Cancer threatens our very existence; when pain is also present, suffering is compounded and leads to spiritual distress. This article presents a nursing strategy to deal with the responses of clients and families in such complex situations. Four case studies were analyzed to describe the methodology and applicability of an approach based upon the Dungan model of dynamic integration. The goal of the first appointment was to teach clients how to effectively deal with the advanced cancer pain that brought them to the center. Presence, caring, genuine concern, and active listening facilitated the therapeutic relationship and were the hallmarks of nursing modalities. Daily appointments with the nurse continued for 6-10 days while clients were also being treated by medical staff. Trust was established by reaching the mutual goal of giving the client control over pain. Spiritual assessment confirmed the diagnosis. Grief was a characteristic of spiritual distress experienced by all clients. Therefore, grief counseling was instituted early and reinforced daily. Spiritual counseling, cognitive reframing, crisis intervention, and reminiscence were used selectively. Because of the complexity of problems faced by families, multi-disciplinary referrals were required by all clients. Outcomes were evaluated positively by participants. All clients increased hope, participated in the grief process, and integrated the possibility of death in such a way as to promote personally defined "quality of life" through their waning days.
This descriptive study measured outcomes of a health maintenance programme (HMP) of regular exercise, health teaching and group participation on physical and mental well-being in a convenience sample of frail older adults living independently. Hand strength, range of motion (flexibility) and blood pressure were used as indicators of physical well-being. Self-esteem and life satisfaction were used as indicators of mental health. A pre-test/post-test design was used taking all measurements before starting the programme and after a 6-month interval of participation. Paired t-tests of mean change scores, with each participant acting as his or her own control, showed statistical improvement in systolic blood pressure and range of motion in right ankle and in self-esteem and life satisfaction using visual analogue scales. Clinical improvement was demonstrated in all measurements and by participant evaluation of the programme.
In this article, the authors present a protocol study developed to evaluate the usefulness of the nursing diagnosis "high risk for ineffective management of therapeutic regimen" among patients with congestive heart failure (CHF). Nursing interventions for increasing the CHF patient's abilities to perform therapeutic self-care for the promotion and maintenance of a prescribed medication regimen were evaluated based on predicted outcomes. Orem's self-care deficit theory of nursing provided the theoretical framework used in the protocol. Orem's supportive-educative nursing system was the approach used. Knowledge deficit was noted to be a major obstacle to maintaining the prescribed medication regimen among CHF patients. Comprehensive teaching of the patient, supported by a therapeutic nurse-patient relationship, was found to be the most important factor in the promotion and maintenance of a prescribed medication regimen among patients with CHF.
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