Community Health Scenario Death is an inevitable destiny of life. It is essential to be able to provide the best care that a patient may need during his last days, when all medical treatment fails. Frequently, the battle of life and death leads one to formulate a concept or an analogy of these two processes. This concept is bound to interfere with what one does in life. As a nurse, my idea of death and dying has an impact on the quality of care I provide to patients undergoing this process.

The ideal attitude of a nurse's care for terminally ill patients involves the criteria of flexibility in interpersonal relations, effective communication about critical issues, such as in Mrs. Thomas's case, and psychological stability and mindedness in relation to dying patients their families. (A Roberta and A. Rolland. Nurses' attitudes about end-of-life referrals. 2009).

According to the Journal of Medicine and Biochemical Sciences, a person's ability to deal with a situation is dependant on certain behavioral components, such as, cognitive and affective. In striving to achieve consistency between these different components, Lev very effectively summarizes the point,

"our attitudes as a pattern of views reflects the cumulative prior perceptions and experiences which one undergoes." (Lev, 1986)

Other factors also influence a nurse's capability to care for a dying patient. These include, age, gender, views on the quality of life, socioeconomic status, religion and level of education.

As a twenty-two-year-old lady belonging to an average family background, my insecurities about dying are high. Personally, I feel that there is yet a lot for me to achieve in life. Most young adults are waiting for an appropriate salary with which they can fulfill their wish list. During my experience with cancer patients, I found it hard to let them give up so frequently, hampering my duty to help these patients deal with their disease. This personal fear towards death also puts me in a panic struck state with patients who refuse resuscitation.

Also, my religious views have made my quality of help greater towards patients who held them in high regard, providing a bias in the care I provide. I believe that enough knowledge about a patient's religion helps one in relaxing and preparing for the dying process.

Moreover, my state of emotion also affects my behavior towards patients. Frustration, depression are anxiety because of situations at home or work is bound reduce patient care. Although, I recall no instances where I tended to overlook any detail concerned with appropriate management or care, in some cases, this has the probability of occurring.

In certain instances, a nurse's attitude can also be affected by recent death experiences amongst family or friends. Family background and the level of family openness are other factors that count.

Helping to deal with fatal illnesses is a challenging crisis. However genuine the desire to help is, one may still be limited by the tools and strategies they use. It, then, makes sense to design and integrate strategies that have proven to yield useful results.

The first strategy that I wish to use in Mrs. Thomas's case is to help her express her feelings. Expressing and exploring thoughts may be disturbing and terrifying on part of the patient.

1) Communicating: It is important to make the patient feel that you understand her problem and empathize as this creates a good patient therapist relationship. Listen to the problems faced by the patient and repeat them in the patients own words so the patient knows that you are on board with her. It is also important to communicate with the patient's family and friends, to answer patiently any questions that they may have. (Gloria, 2004)

2) Assess patients need to end of life care: common symptoms of oncology patients include nausea, vomiting, multiple infections, pain, dyspnea, constipation, anxiety and depression. It becomes important on part of the nurse...

Occasionally, certain symptoms, such as pain, precipitate the need for hospice care. Talking to the patient and the patient's family help them evaluate options through the multidisciplinary approach. (Gloria, 2004)
3) Comforting the patient: Other measures, such as humoring, reading and helping mobilizing the patient as much as possible are other techniques that have proven efficacy in increasing patient comfort. (Bottarf, 1995)

Reviewing the case about Mrs. Thomas, the first plan of action needs to be her management of pain. The ultimate consequence of enduring pain for long periods of time is frustration, hopelessness and despair. Pain killers with out any reported addiction, such as paracetamol can be given. Mrs. Thomas must to be slowly and gradually persuaded to her to life as free of stress as possible. Telling her that her ability to work will be improved with pain medications might be one way of convincing Mrs. Thomas. The simplest route of administration needs to be chosen. (World Health Organization)

Other given complication of chemotherapy and radiation needs to be evaluated. Effort must be made to evaluate and manage the side effects. Many patients, who have received chemotherapy for breast cancer, experience hot flushes and anxiety. Recurrent infections are another feared complication. Other generalized problems such as constipation can be managed with laxatives. Mrs. Thomas should also be encouraged to eat well and drink plenty of fluids, which help with a number of problems. The patient must be comfortable at all times.

Next, allowing Mrs. Thomas to accept her condition and prognosis would be a good step in helping her to acknowledge her state. She must be provided with the information she needs and given enough time and space to understand. Any question raised needs to be answered patiently. Asking the Mrs. Thomas to repeat what she understands of her condition is one effective way of assessing her understanding. It would be advisable to ask her what it was that she wished she could do during her end times and encouraging her in achieving those goals. Also, reminding the patient about their opinions of death and dying, before being diagnosed with cancer, may be helpful in allowing a patient to decide what they want to do during their last few days. Gaining knowledge about Mrs. Thomas's religion would be a good step for the care taker. Most patients find it helpful to cope with death when there is someone to talk to them about the importance that their religion holds for them, depending on the degree of religiousness of the patient and their desire towards it. (Gloria, 2004)

Mrs. Thomas should be encouraged to contact her friends and family to invite them to spend time with her. A study reveals that a physician visits a patient for fifteen minutes a day, nurse visits for about forty five minutes and family and friends spend a total of thirteen minutes with the patient. The patient is alone for the remainder of the twenty three hours. Most people are of the opinion that no one should die alone. However, fear may set one back only coming as regret later on. (Dunn, Cecilia, & Stephans, 2005)

These last few days of Mrs. Thomas is a period of extreme emotion on part of the patient, her husband and two sons. It becomes part of a nurse's duty to demonstrate willingness to listen to suggestions, stories or even criticism, without acting defensive, whether the criticism may be justified or not. An empathetic and lively tone must be kept at all times. Helping Mrs. Thomas perform work, taking her out for a walk, being a good listener, providing sound and honest comments when asked are the many way to help her combat the strong psychological impact.

With time, Mrs. Thomas's mobility is probably to decrease. For most patients, this is extreme agony. Helping Mrs. Thomas to occasionally sit up, change positions every two hours are measures that can help her…