The nursing professional must be adept at dealing with these kinds of conversations, and without increasing the guilt that the family member or patient might be experiencing, and keeping in mind the patient's probable depression; it is the responsibility of the nursing professional to take the conversation back to the treatment and therapies that within the realm of the legal and ethical practices in delivering medical nursing care.
Jacquie Peden, Darlene Grantham, and Marie-Josee Paquin (2005) say that nursing standards in palliative care are based on the values of the nursing profession, and are developed by provincial and territorial regulatory bodies in Canada to guide the professional practice of nursing professionals (p. 2). The hospice palliative nurse, they write:
Believes in the intrinsic worth of others, the value of life, and that death is a natural process.
Establishes a therapeutic connection (relationship) with the person and family through making, sustaining, and closing the relationship.
Provides care in a manner that is empowering for the person and family.
Provides care based on best practice and/or evidence-based practice.
Assists the person and family to find meaning in their lives and their experience of illness.
Preserves the integrity of self, person, and family (p. 3).
These standards reflect caring, personal ethics, and industry professionalism. The nurse who holds these standards dear, is the nurse that is right for the patient suffering from terminal pancreatic cancer, and who help to sustain the family through this difficult and emotional ordeal.
Summary and Conclusion
The people who will be the closest to the patient and the family throughout his illness will be strangers; strangers who must be able to build a bridge between the emotional stress and depression that the patient will suffer, and the clinical therapeutic support and interventions to help the patient live with dignity, and to experience as high a quality of life as possible. Jacquie Peden, Carolyn Tayler, and Carleen Brenneis say that communicating openly, honestly, and with a consideration for the time of the patient and family is integral to the nursing support provided the patient.
The literature addressing hospice care, especially the articles by Peden et al., are the most useful in understanding and gaining a sense of nursing standards and what to expect in caring for the terminal ill patient. There is, however, a gap in the literature between the care that is administered according to the standards, and the condition of depression that is prevalent and, according to the literature, distinct to patients suffering from pancreatic cancer.
Jacquie Peden, Elizabeth Hill, and Daphne Powell (2005) speak to the myths of palliative hospice care. Addressing these myths from the experience and perspective of palliative nursing care enlarges the knowledge of the nursing community, and serves to inform patients and families in a way that resolves much of the fear of the unknown. This could go a long way to resolving the patient's depression, because it is the sense of helplessness, hopelessness, and the fear and anxiety of the unknown which would perpetuate the onset of depression.
All of the works cited here support the need for continued and expanded research involving the different specialties in nursing and oncology to better serve patients and their families. Also, there is little nursing information that is found in the professional peer reviewed journals that speak directly to the issue of pancreatic patients and depression. There is much more literature on the subject from the physician and researcher perspectives, but there is a void in nursing literature. At this point in time, the depression of pancreatic patients as it concerns nursing, has received little attention. Both the nursing profession and pancreatic patients would benefit from further research in this area.
The conclusion from the study of the literature available is that not only is pancreatic patient depression not well understood, it is also lacking in research that would help professionals to address depression in these patients. Also, because it is directly linked to pancreatic cancer, and because the research does support the fact that patients suffering depression and pancreatic cancer do not enjoy the quality of life as those patients who do not suffer from depression, then pancreatic cancer patients and depression should be a distinct and separate therapeutic intervention from other groups of depression.
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