Running Head: The Wit

The Wit

Student: Daljit Banga

Student No: 822-209-474
Date Submitted: November 17, 2014
NURS 360: Nursing Theory
Professor: Anne.Senczuk
Humber College ITAL

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The Wit
After the day cancer is diagnosed, life is never quite the same. Cancer is not just
one disease but many diseases. Cancer is a group of more than 200 diseases
characterized by uncontrolled and unregulated growth of cells (Potter & Perry,
p.347).One of the cancers diagnosed in women is ovarian cancer. Ovarian cancer
has the highest mortality rate of all gynaecologist cancers because most woman
have advanced disease at diagnosis (Potter &Perry .1560).This type of cancer is
silent and the symptoms vary. Currently, there is no screening test to detect the
disease (Ovarian Cancer Canada, 2013) .Cancer affects patient not just physically,
but also psychologically and emotionally. This paper will present the different health
challenges experienced by a cancer patient and its impact on her life in the movie
called the Wit.
The main character of the movie is Vivian Bearing a well educated professor of 17 th
century literature. Both colleagues and students were respected to her until she was
diagnosed with a stage four metastatic ovarian cancer. Her Dr. Kelekian frankly
explained her that she will need to be very tough for eight month chemotherapy
treatment. Without hesitation, she decided to take eight high -dose experimental
chemotherapy treatment. Cancer treatment changed her life, physically,
emotionally, and spiritually. Her condition gave her the chance to reflect about life
and death. She also reflected on significant events during her life. However, she
realized that she should be more kind in her life. Overall, the movie presented how
cancer patient experiences the health challenges and how the role of health care
professionals affects their life, during the treatment.

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Three physical effects of the health challenge:
Based on the Movie, there are three significant physical challenges emphasized by
the character Ms. V. First physical effect is fatigue, second is hair loss and third is
pain.
Fatigue-fatigue is one of the symptoms most commonly reported by patients with
cancer. Cancer related fatigue has been defined as more severe, unrelenting and
distressing than the fatigue experienced by healthy people (Holley 2000). Moreover,
Nausea, vomiting and lack of sleep are frequently experienced by patients with
advanced cancer, and these symptoms can contribute to fatigue. In the movie Ms.
Vivian often experienced nausea and vomiting. She could not eat anything. She can
just drink a sip of water. The physical effort of frequent vomiting is tiring, and if the
patient is unable to maintain a sufficient nutritional intake over time, fatigue can
develop (Millership 2003). According to the Ovarian Cancer Canada, fatigue is the
most persistent challenge among ovarian cancer patients. Second reason is that
contribute to fatigue is lack of sleep. Cancer patients often struggle to sleep well.
Cancer related fatigue and associated sleep disturbance are the most frequent and
disturbing complaints of people with cancer (Barton-Burke, 2006). Sleep may be
difficult to achieve due to a variety of factors such as fear, anxiety, and
hospitalisation.
Hair Loss -Hair loss is one of the most common side effects of the chemotherapy.
For women the hair is a symbol of feminism. Also women feel like their hair is a
crowning glory. Getting bald or loosing hair is very scary for cancer patients. It
could be temporary but hair loss lowers their self-esteem and confidence.

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Pain- Third physical effect is pain that is very common among cancer patients. Pain
is an unpleasant feeling that affects the patient physically and emotionally. The
International association for the study of pain subcommittee on Taxonomy (1979)
defines pain as an unpleasant, subjective sensory and emotional experience
associated with actual or potential tissue damage (p 209-214).Also the pain can be
related to emptiness and loneliness in patient.
Three psychosocial effects of the health challenge:
Isolation-To avoid infection, cancer patients who receive chemotherapy have to
isolate because chemotherapy is the anticancer drug to damage cancer cells, so
they cannot grow and reproduce. If chemotherapy damages the bad cells, it also
affects good cells in the body. Bone marrow suppression is most common side effect
that patient tend to experience with chemotherapy. Therefore, the immune system
of the body gets weakened and patient is more prone to the infection. According to
Canadian Cancer Society bone marrow suppression is a condition in which a low
blood cells count (Leukopenia) increases the risk for infection .This is the reason
chemotherapy patients have to stay in isolation rooms. In the movie Ms. Vivian feels
very emptiness and loneliness when they put her in isolation room. Patients feel
more horrible when they interact with medical staffs f who wears precautions such
as protective gloves, gown, and mask during the care. They feel like they are having
communicable disease.
Degradation -

The patient in the movie felt degraded when ultrasound

technician asked Doctor, she said yes, I had PhD and he ask again your
Doctor. She felt loss of identity. She has always been a proud, independent woman
who stood apart from others, but she felt that disease stole her education status

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.she loses respect to herself. She felt much degraded when one of her former
student gave her pelvic exam. She felt like she is in the pity of other people
especially health care professionals. Also she felt that she was treated like specimen
rather than human being. She was once a boss and now has become a slave.
Embarrassment- Ms. V. felt embarrassed due to her treatment .she had to wear
hospital gown for whole day. Moreover, she felt very uncomfortable when Dr.
Kelekian and his team came to her room for physical exam. They did not even
mention to Ms. Vivian about the procedure and just exposed her in front of
everyone. She felt that her disease robbed her dignity. Also patients who undergoes
chemotherapy losses their hair and quite often hospital staff are not compassionate
to the Circumstances. They often forget to cover their bald head with scarf, hat or
wig. The healthcare professionals often forget that they are dealing with human
beings.
One of the areas for Holistic care:
Emotional distress- cancer and its treatment creates physical and psychological
changes .Emotional distress is one of the sixth vital sign in cancer care patients.
Emotional distress such as anxiety and distress can affect the quality of life of
cancer patients. According to National Cancer emotional institute, anxiety may
increase pain affect sleep, and cause nausea and vomiting. So, emotional distress
should be identified by health care professionals as a core indicator of a patients
health and well-being. It must be the first priority in the holistic nursing care of an
ovarian cancer patient. Nurses should ask open ended questions to the patient. In
this way, they can express their feelings and concerns regarding the treatment.

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Three nursing specific interventions:

Therapeutic Client -nurse communication- Communication is the method

to convey the message through the exchange of ideas, feelings, and expectations.
Nurse client therapeutic interactions improve the clients emotional and physical
comfort (Potter & Perry, p.252). In the movie, some of the health care professionals
were unsuccessful to maintain the therapeutic communication with their client (Ms.
Vivian). When Dr. Kelekian and his team came to Ms. V.s room, they did not
introduce themselves. Moreover, they just started the physical exam. Instead of
explaining the procedure and asking for permission from Ms. Vivian. To maintain the
therapeutic relationship, patient should be involved in their plan of care, diagnosis
and treatment as well.

Educate the Patient-Client education is one of the most important roles for
nurses. They should educate client about the disease or condition, expected effects
on other body systems. They should encourage and support the client to use
relaxation techniques to reduce the stress such as deep breathing, visualization and
music or art therapy. Also they should provide information about support group and
counsellors. Especially in Ms. V.s case who had no family member to support her.
Pain Assessment and Alternative Therapies-Nurses are the front line worker
who does the pain assessment. A thorough understanding of the multiple
dimensions of pain is important for effective assessment and management of
patients with pain, so the nurses can assess the pain thoroughly and communicate
the information to physician or nurse practitioner. Also some alternative therapies

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can relief cancer pain such as rubbing or massaging painful areas, or using warmth
or cold to relieve pain. (Weiger et al.2002; Fellowes, 2004; Liu & Fawcett2008).
Three interprofessional collaborative strategies:
Primary care nurse-Primary nurse always play an important role in health care
setting. She is the frontline worker who provides compassionate care and comfort to
the sick patient. Also she is more close to the patient because the primary nurse is
at the patient beside all the time. She always listens to the patients concern and
provides support.
Social worker- Second, social worker is essential to provide care of ovarian cancer
patient. Social worker provides emotional care to the cancer patient. Social worker
helps the patient with psychological issues such as anxiety, fear of death and
changes in life style during the treatment. Moreover, social workers are very helpful
who has no family support.
Physician-Physician is the most trust worthy person in health care setting. He has
big responsibility to diagnosis the disease and provides better treatment to the
patient. Along with physical needs; physician

should take care of emotional needs such as maintaining hope, positive attitude,
and providing comfort touch through therapeutic relationship.

Two community recourses:

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Canadian Cancer Society and Ovarian Cancer Canada are two community recourses
in Canada that considered to managing emotional distress in cancer patient. The
mission of these organization is to guide and support ovarian cancer patient.
Canadian cancer society provides information about cancer such as type of cancer,
diagnostic tests, side effects, and clinical trials. Cancer patients who experienced
emotional challenges such as anxiety, fear, helpless and anger, they received free
confidential services and support. In addition, the Canadian Cancer Society, help
cancer patients find wigs, provides transportation and accommodation for cancer
patient (Canadian Cancer Society).

References

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Canadian Cancer Society. Cancer Connection.ca online community. Retrieved from
http://www.cancer.ca/en/support-and-services/support-services/connect-withour-online- community/? region=on

Canadian Cancer Society. Travel and accommodation. Retrieved from

http://www.cancer.ca/en/support-and-services/support-services/travel-andaccommodations-on/? region=on

Canadian Cancer Society. Wigs and hair donations. Retrieved from

http://www.cancer.ca/en/support-and-services/support-services/hairdonations/? region=on

National Cancer Institute. Adjustment to Cancer: Anxiety and Distress. Retrieved

from
http://www.cancer.gov/cancertopics/pdq/supportivecare/adjustment/Patient/page3

Ovarian Cancer Canada. Retrieved from

http://www.ovariancanada.org/KnowledgeAwareness.

Potter, P., & Perry, A.G., (2014). In Ross-Kerr, J., Wood, M., Astle, B., & Duggleby, W.
(Eds), Canadian fundamentals of nursing (5th ed). Toronto: Mosby

Tonks, J. (2011). Perspective on Cancer Care .The Atrium, Southern Gate, Chichester,
West Sussex, PO 198SQ, Uk: John Wiley &Sons Ltd.