[The nursing of a lower rectal cancer patient after sphincter-preserving surgery]

The anal sphincter-preserving operation (ASP) has represented a significant improvement in surgical procedure for lower rectal cancer patients in recent years. Discussion has continued, however, on how to manage the reduced fecal function after such surgery. This case report describes how to help a patient with lower rectal cancer after ASP to overcome the problems due to changes in fecal function. Process recording was used to document the nursing process from Jan. 18 to Feb. 1, 2007. Data collected from interview, observation, and medical records, show that the patient revealed four vital nursing problems: fecal function disorder, impaired skin integrity, inappropriate regulation of diet, and powerlessness. After practicing pelvic floor exercises, adjusting her fecal behavior and modifying her food intake, the patient regained control of her fecal function and improved her quality of life.

[Nursing care for lower rectal cancer patients undergoing anal sphincter-saving operation]

In the past, Abdominal Perineal Resection (APR) with a permanent end-sigmoid colostomy was the major operating procedure for lower rectal cancer. Colostomy seriously affects patients' physical and psychological functions. Recently, the development of surgical devices and pre-operation adjuvant treatment combined with chemoradiotherapy have made an anal sphincter-preserving (ASP) operation possible. With these new treatment procedures, both the survival and recurrence rates are improved, as is patients' quality of life. The complications associated with ASP, however, are different from those associated with APR. There is only limited discussion of these issues in the literature on the subject. This paper synthesizes the information in the literature with the authors' personal clinical experiences. We propose several nursing interventions that could be applied by clinical nurses to assist ASP patients in coping with post-operative complications.

Understanding Denial

PURPOSE/OBJECTIVES

To explore the adaptive and maladaptive uses of denial while developing a clearer understanding of denial.

DATA SOURCES

Nursing and psychological periodicals and textbooks.

DATA SYNTHESIS

Oncology nurses tend to have too broad a definition of denial because they overgeneralize similar patient responses and label them as denial. Because of the uncertainty as to its value, denial is viewed as a negative, fixed response to a crisis and can strain the nurse-patient relationship.

CONCLUSION

Denial is a fluid, interpersonal experience that can affect patients during many points of the cancer experience. By experiencing a clearer understanding of denial and recognizing its adaptive value, nurses can provide more effective patient care.

IMPLICATIONS FOR NURSING

Clinicians should not underestimate the value of the nurse-patient relationship when a patient is in denial. Patience, understanding, and self-awareness are crucial for providing a safe, trusting environment for patients who are experiencing denial.

Using the Cancer Rehabilitation Questionnaire in Patients with Colorectal Cancer

This article describes the development and testing of the Cancer Rehabilitation Questionnaire (CRQ) in patients with colorectal cancer. A descriptive, correlational survey was conducted in a sample of patients with colon or rectal cancer who received care at an outpatient cancer clinic at a large, northeastern U.S. academic medical center. Patients were identified from the Tumor Registry (N = 327) and received a mailed questionnaire. One hundred and three patients with colorectal cancer completed the demographic questionnaire, the CRQ developed by the investigators, and the Quality of Life Index (QLI). Significant differences were found between individuals with colon cancer and individuals with rectal cancer on the total CRQ (p < .005) and the physical, future orientation, and role-relationship subscales. For the QLI, significantly lower scores were reported on the family subscale for patients with rectal cancer in comparison with those with colon cancer. More attention to rehabilitation issues and quality of life is required across the trajectory of the cancer experience. With the increasing incidence of colorectal cancer, nurses in rehabilitation practice must address the issues affecting patients with this disease as they progress from diagnosis to treatment and rehabilitation.

Case study: managing and caring for a patient undergoing stoma formation

A 75-year-old man had attended his GP, as he was worried that his altered bowel habits and slight rectal bleeding was more sinister than haemorrhoids. This article describes the subsequent investigations, care and treatment that he received. It highlights how early detection, prompt treatment, appropriate care and management can enable a person to cope with the devastating diagnosis of bowel cancer, surgery and the need for a stoma. This patient was otherwise well which contributed both to the treatment decision and successful outcome. Unfortunately, not all patients have such an experience, and the measures taken to prevent complications are described.

Role of the stoma care nurse: patients with cancer and colostomy

This case study describes the physical, psychological and emotional problems of a female patient suffering from rectal cancer, who required the formation of a colostomy. It highlights the role of the stoma care nurse from diagnosis, though staging of the disease, to treatment and recovery in hospital and at home, and discusses the problems of altered body image and the need for effective communication to enable the patient to achieve a good quality of life.

[Nursing in palliative medicine - palliative care, a specialized form of nursing?]

Nursing in palliative medicine requires new pathways to secure an appropriate care which focuses on the patients quality of life. Besides accepting the incurability of the life threatening illness competence in pain therapy, symptom control and spiritual and ethical issues are necessary. Flexibility and creativity within the nursing practice are important to ensure that the patients requirements are met in an appropriate way. The patterns of care have to be reflected and adjusted. Beyond this the integration of the next of kin is a characteristic of palliative care. That leads to the idea that accompanying dying cancer patients calls for more than only the inner readiness to get involved with patients in their last period of life, far more than just a natural and personal talent. Both are important prerequisites, but they have to be broadened by a specific competence. In Great Britain it is determined that it is the right of every person with a life threatening illness to receive appropriate palliative care and that every health care professional has to be able to practise the palliative care approach. In Germany we have to strive for a development equivalent to Great Britain.

Endoscopic ultrasonography (EUS) and EUS-guided fine needle aspiration for accurate staging of rectal cancer: explanation of tumor staging and a case report

This article describes the diagnosis, staging, and therapeutic options for rectal cancer and the importance of endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (FNA) as a relatively new diagnostic modality. A case study is presented from initial diagnosis through surgery to illustrate how EUS and EUS-guided FNA influenced the treatment plan. Discussion focuses on rectal cancer and the importance of early detection through routine screening. The internationally accepted Tumor Node Metastasis (TNM) staging classification system for rectal cancer is included, followed by a description of EUS and EUS-guided FNA with regard to accuracy in staging. In conclusion, the various stage-dependent treatment options available for rectal cancer that can be individualized based on the patient's medical problems and preferences are discussed.

Practice with persons living their dying: a human becoming perspective

The purpose of this article is to discuss nursing practice with persons who are living their dying, from the perspective of Parse's theory of human becoming. Quality of life from the person's own perspective is the goal of practice guided by Parse's theory; hence, it is particularly relevant for nurses in palliative care settings, where quality of life is paramount. The practice methodology is explained and illustrated with an example drawn from experiences with a woman in a hospice in South Korea. As this woman lived her dying, suffering, joy, and sorrow emerged in cocreated relationships with important others.

Laparoscopic colorectal surgery: a challenge for ET nurses

A growing number of colorectal procedures are being performed either partially or totally by laparoscope. Because of the lack of a major incision, this approach offers numerous advantages, including reduced postoperative pain and shorter recovery time. To familiarize ET nurses with the laparoscopic technique, this article reports a case of laparoscopic abdominoperineal resection and discusses some of the special considerations involved in patient care.

The challenge of adult respiratory distress syndrome during interleukin-2 immunotherapy

During the last eight years, a substantial effort has been undertaken to develop new immunotherapeutic modalities to treat patients who have advanced cancer. One of the therapies used in this effort is the administration of interleukin-2 (IL-2) with or without lymphokine-activated killer (LAK) cells. Tumor responses have been documented in some patients undergoing this treatment, but it can cause life-threatening complications. Adult respiratory distress syndrome (ARDS), a term describing an acute respiratory failure episode, is one of these complications. Unless recognized and treated early, ARDS can progress to severe respiratory failure requiring intubation. The use of IL-2 for cancer treatment still is being studied, but this agent soon may receive approval from the Food and Drug Administration and become more widely used. Knowledge about its toxicity and the need for careful patient monitoring are paramount when administering this therapy.

Caring for a terminally ill person with pain, at home. An Australian perspective

Pain control for a person with a terminal illness provides the same sorts of challenges for those people who choose to stay at home as those who remain in hospital. The differences lie in the choices that are made for treatment, at times, the response to treatment; and the consequential effects treatment may have on families. This article discusses a case study in which the client's pain was managed in the home within a Hospice Care program that incorporates a visiting domiciliary nursing service. In Australia, such a program has all the advantages of a hospital setting, in that it has access to oncology units and the knowledge therein as well as catering to individual's needs in their own environment.