Ms. J. a Portuguese woman, a mother of three and one husband realized a lump in her left breast with her husband. At first nothing wrong clicked in to their minds but after a period of three weeks they realized that the lump was still there.

The case study is based on a health issue of a family member with breast cancer, the family response, and factors influencing the response.

Abstract

Human health is the state of well being in a person. This is the inclusive of the physical health, the mental, as well as the social. At this state there is the absence of the any disease or disorders in the body. A case study on health issue involves the in-depth collection on the information concerning a health problem where in this case it’s on the breast cancer, and the presentation of that detailed collected information. Breast cancer is the growth of the malignant on the breast. It is commonly found in women as compared to men. This case study focuses on the Portuguese lady who was diagnosed on breast cancer. The family’s response to the health problem together with the vulnerabilities and strengths of it, are also discussed. The family culture, legal, and ethical issues relating to the health problem are major factors that shape the communication between the family and the nurse involved. Out of the case study information, there are areas that I need to improve on my clinical practice.

A CASE STUDY OF A FAMILY MEMBER WITH BREAST CANCER

Family Description

Ms. J. a Portuguese woman, a mother of three and one husband realized a lump in her left breast with her husband. At first nothing wrong clicked in to their minds but after a period of three weeks they realized that the lump was still there. Even though the lump wasn’t painful, Ms. J. felt that there was need to take medical examination on the same. After a mammogram medical examination her nurse informed her she might be suffering from breast cancer and therefore several test were to be made to confirm the same. At first she thought that the nurse had not done that test properly or else those results didn’t belong to her. She couldn’t imagine how she could cope with the situation having laid in several roles in the family. Her being a mother in the family she is entitled to carry all the house hold cores which include: cooking, cleaning of the house and maintenance of the compound at large (Budin & Hoskins, 2008).

After several tests the breast cancer was positively confirmed. Fortunately enough the cancer had not spread to other vital organs. She then broke the bad news to the family members concerning her health status. Her three daughters found it hard to accept the condition. Ms. J. had lost her elder sisters who died at the age of 60 and 57 years where her daughters feared to lose their mother also. Her husband however encouraged her in the sense that they had discovered early about the problem, so he was ready to do all that would cost to save her life. These were the most difficult times of the family full of worry but more on Ms. J. since she was the major victim. Apart from her two sisters who died on breast cancer, Ms. J. had lost her mother at the age of eight years. By then she didn’t know where her mother suffered from, and she didn’t bother to inquire the cause of her mother’s death even after she grew up. This was the time that Ms. J. tried to ask her old father the cause of the death of her mother (Yackel & McKennan, 2010).

Ms. J. and her family felt that her three daughters may not escape from the same tragedy. Whereas this might be the case, there is also the possibility of not happening. Even after Ms. J. got a consolation from her husband that he was ready to all it takes to save her life, she still felt that it might not be possible. The family was not earning much of which it was had to fully support itself with all necessary needs and so this seemed not possible to her. She considered the two cases of her sisters who were financially stable yet they didn’t manage to save their lives. In the midst of all those limiting factors and all sort of vulnerabilities the family remained united and they became closer towards each other (Mak & Yeo, 2008).

Family Culture

Ms. J.’s fear of death was more aggravated with what the Portuguese cultural believe towards the disease as a fatal one. She didn’t know how she could even speak it to her friends in fear that they would view her as if she is on the way to her death. There was a common belief in her family that such happens were due to the curse of her grandmother. She didn’t escape from this curse and she feared that her three daughters may not escape from the same case (Mak & Yeo, 2008). This made Ms. J. and her family members to seek for the spiritual intervention that the curse may be broken. Her family is a Christian and therefore several continuous prayers were made over the same which comforted her family. She thereafter believed that since prayers were made on her, then there was no need of her taking any medication. Ms. J. argued that there were many death cases that had happened on breast cancer even after the medication (Yackel & McKennan, 2010).

Ms. J.’s family members however insisted that there was a need for her to seek for medical attention. This raised the misunderstanding among them even though in their Christian faith it is still okay to seek for a medical attention. The religious leaders were however called upon by Ms. J. so as to intervene the case as quarrels with her husband had increased due to her stand. The other members were not supportive too, they viewed that it was as if she didn’t care much concerning her life and health. The religious leaders admitted that even if they had prayed over the problem there was need to seek for medical attention in the notion that she is supposed to get the treatment even as God does His healing. When Ms. J. realized that even the religious leaders were for the idea of seeking medical attention, she decided to visit their family counselor as she thought that he would consider her decision (Lyon & McCain, 2008).

During all this period the nurse who had carried the testing was trying to book an appointment with Ms. J. to no avail. After a period of six months from the day she had confirmed that Ms. J. suffered from breast cancer she however managed to get into contact with her through the husband. The nurse convinced Ms. J. when she informed her she just wanted to discuss concerning the stand she had made, at the same time know the reasons so that she may advice her accordingly. The nurse informed her that she was also a Christian, and it was God who had given her the knowledge on how to treat such kind of diseases. After a lengthy discussion Ms. J. however agreed to take the medication. She changed her decision that she may please her family as she feared that her family might stigmatize her if she fails to up the medical attention (Badger & Chris, 2007).

After a period of now five years, Ms. J. says that she cannot regret on the change of her decision. Out of it she is now living and she has more hope of living longer together with her family. She also says that the whole episode has taught her on how to approach every situation despite the limitations. She doesn’t want to imagine what could have happened if she could have remained stubborn onto her idea, and now she appreciates life as a gift. Ms. J. at the same time appreciates her husband for the effort that he made and the nurse for her convincing power. When Ms. J. agreed to go on with medication, the nurse made an immediate appointment just on the following day. The nurse informed the nurse that her two sisters and her mother had lost their lives due to the same. Out of it she therefore advised her to take the Breast Cancer Gene 1 and 2 (BRCA 1& 2) which are the mutation genes responsible for breast cancer ( Mak & Yeo, 2008).

Ethical & Legal Issues

Out of the results, the nurse advised her that there would ne a need to carry out early testing to her daughters because there was a possibility of them having the same gene, which was to prevent such occurrences if they take early medication. The nurse inquired from her whether she had a health insurance coverage which could help her cater for the treatment. Ms. J. therefore appealed for the health insurance coverage where the company denied the coverage. She explained it to the nurse and advised her to re-appeal and in this second attempt her request was accepted. After the first denial she was not aware whether it was possible to re-appeal but by her nurse advised her to do it (Budin & Hoskins, 2008).

During the discussion between the nurse and Ms. J., the nurse informed her that there were some negative effects that’s would affect her such as the loss of memory which happens when the chemotherapy is done. In this she was advised to choose who would make any decision when such occasions arise, and also because during treatment some times it is not advisable for her to engage in much thinking which would cause stress. The fact was even at this particular period Ms. J. was already stressed and anxious to finish her treatment. Ms .J. chose her husband since he was very supportive and caring. She also called her younger sister and requested her to stay with her for more of the psychological support and at the same time the sister helped her to carry out the household activities when other family members happened to be away (Lyon & McCain, 2008).

Before any treatment was made Ms. J. always chose on whether to take the treatment or not. This was because her nurse didn’t want to do anything before she agreed on it. The nurse could make efforts of giving her different options to make with the most effective ones. In most cases Ms. J. wasn’t decided on what option to take, and when she did she could not choose the most effective one. However through the help of her nurse she would finally choose at least one option. After choosing the option she could discuss with her nurse on the risks and benefits that were involved on such treatment. This helped her to be more prepared and pre-develop approaches on how she could handle the risks (Mak & Yeo, 2008).

Once it was known that Ms. J. had breast cancer at job place, she was stigmatized by her fellow workmates in the small company that she was doing a part time job. She explained that they didn’t believe there was any good production that could come out of her. She got the encouragement from her nurse to be herself, and not to mind on how they react towards her. However this kind of working environment deteriorated her performance such that even when she discussed it with her employer where he summoned her colleagues, things didn’t seem to change. She then decided to quit from working, as she preferred staying at home with peace. This affected the family’s financial status which led into another job search. The nurse advised her not to disclose her health status especially on the breast cancer during the interview or to the colleagues but she was to discuss it with the major employer as she was to take some health leaves for the treatment (Badger & Chris, 2007).

Earlier on when Ms. J. had given the nurse information on the family history concerning the breast cancer disease, she had advised her to take the BRCA 1 & 2 mutation gene test. This was to ensure that once the results were out then it could be determined whether there was the risk of her daughters in relation to the same (Lyon & McCain, 2008). She explained it to the family members the step that she was about to make. One of her daughters could not imagine herself being a victim on the same and therefore she wasn’t supportive on the idea. The nurse however discussed with all family members on the importance of the same and that it wasn’t only to the benefit of Jane but more also to their lives. After the test the results on BRCA 1 gene were positive which led to more counseling to the daughters so that they may make decision of taking breast cancer disease test on mammogram early. Two of them have already taken the test (Budin & Hoskins, 2008).

Despite all these difficulties Ms. J. persevered and she underwent the full treatment and now she is among the few breast cancer survivors. When Ms. J. was informed that there needed a mastectomy surgery, she could not imagine herself living without one of her breast. She was therefore not wiling to undergo through it but her nurse informed her that it was the best way to safe his life. There was reconstruction which was done due this surgery of which it was to promote the symmetrical appearance, at the same time it has promoted her dignity on the physical outlook. At this point Ms. J. faced the challenge of the unwillingness of the health insurance company to cover for her reconstruction even though it had agreed to cover the treatment. Reconstruction is done after the whole treatment and therefore it argued that this wasn’t part of the treatment (Lyon & McCain, 2008).

Lessons from the case study

Finally, in the above case study of Ms. J. who suffered breast cancer it is well evidenced that her other family members are the second patients. This is because when it came to know of her health status it was all affected. These members just as Ms. J. were given counseling which was meant to educate them on the breast cancer (Yackel & McKennan , 2010). They therefore got a more informed consent concerning the breast cancer in their family. This was to make them take prior care to themselves and also for the future generation. Family culture in this case is very important and affect the approach unto which people view breast cancer and at the same time the steps that they take in response of dealing with the health problems. There is stigmatization that comes with this kind of health problem and thus it is therefore important to offer effective counseling (Badger & Chris, 2007).

This case study has helped me in the various ways that I am to improve in my clinical practice. One of the areas is to improve on my communication with the patients as well as the families involved, who are also affected as the second class of patients. The other area will be improving on my understanding of different cultures and try to respect them with the aim of helping the patient, at the same time if the culture is bounding then I should be in a position to convince otherwise. It is also equally important to give a patient the opportunity of knowing the risks and the benefits that accompany every treatment before administering it to them. By any case, I should not carry out any treatment before the patient agrees on the same (Yackel & McKennan , 2010).

References

Badger, T. & Chris, S. (2007). Depression and anxiety in women with breast cancer and their partiners. Nursing Research , 56, 44-53.

Budin, W. & Hoskins, C. (2008). Breast cancer: education, counselling, and adjustment among patient and partiners: A randomized trial, Nursing Research, 57, 199-123.

Lyon, D. & McCain, N. (2008). Cytokine comparisons between women with breast cancer and women with a negative breast Biopsy. Nursing Research , 57, 51-58.

Mak, S. & Yeo, W. (2008). Predictors of lymphedema in patients with patients with breast cancer undergoing axillary lymph node disection in Hong Kong. Nursing Research , 57, 416 425.

Yackel, E. & McKennan, M. (2010). A nurse facilitated program in an Army primary care: An evidenced-based project. Nursing Research , 59,558-565.

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