerns of nursing, rather than a theory describing relationships among phenomena. In this way, the theory distinguished the practice of nursing, with a focus on the 21 nursing problems, from the practice of medicine, with a focus on disease and cure.
Furthermore, Abdellah’s theory has interrelated the concepts of health, nursing problems, and problem solving as she attempts to create a different way of viewing nursing phenomenon. The result was the statement that nursing is the use of problem solving approach with key nursing problems related to health needs of people. Abdellah’s problem solving approach can easily be used by practitioners to guide various activities within their practice. This is true when considering nursing practice that deals with clients who have specific needs and specific nursing problems. Georgia, 1990) CONCEPTUAL FRAMEWORK SUMMARY OF RELATED LITERATURE AND STUDIES To begin with, Faye Glenn Abdellah, pioneer nursing researcher, helped transform nursing theory, nursing care and nursing education. She has been a leader in nursing research and has over one hundred publications related to nursing care, education for advanced practice in nursing and nursing research. In 1960, influenced by the desire to promote client-centred comprehensive nursing care, Abdellah describe nursing as a service to individuals, to families, and, therefore to, to society.
According to her, nursing is based on an art and science that mould the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people , sick or well, cope with their health needs. Abdellah’s patient-centred approach to nursing was developed inductively from her practice and is considered a human needs theory. The theory was created to assist with nursing education and is most applicable to the education of nurses.
Abdellah’s theory would state that nursing is the use of the problem solving approach with key nursing problems related to health needs of people. Such a statement maintains problem solving as the vehicle for the nursing problems as the client is moved toward health – the outcome. (Georgia, 1990) In relation to the theory and it’s application, consider a case of Ryan who experienced severe crushing chest pain shortness of breath, tachycardia and profuse diaphoresis. Assume that the stages of illness state is the main basis to care.
Selected Abdellah nursing problem was brought upon; for instance: to maintain good hygiene and personal comfort. Classification of basic nursing problems and the initiation of the appropriate approach is a must. With the assessment, planning, and diagnosis will give rise to the appropriate Nursing Interventions to render; for instance: administer oxygen, elevate headrest, reposition client, administer prescribed analgesic, remain with client. Thus, yield a positive outcome in the behavior of the patient. (Georgia, 1990) PATIENT PROFILE Biographical Information
Name: Edith B. Dakoykoy Sex: Female Address: Unit IV, OPRRA Village, Kalunasan, Cebu City Age: 40 Place of birth: Cebu City Civil status: Single III. Health History Chief complaint “Dugay naman ni nay mugawas na na-na sa akong totoy. ” Patient complains of: pain on the left chest History of present illness According to the patient, she noticed purulent discharge on her lower left breast ten years ago. She tolerated and did not seek any medical intervention. Social History According to the patient, she spent most of her time earning money.
She do carpool works by sending students to school. She also works in a construction and doing automobile repairs. During her free time, special occasion and weekends, she is into drinking session with her friends. Health Management The patient stated that she maintains her personal hygiene by taking a bath everyday, brushing her teeth twice a day. The patient also said that she was taking some food supplements like vitamins. Aside from taking meds prescribed for her condition, she also takes some medication for her to minimize side effects brought by chemotherapy.
Diagnostics Patient no longer has any record of the diagnostic exam results that were taken in her course in the ward. APPLICATION IN NURSING ADPIE Assessment Subjective: • “Una pa ni nakong chemo. Wala kayo ko nakapaminaw sa doctor unsa buhaton tungud sa kahadlok. ”, as verbalized by patient • Objective: • Requested for information on disease process and home care • Inaccurate follow through of discharge instructions • Sedentary lifestyle noted • Shortness of breath on exertion observed • Recent weight loss noted • Impaired coordination noted Generalized weakness noted Diagnosis Knowledge deficit related to lack of knowledge about disease process and home care evidenced by request for information and inaccurate follow-through of instructions. Planning Short-term goal: • After 8 hours of nursing interventions, the patient and her SOs will verbalize understanding of the disease process and treatment regimen. Long-term goal: • After 2 weeks of continuous evaluation, patient will be able to maintain a healthy lifestyle and will show up regularly in her chemotherapy sessions. Interventions
Independent • Reinforced the importance of adhering to treatment regimen and keeping follow-up appointments. Lack of cooperation is common reason for failure of anti-hypertensive therapy. • Suggested frequent position changes and leg exercises when lying down. Decreases peripheral venous pooling that may be potentiated by vasodilatation and prolonged sitting. • Stressed importance of accomplishing daily rest periods. Increases tolerance to activity progression. Collaborative • Provided information regarding community resources in making lifestyle changes.
Health centers, programs and check-ups are helpful in breast cancer awareness. Evaluation • Evaluated the result of nursing care provided, and to made necessary changes as needed. • The patient and significant others verbalized understanding of the disease process and treatment regimen. • Patient was able to maintain a healthy lifestyle RESULTS AND DISCUSSION To evaluate, Abdellah’s Theory, the 21 Nursing Problems, and Patient – Centered Approach aims to provide a basis in formation nursing care. It primarily focus on the usage of the nursing problems in rendering the effective nursing care for the client.
Furthermore, the framework of the theory seems to focus quite heavily on nursing practice and individuals / clients. This somewhat limit the ability to generalize although the problem solving approach is readily generalizable to clients with specific health needs and specific nursing problems. We can never deny the limitations that our theory may in counter, such as, Very strong nursing centered orientation, little emphasis on what the client is to achieve, her framework is inconsistent with the concept of holism, and potential problems might be overlooked.
But specifically in our case, a table representation of Faye Abdellah’s 21 nursing problem is presented to further visualize and evaluate which problem was intervened or was carried out by nurse to attend nursing care to the client. The table represents on how the theory has contributed to the nursing care of the specific client that we had. Thence, the theory may have pitfalls but in our case it has given more benefits to the nurse and most of all to the patient itself. Faye Glenn Abdellah’s 21 Nursing Problem |A.
Basic to All Patient |Nurse – Patient Evaluation | |To maintain good hygiene and physical comfort |This area is basic to all the patient whether critically ill or supportive | | |educative type of hospitalization. They may say basic but it is barely and most | | |important problems that any registered nurse must attend.
In our case, a palliative| | |and supportive educative care, as a nurse it is a must to educate and/or assist the| | |client in doing the usual ADL’s such as bathing, basic hygiene practices, exercise,| | |proper sleep | | |(assisting the client doing guided imagery, and sleep inducing exercises), safety | | |from injury which includes proper body mechanics, and lastly and the most crucial | | |is promoting physical comfort such as non-pharmacological pain management. Thus, | | |this is a must to attend by the nurse daily. |To promote optimal activity: exercise, rest, and sleep | | |To promote safety through the prevention of accidents, injury, | | |or other trauma and through the prevention of the spread of | | |infection | | |To maintain good body mechanics and prevent and correct | | |deformities | | |B. Sustaining Care Needs | | |To facilitate the maintenance of a supply of oxygen to all body|As the top priority in the nursing care, in this category it implies that care is | |cells |need to sustain the life of the patient.
For instance, the need for oxygenation, | | |fluid and electrolyte balance and the need to have a proper nutrition. In our case,| | |it is one of the crucial and critical area that needs the nurse to be vigilant and | | |practical application of critical thinking skills and common sense. We all know | | |that our patient is ill with a terminal stage breast cancer, we’ll never know how | | |the body responds to the medication and illness.
To site an example, if the | | |metastatic cancer spreads into the lungs and complains shortness of breath, thus, | | |the patient should be given immediate oxygenation. With such, all other categories | | |such as nutrition, elimination, sensory and regulatory functions should be | | |critically assessed, monitored and evaluated every day or every hour. In completion| | |of task, patient will be able to appreciate the rendered care, and verbalize the | | |satisfaction appropriate nursing care rendered to sustain her life. |To facilitate the maintenance of nutrition of all body cells | | |To facilitate the maintenance of elimination | | |To facilitate the maintenance of fluid and electrolyte balance | | |To recognize the physiological responses of the body to disease| | |conditions | | |To facilitate the maintenance of regulatory mechanisms and | |functions | | |To facilitate the maintenance of sensory function | | |C. Remedial Care Needs | | |To identify and accept positive and negative expressions, |When we dissect the word remedial, from the root word remedy which means, it is | |feelings, and reactions |something, such as medicine or therapy, that relieves pain, cures disease, or | | |corrects a disorder.
This serves as the daily interventions for our client, and for| | |clients who have a palliative care illness. In clients with terminal stage cancer, | | |it is best to include in care his/her psychological, emotional, and spiritual | | |dimensions as a holistic individual. For instance, the use of proper therapeutic | | |communication such as giving positive encouragement is good for the client. It | | |gives rise to his/her self-esteem and determination in battling with such disease. | |In our case as a nurse, we need to promote effective and trustworthy nurse – | | |patient relationship, use of proper communication techniques, maintaining | | |therapeutic environment such as a clean and well ventilated room, guided imagery | | |and self-awareness activities, expression of psychological and emotional feelings | | |regarding the disease, and lastly, assistance in the client’s achievement of | | |personal spiritual goal. | |To identify and accept the nterrelatedness of emotions and | | |organic illness | | |To facilitate the maintenance of effective verbal and non | | |verbal communication | | |To promote the development of productive interpersonal | | |relationships | | |To facilitate progress toward achievement of personal spiritual| | |goals | | |To create and / or maintain a therapeutic environment | | |To facilitate awareness of self as an individual with varying | | |physical, emotional, and developmental needs | | |D. Restorative Care Needs | | |To accept the optimum possible goals in the light of |We all know that the end product of such terminal disease is death.
In this | |limitations, physical and emotional |category it is a must for a nurse to assist client in the perception and acceptance| | |of death and dying. In our case the nurse would assist client in identifying aids | | |in the process of perceiving and accepting of death and dying. The nurse is also | | |responsible in the continuing physiological and psychological care of client. At | | |the extremes, the nurse and psychological aids (such as psychologist, family, love| | |ones, relatives, and etc. will give the client the peaceful rest in the end. | |To use community resources as an aid in resolving problems | | |arising from illness | | |To understand the role of social problems as influencing | | |factors in the case of illness | | CONCLUSION
In Conclusion, Abdellah’s theory provides a basis for determining and organizing nursing care. The problems also provide a basis for organizing appropriate nursing strategies. It is anticipated that by solving the nursing problems, the client would be moved toward health. The nurse’s philosophical frame of reference would determine whether this theory and the 21 nursing problems could be implemented in practice. BIBLIOGRAPHY 1. George Julia B. Nursing theories: The base of professional nursing practice 3rd edition. Norwalk, CN: Appleton and Lange; 1990. 2. Abdellah, F. G. The federal role in nursing education. Nursing outlook. 1987, 35(5),224-225. 3. Abdellah, F. G.
Public policy impacting on nursing care of older adults . In E. M. Baines (Ed. ), perspectives on gerontological nursing. Newbury, CA: Sage publications. 1991. 4. Abdellah, F. G. , & Levine, E. Preparing nursing research for the 21st century. New York: Springer. 1994. 5. Abdellah, F. G. , Beland, I. L. , Martin, A. , & Matheney, R. V. Patient-centered approaches to nursing (2nd ed. ). New York: Mac Millan. 1968. 6. Abdellah, F. G. Evolution of nursing as a profession: perspective on manpower development. International Nursing Review, 1972); 19, 3.. 7. Abdellah, F. G. ). The nature of nursing science. In L. H. Nicholl (Ed. ), perspectives on nursing theory. Boston: Little, Brown, 1986.