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People Making Changes Issue 23 -
Care For Cancer Patients

- Dorothy - 24/7/97

Anne Morgan, a Christchurch oncology nurse, discusses the changes faced by cancer patients and the changes in the relationship between hospital staff and patients and their families.

Caring with the patient
Helping patients and their families adjust to cancer is a major part of the work of nurses in oncology wards.

Anne Morgan
Anne Morgan
Anne is a highly trained and experienced nurse who has nursed patients in different areas, but what has drawn her particularly to working in oncology is that she wants to be able to care for her patients holistically. As Anne put it, "When someone has cancer it isn't just the disease that you look after any more. If somebody breaks a leg you can mend it, and the patient goes home and you wave them good-bye. With cancer it's different. It affects the patients, it affects their family, and it affects them spiritually and physically, in every way, so it is for me a much more rewarding type of nursing. It is a journey that the staff and the patient and the family take together, so it's not caring for that person - it's rather caring with the person and giving support. Part of me goes with each patient."

Experience with cancer as a relative
The other reason that Anne has had a vital interest in this work and empathy with patients is that her own brother has had cancer for the last twenty years. She has experienced cancer as a relative of the patient and knows what that feels like.

Not all doom and gloom
Nursing cancer patients in Anne's view is not depressing because there is a lot more honesty. People suddenly have to face their life and look at it head on and because of that honesty it is possible to laugh together and at times to cry together. People look at life in a totally different way. The cancer ward is not a place of doom and gloom.

The role of complementary medicine
Anne has always had an interest in complementary health and with people with cancer there sometimes comes a point where traditional medicine has nothing more to offer and people want to support the rest of their journey with some other form of medicine - often a complementary health modality. Because of Anne's interest in it she can offer advice and support in finding what is helpful. She can also caution people about some of the alternatives that are not going to be helpful to them. The holistic approach encompasses this too.

Staff open-minded about complementary medicine
Life in a cancer ward involves more than traditional medicine. Visualisation, relaxation techniques and aromatherapy all have their place. People will come to the ward who have been to places like the Hoxsey Clinic in Mexico and do not wish to be ridiculed for it. This clinic uses a special tonic that is meant to stall the growth of the cancer cells. Staff in Christchurch are not sure what is in that tonic, but patients are able to have Hoxsey treatment while they are in the ward because of the more open attitude of the staff to alternative therapies. There is far more discussion about the other types of healing offered than would have happened a few years ago.

Cancer a challenge to patients' way of life
Working in the cancer ward staff look at the disease rather differently. Rather than its being a huge passport to fear, Anne views it as a challenge to life and a time to look at the way patients are living and how they want to continue living. Oncology nurses are in a very special role as being able to assist people both with the journey to health again and also with the journey to their death - which is a reality in a cancer ward. The most important service is to provide good quality time.

Changed priorities
Anne's brother, who has lived with cancer for twenty years after being given three weeks to live, says, "I have been lucky. I have had the opportunity to look at my life and not to waste it." He has had a wonderful and good-quality life, and has not wasted a minute since. Many of the patients express the same view. They appreciate so much more what is around them - their family and every good aspect to their lives. Priorities change once a person has had cancer. There is a time of healing of family relationships and material things become so much less important.

Caring a team approach
The whole view of care for people with cancer is a team approach - a multi-disciplinary approach. The patient is at the centre of the team, close around the patient are the family and friends, and further around them are the nurses, the doctors, physiotherapists, occupational therapists, social workers - a huge team supporting the patient.

The patient as team leader
The team approach is absolutely paramount - always with the patient as the focus, and as the leader of the team whenever health and energy permit. Within that team is an enormous amount of experience. There is a lot of sharing among the members of the team - a team in which everybody is equal, nurse, doctor and other therapists. They share information and opinions about what is best for the patient, and the course recommended is always discussed with the patient who makes the ultimate decision.

Staff training
Extensive training is provided for younger or newer staff members - an orientation time for them to learn, to grow and to change the way in which they may have nursed or doctored in the past. If they come from a surgical ward the focus is different from that in the cancer ward and the adjustment takes time. Nursing in an oncology ward is very patient-focused whereas in some other areas it is more treatment-focused.

The spiritual component in healing
Personal faith in some belief system helps patients to cope with their illness. Anne has just viewed a video made by a teenage patient who wanted her journey recorded on video to help other teenagers. It portrays honestly the good times and the times that were sheer hell for her. It is clear from the video that what assisted her to cope with what proved to be a terminal illness was her personal faith.

The spiritual component is of great importance. People gain in strength from having their spiritual needs met. Hospital chaplains offer support when called upon, but most patients bring their own spiritual support with them, either a person who shares their religious faith or a contact with some other spiritual base. Often people who have not been practising Christians when confronted with cancer return to their faith.

Listening skills
One of the most important skills for those working in the cancer ward is active listening. Both patients and their families need to talk and need a lot of time spent with a nurse just listening. Often there is nothing that can or needs to be said in reply. Their need is simply to express their feelings, sometimes anger, hurt or guilt, and they must have time to work through them and come to terms with them. It cannot be rushed and it is important for patients and families to realise that it takes time and that it is okay to feel angry and hurt and guilty and cross, and okay to vent that anger. That realisation helps them to make the changes that are necessary for them to continue.

An individual journey
Cancer is a very personal disease and it is a very personal journey - so different for different people. Some sail through it, while for others it is just hell because they cannot or don't know how to make the necessary changes and they may die with unfinished business and unhappy. Unfortunately that is their journey.

Changes for staff
Anne has made it clear that it is not only the patients who are making changes, but the staff as well.

One change for the nurses is that it is now acceptable for them to show their own emotions. No longer is the controlled approach required, with no feelings shown. Anne is not disregarding professional etiquette if she sheds tears with the patient. The knowledge that the staff are part of the journey helps patients to share feelings openly and feel their distress eased by the process. The other change is the tolerant attitude to complementary medicine.

Anne declares that she cannot speak highly enough of the oncology specialists with whom she works. Their skills and their attitude to the patients and their treatment and to the team in which they function, not as leaders but as equals, are a major factor in the holistic care which patients in the ward receive.

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