NURSING CARE: SUMMATIVE THEORY ASSIGNMENT PART 1 Introduction Health is the condition of homeostasis or the inclination towards physical and psychological well-being (2002). Health covers the prevention of physical sickness and mental conditions that weakens and prevents the person from providing for basic needs as well as wants ( 1994). The concept of homeostasis implies that man has the natural inclination towards health (Brooker, 1997). However, without sufficient knowledge and understanding on health hazards, man is likely to stray from the natural tendency towards health. Health care organizations have taken the revolutionary stand of assuming the task of providing the necessary knowledge about health hazards to empower people to make decisions on their health as well as the traditional role of providing care for ailing patients. In conjunction, the Department of Health (2005a) issued a health information policy that took effect in 2004 providing health information to the public through the television. Health care promotions have been integrated into nursing care. Care pathways is a model of health care promotions that provides for a holistic and integrated approach to nursing care (Gröne and Garcia-Barbero, 2001). These approaches imply that nursing care offers both preventive and actual care ( 2000). In line with different government health agencies headed by the Department of Health, there is an ongoing campaign based on the alcohol harm reduction strategy of the government to apprise the public of cancer and its causes, one of which is alcoholism, with the hope of providing health care before actual physical illness is developed. (2004) The nursing care setting involves a 55-year-old male diagnosed with cirrhosis of the liver whose condition is primarily caused by alcoholism. The paper will focus on two goals, which are actual patient care and preventive actions advocated by concerned health groups to discourage alcoholism and minimize or prevent the development of cancer among drinkers due to the excessive regular intake of alcohol. To provide an in-depth understanding of the patient’s condition, information on the epidemiology and causation of alcoholism and the cancer derived from alcoholism will be discussed. Cancer is the chosen medical condition because the incidence is persistently increasing despite the presence of new technology and new research findings. The rise in the number of cancer patients is based on the prevalence of its cause. The paper considered the causation of alcoholism because it is a cause that can be controlled by individuals, based on their personal decision and as influenced by health and health promotion organizations, relative to the genetic causes of cancer. Briefly outline the epidemiological data on disease causation and distribution relevant to a client with a medical or surgical condition According to a recent report, alcoholism is underestimated as a cause of several types of cancer, particularly in the mouth, larynx, colon, esophagus, liver and breast. This is in light of the increasing rate of alcoholism in both developed and developing countries. The World Health Organization (WHO) reported that as of 2000, excessive alcohol intake is the cause of 185,000 deaths among men and 142,000 among women. However, moderate intake of alcohol is considered to have prevented 71,000 and 277,000 deaths among men and women respectively. ( 2006) The World Health Organization discriminates between moderate and excessive alcohol intake in discussing disease and death causation. In the case of developing countries, excessive alcohol intake is associated with 1.52 million and 301,000 deaths among men and women respectively. Despite the lower cases of cardiovascular health problems in developing countries, excessive alcohol intake accounts for more deaths than in developing countries. ( 2006). The Office of (2005) reported that cancer is a leading cause of deaths in the United Kingdom and Ireland. In the 1990s, there was a documented annual average increase in cancer cases of 270,000 while deaths caused by cancer numbered an average of 165,000 deaths per year. Cancer ranked as the cause of most deaths for women during the 1960s and for men in the 1990s. The same office also reported that certain types of cancer are strongly related to smoking and/or drinking. There are variations to the incidence of cancer caused by smoking and/or alcohol intake across the different geographical regions but the report concludes that if the number of deaths due to cancer in the geographical areas with the lowest incidence is applied to all areas, there would be reduction of cancer mortality by as much as 17,000 each year. Almost three quarters of the reduced number of deaths caused by cancer are related to smoking and/or alcohol intake. Disease causation refers to the factor or factors that result to the development of a disease while distribution refers to the frequency of occurrence or extent of prevalence of disease causation (Berkman and Kawachi, 2003). Some diseases cannot be attributed to infectious causes using Koch’s postulates but could be shown to have genetic bases, particularly if they were inherited according to Mendelian ratios. Furthermore, epidemiology could mean the study of the distribution and determinants of disease in human populations or the scientific study of factors affecting the health and illness of individuals and populations that serves as the foundation and logic of interventions made in the interest of the public’s health and preventive medicine. (2001) According to the (2004), alcohol causes around 1.8 million deaths annually. Excessive alcohol intake is attributed to 20-30% of cancer in the esophagus and liver. Thus, alcohol consumption consists of the highest risk factor for the development of disease in developing countries with low mortality rates and the third highest risk factor in developing countries. The WHO epidemiological data have identified chronic alcohol consumptionas a significant risk factor for upper alimentary tract cancer,including cancer of the larynx and the esophagus as well as of the liver. The increased risk attributable to alcoholconsumption of cancer in the large intestines and in the breastis much smaller. Thus, in considering the high prevalence of such tumours, even a smallincrease in cancer risk is of great importance in individuals who exhibit a higher risk for other reasons. How frequent does this disease occur? Alcohol is a significant cause of cancer deaths. In the case of Europe alone, alcohol intake was attributed with more than 55,000 deaths among young people in the 15-29 age group ( 2002). The table below (2004) shows the risk involved in developing diseases due to alcohol intake. The frequency of the development of cancer depends upon the extent of alcoholism of a person.
Increased risk results to higher probability of incurring cancer. The table below ( 2004) shows alcohol dependence in different countries. Higher rates of alcohol dependence reflects higher incidence of cancer.
According to the patient subject of this study, he drinks an average of five servings of alcoholic drinks a day for the past 10 years causing him to develop cirrhosis of the liver. Drinking was also coupled with occasional smoking speeding the mutation of cells into cancer cells. This implies that excessive alcohol intake increases the risk of developing cancer more so when this is done with smoking. Thus, in the case of the patient, drinking was the primary factor that led to the development of cancer. It can be concluded that if the patient did not have an alcohol problem, he may not have developed cancer.
Discuss relevant HEALTH PROMOTION RESEARCH specifically related to the disease or the behavior change
The World Health Organization periodically updates the Global Status Report on Alcohol to determine changes in the causation of alcoholism and its effect on the epidemiology of alcohol related diseases including cancer. The research serves as the basis of health policies on the effective ways of minimizing alcoholism and its concurrent effects on health. The (2005) periodically conducts risk research initially targeting information update to the whole gamut of health professionals in different fields from preventive to primary health care but eventually extending to risk research for public information. The scope of the risk research covers the different health risks affecting the people of England and Wales such as alcoholism, smoking tobacco, drug abuse as well as obesity. The primary purpose of risk research for health professionals and the public is to identify the targets in promoting healthy living for people to make informed decisions about their dietary and lifestyle choices.
Part of risk research on cancer caused by alcoholism is determining the segments of the population with documented high risks of alcoholism. The (2004) conducted the Alcohol Needs Assessment Research Project. Research showed that across genders in the 16-64 age group, 38 percent of men and 16 percent of women has alcohol use disorder, equivalent to 8.2 million people. Research also showed that 21 percent of men and 9 percent of women are classified as binge drinkers relative to the daily and weekly sensible drinking standard. Overall, alcohol dependence is reported as 6 percent for men and 2 percent for women relative to the national population. Data trend also showed that there was a decline in alcohol dependence with age and there is a lower prevalence of alcohol disorder among black and other ethnic groups. Research findings showed a higher risk of alcohol disorder for white male in the younger age groups suggesting the need for health promotion interventions in this group.
In relation to behavioral change interventions, the (2005b) conducted a Food and Drink Advertising and Promotion Forum gathering representatives from the different food and health departments, advertising firms, and food and drink producers’ organizations to illicit ideas and suggestions on how they can cooperate with the department of health in promoting a healthy lifestyle through advertising and other promotions channels.
What HEALTH PROMOTION research is available about client’s behavior/condition?
Several ways have been introduced as health promotion activities to deter alcoholism and prevent its harmful effects such as cancer. However, the most important are preventive activities that educate people about the health hazards of chronic drinking and provide venues for counseling and therapy. The National Institute on Alcohol Abuse and Alcoholism is actively engaged in information dissemination and intervention. The organization applies brief interventions due to findings that communicating with people is an effective manner of reaching out and helping people with potential or actual problems with alcohol. This is because people are more reactive to face-to-face interaction rather than to impersonal techniques. (2005)
How does this research inform the conduct/approach to your health promotion activity? Current relevant research on the relationship of cancer and alcoholism provides the information necessary to reach out and share to people about the health hazards of drinking to empower them in decision-making. There are three core goals of the health promotion activity, which are: 1) promote health and well-being and prolong life; 2) reduce the incidence of alcohol-related problems and the disease of alcoholism in the general population; and 3) reduce morbidity due to alcohol-related problems and the disease of alcoholism.
Involvement in actions directed towards prolonging life and promoting healthy lifestyle to the general public reduces the incidence of new cases of alcohol related problems and alcoholism by changing social norms regarding drinking and intoxication. Educating people regarding health risks and social consequences associated with alcohol consumption empowers them to make informed decisions on their diet and overall lifestyle.
Health Promotion Strategies
The health promotion and intervention strategies apply the Stages of Change Model [Appendix 7] developed by (1983). According to this model, there are six stages in changing alcoholism. The first stage is pre-contemplation where a person is not thinking about changing his/her behavior because of the lack of desire to change or lack of information on the health risks of alcoholism. The suggested interventions focus on the sharing of information in order for the person to realize the need to change based on an evaluation of his/her behavior. Second stage is contemplation where the person is undecided about actualizing the behavioral change and there is no plan for even short-term change. The suggested intervention involves recognition of level of information, encourage further exploration of options and clarification of causes for hesitation. Third stage is preparation where the person is attempting to change with a short-term plan. The intervention should involve social support and assistance in developing skills for goal setting, planning, implementation and evaluation. Fourth stage is action where the person is actually practicing a new behavior as a long-term plan. Suggested interventions include continued support and recognition of improvements. Fifth stage is maintenance where the person is committed to the behavioral change so that the suggested intervention includes follow-up and reinforcement support. Sixth stage is relapse where the person may go back to the previous behavior. The intervention should include a comprehensive evaluation of causes of the relapse, the issues and difficulties experienced during the change and the determination of stronger coping strategies.
Particular programs to promote health and behavior change among people with alcohol problems at risk of developing cancer and people at risk of developing alcohol problems includes research support, information dissemination and other forms of participatory intervention. Information dissemination and interventions include supporting and promoting national and community-based age-appropriate education programs and alcohol-free alternative activities directed towards pro-active change; advocating advertising and marketing reforms for alcohol beverages; advocating consumer education; encouraging community-based regulatory reforms in relation to drinking establishments; participating in school and community information drives and counseling support are ways of promoting health. Research support covers participating in research and evaluation of primary prevention approaches based on outcome among the general population and specific populations and identifying groups with high-risk of alcohol-related problems based on health facility and community research participations.
Particular health promotion intervention with the patient subject of this study includes support in the treatment and rehabilitation process by participating in the actual health care of the patient during the detoxification stage where the patient has to abstain from drinking alcohol resulting to physiological and psychological difficulties and changes requiring medication. The intervention also covers continued support during the treatment and rehabilitation stage by providing information on alcoholism and the health consequences of alcoholism to provide the patient with the necessary knowledge in making the initiative and decision to change. The purpose of providing adequate information is to ensure initiated change on the part of the patient and discourage the patient from reverting to alcoholism after the physical and psychological difficulties have passed.
What are psychosocial concepts that will influence the health promotion activity?
The holistic approach of considering physical, mental and pastoral support to people with alcohol problems is effective in promoting the overall well-being of the person because changing alcoholic behavior affects the physical and mental condition of the person ( 2004). Examples of interventions targeting the psychological state of a person include open discussions, counseling and encouragement as well as soliciting the support of family members, peers and the community while interventions directed towards the physical well-being of the person includes physical exercises, medication as needed, diet and leisure activities.
A holistic approach is also effective because of the need to address the psychological and sociological factors affecting the health promotion activity. Psychological factors are depression, anxiety disorder, and conduct disorder or anti-social behavior (2002). These factors may limit the willingness of the person to participate and the receptiveness of the person towards information given. This is because they may withdraw themselves from other people and refuse assistance. Social factors include peer influence, environmental factors such as accessibility of alcohol and family environment (2002). Target participant may not cooperate when pressured by peers or they may not see the need to change their behavior because several family members practice alcoholism or the community is not strict in regulating alcohol selling and intake.
Alcohol dependents are empowered to initiate change and develop positive attitudes toward controlling their condition and undergoing treatment. The intervention should be relevant to the age and needs of the person to achieve optimum results. The intervention should also consider both physical and psychological needs of people so that the people providing the intervention should be knowledgeable of the apparent issues surrounding people with alcohol problems and the techniques of assisting people to actualize change in their habits. (1999) Change starts with knowledge and the ability to analyze information. The intervention helps people understand their condition and available options as well as help them develop an analytical mind to use the information to make decisions regarding their alcohol problem. ( 2004) An example of this strategy is to identify people at risk of developing alcoholism, bring the group together in a discussion session, provide information on the risks associated with drinking and discuss options for change.
Discuss how you would plan, implement, assess and evaluate your health promotion activity
Advocating health for the patient with alcohol problems requires information gathering on the medical and alcohol drinking history of the patient by coordinating with family members and friends as well as with the patient. The next step is to coordinate with the other members of the health care team to discuss the health promotion plan based on the suggested best possible intervention method, identifying goals and objectives, creating a time line, and identifying factors or guidelines for evaluation. After the plan is finalized, the target participant and his family are informed about the program and their opinions and suggestions will be solicited to ensure their participation and voluntary cooperation. The participant is also informed about the time line and any inconveniences that may arise. Discussions will commence as scheduled with a group assessment at the end of each session. The information dissemination process involves a string of open discussions on the epidemiology, the health risks of alcoholism and risk behavior of alcoholism relative to the particular condition of the patient as well as discussions or sharing on the comments of participants about the information given. The effectiveness of the intervention program is evaluated based on the achievement of the goals and objectives specified in the plan.
Discuss the nurses’ role and required skills in effective health promotion
Nurses implement relevant health promotion to alcohol dependent patients to influence them to change and to prevent health problems. Nurses, apart from doctors, are the health care personnel that directly deal with patients for the duration of their treatment. Because of their close proximity to patients, nurses are the best repository of research data on actual patients. Nurses check on the condition of the patient upon entry into the health care process and monitor their progress. Nurses are involved in the documentation of detailed information of the changing conditions of patients. Nurses should have research skills. They should be keen in identifying problems, formulating plausible solutions based on experience and facts, analyzing options, coordinating with other health care personnel to find the best solution, implement the solution and conduct evaluations. Nurses are qualified to suggest effective health promotion programs.
PART 2
Reflection based on Driscoll’s Model of Reflection
Driscoll’s model of reflection (2001) provides three elements of reflection: 1. WHAT? A description of the event; 2. SO WHAT? An analysis of the event; and 3. NOW WHAT? The proposed actions following the event. These three elements interact in the different stages of the experiential learning process.
What?
The research focused on a 55-year-old male admitted to the hospital for the early stages of alcoholic cirrhosis of the liver. Based on the history of the patient, he is a heavy and frequent drinker averaging five drinks a day for the last ten years. He was admitted to the hospital after experiencing weight loss, weakness, profuse sweating and abdominal pains. Initially, his diagnosis showed gastritis after complaining of abdominal pains but after thorough examination, he was also diagnosed with liver cirrhosis. His condition did not require immediate liver transplant and other invasive interventions. He stayed at the hospital for two weeks to help him with the abdominal pains and improve his physical condition as well as go through the detoxification stage. The patient developed insomnia due to abstinence from alcohol. He was given 5 mg diazepam two times a day and 10 mg during the night and 30 mg thiamine everyday. After three days, the patient showed agitation and hallucination at night. His medication dosage was doubled. At the end of the week, his sleep improved. After this period, he was released as an outpatient with strict orders to abstain from alcohol, follow a low-sodium, low-fat diet and take medication for pain occasionally. At home, the patient was confined to bed rest because of weakness, exhaustion and fatigue, a recurring nausea, and the occasional pains.
There are several psychological and sociological factors affecting the causation and development of the patient’s condition. Psychological factors include: 1) Depression—a) the inability of the patient to process personal issues and handle problems, b) the extent of depression and the manner that the person handles this determines the person’s propensity to turn towards alcohol, and c) this is a significant risk factor in alcohol abuse; 2) Anxiety disorder—a) the patient either has a social anxiety disorder or a traumatic disorder, b) the patient may have become dependent upon alcohol as a curative or escapist treatment of their problems and the harder the problem gets the more that the patient withdraws to alcoholism; 3) Conduct disorder or antisocial behavior—that is both a cause and a consequence of the patient’s dependence on alcohol. ( 2002)
Sociological factors include: 1) Peer influence—since most of the friends of the patient are alcohol drinkers in varying degrees, alcohol intake is deemed as a normal activity; 2) Environmental factor of having easy access to sources of alcohol—since the patient lives in a neighborhood located near the red light district offering many ways of acquiring alcohol; and 3) Family environment—since the patient belongs to a family with high acceptability of alcohol intake, the practice of alcohol drinking was acquired by the patient from his father and several uncles. ( 2002)
In the case of the patient, he succumbed to depression after his marriage ended ten years ago. The divorce affected him so much that he turned to alcohol as an escape mechanism. His drinking history begun five years into his marriage when he was removed from his job at a manufacturing plant due to downsizing. While looking for work, he started drinking during the weekends with friends. This continued even when he found work at another production company. In the succeeding years, he started drinking during weekdays usually alone. He started to depend upon alcohol to relax his mind and induce sleep increasing consumption from three to five or more bottles a day. It was also during his heightened alcohol consumption that the occasional fights with his wife escalated ending in divorce.
His drinking continued throughout the years until he experienced weight loss and abdominal pains. After he was told of the doctor’s findings, he denied that he has a drinking problem. He only allowed admission to the hospital for his insomnia because of withdrawal from alcohol. The tests showed that he had increased mean corpuscular volume and abnormal liver functions.
The psychological state of the patient showed that he initially experienced depression due to work problems and the divorce. He also has anxiety disorder because he became dependent upon alcohol intoxication to make him relax and sleep to escape from his problems. At the later stage of his alcoholism, the patient also shifted from drinking with friends to drinking alone indicating withdrawal from his social circle. These psychological factors were both causes and consequence of the patient’s continued drinking. The aggregate effect of these psychological factors is continued dependence upon alcohol but denial of the existence of an alcohol problem.
Two sociological factors influenced the patient’s alcoholism. First is that based on the family history his father is an alcoholic who always comes home drunk giving him the idea that alcohol drinking is acceptable. Second is the easy access to alcohol since the patient lives in an apartment with a pub at the first floor and several liquor shops in the surrounding blocks.
Because of these psychological and sociological factors, the patient faces difficulties in abstaining from alcohol intake. As an outpatient, he is still in a depressed state and only his weakened state prohibits him from going downstairs to drink in the pub. Thus, helping the patient to overcome alcoholism to ensure that his condition will not worsen requires a health care program that addresses both the mental and physical manifestations of the patient’s condition.
The Department of Health issued the Alcohol Harm Reduction Strategy for England (Strategy Unit, 2004) that contains the following strategies: 1) better education and communication of the harms of alcohol drinking to encourage ‘sensible drinking’; and 2) improving health and treatment service covering health care skills and social support. These strategies coincide with the needs of the patient for physical care and social support.
So What?
The health care intervention needed by the patient is treatment and rehabilitation that starts with information dissemination ( 2002). This process requires a full understanding of the factors previously discussed in order to find an approach that is both appropriate and effective in assisting the individual to recover from alcohol dependence together with the struggle of the patient against liver cirrhosis. The intervention seeks to help the patient understand alcohol dependence as a serious condition and know the causes of alcohol dependence and the different treatment options available to help the patient realize the existence of a problem and give him a view of what is to be expected from the treatment or rehabilitation program.
The initial issue that needed to be addressed is the non-acceptance of the patient of his alcohol problem. This should be settled before any other intervention can push through. Several factors should be considered in addressing this problem.
The first factor is the presence of actual physical and emotional support extended to the patient by family, friends and health care workers (2002). This is to help the patient deal with certain personal issues such as depression, anxiety disorder and the other psychological causes of alcoholism and help them to understand their condition and the sociological factors influencing their alcoholism. Communication is an important factor in helping patients discover and understand the underlying psychological and sociological causes of their alcohol problem. The patient also responds positively when given reinforcement for enthusiastic cooperation in the activities and progress based on regular assessments. (1985) Through communication, the patient’s family appreciates the support given to their family member and become cooperative in providing information on the circumstances surrounding the alcohol dependence of their family member as well as participate in programs and activities that are part of the rehabilitation program. The information on the drinking history and causes behind this came from discussions with the patient’s daughter.
The second factor is the development of a fiduciary relationship with the patient. ( 1985) A relationship of trust developed with the patient by constantly reassuring the patient that the information he provides will be kept in confidence and will not be divulged without the permission of the client. Developing an open relationship with the patient and his daughter so that all their inquiries and doubts are professionally answered proved effective in gaining their trust and confidence. This also involved the consideration of the preferences of the patient/family after a thorough explanation of the different rehabilitation programs available. (1985) This is important in encouraging the patient and his daughter to become active participants in the rehabilitation process. Participation empowers the patient/family to work on the achievement of their pre-determined goals ( 1985).
The third factor is the application of the approach centered on the patient/family (2002). The patient and his daughter are affected by how I regard them. Since alcohol dependence is considered as a chronic disease characterized by insatiable craving for alcohol, the National Institute of Health (2003) suggested that alcohol dependence should be viewed as a medical condition that is treatable through rehabilitation. Ostracizing or looking down upon the patient dependent on alcohol does not help in his rehabilitation. I had to be professional in viewing the condition of the patient without giving any unnecessary judgments on the character of the patient/family. Every aspect of the rehabilitation should be done objectively.
After a string of open discussion sessions, there was a gradual observed change in the behaviour and attitude of the patient. The pain and discomfort experienced by the patient influenced the change together with a better understanding of his condition due to the information on alcoholism and treatment and rehabilitation given to him. The patient was more responsive to questions about his physical condition and a little bit about his drinking history. Although the patient still does not openly admit to his alcoholism, there was a minimized negative reaction when his daughter mentions it during conversations. There was minimized agitation or protests over discussions about alcoholism but there was also no open admission of alcohol problems. At the least, the patient was in his own way receptive to information given to him about alcoholism and its causes and effects. This is a sign of improvement. During the period of intervention, the patient did not drink any alcoholic drink and he showed interest in complying with diet and medication and continuing treatment and rehabilitation. The patient still has a long way to go in completing the rehabilitation process and maintaining a lifestyle change. However, the patient showed improvement in behaviour and attitude after the discussion sessions.
Being involved in helping an alcoholic patient in treatment and rehabilitation resulted to a sense of fulfillment when progress is observed especially if the patient on his own accord initiates the progress. This is encouraging to me as much as with the patient. Involvement in health promotion intervention also developed the sense of responsibility in me through the knowledge that every action I make is for a defined purpose and it should be implemented with care and caution.
The primary factors that influenced my attitudes towards the health promotion program are the understanding of alcohol dependence and knowledge on the psychological and sociological factors that influence the patient/family as well as sufficient professional training in handling the issues and problems arising from the rehabilitation program for people dependent on alcohol.
Now What?
Information leads to the identification of alternative options and determination of the best possible solution (2002). One of the problems of medical practitioners is their lack of people skills in dealing with patients and their families (1985). As an interventionist, I need to improve my people skills to achieve open communications with the patient/families to develop a relationship of trust. Interventionists should be able to explain medical concepts in the ordinary language so that patients easily understand it and be sensitive to the issues that patients and their families may be experiencing. Communication skills are also important in expressing concern, sympathy and understanding of the condition of the patient and in motivating the patient to make initiatives to recover from condition. People skills enable interventionists to coordinate their efforts to ensure continuity and progress in the gradual accomplishment of the goals of the patient in undergoing a rehabilitation program for alcohol dependence.
Conclusion
Health is an important aspect of the human experience because it is through the achievement of a healthy mind and body that the person is able to reach optimum levels of well-being. Information is the key to the achievement of health. Information is obtained from experience as well as through the health promotion campaigns of different health organizations.
The paper focused on the health care and health promotion intervention to a patient with cirrhosis of the liver who developed the disease due to chronic alcoholism. Understanding the condition of the patient to know the appropriate manner of intervention requires knowledge of the causation and epidemiology of cancer. In terms of causation, alcohol is one of the primary factors affecting the development of cancer. In terms of epidemiology, the World Health Organization (WHO) reported that as of 2000, excessive alcohol intake is the cause of 185,000 deaths among men and 142,000 among women.
In providing health care and health promotions intervention, a nurse has to have sufficient appropriate knowledge on the condition of the patient and techniques for effective intervention. The nurse has to know the causation and epidemiology of alcoholism as well as the particular context of the patient to provide appropriate care and intervention. The nurse also has to have excellent communication and people skills to effectively facilitate the sharing of information with the patient and his family and research skills to objectively document and assess the data.
Involvement in the health care and health promotion intervention of the patient with alcohol problems, especially one who developed cancer, is a learning experience professionally and personally. It helped me to gain knowledge and experience from the data gathering and analysis process and from the progress achieved in addressing the primary issue of denial of alcoholism through the intervention in the initial stages of the treatment and rehabilitation of the patient.
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