By: Sita Maharjan Kudzai Charity Shana

Assumptions about Crisis and Coping Patients:  Taking the disease as a punishment  No fighting spirit- a death sentence  Fear of disfigurement, dependency, disruption of relationships, pain, emaciation, financial depletion, abandonment, and death.  Feeling helpless and worthless  Emotional disturbances

Family:  Frightened of losing their loved ones  Financial crisis  Difficulty assimilating the role changes  Feeling of helplessness Nurses:  Past experiences  Affective, cognitive, and behavioral tasks should be mastered in order to resolve the cancer crisis  Psycho-emotional issues: Emotional attachment while caring for the patient and family

Definitions  Crisis: It refers not to a traumatic event or experience, but to how an individual responds to the situation, event, or stressor.  Coping: is a person's cognitive and behavioral efforts to manage specific external or internal stressors that seem to exceed available resources. Coping can be either positive or negative. Positive coping includes activities such as exercise and use of social support. Negative coping may include substance abuse and denial.

General “Do’s and Don’ts” when in crisis

Related Concepts:  Stress  Death  Hospice  Emotional Disturbances

Defining Criteria:  Crisis:  Three types of crisis:  Dispositional  Life-transition  Sudden trauma

 Coping:  Coping strategies are divided into two catagories:  Emotion-focused coping  Problem-focused coping

Factors influencing coping with cancer diagnosis:  Ability to cope with stressful events in the past  Availability of significant others  Ability to express feelings and concerns  Age at the time of diagnosis

Antecedents : For cancer:  Hereditary  Tobacco use  Alcohol abuse  Excessive sun exposure  Sedentary life style and poor diet

Negative consequences:  Patient:  Depression  Anxiety  Loss of appetite  Fatigue  Negative coping behaviors  Family:  Depression  Anxiety  Alcohol Abuse  Tobacco Use  Unsatisfied with care given to the loved ones

Positive consequences:  Patient:  Asking for help  Exercise moderately and get enough sleep  Eat regularly and healthy diet  Positive coping behaviors  Family:  Pursue a hobby or project for work, church, or community.  Trust in health care providers  Eat a well-balanced, wholesome meal 2 or 3 times a day.  Set priorities and manage time

Case Study: Mrs. Z., a Russian immigrant, was diagnosed with stage IIB breast cancer at age 44. Her treatment plan included lumpectomy followed by a regimen of chemotherapy and then radiation therapy. She attributed her breast cancer to her depression, which developed while she cared for her mother, who suffered from Alzheimer's disease. Her mother died 6 months before her breast cancer diagnosis. After completion of her lengthy breast cancer therapy, Mrs. Z.'s depression worsened. She no longer had her frequent visits to the breast cancer center, and she missed the interaction with the nurses and other patients. In addition, Mrs. Z. expressed fears to her nurse that her cancer would recur and she worried that she would “pass it on” to her two teenage daughters. She would not discuss her fears with her husband or daughters because she did not want to burden them. She began to lose weight and constantly felt fatigued. She felt “alone” with her cancer and lost interest in other aspects of her life. She thought about joining a cancer support group but was embarrassed by her Russian accent.

Critical Thinking Questions: 1. Consider Mrs. Z.'s situation and describe the physiologic and psychologic/emotional stressors with which she is dealing. Describe the possible effects of these stressors on her health. 2.What specific nursing interventions can be included in Mrs. Z.'s management that will enhance her coping strategies? 3.What resources are available to Mrs. Z. to help her cope with her fears related to her cancer diagnosis? 4.Should Mrs. Z. join a cancer support group? If so, how might this benefit her? 5.Review the assessment data provided and write two or more nursing diagnoses. Are there any collaborative problems?

Nursing Interventions  Be available and listen actively to fears and concerns  Exhibit a caring attitude  Provide relief from distressing symptoms  Provide essential information regarding cancer and cancer care  Use therapeutic touch  Assist the patient in setting realistic, reachable short- term and long-term goals  Assist the patient in maintaining usual lifestyle patterns.  Maintain hope, which is the key to effective cancer care.

Discussion about articles

References: Engelking, C., & Cady, J. (2007). Cancer. In Lewis, S.M., Heitkemper, M. M., & Dirksen, S. R. (7 th Ed). Medical- Surgical nursing: Assessment and management of clinical problems. (pp ). St Louis, Missouri: Mosby. Lewis, S.L., & Shaw, C.A. (2007). Stress and Stress Management. In Lewis, S.M., Heitkemper, M. M., & Dirksen, S. R. (7 th Ed). Medical- Surgical nursing: Assessment and management of clinical problems. (pp ). St Louis, Missouri: Mosby.  