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Rights of terminally ill patient

By Shaheen Abdul Muhmmad

This is about a patient I attended in my first clinical rotation. When I enter in the room I saw a middle-aged patient, looking healthy with average weight and height. I felt a dense and sad environment as there was depression on his face, he was lost in deep thought. For a moment he turned his eyes toward me and at that instance I had a feeling of helping him in recovering his lost confidence. But suddenly he turned his face away as he was saying that you are no welcome and I do not want to talk to you. It was shocking for me, I never had such experience and in the next moment I felt annoyed, lost interest to help him. I was thinking that he has misbehaved, he doesn’t have manners but being a nurse I had to attend them. I turned to the lady; she was his wife. She also seem very depress and she also had the expression of saying leave us alone. With selfishness in mind I left the room and was thinking that what have I got to do with them he is just another patient, he do not need help or assistance then why should I be worried it is his life.

I went to read patient’s file and as I kept on reading the situation was getting cleared. The patient was suffering form rectal cancer stage IV; this is the last stage of cancer. The patient experiences immense pain, it is difficult to bear this continuous pain. With disease like this anybody can loose hope and get frustrated. The patient must have had many treatments, every time he had been given hope; which he lost along the way. He has given up hope and wanted to die.

Initial I am unbiased with patient behavior but after reading the file had a very different thought about the patient and I become biased to the patient’s feeling. That any body with this type of chronic illness makes them feel dishearten. Now, I felt very helpless because I don’t know as a nurse what to do, how to help him at this stage only a miracle could save him or cure him. This incident makes a significant effect on us because it tells us about patient’s feelings regarding disease condition.

I can identify the situation that because of having this advance stage of cancer patient is in depression stage of grieving and dieing, as described by Elisabeth Kubler-Ross. . He and his wife became agitated from the situation, their attitude alerted us that he is in a sever depression. When I pondered over the reasons that why this incident happen? I had so many things going on in my mind. Why patient’s conduct was so rudely with me? Why did his wife act discourteously to me? What have I got to do with their problem? The most obvious reason is that the patient is not in a good mood. He is sick for a long time because cancer does not get develop in a day. He is frustrated. The fear of death has affected his thinking and he is not able to behave like an ordinary patient. This fear has made him feel that nurses and related staff are making fun. He is so fed up that he does not want to see any body in fact he now want to be left alone.

The second reason is may be no body is doing any thing for him that way he don’t want to talk or might not get enough consulting by health care provider. The patient should not be neglected, he may want to talk about dying and their families will not permit it. Sometime with long terminal illnesses family members find it difficult to sustain the physical and emotional energy required to maintain the contact with the dying person.

The general perception of nursing profession and local nursing group on this issue is not very considerable, sometime nurses leave them and often call them fussy patients. In spite of giving care they behave very rude with patients. Mostly they are only task oriented they never bothered about psychological aspect of human nature. They ignore this type of nursing aspect and are busy in physiological care of patient, which deliver incomplete nursing care. This is a very severe problem and could occur anywhere until and unless awareness developed among nursing care. I could challenge the assumption that we must have to overcome patient’s feelings and we have to take it as a challenging task for us. Because until we take initiated and deal this issue properly we never get rid from this issue. I could interpret it in a different way that patient might be feeling severe pain that way he become very frustrated and that is why he has tears in his eyes.
When I put my self in this situation, and same incident happen with me then what would be my reaction. And what will I do. When I think about this, I felt very afraid, anxious and may be I could not able to cope with this situation. It is essentially important to a nurse to provide holistic care by keeping close contact with patient related to the treatment as well as be attentive and listen to them. After critical analyzing, I found many solutions. I think the best way is to deal with the problem is to leave the patient at that time and then again go and perform routine care with better explanation, try to build therapeutic communication with patient and his family as it is the essence of modern nursing. By applying good communication techniques a nurse can take the patient in confidence and know more about the actual feelings. It is the communication; which develops professional understanding.

Another possible solution is to stay there let the patient express their feelings regarding disease process, attentively listen to the problem. Patient might feel better after sharing his feelings. Nurse should than try to build therapeutic relationship. If this situation occurs in reality I would like to leave the patient alone for a while and then go to the patient and perform some type of complementary therapy quietly. When patient feel comfortable than give him a chance to share his feelings.

I would like to share one of my clinical experiences, when I deal the patient with end stage chronic obstructive pulmonary disease with cor-pulmonale. He was very depress and don’t want to discuss any things with us. I gave back rub and massage every 2 hourly and then I started communication with him and able to explore his feelings. It works very well at that time I was not aware about more complementary therapy but now I know about many of them and can apply to any chronically ill or depressed patient.

I would like to know more ways to deal with chronically ill patient and their family as this type of disease causes problem not only for patient but for the whole family as Patricia Meier (2002) says that “the diagnosis of cancer has an effect on the entire family as well. The daily life of family has changed; other member may need to assume the role or responsibility of the client or to serve as a family care giver”. So we need to listen to the patient as well as family and counsel them appropriately.

For cancer patient teaching about the disease process is very important Patricia Meier says “if they know what to expect and what is the normal they seem less anxious provide information about disease, treatment, management of side effects and the dynamics can help patient most”. The article of David Kessler (2006) describes “the ten best and worst things to say to someone in grief” has boost my insight about the handling of difficult situation.

I can handle the situation in a much better way after this literature and article review. I can imply and teach more complementary therapy includes music therapy, pray therapy, guided imagery therapy and reflexology and as well as application of concept of present and hope can make patient to better cope. The author say “hope makes the acceptance of death easier for patient and family event where death is highly probable, hope is important and not unrealistic. No one really knows what the fortune holds, and miraculous recoveries have been known” I can apply this new learning into practice by frequently applying complementary therapy in a clinical setting because many of the chronic diseases causes depression in patient, so by utilizing these therapies we can minimize the prevalence of depression among them.

Another important thing is to establish therapeutic communication with patient and families because it is main factor for providing holistic care towards patient. It can act as a bridge between patient and a nurse. By reviewing literature I can deal these issues in better way and will able to provide holistic care towards patient and full fill the oath, which I have taken from my nursing profession.