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Summary of movie: Wit

In the chosen movie, Wit, the main character Vivian Bearing is introduced as a 48 year
old demanding and cold-hearted English literature professor who complained of abdominal pain
and was diagnosed with advanced stage 4 metastatic ovarian cancer. Vivian is recommended by
the physician to undergo eight months of aggressive and debilitating chemotherapy as treatment
and research of the cancer to which Vivian agrees to. One of the medical residents assigned to
look after Vivian is Dr. Posner, a former student in one of Vivians literature class. Throughout
the movie, Dr.Posner as well as other health care professionals portrayed lack of bedside
manners and therapeutic relationship with the clients. There were minimal interactions and
communication between Vivian and the physician and hospital staff. Throughout the stay in the
hospital, Vivian is treated as a guinea pig and considered as any other patient in the hospital.
Many staff and physicians were busily doing the routine protocols without much social
interaction or empathy. The only person in the hospital that treated Vivian with respect and care
was a nurse named Susie. Susie displayed therapeutic nurse client relationship and was able to
develop trust with Vivian. As the treatment of chemotherapy continues, Vivians condition can be
seen as worsening and the fear and anxiety is increasing and the only person Vivian can talk to is
Susie. Nearing the end of the movie, Vivians life was also coming to an end and the decision of
being DNR was made. When Vivian passed away, Dr. Posner disregarded the fact that Vivians
status was DNR and went ahead to revive Vivian. In the end, Susie was able to stop the physician
and allow Vivian to pass as Vivian had wanted.
3 significant physical effects of the health challenge
Throughout the movie, there were three main physiological effects that Vivian had to
endure during the course of the treatment of ovarian cancer. First, Vivian presented with signs of
pain in the abdomen-pelvic region prior to being diagnosed and during the treatment of cancer. In
the movie, Vivian states there were periods of pain located in the abdomen area when Vivian

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would teach. During the treatment, Vivian can be seen to be in a lot of pain as Vivian yelled
God its so painful, so much pain while gripping the side of the bed. There are usually no
symptoms with early stages of ovarian cancer, which unfortunately results in most women with
ovarian cancer having advanced disease at the time of diagnosis according to Stern (2007).
Normally, the body has a fatty tissue that is attached to the small and large intestine known as the
omentum. According to American Journal of Pathology (2010) patients with stage 4 ovarian
cancer will have had the cancer cells spread to the omentum that covers the abdominal cavity.
This can cause an obstruction to the stomach, small and large intestine which prevents the
passage of fluid or digested food causing significant pain. The cancer at this stage however, may
have spread to other organs such as the liver and lungs. The second main physical effect is
nausea and vomiting. During the treatment and stay at the hospital, there would be times where
Vivian would throw up all that was eaten, multiple times a day. Advanced ovarian cancer often
results in blockage of the intestines, causing severe nausea, vomiting, pain which can result in
weight loss (Sims, D, 2003). Nausea and vomiting can alsobe due to the chemotherapy treatment.
Chemotherapy drugs kill cancer cells but also damages some normal cells which can cause common
side effects such as loss of appetite and nausea and vomiting according to ACS (2013). The third
physical effect of the health challenge is fatigue and weakness. Throughout the film, Vivian was
having shortness of breath and was easily tired from the ultrasound and routine testings. I dont
mean to complain but I am very sick. Very sick. Ultimately sick, as it were. According to the

Journal of Oncologist (2007), it is common for cancer patients to experience fatigue. The fatigue
can be a consequence of the cancer itself and as a side effect of cancer treatment.
3 significant psychosocial effects of the health challenge
When an individual is diagnosed with ovarian cancer
or cancer in general not only are there physical effects, but as well as
psychosocial effects that can result from the diagnosis. Depression is one of

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the many psychosocial effects that results from hearing the words cancer. In
the movie, it clearly shows Vivian going through depression, contemplating
about life and deciding if it should end. Patients under active treatment for
newly diagnosed ovarian cancer exhibit a substantially higher number of
depressive symptoms. (Cancer Network,1999). In fact, up to 1 in 4 people
with cancer have clinical depression according to Cancer Society (2007). The
individuals future plans may have seemed so sure before, but now becomes
uncertain. Some dreams and plans may be lost forever which results in
depression. Secondly, feelings of isolation can occur for individuals living
with ovarian cancer. The individual, like Vivian will feel like nobody
understands what that person has to go through every day, and that no one
cares. According to the National Cancer Institute (2014), there could be
feelings that no one understands what the cancer patient is going through.
This can be due to feelings of not being able to live life normally like they
used to, not being able to go out and do certain activities, or be in a hospital
room all day with limited visitors. Thirdly, cancer patients during times of
treatment and recovery may be anxious and fearful. For example, patients
may have fear of having to do tests, the outcome of treatments and doctor
visits which can cause apprehension. Studies show that almost half of all
patients with cancer say they feel some anxiety and about one-fourth of all
patients with cancer say they feel a great deal of anxiety. (National Cancer
Institute, 2014)
One area of priority for holistic nursing care
Out of all the effects of ovarian cancer, pain was chosen as the
one area of priority for holistic nursing care. The sheer potential for

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suffering from cancer can be a horrifying experience, while pain is probably

one of the most frightening of all cancer symptoms for patients. (Nersesyen,
2007) Pain is most often caused by the cancer itself, but can also be caused
by the treatment or the tests done to diagnose cancer. With advanced
cancer, the cancer has spread to other organs such as the stomach and
intestine which can cause obstruction, at times it can also spread to the
lungs and liver resulting in severe pain. The pain can also arise from the
treatment of cancer such as chemotherapy which may cause pain for some
people according to ACS (2014). The main focus is to relieve the pain caused
by either the cancer itself or by any treatments and procedures. In one
particular scene, Vivian is shown to be suffering from severe pain. It shows
Vivian, gasping for air, in distress and holding her abdomen very tightly.. The
pain affected and delayed the treatment as well as routine testing that
needed to be done. It is important to relieve a patient from pain because
pain ultimately affects a persons life and has an effect on the quality of life.
Severe pain affects an individuals physical and mental functioning, quality of
life, and productivity according to Institute of Medicine (2011). Cancer pain
can exhaust the patient and keep an individual from doing thing that they
want and things that need to be done. For example, because Vivian was
suffering from pain, tests and treatments had to be delayed for a later time.
Controlling pain helps to provide peace to those who are living with cancer,
but pain control may also prolong life by reducing the negative effects that
pain has on the body according to CHealth (2014)
3 nursing specific intervention for pain
Pain is experienced by all but unique to each individual. As

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nurses it is important to effectively manage the patients pain and provide

maximum pain relief with minimal side effects. Minimizing or preventing pain
can be done by using pharmacological treatments. When using medication
as a form of treatment for pain, the medication chosen depends on the
severity and patients known allergies. The usual approach to treat mild to
moderate pain is to start with a nonopioid analgesic or with acetaminophen
or ibuprofen , but in the case of severe pain (in Vivians case) opioids such as
codeine or stronger opioids such as morphine can be administered to relieve
the pain according to Park (2010). Medications given to the patients by the
nurse must be administered as by the doctors order and patients level of
pain. After administering the medication, it is the nurses responsibility to
reassess the patient and determine if the medication had decreased the pain
level. Relieving and managing pain does not only consist of using
pharmacological approaches but non-pharmacological approaches as well.
Aside from medications, distraction is the intervention most frequently used
to guide attention away from the pain. Srouji (2010) Methods such as giving
a massage during baths can help improve circulation and relieve pain.
Distraction techniques such as the use of pictures and T.V that involves use
of the five senses to distract oneself from pain can help in relieving pain. It
can also include relaxation techniques such as breathing exercises and music
therapy which can help reduce both the sensation and distress of pain
according according to Gulanick et al (2013). Another nursing intervention as
well as responsibility that nurses can do to help client manage pain is to
advocate for clients. Advocacy is an essential part of the nursing care and is
important in the nurse-client relationship and decision making about pain

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management. When a client is still complaining of pain when non

pharmacological methods and pain medication has been given, it is the
nurses responsibility to advocate and speak on behalf of the client. The
nurse can talk to the physician in increasing the dosage of pain medication,
or perhaps recommend a PAC pump. Patient-controlled analgesia (PCA) is a
method of pain control designed to allow the patient to administer pre set
doses of an analgesic, on demand. (Wuhrman et al ,2006) This can allow the
client to control the pain themself without having to call the nurse and wait
for the nurses to come and administer the medication. Some clients also feel
like an annoyance to nurses if help is needed frequently and therefore would
refrain from asking for pain medications.

interprofessional collaborative care strategies

A part of providing the best care for clients is
interprofessional collaboration. The World Health Organization defines
collaborative practice as when multiple health workers from different
professional backgrounds provide comprehensive services by working with
patients, their families, caregivers and communities to deliver the highest
quality of care across settings. (WHO, 2014) In order to provide effective
pain management for clients, nurses collaborate with physicians. Physicians
diagnose and know which type of medications is best for the clients. Nurses
interact with clients more often than physician do, therefore, working with
the knowledge of the physician and nurses knowledge of the client, the two
can work together to determine what type of medication, dosage, types of
pain management is best for the client. Psychiatrist and physical therapists
are also health care professional who can help manage pain. Many people do

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not consider a psychiatrist in managing pain, but psychiatrist can help in

many ways. According to Whitman (2014) referring a client to a psychiatrist
will be of benefit for pain management .Psychiatrist can be support for the
clients, and can help to teach the client and nurse skills such as relaxation
techniques, visualization and guided imagery to decrease pain. The third
interprofessional collaboration is with the pharmacists. Pharmacists are
available to be reached in facilities and nurses can work along side
pharmacists in determining the side effects and compatibility of certain pain
medications. If the nurse is unsure of a specific medication that the physician
had ordered, communicating and collaborating with the pharmacists can help
in providing the knowledge needed before administering a medication that
the nurse does not know about. Overall, all health care professional should
work together in the best interest of the clients.
2 community resource
For pain management associated with ovarian cancer there are many
community resources that can help in managing and treating pain.
Wellspring Support Group is located in downtown Toronto. The support group
is for women that are newly diagnosed with ovarian cancer or have been
post treatment many years. The support group allows the women to share
experiences, discuss issues, ask questions and to give support to one
another which can help (Vivian) relieve stress and decrease pain. The
Princess Margaret Cancer Pain Clinic is also located in Downtown Toronto.
The Cancer Pain Clinic is dedicated to managing the pain that cancer
patients may experience. The pain clinic runs a wide variety of classes and
activities for patients, family members and friends. The hospital also has

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library resources about cancer and cancer pain for patients and family. Both
resources run from Monday to Friday and is easily accessible.

References
Hofman, M., Ryan, J. L., Figueroa-Moseley, C. D., Jean-Pierre, P., & Morrow, G. R. (2007).
Cancer-Related Fatigue: The Scale of the Problem. The Oncologist, 12(1), 4-10.
Lengyel, E. (2010). Ovarian Cancer Development and Metastasis. American Journal of
Pathology, 177(3), 1053-1064.
Sims, D. (2003). An ovarian cancer companion. Burnstown: General Store Pub. House.
Taking Time: Support for People with Cancer - National Cancer Institute. (2014). Retrieved
from http://www.cancer.gov/cancertopics/takingtime/page2
Watch for Signs of Depression in Ovarian Cancer Patients | Cancer Network. (1999, July 1).
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Nersesyan, H., & Slavin, K. (2007). Current aproach to cancer pain management: Availability
and implications of different treatment options. Therapeutic Clinical Risk Manag, 3(3): 381400

About the Cancer Pain Clinic. (2013, November 27). Retrieved from
http://www.theprincessmargaret.ca/en/PatientsFamilies/ClinicsAndCentres/PainClinic/Pa
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American Cancer Society . (2103, September 20). Retrieved from

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aranddepression/anxiety-fear-and-depression-depression
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Pumps: Position Statement with Clinical Practice Recommendations. Pain Management

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