Key Concepts Relevant to the Case Study
This paper focuses on the case study of Mrs. Maria Mendez, a 72-year-old Hispanic patient with advanced breast cancer with metastasis to the bones and lungs. This case study presents multiple physical, social, emotional, and spiritual issues. Understanding and considering these aspects is crucial in promoting holistic, patient-centered care to ensure optimal outcomes. Mrs Mendez has a breast tumor the size of an orange with a purulent malodorous drainage. This advanced disease poses several physical challenges, including significant pain and discomfort. Despite the severity of her condition, Mrs. Mendez refused a mastectomy due to cultural beliefs and even stopped chemotherapy after experiencing increased bone pain. The disease poses a challenge in managing the pain and other symptoms effectively. Mrs Mendez is on an intensive wound care plan and uses various medications, including Vicodin and morphine, for pain management. With worsening symptoms, Mrs Mendez experiences difficulties sleeping and severe pain, necessitating more frequent administration of opioid painkillers, predisposing her to extreme constipation. Metastasis to the lungs presents with severe respiratory symptoms. Generally, Mrs. Mendez’s physical condition is deteriorating rapidly.
Mrs. Mendez’s family is experiencing grief and loss, having lost their father seven years ago and their mother’s impending death due to advanced breast cancer. The illness and its progression have put an emotional toll on the family as the children struggle with caregiving and watch their mother agonize with symptoms such as severe pain and a malodorous wound. Moreover, Mrs Mendez herself has fear and emotions of helplessness about her condition and its impact on the family dynamics. Emotional stress within the family and the different coping mechanisms of each child also worsen the situation. Gloria is more accepting of her mother’s deteriorating condition, having cared for their father on his deathbed, as opposed to Christina, who is in denial. Despite her commitment and resilience, Gloria is burdened with caregiving and even breaks down. The family’s youngest son has been distant from the family, and even as the family goes through such a tough time, he is not with them, only to be located way later when their mother’s health is at its worst.
The social aspects include family dynamics, roles, and community support. With the passing on of their father, Jose, the eldest son, had to take up the leadership and decision-making roles of the family. Despite his physical absence, he directs his siblings on what to do. He also finds his younger brother Pablo, who had been estranged from the family and even asks him to visit their mother before she passes on. On the other hand, the family seeks alternative therapies such as herbs, cat’s claw, and the services of a healer. Mrs. Mendez’s cultural beliefs significantly influence her treatment decisions. For instance, she refuses mastectomy with the belief that the soul resides in the breast. This factor also portrays her spirituality as well as the fact that she uses prayer to cope with her illness.
Moreover, the ongoing prayer vigils and the involvement of church members reflect the family’s reliance on spiritual practices. The family seeks spiritual support to provide them with comfort and hope as they navigate Mrs. Mendez’s condition. Therefore, it is essential to consider and integrate these aspects into Mrs.Mendez’s care plan to ensure comprehensive care.
Middle Range Theory and Rationale for its Selection
Nola Pender’s Health Promotion Model (HPM) offers a valuable framework for understanding and promoting health-enhancing behaviors for patients1. Therefore, this theory would be essential in Mrs.Mendez’s case. HPM focuses on three core aspects: individual experiences and characteristics, behavior-specific affect and cognition, and behavioral outcomes. Pender believed that each individual can seek practices that improve their health. The model provides a structured approach to assessing Mrs Mendez’s perceived barriers to health promotion and the influence of her sociocultural beliefs on her healthcare decisions. Furthermore, the model considers physical, psychological, and sociocultural factors influencing health-promoting activities.
This model is suitable for Mrs.Mendez’s case because it addresses her unique needs, sociocultural beliefs, family dynamics, and influences concerning her health-promoting behavior. Mrs. Mendez discovered the breast lump but did not seek medical intervention promptly, leading to a diagnosis made when the disease was already advanced. Furthermore, she refuses mastectomy and chemotherapy, which would have improved her prognosis and overall outcome. The HPM model emphasizes the importance of empowering Mrs.Mendez to make informed health decisions that align with her values and beliefs, considering all the factors influencing her health behaviors1.
HPM Model In Guiding Clinical Assessments and Interventions
HPM guides clinical assessment and interventions by helping identify the motivational and barrier factors2. Clinical assessment helps gather data on prior behavior, patient perceptions, personal factors, and competing demands. Thus, it ensures a comprehensive assessment to gauge Mrs Mendez’s understanding of her illness and her attitudes towards various treatment options. Moreover, it checks on her social support system, cultural influences on health perceptions, and her emotional response to her condition. Accordingly, HPM prompts the perceived barriers to seeking early medical intervention and adherence to treatment. Thus aiming to understand the personal and cultural hindrances to engaging in health-promoting behaviors.
Moreover, it assesses perceived benefits, helping the nurse understand Mrs Mendez’s views on the benefits of her current treatment regimen. This approach also helps understand her views on alternative therapies versus conventional medicine, thus personalizing care. The model would also help understand her self-efficacy in managing her symptoms, thus identifying the areas for improvement and support. It is also vital to understand interpersonal influences, such as how the family dynamics and her children’s opinions influence her health decisions. Asking about her current priorities in life and care would ensure her involvement in her care plan.
The knowledge gathered from the clinical assessment using the HPM would help tailor interventions appropriately1,2. Consequently, it is essential to tailor education to her beliefs and values. Integrating alternative and conventional therapies would increase her perceived benefits, thus promoting positive outcomes. Additionally, integrating spiritual care into her treatment plan would acknowledge her spirituality and thus reinforce positive health behaviors. To improve her self-efficacy, it is essential to provide Mrs Mendez with tools and resources to manage her symptoms, such as pain management techniques and decision-making guides for her care.
For the family members, HPM would inform family counseling to address the emotional and psychological impact of their mother’s condition on them. Therefore, family counseling will focus on communication and decision-making strategies to help manage the interpersonal influences on Mrs. Mendez’s health behavior. Open communication would help the family clarify and negotiate the roles and responsibilities of each member to address the immediate competing demands. Furthermore, educating the healthcare team on Mrs. Mendez’s cultural beliefs would help them offer culturally sensitive care, enhancing the health outcomes.
Knowledge From Interprofessional Health-Related Sciences
Interprofessional health-related sciences such as biomedical and social sciences are invaluable in advanced nursing practice to promote holistic care3. Moreover, these sciences enable the achievement of health, which is a state of physical, spiritual, psychological, and emotional wellness. For instance, integrating knowledge from biomedical sciences would help understand the pathophysiology of breast cancer and the symptoms and possible complications, thus guiding medical management. Medical management is essential in preventing further disease progression and managing symptoms. Therefore, pharmacology will play a key role in managing pain and other symptoms to improve the quality of life.
On the other hand, social sciences would be vital in addressing the sociocultural and spiritual aspects4. Psychology is a science that helps promote emotional well-being, in this case, for Mrs Mendez and her family. Sociocultural studies ensure that patients’ cultural beliefs and values are respected and addressed to ensure culturally competent care. Moreover, social sciences help recognize the importance of spiritual care as some patients seek comfort and solace from spiritual rituals and practices. Therefore, these cultural and spiritual considerations would be crucial in managing Mrs.Mendez while respecting her beliefs and preferences. Accordingly, social work helps address the social determinants of health, facilitates access to resources, and improves social and emotional well-being. Conversely, nutrition and dietetics address the importance of a healthy diet, essential in maintaining health and preventing illnesses5. Adopting an interprofessional approach in patient care ensures that all physical, emotional, spiritual, and social aspects are addressed, thus promoting holistic care1.
References
- Zaccagnini ME, Pechacek JM. The Doctor of Nursing Practice Essentials: A New Model for Advanced Practice Nursing. Jones & Bartlett Learning; 2021.
- Shahroodi MV, Sany SBT, Khaboshan ZH, et al. Psychosocial Determinants of Changes in Dietary Behaviors Among Iranian Women: An Application of the Pender’s Health Promotion Model. Community Health Equity Res Policy. 2022;42(2):209-218. doi:10.1177/0272684X20976825
- Josi R, Bianchi M, Brandt SK. Advanced practice nurses in primary care in Switzerland: an analysis of interprofessional collaboration. BMC Nurs. 2020;19:1. Published 2020 Jan 2. doi:10.1186/s12912-019-0393-4
- Rawlinson C, Carron T, Cohidon C, et al. An Overview of Reviews on Interprofessional Collaboration in Primary Care: Barriers and Facilitators. Int J Integr Care. 2021;21(2):32. Published 2021 Jun 22. doi:10.5334/ijic.5589
- Griffiths JC, De Vries J, McBurney MI, Wopereis S, Serttas S, Marsman DS. Measuring health promotion: translating science into policy. Eur J Nutr. 2020;59(Suppl 2):11-23. doi:10.1007/s00394-020-02359-1
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