Research Articles Base: Cancer Nursing Research

PROSTATE CANCER

Prostate Cancer Incidence, Diagnosis and Staging             Cancer of the prostate gland is a common cause of death, accounting for about 2 to 3 percent of all male deaths (Guyton & Hall, 2000). Adenocarcinoma of the prostate accounts for the majority of malignancies in men over age 65. The etiology is unknown. Sarcoma of the prostate is rarely found in children. Undifferentiated prostatic carcinoma and squamous cell carcinoma of the prostate probably represent variants of adult adenocarcinoma and are less responsive to the usual measures of control.             Prostate cancer is also the most common cancer among men in the United Kingdom and the second most common cause of cancer-related deaths. In 1999, 20,842 new cases of prostate cancer were registered in the UK, giving a crude incidence rate of 75 cases per 100,000 men. Overall, 1 in 6 new cases of male cancers were prostate cancer and 9,491 men died from the disease. Prostate cancer accounts for 1 in 8 of all male cancer deaths (PR Newswire, 2002).             The usual prostatic malignancy is glandular, not unlike the histologic configuration of normal prostate. Frequent mitoses, stromal invasion, and involvement of perineural lymphatics constitute the principal histologic criteria of diagnosis.             Prostatic carcinoma is generally slowly progressive and may cause no symptoms. Late in the course of the disease, symptoms of bladder outlet obstruction, hematuria, and pyuria may appear. Matastases to the pelvis and lumbar spine may cause bone pain.             Stony hard induration of the prostate raises the suspicion of prostatic malignancy and must be distinguished from granulomatous prostatitis, prostatic tuberculosis, prostatic calculi, and other more unusual prostatic diseases. The firm and nodularly irregular prostate is pathognomonic of prostatic carcinoma, later exhibiting extension of induration and fixation of the gland to the rectum and the lateral pelvic walls.             There is a blood test for a protein called PSA, which can help to detect prostate cancer - but it needs to be used along with other tests to make a definite diagnosis. Prostatic carcinoma must be suspected on the basis of rectal findings. A solitary firm prostatic nodule should be biopsied immediately, preferably by open surgery to permit radical prostatectomy if indicated.             The more extensive processes may be defined by needle biopsy, either transrectally or transperineally. An elevated serum acid phosphatase indicates a large local tumor or metastases. Prostatic carcinoma produces osteoblastic bony metastases, and their radiographic demonstration in the presence of a stony hard prostate is diagnostic of cancer. Aspiration of bone marrow and demonstration of prostatic cellular configuration in metastatic cells confirm a diagnosis of incurable disease.   Risk Factors Associated with Prostate Cancer   Many men are unaware they even have prostate cancer, it develops from cells within the prostate gland but it is usually very slow growing. However, in some cases, it may grow more quickly and spread to other parts of the body. Age is a risk factor – as it is rare to find prostate cancer in men under 50 (Daily Record, 2002). About 9 per cent of prostate cancer cases are diagnosed in men in their 50s, 30 per cent in men in their 60s and 40 per cent in men in their 70s. But having an elderly relative with prostate cancer is not uncommon and does not increase a person’s own risk.             Three risk factors for prostate cancer are associated with an increased likelihood of developing aggressive prostate cancer or dying of the disease. People with high levels of the acid-labile subunit (ALS) glycoprotein that regulates the bioavailability of the hormone insulin-like growth factor 1 (IGF-1) may have an increased risk for prostate cancer and its aggressive forms. Low plasma levels of vitamin D appear to significantly increase the risk of aggressive prostate cancer, especially in patients with a particular polymorphism of the vitamin D receptor (Evans, 2005). The major risks are increasing age, especially past 50, a family history of the cancer, having a high-fat refined ‘Westernised’ diet and being of African or African-Caribbean origin (The Daily Mail, 2006). Knowing more about the risks won’t stop a person from getting prostate cancer, but it will increase their chances of spotting it as early as possible and getting it successfully treated.   Treatment Options – with reference to available guidelines               Once cancer of the prostate gland does occur, the cancerous cells are usually stimulated to more rapid growth by testosterone and are inhibited by removal of both testes so that testosterone cannot be formed (Guyton & Hall, 2000). Also, prostatic cancer can be usually can be inhibited by administration of estrogens.             Early and localized prostatic carcinoma may be cured by radical perineal or retropubic prostatectomy. Extensive local disease or metastases may preclude surgical cure, in which case diagnostic confirmation should be followed by hormonal control, irradiation, or both. The treatment of choice is bilateral orchiectomy accompanied by estrogens.             Failure to respond to the hormone, or reactivation of disease, may be controlled with bilateral surgical adrenalectomy or “medical adrenalectomy.” Irradiation may provide prompt relief of pain from bony metastases refractory to other treatment and may be efficacious in control of local disease as well; long-term regression and possible cure of prostatic carcinoma have been observed in some cases treated by radiotherapy.             Even some patients who have prostatic cancer that has already metastasized to almost all bones of the body can be successfully treated for a few months to years bye removal of the testes, by estrogen therapy, or both; after this therapy the metastases usually diminish in size and the bones partially heal (Guyton & Hall, 2000). This treatment does not stop the cancer but does slow it and sometimes greatly diminishes the severe bone pain.   External Beam Radiotherapy Technique               Radiotherapy is the treatment of disease with radiation, especially by selective irradiation with x-rays or other ionizing radiation and by ingestion of radioisotopes. It is also called as radiation therapy. Long-term control of prostate cancer can be achieved in a relatively high-risk patient population using interstitial brachytherapy in combination with external beam radiation therapy (Hitt, 2003). External beam radiation has proven successful in the treatment of localized prostate cancer and is associated with a success rate comparable to surgery for patients with localized prostate cancer. The survival rate for patients with localized prostate cancer, stages A and B, treated with external beam radiation is similar to that for age-adjusted cohorts without prostate cancer (Newman, 1996). External radiation generally is delivered in a daily dose of 180 cGy to 200 cGy for a period of 6 to 7 weeks (total dose 6200 cGy to 7400 cGy). Potential complications include impotence, incontinence, cystitis, urethral strictures, prostatitis, diarrhea, edema of the lower extremities and bone marrow suppression. Patients also may become physically tired, and they should be instructed to get as much rest as possible during their course of treatment. It is not uncommon for erythema to develop and for the skin to become red or dry in the area of treatment. Affected skin should be exposed to the air as much as possible and patients should be instructed to avoid wearing tight clothing. Patients also must be instructed not to use creams or lotions on affected skin without their doctor’s approval (Newman, 1996).   Support Mechanisms Available to these Patients within the Radiotherapy Department               Acute radiation sickness usually follows therapeutic irradiation. It is characterized by nausea, vomiting, diarrhea, anorexia, headache, malaise, and tachycardia of varying severity. The discomfort subsides within a few hours or days. Nutrition management of the client with cancer focuses on maximizing intake of nutrients and fluids (Potter & Perry, 2004).             Psychological interventions are also available for prostate cancer patients who underwent radiotherapy. These are usually handled by nurses. Response to this intervention has been very positive from both nurses and patients, nurses feel that they are better equipped to help patients emotionally and patients feel better able to cope with what can be a very traumatic time (PR Newswire Europe, 2005).       REFERENCES Guyton, A. and Hall, J. (2000). Textbook of Medical Physiology 10th Edition. Harcourt Asia Pte Ltd. Hitt, E. (2003). Combination Therapy Provides Long-Term PCa Control: External Beam Radiation/Brachytherapy Results in 70% 10-Year Relapse-Free Survival, Urology Times. Newman, J. (1996). Epidemiology, Diagnosis and Treatment of Prostate Cancer, Radiologic Technology. No Author. (2002). A to Z of Health Part 1: Prostate Cancer: Age a Risk Factor, Daily Record (Glasgow, Scotland). No Author. (2006). The Unknown Risks of Prostate Cancer, The Daily Mail (London, England). No Author. (2002). UK and US Companies Link to Accelerate Prostate Cancer Research, PR Newswire. No Author. (2005). UK Cancer Patients Set to Benefit from New Psychological Support Treatment, PR Newswire Europe. Potter, P. and Perry, A. (2004). Fundamentals of Nursing. Mosby. Credit:ivythesis.typepad.com

PROSTATE CANCER

Prostate Cancer Incidence, Diagnosis and Staging Cancer of the prostate gland is a common cause of death, accounting for abou...

BREAST CANCER

Cancer of the breast is the most common malignant condition among women and carries with it the highest fatality rate of all cancers affecting this sex. Breast cancer is rare in men, but when it does occur, it is usually not recognized, until late, and thus the results of treatment are poor.             Breast cancer appears to have reached epidemic levels. Talk to any group of people anywhere in the UK and they all seem to have some experience of it–someone in their family, a friend, a neighbor or work colleague. And it is not just a vague impression that this is the case, there are hard statistics to back it up. Every year around 39 000 women and between 200 and 300 men are diagnosed with breast cancer in the UK. Government figures show that the number of people who develop breast cancer every year has increased by 70 per cent since 1971, and by 15 per cent in the ten years to 2000. It is by far the most common form of cancer in women and the most common cause of cancer death in women (Ogden, 2004). While history, physical examination, and mammography or thermography may strongly suggest breast cancer, the diagnosis can be made only by microscopic examination of tissue removed by open or aspiration biopsy.             Human breast cancer appears long after the organ finishes its development. Age is associated with the location of the tumors. The area of the breast where breast cancer originated was more central in the older patient population we studied. Breast tissue involutes first in the lobular parts and then in the larger central ductal structures. Declining ovarian function in the premenopause leads to regression of epithelial structures and stroma. The central duct system remains but the lobules shrink and collapse. The last structures to appear with sexual maturity are the first ones to regress. This is reflected in the location of breast cancers in younger as opposed to older women. The cancers originate first in lobular ducts and later in the larger ductal structures (Janssens, 1999). Breast cancer, unlike colon cancer, probably originates in an involuting target organ with a time relationship between the histogenesis, histoapoptosis, and development of breast cancer. It is surprising that breast cancer does not originate in the developing organ, as is the case for nearly all other epithelial and stromal cancers, which usually initiate and grow in regenerating or rapidly developing tissues. It is rare for breast cancer to develop before the age of 24. This is exactly the time when normal involution starts in most women. Involution of human breast tissue is well known to clinicians through mammography or magnetic resonance imaging and is a normal aging process. The development of breast cancer in involuting tissue argues that susceptibility to breast cancer is probably created much earlier in life (Janssens, 1999).             Many, if not most, ailments of the body cause pain and this includes breast cancer. The sense organs for pain are the naked nerve endings found in almost every tissue of the body. Pain has been classified into two major types: fast pain and slow pain. Fast pain is felt within about 0.1 second after a pain stimulus is applied, whereas slow pain begins only after 1 second or more and then increases slowly over many seconds and sometimes even minutes (Guyton & Hall, 2000). Fast pain is also described in many alternative names, such as sharp pain, pricking pain, electric pain and acute pain. Acute pain is generally the result of a specific injury and can be clearly explained in terms of where we feel it in the body. This type of pain is felt when a needle is stuck into the skin, when the skin is cut with a knife, or when the skin is acutely burned. It is also felt when the pain is subjected to electric shock. Fast, sharp pain is not felt in most deeper tissues of the body.             Slow pain also goes by multiple additional names, such as slow burning pain, aching pain, throbbing pain, nauseous pain, and chronic pain. This type of pain is usually associated with tissue destruction. It can lead to prolonged, unbearable suffering. It can occur both in skin and in almost any deep tissue or organ. Chronic pain is the other type of pain which is so called because it can continue for months or years and even trigger additional health problems such as depression and lead to lifestyle changes in attempts to remedy the situation.         Breast cancer presents a type of slow or chronic pain. This pain largely results from overstimulation of nerve endings. The nerve endings may be stimulated by inflammatory substances that are produced by damaged cells from the cancer and released from the surrounding capillary network. The pain receptors, also called nociceptors, in the skin and other tissues are all free nerve endings. They are widespread in the superficial layers of the skin as well as in certain internal tissues, such as those found in the breasts. Most other deep tissues are not extensively supplied with pain endings but are sparsely supplied; nevertheless, any widespread tissue damage can still summate to cause the slow-chronic-aching type of pain in most of these areas (Guyton & Hall, 2000).             Pain can be elicited by multiple types of stimuli. They are classified as mechanical, thermal, and chemical pain stimuli. Slow pain can be elicited by all three types. Some chemicals that excite the chemical type of pain are bradykinin, serotonin, histamine, potassium ions, acids, acetylcholine, and proteolytic enzymes. In addition, prostaglandins and substance P enhance the sensitivity of pain endings but do not directly excite them. The chemical substances are especially important in stimulating the slow, chronic type of pain that occurs after tissue injury.             In contrast to most other sensory receptors of the body, the pain receptors adapt very little and sometimes not at all. In fact, under some conditions, the excitation of the pain fibers becomes progressively greater, especially so for slow-aching-nauseous pain, as the pain stimulus continues. This increase in sensitivity of pain receptors is called hyperalgesia (Guyton & Hall, 2000).             Even though all pain receptors are free nerve endings, these endings use two separate pathways for transmitting pain signals into the central nervous system. The two pathways mainly correspond to the two types of pain, a fast-sharp pain pathway and a slow-chronic pain pathway (Guyton & Hall, 2000).             The slow-chronic type of pain is mostly elicited by chemical types of pain stimuli but also at times by persisting mechanical or thermal stimuli (Guyton & Hall, 2000). Pain impulses are transmitted to the central nervous system by two fiber systems. The nociceptor system responsible for the pain felt in osteoarthritis consists of unmyelinated (Ganong, 2001) C fibers 0.4-1.2 µm in diameter. This slow-chronic pain is transmitted in the peripheral nerves to the spinal cord by the type C fibers at velocities between 0.5 and 2 m/sec. These roots are found in the lateral division of the dorsal roots and are often called dorsal root C fibers (Ganong, 2001). A separate peripheral pain type A delta fiber also carries the fast-sharp pain stimuli.             Because of this dual system of pain innervation, a sudden painful stimulus often gives a double pain sensation: a fast-sharp pain that is transmitted to the brain by the A fiber pathway followed a second or so later by a slow pain that is transmitted by the C fiber pathway.             Localization of pain transmitted in the paleospinothalamic pathway is poor. For instance, the slow-chronic type of pain can usually be localized only to a major part of the body, such as to one breast but not to a specific point on the arm or leg. This is in keeping with the multisynaptic, diffuse connectivity of this pathway. It explains why patients often have serious difficulty in localizing the source of some chronic types of pain.             The evidence that endogenous sex hormones influence risk of breast cancer has been reviewed extensively elsewhere; for pubertal girls, however, the modulation of endogenous estrogens is much more important. The main difference between high and low risk women for breast cancer is the persistent difference in serum estrogens secondary to early and late menarche. In addition, the serum levels might be further modulated to a great extent by nutrition, body fat, and exercise during puberty. Adipose tissue converts androgens to estrogen by aromatization. Bodies weight (fatness) influences additionally the direction to potent and less potent forms of estrogens (catecholestrogens). Late pubertal development and late menstrual patterns are thought to result in part to smaller amounts of body fat (Janssens, 1999).             Breast Cancer Campaign funds independent research into breast cancer at centers of excellence throughout the UK. The Charity aims to find a cure for breast cancer by funding research which looks at improving diagnosis of breast cancer, better understanding how it develops and ultimately either curing the disease or preventing it.             Friends and relatives can be a major source of support, but face their own difficulties. They have to provide emotional support, physical care and help in making decisions about treatment. Many of the observations about the impact of cancer are as true for them as for the patient. Their response to the illness depends on things such as their relationship to the patient, the stage of the disease and their own personalities.             It is important that healthcare professionals, especially the nurses, examine the breasts of male and female clients. A small amount of glandular tissue, a potential site for the growth of cancer cells, is located in the male breast. In contrast, the majority of the female breast is glandular tissue.             Early detection is the key cure to breast cancer. It is therefore a major responsibility for nurses to teach clients health behavior such as breast self examination. Studies suggest that only a minority of women perform breast self-exams (Potter & Perry, 2004).             Surgery, radiotherapy, and chemotherapeutic agents are the major modalities used to treat patients with cancer, though various biologic therapies are beginning to have a significant impact. The basic problem is to make available drugs (natural products or synthetics) that kill cancer cells effectively but are not excessively toxic to normal cells.             Current cancer treatments – “cut, burn, poison” – are recognized as crude and painful. Promising new methods focus on delivering anticancer drugs precisely to the cancer (via monoclonal antibodies that respond to one type of protein on a cancer cell) and on increasing the immune system’s ability to fend off cancer (Marieb 2004). In all these, the nurses are responsible for co-ordinating care following any operations and/or treatment for breast cancer. As well as supporting the patients and his/her family through the operation and treatment, the nurses can provide the patient and his/her caregivers with clear written and verbal information; and can also examine the patient and arrange any tests that might be needed. The NHS Cancer Plan, published in September 2000, sets out the first ever comprehensive strategy to tackle the disease. It is the first time any government has drawn up a major program of action linking prevention, diagnosis, treatment, care and research. The NHS Cancer Plan contains a wide range of targets and commitments. The NHS Cancer Plan Progress Report released in March 2005 substantial progress has been made in meeting the Plan’s targets. The thirty-four cancer networks which have been established have achieved important improvements in delivering cancer services across England (National Audit Office, 2005). The progress report also mentioned that cancer networks have helped improve cancer services and have achieved some particular successes. These include planning for the introduction of new cancer drugs and developing plans for funding specialist palliative care. In addition to the NHS Cancer Plan, the Department has launched other initiatives to improve cancer services, including a tobacco advertising ban and a strengthening of the partnership between the NHS and the voluntary sector (National Audit Office, 2005).                           REFERENCES   Breast Cancer Campaign, Retrieved from: www.breastcancercampaign.org Ganong, W. (2001). Review of Medical Physiology 20th Edition. McGraw-Hill. Guyton, A. and Hall, J. (2000). Textbook of Medical Physiology 10th Edition. Harcourt Asia Pte Ltd. Janssens, J.P. (1999). Risk Implications for Research and Dietary Guidelines for Children. Nutrition Today. Marieb, E. (2004). Essentials of Human Anatomy and Physiology 7th Edition. Pearson Education Inc. NHS Cancer Plan. Retrieved from: http://image.guardian.co.uk/sys- files/Society/documents/2003/08/26/cancerplan.pdf Ogden, J. (2004). Understanding Breast Cancer, Wiley. Potter, P. and Perry, A. (2004). Fundamentals of Nursing. Mosby. The NHS Cancer Plan: A Progress Report.  (2005). Retrieved from: http://www.nao.org.uk/pn/04-05/0405343.htm   Credit:ivythesis.typepad.com

BREAST CANCER

Cancer of the breast is the most common malignant condition among women and carries with it the highest fatality rate of all cancers affe...

Disability after Breast Cancer Surgery, Nursing Approach

Disability after Breast Cancer Surgery, Nursing Approach   Based on this research, breast cancer is the second most common cancer in the world and the fifth most common cause of cancer death among women worldwide.  And, the most common type of breast cancer is mammary ductal carcinoma.  There are two types of mammary ductal carcinoma; first is the Infiltrating Ductal Carcinoma; it is invasive proliferation of malignant cancerous cells in the breast tissue.  The second one is the Ductal Carcinoma in Situ; it is non invasive cells that may be malignant and are confined to the lactiferous ducts. The ductal carcinoma in situ is considered a stage zero cancer.  In this regards, there are various screening tests for the detection of cancerous cells in the breasts such as MRI imaging, mammograms and biopsies.  All these medical procedures are very crucial in detecting different types of breast cancer.  However, it is important to take into account that there are instances that current medical diagnostic procedure falls short.  In the event that inflammatory breast cancer is being detected, a surgical biopsy must be done through breast skin sample; so as to the sample of the underlying breast tissue. PET scan is mostly preferred testing technique by oncologists for inflammatory breast cancer; for it enables to reveal more the disease.  Moreover, most patients with inflammatory breast cancer should undergo chemotherapy to minimize the spread of the cancerous cells and to resolve skin issues.  After chemotherapy, a mastectomy must be performed; since lumpectomy is not recommended by the physicians for treatment of inflammatory breast cancer together with additional chemotherapy treatments. Whenever, the surgical area has healed and chemotherapy has been completed, most oncologists initiate a course of radiation to kill any remaining cancer cells in the breast area and underarm area.  Normally, oncologists use a staging system in evaluating the extent of an individual’s breast cancer.  Subsequently, cancer stages are based upon the following criteria: size of the tumor, whether or not the cancer is invasive or non invasive, as well as whether or not the cancer spread beyond the breast, and whether or not the lymph nodes are involved. (http://www.disabilitysecrets.com/social-security-disability-breast-cancer.html) Accordingly, the incidence of arm edema is common after breast cancer surgery. And, arm pain on motion is the most common disability seen among patients. Arm morbidity has a strong impact on the disability and quality of life level of breast cancer patients.  When you say arm morbidity, it is one of the most serious complications of breast cancer surgery and treatment that affects tremendously to the daily life of the breast cancer survivor.   Through Sentinel Node Biopsy (SLNB) procedure, many breast cancer patients having a high risk of developing arm lymph edema.  And, due to this, the most common impairments that have been reported experiencing by majority of the breast cancer survivors are reduction of range of motion (ROM) of the shoulder, numbness of the axilla or lateral chest wall, reduction of grip strength, as well as the arm edema with a high level of functional impairment due to excessive pain.  Nevertheless, the importance of these undesirable conditions of the breast cancer patients has been emphasized by Coster et al who focused on the importance of health professionals’ understanding about the accurate information on the majority of the incidence of postoperative arm morbidity prior to breast cancer surgery procedure.  In addition to that, modern treatment intervention for breast cancer caused more women to become long-term survivors; but   it should be also taken into account the health related quality of life that the patients have before surgery.    (http://www.disabilitysecrets.com/social-security-disability-breast-cancer.html) Furthermore, this study revealed that sixty seven   breast cancer patients who underwent Modified Radical Mastectomy ((MRM) or Breast Conserving Surgery (BCS) were being studied by medical experts.  MRM includes simple mastectomy with the help of Auxiliary Lymph Node Dissection (ALND).  Hence, breast cancer patients after their surgery are being treated to rehabilitation specialist for therapy and regular follow up.  More than that, after bilateral mastectomy, the patients is also experiencing severe debilitating cardiopulmonary disease prior to the treatment of their arm edema, active infection on the affected side.  In the same way, the patients are also experiencing neurologic and rheumatologic illnesses that composed of range of motion for both function of two arms. Clinical review shows that patients’ shoulder joint ROM is being measured in abduction, flexion, external and internal rotation using a goniometer.  This is done as the patient stands straight up facing the wall.  Aside from this, patients’ handgrip strength is being measured using an air pressure infusion hand dynamometer. An average of 3 grip strength measurements was being recorded for each hand. Additionally, the unaffected side is used to control for the evaluation of arm edema, handgrip strength and shoulder function. (http://journals.lww.com/smajournalonline/Fulltext/2010/01000/Disability_and_Health_Related_Quality_of_Life.10.aspx) References: (http://www.disabilitysecrets.com/social-security-disability-breast-cancer.html) (http://journals.lww.com/smajournalonline/Fulltext/2010/01000/Disability_and_Health_Related_Quality_of_Life.10.aspx)   Credit:ivythesis.typepad.com

Disability after Breast Cancer Surgery, Nursing Approach

Disability after Breast Cancer Surgery, Nursing Approach Based on this research, breast cancer is the second most common cancer in th...

Stoma or Cool-Rectal Cancer

Introduction               Stoma or Cool-rectal Cancer   Several studies have indicated that colorectal cancer is a cancer type that is high in frequency among both the male and female population (1999  2003). According to Parker, et al (1997), colorectal cancer is the second highest cancer disease (lung cancer being the most prevalent case) and the leading cause of cancer-related disease in the United States wherein an estimated 131, 000 Americans were diagnosed with colorectal cancer and 55, 000 died of the disease.    A number of medical researches and studies have claimed that proper screening and treatment of colorectal cancer can alleviate and decrease the statistics pertaining to the suffering and deaths of the disease. Medical studies have found out that detecting and removing adenomatous polyps can prevent the development of colorectal Aden carcinoma while detecting and treating early-stage cancers can lower the cases of deaths for colorectal cancer (Newcomb, et al, 1992).et al (1997) recommended that by 50 years of age, most persons at average risk for colorectal cancer should begin regular screening for polyps and malignancies (http://www.aafp.org).   Colorectal cancer is a disease in the digestive evident in the parts of the large intestine such as the colon or the rectum. As such, tumors form in the lining of the large intestine which is also called the large bowel. Colorectal cancer is common both among the male and female population as development of the disease normally arises at the age of 50. Colorectal cancer can be metastasis in which cancer spreads from its original location in the colon to other parts of the body like the liver or lungs (National Institute of Health, 2005). Figure 1 below presents the four sections of the colon where cancer can start or in the rectum. The walls of the colon and that of the rectum are composed of several tissue layers where cancer starts. From the inner layer, the cancer can grow to some or all of the layers. As such, the degree or stage of colorectal cancer is popularly screened and investigated through the examination of these tissue layers (American Cancer Society, Inc., 2005).   According to Burke (2003) “colorectal cancer arises from a series of histopathology and molecular changes caused by complex interactions between genetic susceptibility and environmental factors”. In this regard, the molecular changes are identified as (a) the multiple, acquired genetic alterations within colonist ontogenesis that promote malignant transformations and (b) the tumor suppressor genes which cause loss in the inhibition of cellular proliferation. Researches on carcinogenesis discovered mutations in the genes that are responsible for the repair of mismatched DNA pairs. These mismatched-gene-repair inactivation cases are found to be common among 15% of sporadic colorectal cancers.   The patient, having undergone polyps colonoscopy before complaining the symptoms of his rectal cancer increased his chance of experiencing the results of his latest medical examination and operation. As stated, polyps or the benign growths in the inner wall of the colon and rectum that increase a person’s risk of developing colorectal cancer. Familial polypus’s causes hundreds of polyps to form in the colon and rectum which lead to colorectal cancer if not treated early (Baddish, 2003).   Although it was his colon that has been previously operated, the inseparability of colon and rectal cancer is very thin that most people are diagnosed with both, simultaneously or consequently. His rectal examination revealed no masses but a strongly haemoccult-positive stool indicated the seriousness of the patient’s condition as a rectal cancer symptom. It is also obvious in this case that cancer in the colon spreads and has the tendency to recur to a person who has been treated.               Aside from his medical history of polyps operation, his age also contributed as a factor that increased his risk of colorectal cancer as the disease is more likely to occur as people get older, usually individuals who are over the age of fifty (2003). Patient RM is 63 years old which included him in the category of people with high risk of colorectal cancer. The latest medical condition of the patient is indicative of his early cancer stage in the rectum. The abdominoperineal resection made in his body is the usual medical procedure when diagnosed with rectal cancer.    The physical and psychological impact of cancer to its patients have been an important issues in the field of medicine (National Cancer Policy Board:2006). However, it is only recently that survivorship is coming to be recognized as a distinct phase of the can trajectory. Findings from research studies that have tracked the health and well-being of patients after cancer treatment has ended  have identified risks that both survivors and their health care providers should recognize. Advances in knowledge of how to manage conditions that arise in the post-treatment period have led to the development of some guidelines for health care providers. The coping period gives many chances to progress the health and quality of life of cancer survivors.     Background of the Study             Qualitative Study The complex and often idiosyncratic nature of the methods and the narrative style of findings  from qualitative studies make using the traditional format for reporting quantitative work awkward at best (Roskos:2000). In quantitative studies, research designs, sampling strategies, and statistical analysis procedures have been standardized and codified in ways that make it possible to summarize these in very few words. Similarly, findings are reported using terms and numbers that are relatively brief and straightforward (at least to those inside the quantitative research community). Qualitative methods are frequently adapted to the settings under investigation, and questions often emerge or change as studies progress, making codified descriptions of data gathering and analysis procedures difficult. Further, since understanding the contexts of a study is essential to interpreting the findings of a qualitative report, collapsing these into a few words in a review can distort important meanings generated in the study. Finally, since qualitative findings are descriptive in nature, shorthand versions like those found in traditional reviews of research are likely to leave out  a great deal of the descriptive power. Quality of Life Research The principal criteria guiding the patients’ acceptance of treatment are most often the patients’ subjective feelings i.e. the quality of their lives (Glise:1993). As the surgery asks patients to trade present discomfort and risk for future gains, in gauging the achievements of surgical treatment it is important to try to measure the quality of functional result vouchsafed to the patient. Another reason is that “surgery is forever” and cannot be undone. Broadening the choice of endpoints beyond traditional, so-called “hard” variables, and including SOL in surgical studies has advantages for both surgeons and patients. Because the impairments of function that may occur after different operations vary considerably, an operation-specific assessment of SOL for each type of surgical procedure is essential. Until now most of the SOL studies have been performed by non-surgeons with psychometric support, but it is time for the surgeons to provide leadership in SOL studies. Performing these studies will allow the surgeons to bridge another divide, open doors to showing more sensitivity, leading to better communication with their patients. A free and frank discussion, about SOL gains, as a benefit of surgery, at the time of counseling will go a long way in ensuring that the patients’ perspectives get their rightful place in decision-making. So the answer to the question, SOL measurements: who benefits? is that everyone benefits, surgeons as well as patients.   Aims and Objectives of the Study             The aim of this is to be able to identify and examine the patient’s perspective on the psychological impact of a stoma or cool-rectal cancer: The subject can be basically generalized and can be conducted using qualitative research method. The aim of the proposed study is:   “to explore and describe the psychological impact of stoma in the perspective of the patients.”               The following are the objectives of the research:   ·        To have in depth knowledge about stoma or cool-rectal cancer. ·        To identify the psychological impact of stoma to its patients after the treatment. ·        To examine the different issues of the stoma patients after their treatment. ·        To know how the stoma patients cope with the psychological impact of stoma after their treatment.   Methodology             The methodology of the study is qualitative in nature. The complex and often idiosyncratic nature of the methods and the narrative style of findings  from qualitative studies make using the traditional format for reporting quantitative work awkward at best (Roskos:2000). In quantitative studies, research designs, sampling strategies, and statistical analysis procedures have been standardized and codified in ways that make it possible to summarize these in very few words. Similarly, findings are reported using terms and numbers that are relatively brief and straightforward (at least to those inside the quantitative research community). Qualitative methods are frequently adapted to the settings under investigation, and questions often emerge or change as studies progress, making codified descriptions of data gathering and analysis procedures difficult. Further, since understanding the contexts of a study is essential to interpreting the findings of a qualitative report, collapsing these into a few words in a review can distort important meanings generated in the study. Finally, since qualitative findings are descriptive in nature, shorthand versions like those found in traditional reviews of research are likely to leave out  a great deal of the descriptive power. In order to come up with the most suitable research approaches and strategies for this study, the research process “onion” is used.  This is because conducting a research is like peeling the back layers of an onion—in order to come to the central issue of how to collect the necessary data needed to answer the research questions and objectives, important layers should be first peeled away. With the said process, the researcher was able to create an outline on what measures are most appropriate to be applied in the study. Saunders et al (2003) said that while it is not unusual for a researcher to first think of his research undertaking by considering whether one should, for instance, administer a questionnaire or conduct interviews, thoughts on this question should belong to the centre of the research ‘onion’. That is, in order to come to the central issue of how to collect the data needed to answer one’s research questions, there are important layers of the onion that need to be peeled away: the first layer raises the question of the research philosophy to adopt, the second considers the subject of research approach that flows from the research philosophy, the third examines the research strategy most applicable, the fourth layer refers to the time horizon a researcher applies to his research, and the fifth layer is the data collection methods to be used. The researcher conceptualized the research approach to be applied in this study by Saunders et al (2003), in order to come up with the pertinent data needed to answer the research questions stated in the first chapter, as well as to arrive to the fulfillment of this research undertaking’s objectives.             Then again, the research philosophy that is reflected in this study is positivism. With this research philosophy, a researcher prefers to work with an observable social reality in order to come up with law-like generalizations similar to those produced by the physical and natural scientists (Remedy et al, 1998), and in this tradition, the researcher becomes an objective analyst, coolly making detached interpretations about those data that have been collected in an apparently value-free manner (Saunders et al, 2003). In addition, the emphasis is on a highly structured methodology to facilitate replication (Gill & Johnson, 1997) and on quantifiable observations that lend themselves to statistical analysis (Saunders et al, 2003). In here, the assumption is that the researcher is independent of and neither affects nor is affected by the subject of the research (Remedy et al, 1998; Saunders et al, 1998).             Meanwhile, the second layer shows that this study has undertaken a deductive approach. Accordingly, this approach has five sequential stages: deducing a hypothesis; expressing the hypothesis in operational terms; testing this operational hypothesis; examining the specific outcome of the inquiry to either confirm the theory or indicate the need for its modification; and finally, modifying the theory in the light of the findings (if necessary) (Robson, 1993, p. 19).             Further, the deductive approach has a number of important characteristics. First, this approach is a search to explain causal relationships between variables, which consequently leading to the development of a hypothesis. Second, it involves the collection of a quantitative data (although it can, as well, use qualitative data), and these data are important to test a hypothesis that has been previously developed. The third characteristic of a deductive approach is that it controls to allow the testing of hypothesis. However, one must remember that with this approach, it is important that the researcher is independent of what is being observed—that is, the researcher should be objective and not subjective—so that the principle of scientific strictness will be pursued, as this approach emphasizes scientific principles. (Saunders et al, 2003)             Also, it is important that concepts are operationalisation, which will enable facts to be measured quantitatively. Finally, the deductive approach is generalization (e.g., to be able to generalize about regularities in human social behaviour, one must be able to select a sufficient numerical size of samples). (Saunders et al, 2003)   Data Collection and Strategies In order to obtain the desired data, the researcher has chosen to use the primary research data, which is to collect firsthand the data to be used for the outcome of the research. In able to do this, the researcher must have a data collection instrument to be presented to the respondents. Thus, the researchers have chosen obtaining data through the questionnaire. The questionnaire is administered by writing questions on a page and distributing it to the respondents, expecting them to return the paper with their answers on it. This is easier than other methods of data-collection (e.g., interview, observation, etc.) as particular details may be hard to talk about during interviews and cannot be drawn out from observation.               The advantage of using the questionnaires method is that the respondents have time to think of their answers, thus allowing smaller rate of errors. Also, concerning delicate matters, the respondents may feel more at ease when answering questionnaires as they are not required to speak with someone else in order to give information. The disadvantage of the questionnaire method is when the respondents are unable to read or write; then the questionnaire will be rendered useless by the respondents as they may need interpreters for the questionnaires. Thus, in case such that unlikely event may happen, then the researcher will have no choice but to quickly switch to the interview method, wherein the researcher will be allowed to interact with the respondent and ask the questions based on the prepared questionnaire.               During the interview, the interviewer encouraged the interviewee to clarify vague statements or to further elaborate on brief comments. More importantly, the interviewer was objective and did not attempt, in any way, to influence the interviewer’s statements. In order to do this, the interviewer did not share his/her own beliefs and opinions. Also, the questions thrown at the interviewees had been phrased clearly, so that interviewees can understand them, and they were delivered in neutral tone of voice. The researcher also avoided long questions, or those that are really made up of two or more questions, because as Robson (2002) said, by asking long-questions, the tendency to obtain a response for each aspect a researcher wants to explore will be lost. The researcher also avoided too many theoretical concepts or jargons, as the researcher’s understanding of such terms may vary from that of the interviewees. Also, during the interview, the researcher was determined to establish trust by not being too assertive and by being attentive to the interviewees’ responses. Finally, the researcher made sure that the interview did not last too long and did not consume much of the respondents’ time, as this may instigate uncooperativeness from the respondents Data Analysis Data will be analyzed based on the descriptive statistics performed in data processing. What’s more, the content analysis of documentary materials in this study was qualitative because the interpretations and conclusions from the findings depend almost entirely on the output in processing the frequency counts of the perceptions of the respondents. So, the occurrences of the perception of the respondents were tallied one by one, upon the frequency of the occurrences depends the analysis and interpretation. To further enhance the perception of the respondents, they were also given time for an interview that is subjected to their respective insight to the topics. The interview results were then used to justify their answers.             As has been mentioned above, content analysis of the documentary materials of this study was systematic. Hence, it follows scientific methods of research. The steps follow: ·        Recognizing the Problem- ·        Forming hypothesis- ·         Doing the library research. ·        Designing the study. ·        Developing the instrument. ·        Collecting the data. ·        Analyzing the data. ·        Making conclusions ·        Making recommendations Access and Sampling The study will consist of 10 stoma patients from different hospitals within the area. Respondents will be chosen randomly through stratified-random sampling approach. The researcher, in choosing subjects or respondents for the topic at hand, is usually thought of to have the power over who the respondents of the study will be. Such a task would have been easier, except a researcher cannot simply choose out of whim; the subjects must be selected carefully with the intention of having subjects who each posses characteristics that, when put together, will represent a community. It is not only themselves, whom these subjects will represent, but the bigger whole or the whole population. The characteristics which the researcher has chosen them for will determine which part of the community they belong and what part of the community they are representing. Thus, the choosing of the subjects must be based on their characteristics.   Ethical Consideration                 Because the respondents of the study will be cancer patients, ethical considerations should be observed strictly. First, the researcher will make sure that the time and place of the survey will be convenient to the patients and will be approved by their assigned specialist. Confidentiality of the respondents’ identity will also be ensured, as well as their responses. The objectives of the study will also be read and explained to the respondents so as they will understand why it is being conducted. Conclusion             In conclusion, this proposal has identified the different issues on the psychological impact of stoma in the perspectives of the clients. The study will focus on the quality of lie, body image, sexuality and sexual concerns, psychological adjustment, coping and practical adjustment of the patients. Credit:ivythesis.typepad.com

Stoma or Cool-Rectal Cancer

Introduction Stoma or Cool-rectal Cancer Several studies have indicated that colorectal cancer is a cancer type that i...

Nasopharyngeal Carcinoma (Stage II): a patient case study

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

Nasopharyngeal Carcinoma (Stage II): a patient case study

Nasopharyngeal Carcinoma (Stage II): a patient case study This patient case study focuses on nasopharyngeal carcinoma (NPC). Specifica...