Nasopharyngeal Carcinoma (Stage II): a patient case study


 


This patient case study focuses on nasopharyngeal carcinoma (NPC). Specifically, it analyses the progress of becoming and being ill as well as the process of recovery.  It identifies and explains how the illness affects the psychosocial functioning of the patient. It similarly analyses how the patient’s own psychosocial characteristics (e.g. belief, personality, social relationship etc.) influence the process of illness and recovery.


 


Nasopharyngeal Cancer: a brief description


The National Cancer Institute (NCI) of the U.S. National Institutes of Health defines nasopharyngeal carcinoma (NPC) as a “cancer that forms in tissues of the nasopharynx (upper part of the throat behind the nose).” It is believed that nearly all nasopharyngeal cancers are considered squamous cell carcinomas due to its identified origin in flat cells lining the upper part of the throat behind the nose or the nasopharynx. Wang and colleagues (2008) agree that the usual case of nasopharyngeal carcinoma (NPC) include the upper part of the throat behind the nose with a well-developed group of lymphatics and cervical lymphadenopathy. They also describe it as a common cancer among Asians, especially in southern China. There have been abundant collections and a number of documented examples presented in epidemiological studies supporting the hypothesis of a relationship between childhood diet and later cancer. The more consistent evidence relates to the relationship between salted fish consumption in various Chinese populations and the risk of nasopharyngeal cancer. This relationship, which is supported by animal experimental work, shows that early dietary effects on cancer can be highly specific and of appreciable magnitude. There are, unfortunately, no other similar examples.


 


Stage II nasopharyngeal cancer


From the same reference as above, “Stage II is divided into stage IIA and stage IIB. In stage IIA, cancer has spread from the nasopharynx (the upper part of the throat behind the nose) to the oropharynx (the middle part of the throat that includes the soft palate, the base of the tongue, and the tonsils), and/or to the nasal cavity. In stage IIB, cancer is found in the nasopharynx and has spread to lymph nodes on one side of the neck, or has spread to the area surrounding the nasopharynx and may have spread to lymph nodes on one side of the neck.”


 


Discussion


One of the strategies employed in addressing a number of psychological problems and illnesses is the use of different kinds of psychotherapy. Aside from pharmacology, many psychiatrists and psychologists practice different techniques in psychotherapy in order to lessen drug-dependence of clients suffering from mental disorders. One of the psychological therapies used is Cognitive Behavioral Therapy, which helps enhance the therapeutic relationship that exists between the psychologist or psychiatrist and the client. However, Beck argues that the therapeutic relationship that exists between the client and the doctor in Cognitive Behavioral Therapy may not be sufficient to achieve a health or wholesome outcomes. With this statement, this essay discusses the concepts underlying Cognitive Behavior Therapy, with the emphasis on therapeutic relationship. Such concepts would be the basis for justifying Beck’s statement.


 


Cognitive Behavior Therapy


 (1995) defines Cognitive Behavior Therapy as a branch of applied psychology that seeks to change problematic behavior through a number of methods. Methods include modifying the environmental contingencies that surround the problem, weakening previous conditioned associations that have resulted in maladaptive emotional reactions, offering clients more effective models of problem-solving and interpersonal behavior, seeking to change ways in which stimuli are recognized and interpreted in the first place, and offering an objectively superior basis for the therapeutic, counseling or casework roles of the psychologist or psychiatrist (1995). Such methods or approaches are not restricted to any one theoretical technique, but involves diverse yet interrelated strategies for providing new learning experiences that engage procedures and analysis. In addition, cognitive behavior therapy is guided by a number of principles, which serve to guide the therapist in the treatment of the client. Primarily, cognitive mediation processes are involved in human learning, such that the human organism responds mainly to cognitive representations of its environment rather than to the environment per se. Second, thoughts, feelings, and behavior are causally interrelated, thus, alterations to one aspect of the system will have effects on the other features. Third, cognitive activities are important in understanding psychopathology and producing therapeutic change. Fourth, cognitive processes can be cast into testable formulations that are integrated with behavioral paradigms, thus, desirable to combine with behavioral procedures, such as modeling, role-plays, and contingency management. Lastly, the task of the cognitive-behavior therapist is to act as a diagnostician, educator, and consultant, who assesses maladaptive cognitive processes, and works with the client to design learning experiences that may remediate these dysfunctional cognitions and behavioral patterns ( 1993). In this regard, it can be perceived that the process of cognitive behavior therapy involves addressing the feelings, behaviors and thoughts of the client during the therapy process in order to change or alter the maladaptive behavior of the client. In the process, the relationship between the client and the therapist is being emphasized.


 


Therapeutic Relationship in Cognitive Behavior Therapy


            The review of Beck and Freeman in 1990 of cognitive behavioral treatment emphasizes that cognitive behavior therapy is based on the collaboration of the therapist and the client, thus, both of the parties work together to establish their goals, assignments, and means for success ( 1999). In this regard, the therapeutic relationship between the client and the therapist is being established. It has been reported that therapeutic relationship is at the absolute heart of psychotherapy, and is the vehicle whereby therapeutic change occurs ( 1991). It is regarded as the journey of both parties, which involves the participation, passion, cooperation, trust, and concern from both. In addition, a good therapeutic relationship is crucial to the success of cognitive behavior therapy for the therapist to carefully nurture the therapy alliance and pay attention to any ruptures within the relationship ( 2002). Because the success of the therapy lies on the relationship that exists between the therapist and the client, a careful and relevant approach must be employed by the therapist in order to ensure the effective treatment of the client.


            Therapeutic relationships can be achieved through different means. Primarily, the therapist can use the process of collaboration, which involves establishing an equal partnership with the client through bringing skills, knowledge, emotion, and techniques that would help the client in the process. Another way is through formulation, which is a unique map of presenting problems or situations to the client that would integrate information from assessments of the therapist. Third, the therapist can use a Socratic dialogue or guided discovery, which involves gently probing or questioning for people’s meanings to stimulate alternative ideas. It explores and reflects on styles of reasoning and thinking differently. Lastly, the therapist can assign homework to the client, to allow him or her to try things out in between therapy sessions, thus, putting into practice what the client has learned in the therapy sessions ( 2005). With such methods, the therapeutic relationship between the client and the therapist can be established and determined. However, the problem that can be encountered in this sense is the fact that the client may have apprehensions towards the therapist, thus, limiting his or her disclosure of information. In this regard, the statement of Beck, emphasizing that such therapeutic relationship may not be enough to obtain desired outcomes come into picture.


 


Justifications of the Statement


            The therapeutic relationship established through such means may not be effective due to a number of reasons. Primarily, the therapeutic relationship would not be effective in achieving healthy outcomes without the trust of the client to the therapist. It has been reported that the cognitive behavior therapist works with schemas, which are the collections of people’s beliefs, experiences and rules of behavior about themselves, others and the world (1999). If the client has schematic beliefs of mistrusting other people, then the therapist would have a hard time encouraging the client to disclose information. In this regard, the genuineness of the therapist must be observed, which has to do with confidence, appearing relaxed and at with one’s self, thus, presenting the therapy in a way that it would not sound artificial to put up a barrier between the therapist and the client ( 1995). Another hindrance to the practice is the lack of sensitivity on the part of the therapist. If the therapist is not sensitive enough for the needs of the client, then the client would not be able to obtain the best treatment that would help him or her to improve and develop as an individual. In this regard, non-possessive warmth must be expressed by the therapist, which consists of getting across to clients feelings of respect, liking, caring, acceptance, and concern, and managing these in a non-threatening way (1995). It is not enough that probing and collaboration with the client must be done, but the client must be able to feel the care and concern of the therapist.


Therapeutic relationship is also not enough if there is incompatibility between the client and the therapist. Incompatibility can be observed through the incompatibility of the approaches of the therapist, and incompatibility on the response of the client that hinders adequate and effective assessment. In this regard, it can be perceived that the relationship of the client and the therapist must be based on compatible approaches and strategies that would not only benefit the client, but provide learning and experience on the part of the therapist as well. Having a client-therapist relationship is not a mechanical and predictable relationship that provides help to the client because of sympathy. In this regard, empathy must be extended by the therapist, which involves letting the client know that the therapist has a grasp on his or her problems, showing the client that the therapist sees things on the client’s perspective, and letting the client feel and see that the mood and feelings of the therapist are in tune with him or her ( 1995). As such, the trust and confidence of the client can be obtained. In addition, the time allotted by the therapist also counts in cognitive behavior therapy. Therapeutic relationships must not only focused in providing cognitive activities and workshops to the client, but making the client feel that his or her problems matter to the therapist through providing ample time for listening to the client. However, psychotherapies, such as cognitive behavior therapy takes a lot of time and effort on both the client and the therapist, is a time-consuming process, and its full analysis may take several years ( 1988). In this regard, each therapy session between the client and the therapist must be grasped and taken advantage in order to yield the best possible result. However, the problem that can be encountered due to the slow and time-consuming process is that the client or the therapist may get tired, given the slow development of the client. In this case, psychotherapeutic activities must be done simultaneously to ensure the speedy improvement and treatment of the client. From this, it can be perceived that the therapeutic relationship between the client and the therapist that was established through probing, collaborating, and assigning homework must not be based only on by-the-book approaches. Such activities must be done with the empathy, genuineness, and sensitivity of the therapist to the needs of the client. 


 


Important Consideration: Aged Care Assessment


Aged patients vary in physical needs, psychosocial needs including family involvement, and pathophysiological disorders that influence the person’s nursing care. In this case, an aged stroke patient is described whereas rapid assessment and early intervention is a requirement (1999).


In terms of physical needs, aged patients need more assistance. Diet, nutrition, and eating are given special attention since the patient not able to chew and swallow foods. Since the patient is not capable of normal locomotion, his ability to dress and groom himself is no longer possible. Thus, assistance is always needed. In the same manner, a satisfactory nursing care is based on the need to maintain the skin care, feeding, hydration, positioning, and monitoring vital signs such as temperature, pulse, and blood pressure of the patient. On the other hand, psychosocial needs include attention, care, understanding, and continuous support from other people. The patient may have the tendency of having sudden changes in emotion. Depression is prevalent as a cause of self-acceptance of the disability. This is the reason why family involvement matters a lot especially in the recovery and therapy of the patient. Pathophysiological disorders that influence the person’s nursing care may range from the kind of stroke that the patient had experienced. In general, the risk of another stroke occurrence is recognized. The death of brain tissue may elicit several conditions.


The person who reaches the ageing stage of life biologically changes over time due to cellular senescence. Cellular senescence is the ageing of cells and characterized by the loss of its ability to divide. According to  (2004), “the aging process may derive from changes occurring in parallel in different tissues due to intrinsic cellular mechanisms or changes in one tissue may be predominant”. Cell and tissues are considered to be significant reasons on why people age as described with the presence of strong genetic components that ( 2004; 2000). In the programmed based theories of aging, it was indicated that aging is not a result of random or stochastic process but rather driven by genetically regulated processes ( 2004). This means that the aging of an individual is natural.


 


Nursing refers to the functions and duties carried out by persons who have had formal education and training in the art and science of nursing. To promote the restoration and maintenance of health in their clients, nurses become more particular in enhancing their knowledge through integration with health and biological sciences (1993). As an applied discipline, the vocation of nursing evolves within a dynamic body of knowledge. The quality of nursing practice is dependent on the knowledge of individual practitioners as well as their willingness to engage in professional relationships and behaviors.


Nurses are required to have the skills and know-how to explore, confirm, and direct the progress of nursing practice. Five value concepts uphold professional development: the (1) knowledge base, which is the foundation knowledge base upon which clinical practice decisions are made, (2) continuing education which comprise of the continuing learning activities that are crafted to benefit the individual and the profession, (3) mentoring and networking which are the professional relationships that are instituted with the intent of supportive growth for the individual as well as the profession, (4) research which is the qualitative and/or quantitative investigation of the factors which affects the professional nursing practice, and lastly (5) career development which are purposeful, planned strategies that are designed to boost short and long term professional goals ( 1998).


It has not been long since nurses have had specialized training especially on patient management; these specialized trainings include the situation in which they are more likely to find themselves, thus affecting how they will react to the situations presented before them. The differences of their actions mean very much to the patients, and thus they must learn how to distinguish the different factors and be able to help their patients in achieving the best method of improving their health and returning to their vigorous states.



Credit:ivythesis.typepad.com


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