Case study - Cancer and coping: Nursing

Nurse Rebecca works at an oncology clinic and is caring for Patricia, a 53 year old female who had a breast biopsy, confirming the diagnosis of breast cancer.

Nurse Rebecca goes through the steps of the clinical judgment measurement model to make clinical decisions about patricia's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions taking action and evaluating outcomes.

First, nurse, Rebecca recognizes important cues including patricia's vital signs which include temperature, 98.6 °F or 37 °C, heart rate, 105 BPM respirations, 21 breaths per minute BP, 138/88 millimeters of mercury and oxygen saturation.

97% on room air. Nurse, Rebecca also notes that Patricia is restless crying and shaking and states she just doesnt know how to handle her diagnosis.

Next. Nurse Rebecca analyzes these cues.

She reviews the electronic health record or EHR and notes that Patricia has a family history of breast cancer. Nurse, Rebecca also sees that previous nursing assessments document Patricia's report of fatigue and difficulty sleeping.

Nurse. Rebecca recognizes that Patricia is experiencing emotional distress related to her breast cancer diagnosis Now using the information shes gathered along with Patricia medical history.

Nurse Rebecca chooses a priority hypothesis of difficulty coping. Then she generates solutions to address patricia's coping difficulties that will include non pharmacologic interventions.

And she establishes the expected outcome that Patricia will demonstrate effective coping skills regarding her breast cancer diagnosis by her next follow up visit.

Nurse Rebecca then takes action to implement these solutions. After the health care provider discusses the expected treatment plan with Patricia.

The registered nurse provides Patricia with education on coping strategies. Later.

Nurse Rebecca follows up to see how she's feeling about the information she's received and to reinforce any information.

How are you feeling after talking with your health care provider and the RN? Well, I'm feeling very overwhelmed and stressed.

I don't know how I can handle this. It's normal to be overwhelmed.

You received a lot of information today. What were some of the coping strategies you identified that have been useful in the past?

I usually talk everything through with my partner or try to meditate. Those are great ways to cope with stress.

Why don't we go through some meditative strategies before you leave the clinic and then we can call your partner? Ok.

That would really help nurse Rebecca reviews, some guided meditation apps that are free and available on Patricia's smartphone.

She also refers her to a local support group for patients with breast cancer. Patricia.

Thanks her and states that she'll plan to use these strategies when she feels overwhelmed afterwards. Patricia calls her partner on the phone to discuss her diagnosis.

One week later, Patricia returns for her follow up appointment and nurse Rebecca evaluates the outcome of her actions. Patricia's vital signs are temperature 97.8 °F or 36.5 degrees.

Celsius, heart rate, 85 BPM, respirations, 15 breaths per minute, BP, 132/84 millimeters of mercury and oxygen saturation.

98% on room air. When asked how she's feeling.

Patricia says that she's feeling less overwhelmed after talking everything through with her partner. She also reports that she's been using the guided meditation app when she feels stressed and before bedtime and that she's joined the local support group.

All right, as a quick recap, nurse Rebecca recognized and analyzed cues related to Patricia's difficulty coping and prioritized hypotheses and generated solutions to address this problem.

Nurse Rebecca then implemented non pharmacologic measures to address patricia's concerns about her diagnosis and evaluated patricia's outcomes comparing them to the expected outcomes.

Since Patricia demonstrated effective coping skills, nurse Rebecca determined the plan of care was successful.