In all healthcare settings, both the physical and mental health needs of patients are important. We don’t fully understand all the ways our body connects to our mind because the connections are so complex. Physiologic and psychologic health influences each other in an infinite number of ways. For example, high and consistent amounts of stress will increase cortisol levels, which can lead to physical reactions such as hypertension, weight gain, and headaches. On the other hand, physical ailments can cause or increase psychological ailments. For example, if a patient receives a poor cancer prognosis, they may experience depression and anxiety. It is essential for the nurse to be aware of this and know how to care for patients that may be experiencing an exacerbation of not only a physical disorder, but a mental disorder as well. No matter what specialty or setting a nurse works in, caring for patients in a holistic manner is key to providing quality care for the patient’s needs.

            For the past year, I have worked in hospice and home care as a home health aide. There is a wide range of diagnoses I have seen, both physical and psychological. One client in particular stood out to me. This client’s primary diagnosis was terminal metastasized cancer of the bone. She was a hospice patient who was given only weeks to live. Her cancer was literally eating away at her. Her right leg had large amounts of gauze starting just above her hip and extending down to her ankle on the lateral side. As an aide, I am told to leave bandaging alone, so I did not disturb it. The patient told me several times about how excruciating her pain was and how she could not roll onto that side. I did not understand what was under her bandages, all I knew was that she had a leg wound and that the nurse changes the dressings every few days. During my second visit about a week later, I went with the nurse because the client’s condition was deteriorating. This was when I saw the wound. It was black in many spots, and it was so deep in certain areas that the bone was visible. There was a strong odor coming from the area as well. I was shocked to see the wound and quickly understood why she was in so much pain. I could also understand why the patient didn’t want to look at it and felt ashamed. I tried to give her dignity by talking to her about the weather and other mundane things while the nurse tried to manage the wound. The nurse could not touch it without the client screaming in pain so she cleaned it the best she could and replaced the dressing. The client passed away four days later.

            The client had a history of depression and anxiety from before her cancer diagnosis. Receiving a cancer diagnosis dramatically influenced her mental health, as well as her terminal prognosis at the end of her life. The husband filled in a lot of background about my client because she was typically sleeping or in too much pain. He told me that her depression increased significantly after her diagnosis. She did treatment but was losing hope by the day. She felt that she did not get a chance to do the things she wanted to do, like she was cheated out of a full life. She knew that her depression was worsening, because her husband told me that she apologized many times to him for being irritable and angry. I could see this in her while doing her care. She told me how she wanted to give up, but her body was still trying to fight. I had an assumption before meeting her that she would be still trying to fight her diagnosis, but I was wrong. Instead, she was burnt out and exhausted, begging for the pain to end. I felt and still feel sympathy for her, as well as her husband, and all I could do was treat her with respect and bear witness to her suffering.

Every time I adjusted her or touched her, she prayed out loud that God would let her go. The physical pain she was experiencing from her cancer was so unbearable that she wanted to die. She didn’t understand why her death was so painful because she said she had always hoped it would be peaceful. I felt helpless and just held her hand for a while. The nurse addressed her pain by teaching her husband how to administer liquid morphine. The client said it was bitter and she was upset that something that was going to ease her pain tasted so poorly. The nurse coated the tip of the dropper with sugar so the client would taste the sweetness of it instead. This really eased her and seemed to be a small moment of relieve. I also connected her anxiety to her end-of-life prognosis. She told me when they put her on hospice, she was anxious about death. She had the insight into her cancer, and she knew it would take her life, but she felt like she wasn’t prepared for death yet. The nurse suggested to the husband that he should contact their priest of their church and have him come in to see her. I thought maybe this should have been done earlier to help her have more insight into her mortality and help her work through her anxieties about death.

The client was married and living at home with her husband. They did not have children and had mostly friends and other relatives as a support. Her husband said many had not come to visit in the last few weeks because the client was in too much pain and did not want her loved ones to see her in that state. She and her husband were religious and often prayed together. They belonged to a church that they found support through. Throughout her care, her husband was by her side and was her caregiver. His support gave her strength, as well has her faith. Including him in some of her care while we were there helped her ground herself. I talked to her about her faith and let her pray when she needed. This seemed to help her feel respected and dignified. Her previous occupation and her economic status were not addressed. An assessment of these may have led us to better insight and would have identified any financial worries, so it should have been given more attention.

For the biologic domain, this client is at risk for impaired self-care. Her pain coupled with her depression leaves her unable to take care of her own needs such as bathing and getting dressed. Two priority nursing interventions would be to provide positive reinforcement and allow for maximum independence. These both would encourage the client to perform the tasks she can and give her the confidence to do so, even if it’s just brushing her own teeth. For the psychological domain, the client would be at risk for ineffective coping of her prognosis. A priority nursing intervention would be to use therapeutic and compassionate communication with the client. Showing her that she has support from the nurse may help her learn to cope with her mortality. For the social domain, the client is at risk for social isolation. The client wouldn’t allow visitors due to her condition, so she only received interaction with her husband and the care team. A nursing intervention for this would be to encourage the client to reach out to a friend or relative she trusts and set up a video chat. She could see and talk to this loved one but also won’t feel as insecure.

I feel that not all of my client’s mental health needs were fully addressed. This may be due to a combination of the short time on hospice as well as the severity of the leg wound. Because the leg wound was focused on, her anxiety and depression weren’t managed as well as expected. Using some of the nursing interventions mentioned previously as well as setting up counseling would address these needs further. Prioritizing mental health alongside physical health will help to provide the quality and compassionate care the client deserves.