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Nursing Study

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Submitted By jessica1972
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The physical, emotional, cognitive and behavioral responses from an individual are likely to experience in response to a newly diagnosed condition with a poor prognosis.
Imagine a person newly diagnosed with a poor prognosis and what the person response would be? Prognosis is a medical prediction of the future course of a disease and the chance for recovery.This essay will attempt to discuss responses from four aspects which are physical, emotional, cognitive and behavioral when person diagnosed with a poor prognosis. Essay will identifies response of each aspect and give examples. Identify the most of responses associated with grief. Essay introduces Kubler Ross’s Stage of dying theory and use theory to demonstrate emotional responses. A new diagnosis of life-threatening disease has a broad impact on a person's emotional, cognitive, social, spiritual, and physical well-being (Hill, Muers, Connolly, & Round, 2003) When someone confronts life-threaten illness that exceed coping resources, the reaction from emotional, cognitive, behavioral, and physiological is psychological stress. Responses are dependent on wide range of factors, such as the nature of the stressor, individual's physical and emotional capabilities, life experiences, social environment, coping skills, resources, and so on. (N.A. Kasparian.2013)
Physical responses depend on disease such as painful, insomnia, headache, tachycardia, hyperventilation, anorexia, and diarrhea and so on. Other responses come with the grief. “Grief can be represented by physical sensations, such as a lump in the throat, tightness in the chest, aching arms, oversensitivity to noise, shortness of breath, lack of energy, muscle weakness, dry mouth, or loss of coordination.” (Gill.2012).
Psychiatrist Elisabeth Kubler-Ross focuses attention on the emotional needs and reactions of dying patients. Stage of dying theory demonstrates emotional responses to the knowledge that person has a serious and probable fetal, illness. (Gill.2012) The first stage of Kubler-Ross’s five stages of dying is denial and isolation. Patient first response with poor prognosis usually is “No, It can’t be!” It is a defense mechanism that isolated from conscious awareness. Patient refused to admit that got sick subconscious. Example patient maybe not tell anyone else the conclusion about prognosis, keep bad news as a secret to family. Second stage is anger. Patient will angry with anyone who is handy, such as doctor, nurse and family number. In this stage, patient will really sensitive. Third stage is bargaining. Bargain for medical staff, less pain or a little bit longer time. Forth stage is depression. Patient feels hopeless, anxiety, loneliness, shock and relief. The last stage is acceptance. Patients who accept death may want to discuss how they are approaching this potentiality. Some patients may seek an approach to enjoy the rest of living life when they are comfortable with the reality of their death. (Browall, Melin-Johansson, Strang, Danielson, & Henoch, 2010).
Emotional response is the main aspect. In a large sample of patients with cancer (N = 4,496), psychological distress rates were 35% (n = 1,578) for the overall group and 43% (n = 273) for the subset of patients with lung cancer (N = 629) (Zabora et al., 2001) Individuals with cancer who present with emotional distress often have underlying death anxiety, responses may such as seek information that distracts focus from existential-related concerns. (R.H, Lehto. 2012) “Patients with advanced cancer experience multiple demands as their disease progresses. These include fatigue, pain, loss of mobility, increasing dependence on caregivers and cognitive impairment.” (D. Ryan.2011) Patient feels lost their previous life; independence and then grief will come along with. Responses demonstrate such as sadness, guilt, shock, fatigue, emancipation and so on (Gill.2012). For example, patients may feel sadness and anger about potentially not having the opportunity to see their children grow. Feel fear relate with long term treatment. Fear the time left to live and loss of a productive future. Some patients are less able to endure uncertainty such as experience much higher levels of potentially disabling, worry in situations that lack structure, are uncontrollable, and carry potentially threatening outcomes (Dugas, Buhr, & Ladouceur, 2004).
Cognition refers to the “higher” brain functions such as memory and reasoning. As Kubler-Ross’s five stages of dying theory, the first stage wills denial the bad news. People cognitive response will such as refuse to know the knowledge about disease, treatment process. Start to presence of the deceased. Some memory about other relative had same prognosis. Example past memories of experiences with friends or family who previously have died of disease. “Interactions with significant others who experienced pain or suffering at the end of life, those thoughts can be particularly anxiety provoking “(R.H, Lehto.2012) Patients may feel grief related to having a limit time for life, cognitive response come with grief such as disbelief, confusion, preoccupation. (Gill.2012)
Behavioral responses depend on wide arrange too. They are such as person growing up environment, life style, status in family and capabilities of emotional coping. Some responses like overdose drug use, drunk, isolate from community, sleep, plan for future for family, making willing. Example ,patients prepare to offset the financial and legal burdens on the surviving family; patient start concrete action plans for managing an uncertain future, give up hope and start drunk. Some patient has important status in family, worry about impact on family number when they passed away. (R.H, Lehto.2012) When patient accept death and can face to dying, responses will make a plan to enjoy their living life. Some of responses come from grief such as absentmindedness, loss of interest in activities that previously were sources of satisfaction, crying, avoiding reminders of the death. (Gill 2012).
Person newly experience diagnosis the poor prognosis will feel shock. Responses come from four different aspects, physical, emotional, cognitive and behavioral. Most of responses associated with grief. Kubler Ross’s Stage of dying theory is important to demonstrate emotional reactions of dying patients.

Reference
Browall, M., Melin-Johansson, C., Strang, S., Danielson, E., & Henoch, I. (2010). Healthcare staff's opinions about existential issues among patients with cancer. Palliative and Supportive Care, 8, 59-68. DOI:10.1017/S14789515099071X
D.Ryan.(2011) Methodological challenges in researching psychological distress and psychiatric morbidity among patients with advanced cancer: What does the literature (not) tell us? Palliative Med March 2012 vol. 26 no. 2 162-177
Dugas, M.J., Buhr, K., & Ladouceur, R. (2004). The cognitive role of intolerance of uncertainty in etiology and maintenance. Generalized anxiety disorder: Advances in research and practice (pp. 143-163).
Folkman S, Guer S. (2000). Promoting psychological well-being in the face of serious illness: when theory, research and practice inform each other. Psycho-Oncol 2000; 9:11-9
Gill, A. (compiler) (2012) The Person, Health and Wellbeing South Melbourne: Cengage Learning Australia
Hill, K.M., Muers, A.Z., Connolly, K., & Round, C. (2003). Do newly diagnosed lung cancer patients feel their concerns are being met? European Journal of Cancer Care, 12, 35-45
N.A. Kasparian. (2013)Psychological stress and melanoma: Are we meeting our patients' psychological needs? Clinics in Dermatology (2013)31, 41–46
R.H, Lehto. (2012) Challenge of existential issues in acute care: nursing considerations for the patient with a new diagnosis of lung cancer. Clinical Journal of Oncology Nursing. 16.1 (Feb. 2012): pE4. DOI: http://dx.doi.org.ezproxy1.acu.edu.au/10.1188/12.CJON.E1-E8.
Zabora, J., BrintzenhofeSzoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. Psycho-Oncology, 10, 19-28.…...

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