NRSG353 Assessment Task 1: Case Study on Chronic Illness & Care

This case study explores the experiences of a 67-year-old female patient named Cathy, who is receiving palliative care for stage four breast cancer. The case details Cathy's diagnosis at age 50, her various surgeries, radiation treatments, and chemotherapy regimens, along with the emotional and physical toll of the disease. The study highlights Cathy's constant fear, pain, depression, and changing treatments, but also her coping mechanisms, such as gardening and walking. The analysis references relevant literature, including the Kubler-Ross stages of grief, to understand the patient's acceptance and evolving perceptions of health and illness. It underscores the importance of considering the emotional and spiritual needs of chronically ill patients in addition to medical treatments. The paper also fulfills the assignment brief to reflect on a chosen publication related to chronic illness and palliative care, using the 5 R's model and referencing relevant nursing resources.

Running head: NRSG353 1
Assessment Task One-Case Study
(Author’s name)
(Institutional Affiliation)

NRSG353 2
The article presents a case story of a 67 years old female patient
named Cathy who is currently under palliative care due to breast cancer. Her
condition has progressed up to stage four breast cancer. Cathy was first
diagnosed with breast cancer when she was at 50 years old which made her
undergo several surgical operations for a period of two years. These
surgeries included a double mastectomy and removal of ovaries. Cathy was
emotionally affected during the surgical operations which were occurring one
after the other. She could not rest and only hoped all the surgeries could be
over soon. The treatment process did not involve surgical operations only but
also, she had to undergo a number of radiations. After undergoing surgery
and a number of therapeutic radiations, the prognosis of the disease did not
go very well which made her to be put under a chemotherapy regiment.
However, after seven years, her chemotherapy treatment ceases to
work and therefore the doctors had to change to a better treatment option
after several trials. Due to this reason, she started fearing surgical
operations wondering what next could be removed from her body. Cathy
have been struggling with painful symptoms since diagnosed with stage four
breast cancer in the year2012. Most of her common symptoms include hair
loss, joint pain, and depression. Constant medication changes, cancer scans,
thought of possible more surgical operation, and constant doctors’
appointments has brought Cathy to her breaking point. However, Cathy
enjoys working at the garden and walking saying she will take her limited

NRSG353 3
time trying to enjoy life as nothing more can be done to change health
condition.
From the above case story, people at end stages of life and with
chronic illness have different perceptions and views of health and illness.
Cathy lives in constant fear regarding her health. She is constantly at pain,
depression, and changing more chemotherapy regiments. This has made her
to be emotionally unstable as most of the time she is overwhelmed by stress.
However, as seen in Cathy story, most people with chronic illness and at final
stages of life usually accept the way they are and tries to create positive
attitudes towards life as a way of coping mechanism (Kaptein, Schoones,
Fischer, Thong, Kroep, & van der Hoeven, 2015)
According to Hole and Salem 2019, individuals with chronic illness and
at the end stage of life usually live in the present and reflect deeply in
continuous of life other than their illness. People who are dying have an
understanding of their circumstances and therefore they may opt to focus on
enjoying their remaining lives positively (Hole & Salem, 2019). For instance,
Cathy is currently focusing on gardening and walking around other than her
illness since she understands she has little time remaining. Other than that,
chronically ill and dying patients may refuse to follow treatment regimen or
doctors’ sessions since they see no further needs for treatment (Hole &
Salem, 2019). Furthermore, patient who are terminally ill usually have lost
hope of recovery and therefore prone to more emotional disturbance.

NRSG353 4
According to Kubler Ross stages of death and grief model, Cathy is at
the final stage of death, which is the acceptance. At the acceptance stage,
the dying patients from chronic illness have already accepted there is
nothing more that can be done (Nunstedt, Rudolfsson, Alsen & Pennbrant,
2017). Therefore, they are willing to live their final lives with enjoyment with
little or no home about their health status improvement (Nunstedt et AL,
2017). At the beginning of the treatment, Cathy was willing to undergo
various surgeries, radiation and several chemotherapy regiments. She no
longer wishes for any surgery and she is fed up with frequent appointments
and various chemotherapy regiments. She has accepted her health status as
she does not think there is anything more that can be done.
In conclusion, from my understanding from the case story, patients
with chronic illness and at the end stage of life usually have lost hope,
emotional problems and may often refuse to adhere to treatment regiments.
Dying patients perceive health and illness differently of which they may
often seek spiritual and self-actualization needs rather than medical
therapeutic requirements (Kaptein et al., 2015). Therefore, understanding
their needs and what they want most may be more helpful other than
focusing on medical treatment only. When dealing with chronically ill
patients, it is always better to consider their emotional, health attitudes and
perceptions in order to cater for their self-actualizations activities at end of
life period.

NRSG353 5
References
Hole, B., & Salem, J. (2019). How long do patients with chronic disease
expect to live? A systematic review of the literature.
Kaptein, A., Schoones, J., Fischer, M., Thong, M., Kroep, J., & van der Hoeven,
K. (2015). Illness Perceptions in Women with Breast Cancer—a
Systematic Literature Review. Current Breast Cancer Reports, 7(3),
117-126. doi: 10.1007/s12609-015-0187-y
Living well with serious illness: Cathy’s breast cancer story. (2019). Retrieved
13 August 2019,from https://getpalliativecare.org/living-well-serious-
illness-cathys-breast-cancer-story/
Nunstedt, H., Rudolfsson, G., Alsen, P., & Pennbrant, S. (2017). Patients
´ Variations ofReflection About and Understanding of Long-Term
Illness- Impact
of Illness Perceptionon Trust in Oneself or Others. The
OpenNursing Journal, 11(1),
43-53. doi:10.2174/1874434601711010043