Cancer, Ostomies and Wounds: Caring for Our Patients Needs
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1 Cancer, Ostomies and Wounds: Caring for Our Patients Needs Sara Dunning Lambert, RN BSN CW ON Providence Regional Medical Center W ound Ostomy Department Who I Am W ound RN Ostomy RN Breast Cancer Survivor 1
2 Overview H olistic Care Body Image - Before Cancer, After Cancer Physical Challenges - W ounds, Scars, Ostomies Pain, Palliation, H ospice Oncology RN Role Holistic Care Person with Challenges Disease Process Cultural Background Emotional and Spiritual N eeds Individualized Care 2
3 Body Image Changing phenomenon based on Physical sensations Emotional perceptions Relational aspects Cognitive interpretations Environment Developing sense of personal identity Body Image Origins in ancient philosophy - Plato Importance of subjective experience Multidimensional Research focused on eating disorders 3
4 Ideal Body Image Societal standards W hat we see in the media Culturally ingrained Realistic? Changing Body Image Injuries Disease Burns Cancer Cancer-related treatments 4
5 Body Image and Cancer Impact of cancer & cancer-related treatments Physical changes Emotional changes Self esteem Coping Body Image and Cancer Talking about body changes before and after treatment Factors in determining individual impact Time since diagnosis Visibility of affected organ/body part Permanence of changes Emotional impact Treatment and stage of disease 5
6 Body Image and Cancer Time since diagnosis denial early coping acceptance Body Image and Cancer Visibility of Affected Body Part head and neck breast colon 6
7 Body Image and Cancer Permanence of Changes mastectomy hair loss stoma Body Image and Cancer Emotional impact perception adaptational disorders relational changes 7
8 Body Image and Cancer Treatment and Stage of Disease early stage vs. later stage chemotherapy, radiation, surgery, alternatives Dealing with Physical Challenges Scars W ounds Ostomies 8
9 Dealing with Physical Challenges Scars surgical skin changes ports, lines, tubes tatoos Dealing with Physical Challenges W ounds malignant cutaneous surgical, non-healing metastasis 9
10 Dealing with Physical Challenges Ostomies - temporary and permanent Colostomy Ileostomy Urostomy Wound Pain, Palliative Issues Pain Palliation H ospice 10
11 Pain Disease related acute or treatment related chronic or systemic N europathic Procedural Emotional factors Palliative Care Patient and family centered Quality of life is key Anticipation, prevention, relief of suffering Part of plan of care beginning with diagnosis 11
12 Hospice Care End of life Comprehensive support Consider withdrawal of treatment Cancer Related Wounds Primary cutaneous tumor Surgical, non-healing Metastasis Malignant transformation of exiting ulcer 12
13 Oncology Nurse Role Pain Interventions Talking about Body Changes Providing Information - Education Assisting with Decision Making Emotional Support Introducing Mirror Use Oncology Nurse Role Pain Interventions atraumatic dressing changes control/prevent bleeding manage skin issues control odor manage drainage 13
14 Oncology Nurse Role Talking About Body Changes pre-treatment during treatment use of touch acceptance Oncology Nurse Role Providing Information - Education disease related individually designed support groups 14
15 Oncology Nurse Role Assisting with Decision Making emotional support education providing resources Oncology Nurse Role Introducing Mirror Use coping with changes in body image first step in recovery and acceptance nurse intervention 15
16 Review H olistic Care Body Image - Before Cancer, After Cancer Physical Challenges - W ounds, Scars, Ostomies Pain, Palliation, H ospice Oncology RN Role Questions? 16
17 Resources Annunziata, A.M., Giovannni, L., & Buzzatti, B., 2012, Assessing the body image: relevance, application and instruments for oncological settings, Support Care Cancer 20: Bates-Jensen, B.M., Seaman, S., Management of Malignant W ounds and Fistulas, 2001, Sussman, C., & Bates-Jensen, B.M., W ound Care, a Collaborative Practice Manual for Physical Therpists and Nurses, p , Lippincott W illiams & W ilkins Goldberg, M.T. & Bryant, R.A. Managing W ounds in Palliative Care, 2012 Bryant, R.A. & N ix, D.P., A cute and Chronic W ounds, Current Management Concepts, 4th edition, p , Elsevier, Mosby Messner, C., Vera, T., W ashington, C., Doyle, I., Quinlan, S., W ong, A., Zador, D. 2013, Issues of Self-Image, Disfigurement, and Sadness in People Living with Cancer, The Oncology Nurse, 6 (3):22-26 Freysteinson, W.M., 2012, October, Use of Mirrors as N ursing Intervention to Promote Patients Acceptance of a N ew Body Image, Clinical Journal of Oncology Nursing, 16 (%):
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