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The study purpose is to discuss a nurse’s role in providing holistic care of the patient and the family when presented with a difficult situation of possible death of the patient due to breast cancer. It will look into how nurses should provide spiritual care for the ailing person plus his or her family.

The case is based on a 38 year old woman and her family, living in Sydney. Beth complained of small lump in her left breast that had been present for one and a half years .A mammogram was performed in June 1993 and another one in September 1993 and indicated the lump was normal and the lump was fibrocystic and benign (Strayer,  Richman, 2010). Her mother had died at the age of 46 because of breast cancer and her father and three sisters are healthy. She is working as a nutritionist. Her medical history indicates that she started her menses at the normal age and physical examinations shows that she is normal. During the months that followed the patient indicated that she became very fatigued to the point that she was unable to walk by herself or do her normal activities without resting. Her husband noted that she was loosing hair at the temples and she noticed that her nails were cracking. Being a nutritionist she began a nutrition therapy for herself but the condition did not improve. She decided to seek a second opinion and was diagnosed with stage IIa infiltrating lobular carcinoma from a biopsy. She was offered the treatment of mastectomy which she refused because she did not want to experience the side effects of any surgical procedure, radiography or chemotherapy. She settled on Insulin therapy.

Her husband stays at home after he was retrenched during the global recession and he now does part time work as a computer technician.  Her eldest daughter is 15 years old in high school while the other one is 8 years old in primary school. For several days, Beth has had to stop working so that she can rest. The insulin therapy worked for some years before her condition started deteriorating while her cancer advanced over the years to a stage that neither surgery nor chemotherapy could reverse the condition and she was placed under palliative care. Being the bread winner in the family, she is depressed because her children need school fees so that they can complete her education. The house she lives in is on mortgage which remains only seven months to be completed but her husband does not have the capability to pay the mortgage and take care of the needs of the family. Her worry is that her family will be kicked out of the house when she is gone. The doctors say she has less than a month to live.

How to take care of the patient and the family

Spirituality is interpreted in a number of ways depending on what a person believes (Boogaerts, & Merritt, 2008). Sometimes it is equated to religion while on another perspective it points at quest for understanding life’s meaning as well as section of their lives played by the suffering. Dying patients, families and friends might want to return to the religion they were brought up with hoping to find the comfort while others might want just the presence of someone to be with them during this time of loneliness (Tollefson, Piggot & Fitzgerald, 2008). These are the aspects to take care of spiritually, for those with religious meanings, and also those who are not involved in any spiritual and religious interest. Value of interaction can strengthen and uphold the spirit of a patient who is dying from nurse’s support. Palliative support is taking care of the dying patients, encompassing the care of patients with advanced, progressive illness and families’ support in case of patient’s demise. Focus is geared on lessening ailment-related and other pain which can affect the patient and close associates such as family and friends, by ensuring quality is provided in respect to sustaining patients’ spirit in life.

Mostly, nurses get exposed to signs of spiritual distress and as Johnson and Jackson (2005) suggest, they should be taught how to support loss, suffering and death using the arts and humanities. Spiritual distress might manifest in several ways where some patients may be coherent about how they feel while pothers do not have a clue about the spiritual dimensions to their experience of illness (Marr, et al, 2007). Support can also help the patients close and next of kin regarding the situation, on spiritual aspects. The spiritual distress manifests itself physically, emotionally and through questioning in search of answers.

Communication is the best approach for of taking care of the spiritual needs of the patient and their families (Haley & Daley, 2008). A nurse should ensure that they are given opportunities to talk about their concerns on the changing situation. Effective communication on processes and procedures in each level of the illness and also the treatment, will garner understanding of the illness and the solutions meant to be applied, for assisting the patient. Such information assists the patient, in relations to their decisions for the intended support, to help them in making comprehensive plans with regards to themselves and their close kin.

The patient’s kin might find difficulties to discuss the patient’s condition or the implications because it is a distressing topic. It is therefore important to encourage them to talk together as a family to provide one another with mutual support and comfort.

It is important to keep care at personal level like addressing the patient by the name they prefer to be addressed (Hermann, 2007). It is not uncommon to find a patient with a name that is different from the ones used in their registration. This will help foster a personal relationship since the patient will not be feeling anonymous. Also communication will make care to the patient more effective and easy. At the same time the nurse should build trust with the patient through making time to be with the patient (Olson et al, 2006). This will help in accessing the deeper needs of the patients because they will easily trust strangers with their deepest secrete as opposed to trusting their families. For example asking a patient how they feel then take time to listen to their response which shows genuine concern for the patient (Chang, & Johnson, 2008). It is important for the nurse to talk about spirituality of the patient but care must be taken as such opportunities should be created when the patient is in a better mood. Sometimes nurses feel like they do not want to ask such questions as they might be unfamiliar with the topic personally and they might fear to upset the patient. For example use of opening statement like asking the patient to tell you about themselves can go a long way in opening up a discussion on spirituality (Mok et al, 2010). The nurse should explore priorities and choices so that patients may express their preferences in how they want to be taken care of (Mok, Lau, Lam, Chan, Ng & Chan, 2010). This is because priorities may change as the patients come to terms with their dying status. The patient should be offered as much privacy as possible so that they can grieve and families can be alone with their loved one (Barnett & Fortin 2006). This will have to be the preference of the patient because some may view a single room as being kept in isolation which might worsen their spirituality.

References to the illness or symptoms should be kept minimal though it is important to ask the patient how they feel about themselves while keeping the space around the patient clean to take care of other matters that do not concern medication (Puchalski,et al, 2009). At times the nurse may hold the hand of the patient to give reassurance through sharing of humanity. Relatives or patients may request for some things to be added to the care of the patient during the last days and it is important that the nurse is sensitive to such requests (van Leeuwen, Tiesinga, Jochemasen, & Post, 2007). Medicine might be required for some conditions like sedatives because of lack of sleep or some pain killers (Tanyi, McKenzie, &Chapek, 2009). Proper nutrition for the patient should also be considered. Care for the family and friends should also continue even after their loved one is gone because they might experience some conditions like depression due to bereavement.






Baldacchino, D R. (2006) Nursing competencies for spiritual care. Journal of Clinical Nursing, 15(7), p885-896, DOI: 10.1111/j.1365-2702.2006.01643.x

Barnett, K. G; Fortin VI, A H. (2006). Spirituality and Medicine JGIM: Journal of General Internal Medicine, 21(5), p481-485, DOI: 10.1111/j.1525-1497.2006.00431.x

Boogaerts, M., & Merritt, A. (2008). Psychosocial care. In E. M. L. Chang & A. Johnson (Eds.), Chronic illness and disability: Principles for nursing practice (pp. 50-65). Chatswood, NSW: ElsevierAustralia.

Chang, E. M. L., & Johnson, A. (2008). Chronic illness and disability: Principles for nursing practice. Chatswood, NSW

Haley, C., & Daley, J. (2008). Palliation in chronic illness. In E. M. L. Chang & A. Johnson (Eds.), Chronic illness and disability: Principles for nursing practice (pp. 168-183). Chatswood, NSW: ElsevierAustralia

Hermann, C. P. (2007) The Degree to Which Spiritual Needs of Patients Near the End of Life Are Met Oncology Nursing Forum, 34(1), p70-78, DOI: 10.1188/07.ONF.70-78

Johnson, A and Jackson D, (2005). International Journal of Palliative Nursing. Vol. 11, No. 8, p 438-443.

Johnstone, M.-J. (2009). End of life decision-making and the nursing profession. In Bioethics: A nursing perspective (5th ed., pp. 319-348). Chatswood, NSW: Churchill Livingstone Elsevier.

Marr, L; Billings, J. A; Weissman, D. E. (2007) Spirituality Training for Palliative Care Fellows. Journal of Palliative Medicine, 10(1), p169-177, DOI: 10.1089/jpm.2006.0076.R1

Mok, E., Lau, K., Lam, W., Chan, L; Ng, J & Chan, K. (2010). Health-Care Professionals’ Perspective on Hope in the Palliative Care Setting Journal of Palliative Medicine, Vol. 13 no.7, p877-883, DOI: 10.1089/jpm.2009.0393

Olson, M. M.; Sandor, M. K; Sierpina, V S.; Vanderpool, H. Y.; Dayao, P. (2006) Mind, Body, and Spirit: Family Physicians’ Beliefs, Attitudes, and Practices Regarding the Integration of Patient Spirituality into Medical Care Journal of Religion & Health, 45(2), p234-247, DOI: 10.1007/s10943-006-9020-2

Puchalski, C., Ferrell, B., Virani, R., Otis-Green, S., Baird, P., Bull, J., Chochinov, H., Handzo, G., Nelson-Becker, H., Prince-Paul, M., Pugliese, K. and Sulmasy, D. (2009) Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference Journal of Palliative Medicine, 12(10), p885-904,

Strayer, A, D. and Richman S (2010), Breast cancer screening: minority, low-income and inner-city women, Cinahl Information Systems.California

Tanyi, R A., McKenzie, M &Chapek, C. (2009) How family practice physicians, nurse practitioners, and physician assistants incorporate spiritual care in practice Journal of the American Academy of Nurse Practitioners, 21(12), p690-697, DOI: 10.1111/j.1745-7599.2009.00459.x

Tollefson, J., Piggot, K., & Fitzgerald, M. (2008). Management of chronic pain. In E. M. L. Chang & A. Johnson (Eds.), Chronic illness and disability: Principles for nursing practice (pp. 110-125). Chatswood, NSW: ElsevierAustralia.

van Leeuwen, R, Tiesinga, L J., Jochemasen, H & Post, D. (2007) Aspects of spirituality concerning illness Scandinavian Journal of Caring Sciences, 21(4), p482-489, DOI: 10.1111/j.1471-6712.2007.00502.x


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