Part 4 The Lewis Family
4.3 Lewis family case study 2: Sally goes into surgery
Nicola Whiteing
Introduction to case study
Learning Objectives
By the end of this case study you should be able to:
- Identify the risk factors for developing breast cancer.
- Articulate the role of the nurse and other interprofessional team members in promoting a person-centred approach to the care of Sally and her family as she undergoes surgery.
- Discuss the role of the nurse and the relevance of considering natural and lifestyle therapeutic choices.
- Discuss safe surgical practice for a patient undergoing a mastectomy.
Scenario
Sally is showering when she finds a small lump in her right breast. After her mother’s experience of breast cancer Sally is scared to go to the GP and convinces herself it is just due to her cycle and it will go away. After 3 months the lump is still there and her right breast has some slight dimpling. Sally makes an appointment with her GP, and, following an ultrasound, tomogram and a biopsy, Sally is diagnosed with Stage III breast cancer.
Sally undergoes chemotherapy and hormone therapy to shrink the tumour prior to surgery. Sally has also been taking fish oil and vitamin E. Unfortunately, these therapies do not shrink the tumour sufficiently to allow for breast-conserving surgery (a wide local excision). As a result, Sally is admitted to hospital for a mastectomy, in which the whole right breast will be removed.
Following surgery, Sally undergoes radiotherapy and continues with hormone therapy. Sally and the rest of the family have a long journey ahead of them.
Case study questions
- What are the risk factors for developing breast cancer? Considering the background information in this case study, what factors put Sally at more risk of developing breast cancer?
- From the information provided in the case study, consider what concerns Sally may have prior to her admission to hospital. Which of these can you address as a nurse and which may need the involvement of other members of the interprofessional team?
- As the registered nurse looking after Sally, what pre-operative, peri-operative and post-operative care will she require? It would be helpful to access a surgical nursing text to answer this question.
Key information and links to other resources
Australian organisations providing information on cancer
A number of different organisations provide resources and supports for both healthcare practitioners, patients and families. These are just a few:
Complementary and natural / lifestyle therapies
The use of complementary and lifestyle medicine is increasing globally at a rapid rate (Steel et al., 2018; Frass et al., 2012). A study by Steel et al., (2018) finds that 63.1% of the adult Australian population have used some sort of complementary medicine. More patients are choosing to supplement conventional healthcare with other methods as a way of addressing issues not met by conventional medicine or psychological aspects of care (Hall et al., 2018; Leach, 2016). With an increase in the use of complementary therapies (CTs), nurses need to have an awareness of their use so they can encourage informed decision-making and improve patient safety (Hall et al., 2018; Lindquist et al., 2018; Cooke et al., 2012).
Sally is an advocate for complementary and natural lifestyle approaches to health. Research demonstrates the positive effects natural and lifestyle therapies can have on cancer and a person’s wellbeing. These include supplements such as vitamin E and/or selenium, therapies such as music therapy, meditation, relaxation, stress management, yoga and tai chi as well as exercise (Singh et al., 2018; Greenlee et al., 2017; Larkey et al., 2015).
Thinking points
- Consider your role as a surgical nurse in managing Sally’s care. What do you think is your role in supporting Sally’s choice of using natural and lifestyle approaches?
- What advice might you give to Sally as she prepares for surgery?
- What should you consider as Sally prepares for discharge in relation to natural and lifestyle approaches, including the use of supplements?
Family impact
A cancer diagnosis will have a significant impact on all members of the family.
Thinking points
- How might Sally’s diagnosis and admission to hospital affect other members of the family?
- What strategies might be useful in helping family members manage these effects?
- Based on what you know about the Lewis family and the information provided above, what interventions may be appropriate to ensure the wellbeing of each family member? (Remember to take a holistic approach and consider their physical, psychological, social, cultural and spiritual wellbeing).
- Based on your answers to the questions above, which professionals would be important when it comes time to form the interprofessional team? What might the roles and responsibilities of each professional be?
Case study 2 summary
Through this case study you have had the opportunity to learn more about Sally, her diagnosis of breast cancer and her treatment. A diagnosis such as this has a significant impact on not only Sally but the wider family as well. In considering a person-centred approach to care, you have reflected upon and considered the needs of all family members and how your role as a nurse and member of the interprofessional team can contribute to care.
References
Cooke, M., Mitchel, M., Tiralongo, E., & Murfield, J. (2012). Complementary and alternative medicine and critical care nurses: A survey of knowledge and practices in Australia. Australian Critical Care, 25(4), 213-223. https://doi.org/10.1016/j.aucc.2011.12.055
Frass, M., Strassl, R. P., Friehs, H., Müllner, M., Kundi, M., & Kaye, A. D. (2012). Use and acceptance of complementary and alternative medicine among the general population and medical personnel: A systematic review. Oschner Journal 12(1), 45-56.
Greenlee, H., DuPont‐Reyes, M. J., Balneaves, L. G., Carlson, L. E., Cohen, M. R., Deng, G., Johnson, J. A., Mumber, M., Seely, D., Zick, S. M., Boyce, L. M., & Tripathy, D. (2017). Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: A Cancer Journal for Clinicians, 67(3), 194-232. https://doi.org/10.3322/caac.21397
Hall, H., Brosnan, C., Cant, R., Collins, M., & Leach, M. (2018). Nurses’ attitudes and behaviour towards patients’ use of complementary therapies: A mixed methods study. Journal of Advanced Nursing, 74(7), 1649-1658. https://doi.org/10.1111/jan.13554
Larkey, L. K., Roe, D. J., Weihs, K. L., Jahnke, R., Lopez, A. M., Rogers, C. E., Oh, B., & Guillen-Rodriguez, J. (2015). Randomized controlled trial of qigong/tai chi easy on cancer-related fatigue in breast cancer survivors. Annals of Behavioural Medicine, 49(2), 165-176. https://doi.org/10.1007/s12160-014-9645-4
Leach, M. (2016). Profiling the Australian consumer of complementary and alternative medicine: A secondary analysis of national health survey data. Alternative Therapies in Health and Medicine, 22(4), 64-72.
Lindquist, R., Tracy, M. F., & Snyder, M. (Eds.) (2018). Complementary and alternative therapies in nursing (8th ed.). Springer Publishing Company.
Singh, B., Spence, R. R., Steele, M. L., Sandler, C. X., Peake, J. M., & Hayes, S. C. (2018). A systematic review and meta-analysis of the safety, feasibility, and effect of exercise on women with stage II+ breast cancer. Archives of Physical Medicine and Rehabilitation, 99(12), 2621-2636. https://doi.org/10.1016/j.apmr.2018.03.026
Steel, A., McIntyre, E., Harnett, J., Foley, H., Adams, J., Sibbritt, D., Wardle, J. & Frawley, J. (2018). Complementary medicine use in the Australian population: Results of a nationally-representative cross-sectional survey. Scientific Reports, 8, Article 17325. https://doi.org/10.1038/s41598-018-35508-y