An application of social cognitive theory

Introduction

Meditation is about balancing your inner and outer world. The power of meditation is felt rather than read. As per the RAJA YOGA meditation Guide developed by Brahma kumaris in 1994, when your attention is focused more on your surroundings than in your inner qualities, your situations become stronger than you which distract you and make you feel lack of concentration and clarity.

Social cognitive theory is based on observational learning. Social cognitive theory focus on the person’s self-regulation to achieve goal directed behaviour. It considers the unique way in which a person acquire and maintain behavior over a period of time, while also considering the social environment that influence a person to perform the behavior. The theory considers person’s past experiences which determine the probability of adoption of behaviour.

Meditation is good for relieving stress and anxiety as many researches have shown but I was not


able

[SS1]
to perceive that behaviour because I am living in an environment where I cannot spend time for myself. The study stress and workload was affecting my eating habits as well. So I thought I should start doing meditation which was again a challenging behaviour for me as I was thinking, I would not be able to spend time for myself and focus living in a small 1bedroom room apartment with so much of work load. Therefore I selected meditation as a challenging behavior to help me lowering my mental stress and keeping my self away from environmental influences.

In this regard, There was a need to learn doing meditation and keep myself calm. Social cognitive theory would help forming strategies to improve Behavioral Capability, Observational Learning, Expectations, Self-efficacy and self-control to perform meditation regularly. As per the theory, I could learn better if I observe a model doing same behaviour.


Looking in to literature, there is no study with a meditation intervention applying social cognitive theory

[SS2]
but there is a published research study in MEDLINE data base by Mehta and Sharma (2012) who have conducted a Yoga intervention of 10 week to reduce anxiety using the social cognitive theory based strategies. Though I could not find full text study, looking in to abstract I found meditation and yoga almost similar behaviours and chose the social leaning theory to plan my behaviour challenge 3 week intervention.

Broad Objective:

To adopt a healthy lifestyle behaviour by engaging in 15 minutes of meditation every day with a view to manage stress.

Specific Objectives:

1. To help balance hormonal levels of my body.
2. To obtain more focus in my study than my busy personal life.
3. To improve my self-efficacy, concentration and peace of mind.
4. To feel the joy of the thoughtless state obtained during meditation.
5. To help myself getting free from emotional attachments.

Methods and Tools:

strategies were made using social cognitive theory to perform the behaviour and tools were selected to measure the outcome. An alarm was set in the cellphone to remind me of performing the behaviour and a record was kept every day after performing the behaviour in the record keeping sheet attached on the wall in my bedroom where I performed meditation every day.

Strategies for learning meditation:

1. Download and read guide by brahma kumaris-how to perform meditation
2. Watch online video of meditation

Strategies for performing behaviour:

1. 
   
   Choose a Convenient Time
2. Choose A Quiet Place
3. Sit in a comfortable posture
4. Keep a relatively Empty Stomach
   
   [SS3]
5. 
   
   Choose one object to focus i.e. the video of meditation (
   
   https://www.youtube.com/watch?v=YHDQBSWXqZg
   
   )
6. Listen the audio instructions for meditation
   
   [SS4]

Measurement of outcome:

A scale was developed to rate the self- efficacy from 0-100. Examples of everyday possible difficult situations were written on the scale and marked any applicable situation followed by rating.

The scale used for measuring self-efficacy is given below:

Rate your self-efficacy

Rate your degree of confidence by recording a number from 0 to 100 using the

Scale given below:

0 102030405060708090100

Cannot Moderately Highly certain

do at allcan docan do

Mark the applicable situation you felt for today:

When I am feeling tired _____

When I am feeling under pressure from study _____

During or after experiencing personal problems _____

When I am feeling depressed _____

When I am feeling anxious _____

When I feel physical discomfort when I meditate _____

When I have too much work to do at home _____

When there are other interesting things to do _____

When I have other time commitments _____

After experiencing family problems _____

As a self-monitoring, everyday record was kept for the following outcomes by rating them out of 10.

1. Rate your concentration: how much you achieved today
2. Rate your breathing rhythm
3. Rate your mental calmness after meditation
4. State any barrier in your performance

Barriers or challenges:

In total I did not perform the meditation for 4 days. The reasons were following:

• I was feeling sleepy due to my menstrual cramps.
• I was very busy with my submission and could not even afford to spend half an hour to perform meditation followed by record keeping
• I was very happy and did not feel like doing meditation
• I just focused on breathing for 5minutes to save my time

Whereas in all other days I performed meditation because it was really helping me. I was feeling very relaxed after doing it at least for a night. Record keeping was a challenging because sometimes I had to think how much successful I was in my behaviour? An alarm at 10 o’clock was very annoying for my husband in the weekends because he had to leave the bedroom while I perform meditation. I did not find so much challenging to do meditation because I started enjoying it any may be because I knew I had to make a report and I need to record my points to make a good report. Though it is challenging on the previous day of any submission, I have planned to continue this behaviour as much as possible throughout my master’s program. Overall the experience of meditation is great because it taught me to love and care for myself which I forgot after getting married and living with my in laws. Meditation helped me spend time for myself alone in the room even when my husband is at home. That was because he knew it is a part of my submission Mediation help feeling an inner ability that you are the best and you have power to do every task. I was feeling so positive after doing meditation. I did meditation 2times before my facilitation in Nick’s class and I was so confident.

Application of my experience as a Nutrition communicator:

Since my behaviour is more of changing lifestyle, it can be applied as an intervention to reduce stress and anxiety in someone’s everyday life. This behaviour can be very beneficial for working women, university students and those who suffer with anxiety and sleep disorders. If meditation is performed on a regular basis for a longer time, it regulates your hormonal imbalances and change your overall personality and mood. This behaviour can also be useful for people who tend to eat more when they are stressed. So indirectly meditation would help losing weight. As a nutrition communicator I would recommend not only healthy eating but also healthy lifestyle which regulate an overall metabolism of the body. If the behaviour is challenging to adopt, I would recommend to learn and perform using Video because the music and audio instructions help focusing and learning and saves time because a person can do it at home without joining classes or workshop.

Utility of theory and strategies to change my behaviour:

A social cognitive theory helped me creating strategies to perform and learn the meditation. For example, choosing a convenient time and quite place driven me to perform the behaviour every day. It improved my self-regulation in my home environment. I performed behaviour at night around 10pm because I study every night until late and meditation helped me focusing more in study and I taught me how to keep myself away from the social life. A strategy of focusing on video and listening to their instructions helped me learn meditation and focusing. Focusing without a music was very difficult as I tried it on the first observational day of my behaviour. A record keeping helped me measuring my self- efficacy and also it was a motivation to reach to a maximum rating.

References

Mehta, P., & Sharma, M. (2012-13). Evaluation of a social cognitive theory based yoga intervention to reduce anxiety. International Quarterly of Community Health Education. 32(3), 205-217.

Raja Yoga. (1994). Meditation step by step guide by brahma kumaris available at

http://brahmakumaris.info/download/BK%207%20Days%20Course/RY-Meditation-Teachers-Guide-1994.pdf

retrieved on 17th September 2014

(

https://www.youtube.com/watch?v=YHDQBSWXqZg

)

---

[SS1]
Rational of my behaviour

[SS2]
Application of theory in my behaviour with example of similar research

[SS3]
First 4 strategies help improving self-regulation over behaviour

[SS4]
Last 2 strategies help develop

Observational learning

Assessment Task – 1

The following essay is a discussion of the correlation between family and domestic violence and impacts this has on mental health. Authoritative journal articles which form the basis of evidence-based practice will be used to discuss the impact of domestic violence on mental health taking into consideration bio psychosocial factors influencing domestic violence and mental health for adults and children. This essay will discuss nurses role that identified holistic and consumer-oriented recovery approach by using effective therapeutic communication and it will be also focusing on nursing professional boundaries that recognize a range of nursing assessment and legal responsibility.

Domestic violence is one of the main factors of mental health issues that affect the psychosocial well- being of thousands of families a year (Healey, 2014). Domestic violence is defined as occurring when an abused person within an intimate relationship is intimidated, threatened or controlled by the abusing partner (O’Brian et al, 2013). Domestic violence includes emotional, psychological, physical, sexual and economic abuse (Healey, 2014). Amnesty International Australia (2013) identified that in the majority of cases, women and children are the victims of domestic violence. Children experience trauma witnessing violence in the family, which can have a prolonged psychological effect (Amnesty International Australia, 2013) for example, children living where they witness that their father abusing the mother on daily basis, can result in an aggressive mentality towards women. O’ Brian et al., (2013) stated that domestic violence can also occur between female on male, and between same-sex couples. There are many types of family structure including single parent families, same sex parents’ families, nuclear families and blended families. For the purpose of this essay, the main focus will be on the correlation between on the family members and domestic violence and the impact this has the mental health of the mother, father, and child. According to O’Brian et al., (2013) men are more likely to be the act of continuous, physical and sexual abuse whereas women are more likely to exhibit emotional abuse. In terms of the impact of domestic violence on mental health, there is a consensus among the literature which indicates similar feelings and experiences of men and women which include fear and loss of feelings of safety, feelings of guilt and shame, anxiety, unresolved anger, loneliness and isolation and depression. Although, the physical and psychological issue is common in domestic violence, psychological abuse has long-term adverse effect on victim’s well-being (Ramsay et al., 2012). In domestic violence studies, physically and sexually assaulted women have a high rate of depression which leads to post-traumatic stress disorder (PTSD) (Lacey et al., 2013). Most of the studies mainly focus on female victim; the main reason behind violence against men goes unreported due to fear of humiliation from the society and lack of available support group for men (Dirjber, Reijnders, & Ceelen, 2013). Studies found that men are experiencing less physical assault; however, mostly they face emotional, psychological and verbal abuse (Day et al., 2009). Although, men and women experiencing domestic violence differently; the long-term impact are same which associate with different mental disorder such as dysthymia, anxiety disorder, post-traumatic stress disorder, bipolar affective disorder, depression, schizophrenia and non-affective psychosis (Trevillion et al., 2012). Growing up in the violent environment, children will have less attachment with their parents and antisocial behavior later on their life (Herrenkohl et al., 2011; Bailey & Eisikovits, 2014). Lanius, Vermetten and Pain (2010) stated that physical abuse is one of the major factors of childhood trauma which lead to risk for psychiatric morbidity. The conflict between partners, not only affected their relationship it also impacts on mental status of their children.

Health professional spend more time to assess their patient, which allowed them to identify patients problems and determined to choose the best action for the recovery. Wright, Sparks and O’Hair (2013) have identified that the verity of assessment is the main tool to connect and communicate with the patient to detect key problems. Hungerford et al., (2015) have stated that the assessment determines what patient experiencing and how these experience affecting them. It can be only possible when health professional build therapeutic communication with the patient. A bio psychosocial approach brings together all the aspects to avoid conflicts which consider biological, psychological and social dimensions (Hungerford et al., 2015; Melchert, 2010). According to Sadigh (2013) a bio psychosocial assessment useful to get past and current information, and look for patients’ future condition. Therefore, this identifies patients past and present issues and encourage them to discuss about what changes that they would like to make to recover from those issues. Person-centred care is an approach which involves patient and their families’ decisions to assure most appropriate need (Clissett at al., 2013; Hungerford et al., 2015). When health professional taking person-centred care approaches, they have to consider patients own decision about how they wish to receive. It is also important that health professional should not prejudge to the mental health patient and build trusting relationship by applying therapeutic communication (Hungerford et al., 2015). Nursing consideration is all about gathering more information from the client, by using various types of assessment and communication techniques. It is also important for the nurse to aware patients’ age, gender, religion, employment status and relationship with their family or partners. Townsend (2015) described that a therapeutic interpersonal relationship is the nursing process, where psychiatric nurse focuses to get more information from the patient in various mental health setting. A therapeutic interpersonal relationship classified in four phases: the interaction phase, the orientation phase, the working phase and the termination phase. In preinteraction phase nurse prepare for first meeting with the client, during orientation phase nurse create environment to establish trust with the client, working phase nurse maintain trust promoting clients’ insight and perception, and termination phase evaluate client condition for the further assessment. According to Townsend (2015) while implementing therapeutic interpersonal relationship, nurse must be aware of the boundaries in nurse and client relationship; which includes: materials, social, personal and professional boundaries that allow nurses to recognise acceptable limit. For example, touching clients provide them comfort and encouragement as nature of nursing care; however, nurse must considerate professional boundaries and apply appropriate non-verbal communication. Nurse must maintain the professional relationship towards client instead of personal relationship; i.e. romantic, sexual, or other similar personal relationship is not appropriate between nurse and client. Every individual patient have their own triggers, the nurse must understand and implement accordingly. Although, mental health assessment considers all aspect of the patient, each time it should occur when health professional interaction with the patient (Hungerford et al., 2015). Mental state examination (MSE), clinical risk assessment, and suicidal assessment are the most common assessment mental health (Hungerford et al 2015). Mental state examination is the fundamental factor of patients’ assessment, clinical risk assessment identifies potential risk and minimized the level of risk (Szmukler and Rose, 2013) and suicidal assessment include variety of interventions to assure patients safety and encourage better health. Every state has their own mental health assessment and framework, whereas New South Wales implemented the Mental Health Outcomes and Assessment Tools (MH-OAT) to measure the effectiveness of the health care provided (NSW Health, 2013). MH-OAT includes MSE, substance use, physical examination, family history and development history (Hungerford et al 2015). MH-OAT helps health professionals to work effectively and efficiently by ensuring NSW meet National Standard of Mental Health Care and which provide standard clinical document that include triage, assessment, care plan, review and discharge (NSW Government Health, 2014). According to the Australian Collage of Mental Health Nurses (2013) standard practice provide practical benchmark which minimise level of performance for register nurses in mental health setting; this includes 9 standard practices which are: acknowledging cultural diversity, establishing collaborative partnership, developing therapeutic communication, values other stakeholders contribution, reduce stigma, demonstrate evidence-based practice, practice common law and specialist qualifications. It is very important that nurses must familiar with the legal and ethical context of mental health care. In Australia, each state has its own mental health legislation which known as ‘Mental Health Act (MHA)’; MHA protect as individual and community by emphasising on providing right treatment in least restrictive environment (Hungerford et al 2015).

In conclusion, this essay successfully correlated between family and domestic violence which lead to various mental health problems by giving perfect example of affected family. It discussed major mental health priorities and strategies such as effective therapeutic communications, therapeutic interrelationship, person-centre approach and bio psychosocial approach which reduce conflict and minimize potential risk for themselves and patients. It also explained the importance of the nursing assessments and legislations for the nurses.

References

Amnesty International Australia. (2013, July 19).

Mythbusting violence against women

. Retrieved from

www.amnesty.org.au

.

Bailey, B., & Eisikovits, Z. (2014). Violently reactive women and their relationship with their abusive mother.

Journal of Interpersonal Violence, doi: 10.1177/0886260514549463

, 1-24.

Clissett, P., Porock, D., Harwood, R. H., & Gladman, J. R. (2013). The challenges of achieving person-centred care in acute hospitals: A qualitative study of people with dementia and their families.

International Journal of Nursing Studies, 50

(11), 1495-1503.

Day, A., O’Leary, P., Chung, D., & Justo, D. (2009).

Domestic Violence – Working with Men: research, practice experiences and integrated responses.

Leichardt, NSW, Australia: The Federation Press.

Dirjber, B. C., Reijnders, U. J. L., & Ceelen, M. (2013). Male victim of domestic violence.

Journal of Family Violence, 28

(2), 173-178.

Healey, J. (2014).

Domestic and family violence.

Balmain, NSW: The Spinney Press.

Herrenkohl, T. I., Moylan, C. A., Tajima, E. A., Klika, J. B., Herrenkohl, R. C., & Russo, M. J. (2011). Longitudinal Study on the Effects of Child Abuse and Children’s Exposure to Domestic Violence, Parent-Child Attachments, and Antisocial Behavior in Adolescence.

Journal of interpersonal violence, 26

(1), 111-136.

Hungerford, C., Hodgson, D., Clancy, R., Monisse-Redman, M., Bostwick, R., & Jones, T. (2015).

Mental Health Care: An Introduction for Health Professionals in Australia

(2nd ed.). Retrieved from

http://online.vitalsource.com/books/9780730317487/epubcfi/6/62

.

Lacey, K. K., McPherson, M. D., Samuel, P. S., Sears, K. P., & Head, D. (2013). The Impact of Different Types of Intimate Partner Violence on the Mental and Physical Health of Women.

Journal of Interpersonal Violence, 28

(2), 359-385.

Lanius, R. A., Vermetten, E., & Pain, C. (2010).

The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic.

United Kingdom: Cambridge University Press.

Melchert, T. P. (2010). The growing need for a unified biopsychosocial approach in mental health care.

Procedia – Social and Behavioral Sciences, 5

(1), 356-361.

NSW Government Health. (2014, August 28).

MH-OAT for Mental Health Professionals

. Retrieved from

http://www.health.nsw.gov.au/mhdao/DM/Pages/professionals.aspx

NSW Health. (2013, October 30).

MH-OAT for Mental Health Professionals

. Retrieved from

http://www.health.nsw.gov.au/mhdao/mhprof_mhoat.asp

O’ Brian, K.L., Cohen, L., Pooley, J. A., & Taylor, M. F. (2013). Lifting the Domestic Violence Cloak of Silence: Resilient Australian Women’s Reflected Memories of their Childhood Experiences of Witnessing Domestic Violence.

Journal of Family Violence, 28

(1), 95-108.

Ramsay, J., Rutterford, C., Gregory, A., Dunne, D., Eldridge, S., Sharp, D., & Feder, G. (2012, Sep). Domestic violence:knowledge, attitudes, and clinical practice of selected UK primary healthcare clinicians.

British Journal ofGeneralPractice, 1

(1), 647-655.

Sadigh, M. R. (2013). Development of the biopsychosocial model of medicine.

Virtual Mentor, 15

(4), 362-365.

Szmukler, G., & Rose, N. (2013). Risk assessment in mental health care: Values and costs.

Behavioral Sciences & the Law, 31

(1), 125-140.

The Australian Collage of Mental Health Nurses. (2013).

Standards of Practice in Mental Health Nursing

. Retrieved from

http://www.acmhn.org/publications/standards-of-practice

Townsend, M. (2015).

Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice

(8th ed.). Philadelphia, PA: F. A. Davis Company.

Trevillion, K., Oram, S., Feder, G., & Howard, L. M. (2012). Experiences of Domestic Violence and Mental Disorders: A Systematic Review and Meta-Analysis.

PLoS ONE, 7

(12), e51740.

Wright, K., Sparks, L., & O’Hair, D. (2013).

Health Communication in the 21st Century

(2nd ed.). New York: Wiley-Blackwell.

Introduction

The purpose of this assignment is to reflect on a clinical experience in palliative care and demonstrate the knowledge and skills associated with this. The symptoms, symptom management and government guidelines and standards will also be discussed in relation to how this will impact the care of the patients who are experiencing life threatening illnesses. This will be achieved through using Gibbs (1988) model of reflection. I chose this model of reflection because it is clear and cyclical model which allows the reflector to revisit the same problem and also to examine my practice which will help me to develop and improve in the future.

Description

As an adult nursing student, I will be reflecting on an experience with a patient who was receiving palliative care that I encountered during my community placement. The patient received palliative care and required management of symptoms to help maintain their quality of life for the patient and their family. This involved a patient, who will be named Mr. Jones for confidentiality reasons. Mr. Jones was an elderly patient who had been diagnosed with bowel cancer along with liver metastases, the cancer was in the advanced stages. Mr. Jones was being cared for at home by his wife and carers who visited him at home twice a day to help with getting him up, washing and dressing and helping him back to bed. The district nursing team also visited him on a regular basis. When meeting with the patient his main concern was his pain control and available options which he would be able to receive to manage this.

Feelings

Initially when I heard about the diagnosis I was intrigued and wanted to find out more about the patient and their condition. When I met the patient I felt sympathetic towards him and the family and upon discussion he revealed that he felt like ‘giving up’ and ‘ending it all’. A mixture of thoughts entered my mind, although I could understand why he would want to give up, the only reason was because he was worried about the pain he was starting to experience. When the nurse and I discussed the pain control options he appeared to be more positive about the situation and apologized for what he had said. On reflection it was a positive experience as it allowed me to see how people cope differently with terminal conditions, and the impact it has on the family and carers

Evaluation

During this experience I thought that the nursing team had built a good professional relationship with the patient and their family. The patient had plenty of time to discuss any concerns or issues that he had .The issues discussed such as symptom management were all assessed and prioritized well; how the patient is feeling is important and needs to be taken into consideration. This would also need to be discussed with his wife alone, to find out how she is feeling and to offer her support. When discussed further, the feelings of ‘giving up’ related to his pain management. This is why the Visual Analogue Scale was used for a couple of weeks to monitor the progression of his pain (Crichton 2001). I found the tool to be beneficial for effective management of pain because it was a good indicator as to when we would need to adjust his analgesia using the World Health Organization (WHO) analgesic ladder (WHO, 2004). This aims to give the correct drug, correct dose, given at the correct time and proves to be inexpensive and 80-90% effective (WHO, 2004). This ensured the patient was in the least amount of pain which enabled them to carry on with activities of daily living.

Analysis

The World Health Organization (2009) has defined palliative care as: “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems such as physical, psychosocial and spiritual.”Caring for those receiving palliative care in the community during the end stages of life requires an extraordinary commitment from the nursing team, not only human resource but also competence, compassion and focus in anticipating the needs of the patient and family. It is a complex activity involving a holistic approach, building relationships together with expert professional skills and decision making processes (Melvin 2003). As well as pain, other common symptoms during advanced cancer are nausea and vomiting, with rates ranging from 50-60% (Kearney and Richardson, 2006). It is important to treat the reversible causes of nausea and vomiting before resorting to antiemetics. This can be achieved by appropriate assessment and documentation of symptoms which evaluate the effect of treatment given and can be completed and reviewed quickly to utilize less patient energy and nursing time (Kearney and Richardson, 2006). Cancer patients also experience psychological or affective symptoms of fatigue which include lack of energy and motivation, depression, sadness and anxiety, the sense of willpower and ‘fighting spirit’ is often lacking and personal resources that have usually kept a person going in the past are ineffective (Juenger, 2002). Fatigue can take away the ability to do things that the patient and family want to do or need to do. The control over life events reduces, further affecting the person’s quality of life. An essential part of nursing care for fatigue includes returning some of that control (Porock 2003). Giving information can be a positive way to do this. Nurses can explain that the person is not alone in the experience as fatigue is an expected occurrence in advanced cancer and discuss the causes of fatigue, effects and side effects of treatment and the impact of stress and depression, this will help the patient to manage the fatigue more effectively (Porock 2003).Mr. Jones was prescribed oral slow-release Morphine Sulphate for his pain, however he was beginning to experience break through pain, nausea and vomiting which was making it difficult for him to take his morphine. We suggested he kept a record of his pain over a couple of weeks using a visual analogue scale (VAS). When we visited him again we were able to use the VAS to assess his pain and make changes to analgesia as appropriate using the analgesic ladder (see appendix). From the assessment it was appropriate to increase his analgesia to step 3 of the analgesic ladder (WHO, 2004). A syringe driver was prescribed to administer morphine and an antiemetic over a 24 hour period which could be increased or decreased as required. Providing drug compatibilities have been checked, a combination of three drugs can usually be administered safely with the advantage that vomiting will not affect absorption, as it is given subcutaneously and the gut is not involved (Thompson, 2004). Although using a syringe driver improves symptom management with minimal inconvenience, complications can arise and nurses should be able to recognize these quickly and solve the problems efficiently (Lugton, 2002). The disadvantages of using this equipment is the painful injection site, infection risks and infusion rate problems (Thompson, 2004).

Mr. Jones commented on ‘giving up’ and after further discussion, we found this related to his pain. Evidence shows that there is a link between chronic pain and depression as they share similar physiological pathways, whilst social and psychological factors appear to affect the severity of it and when they co-exist the severity of both conditions appears to worsen (Gray, 2001). Ineffective management of psychiatric disorders can be caused by failure to recognize, diagnose and treat appropriately in palliative care settings with 50% of psychiatric disorders being undetected (Payne et al, 2007). Patients with cancer should have access to appropriate psychological support and should be assessed regularly by trained professionals as recommended by National Institute for Clinical Excellence (NICE, 2004).Many people may wish to try complementary and alternative medicines to improve symptoms of their cancer, the reason being many feel dissatisfied with conventional medicine and feel the desire to experience holistic health care for symptomatic relief with a sense of well being (Nayak et al 2003). Auricular acupuncture (acupuncture to the ear), therapeutic touch, and hypnosis may help to manage cancer pain, whilst music therapy, massage, and hypnosis may have an effect on anxiety, and both acupuncture and massage may have a therapeutic role in cancer fatigue (Mansky and Wallerstedt 2006). However there is a lack of evidence to support that complementary and alternative medicine treatments are effective, the risks associated with them are unknown and can potentially be harmful. There has been increasing concern with the use of botanicals and dietary supplements by cancer patients because of the potential interaction between them and prescription drugs (Mansky and Wallerstedt 2006). During this experience, I realised just how important communication is, not only in this situation, but any situation that includes the patient, relatives, carers and multi-disciplinary team. Communication is an essential part of good nursing practice and forms the basis for building a trusting relationship that will greatly improve care and help to reduce anxiety and stress for patients, their relatives and carers (NMC 2008). Groogan (1999) acknowledges that communication is not something that people to do one another, but it is a process in which they can create a relationship by interacting with each other. From Mr. Jones’ perspective, patient-focused communication can be the most important aspect of treatment, due to its capacity to exacerbate or relieve the fear that often accompanies cancer, with evidence of effective communication resulting in decreased anxiety, greater coping ability and adherence to treatment (Dickson 1999). Communication can be divided into three types; cognitive, emotional and spiritual. Cognitive communication involves the giving and receiving of information, emotional communication involves the feeling and expression of psychological responses and spiritual communication involves the expression and feeling of thoughts relating to existing issues beyond the person (Fallowfield & Jenkins 1999). When speaking with Mr. Jones and his family the language used was clear and easy to understand. Stress, emotions and fatigue that accompany a terminal illness make it necessary for the information to be repeated to ensure the patient and family have absorbed it and feel reassured (Latimer 2000).Mr. Jones was given enough time to discuss his concerns and issues without feeling like he had a limited period or that the nurses had many other patients to see, however, what often matters is the quality of interaction rather than the length of time. Giving a few moments of time which are totally focused on the patient’s communication needs can often limit the amount of time spent communicating later when further explanation or clarification is needed (Faull et al, 2005). Mallet and Dougherty (2000) suggested that patients tend to be more dissatisfied with poor communication than with any other aspect of their care and concluded ineffective communication continues to be a major issue in health care.The Department of Health has produced the End of Life Care Strategy (DoH 2008) which promotes high quality care for all adults at the end of life which is the first for the United Kingdom and covers adults in England. Its aim is to provide people approaching the end of life with more choice about where they would like to live and die. In addition, the Macmillan Gold Standards Framework (2003) is another way of combining many different practices. The framework includes 7 Gold Standards which relate to key aspects of care, and guidelines for best practice on teamwork and continuity of care, advanced planning, symptom control and support for patients and their carers. Primary Health Care Teams who join the programme are guided and supported through a combination of workshops, resource materials and networking (Macmillan Cancer Relief 2003). In place is also the NICE clinical guidance on supportive and palliative care (NICE 2004) which advises those who develop and deliver cancer services for adults with cancer about what is needed to make sure that patients, their families and carers, are well informed, cared for and supported. These initiatives had a positive impact on Mr. Jones as the nurses were able to use these guidelines to offer Mr. Jones the best care suited for him and he was then able to make informed decisions regarding the care he would like to receive. These initiatives also have a positive impact on health care professionals as they are supported and encouraged to improve their knowledge through workshops and resource materials.

Action Plan/Conclusion

My reflection of this experience has taught me how complex it is caring for someone receiving palliative care. It requires a holistic approach to ensure the patient and the family receive the best possible care in accordance with the guidelines and standards, in which they must remain empowered and make informed choices regarding their care and treatment with the help of health care professionals. I now understand how complicated symptom management can be; cancer patients experience many symptoms from their condition and also side effects from their medication. Assessments are vital to ensure the appropriate treatment and management of symptoms. The importance of communication has been brought to my attention once again, in my future nursing practice I will focus on my communication skills as this is an essential part of good nursing practice and plays a vital role in palliative care. Although this was an upsetting experience it has also been a positive one as this will affect my future nursing practice a great deal as I have gained vital skills to look after those receiving palliative care and I am now aware of the various strategies and frameworks in place to ensure patients and families receive a high standard of care.