The Emerging Role of Nursing in the Care of Patients with Lung Cancer in Saudi Arabia (Dissertation Sample)

The Emerging Role of Nursing in the Care of Patients with Lung Cancer in Saudi Arabia
Name
Institution
LITERATURE REVIEW
Introduction
This chapter provides a review of literature relating to the emerging role of nurses in the delivery of care for patients with lung cancer. The methodology utilised to locate the literature is first described. The review then focuses on two themes: the experiences of lung cancer patients throughout the care trajectory and the implications of the experiences for nursing practice. The need to understand the experiences of lung cancer patients is informed by the fact that nurses must first comprehend patient experiences if they are to effectively be involved in their care. A summary of the literature review is provided in the conclusion section, clearly identifying gaps in extant literature.
Methodology
The literature referred to in this review was located from PubMed, Scopus, and Cinahl databases using the following search phrases: lung cancer patients, lung cancer nurse specialist, nurse role, nursing management, and nursing care. Attention was particularly paid to locating studies conducted specifically within the context of nursing. The initial search provided access to more than 1,000 articles. The search was then narrowed to studies conducted within the last five years, 2011-2016. The choice of this temporal horizon was specifically informed by the need to locate the most recent debates on the research topic. Based on this criterion, 256 articles were potentially relevant.
In the next stage of the search, articles not published in scholarly journals were eliminated. This implies that unpublished dissertations or theses, conceptual articles, as well as articles published in books were excluded. On the basis of this criterion, 47 articles were eliminated. Focus was then shifted to the type of article. Essentially, the search was further narrowed down to original qualitative studies. This implies that quantitative studies, opinion articles, meta-analyses, and systematic reviews were not included in the review. 95 articles were excluded on the basis of this criterion. The remaining articles were subjected to a more rigorous evaluation that involved the analysis of not only titles and abstracts, but also contents. Duplicate articles were also removed. In the end, 18 articles were located, which were included in the review. The findings of the articles are summarised in the remainder of the chapter. Figure 1 below provides a diagrammatic representation of the search process.
Articles identified following the initial search: >1,000
Potentially relevant articles identified: 256
Articles eliminated on the basis of being published outside scholarly journals: 47
Articles assessed on the basis of type of article: 209
Articles eliminated on the basis of type of article: 127
Articles subjected to further screening: 82
Articles eliminated on the basis of titles and abstracts: 64
Articles included in the review: 18
Figure 1: PRISMA flow diagram
Experiences of Patients with Lung Cancer
Lung cancer is one of the major causes of cancer deaths round the world (Missel et al., 2015). As such, news of the presence of the disease can be a significant source of emotional distress for the victim (Eustache, Jibb & Grossman, 2014). According to Missel et al. (2015), whose findings were informed by a longitudinal study of 19 patients with lung cancer drawn from a Copenhagen hospital, a diagnosis significantly affects the patient’s day to day life. In other words, the shocking news often result in denial, anxiety, hopelessness, disrupted social relationships, perceptions of uselessness, reduced energy for day to day living, the fear of death, as well as concerns about family and loved ones in the likely event of death. In another study, which involved semi-structured interviews with 34 newly diagnosed lung cancer patients drawn from a cancer centre in Midwestern US, similar findings are reported (Lehto, 2011). A major strength of this study is that it considered patients’ concerns not only prior to treatment, but also after treatment. While lung cancer diagnosis tends to be devastating for most victims, Dickerson et al. (2012) argue that it may not be surprising for some patients.
Lung cancer patients also tend to be victims of stigma and nihilism. This fact has been demonstrated by Tran et al. (2014), whose study involved semi-structured interviews with 74 Canadian health care professionals drawn from diverse disciplines, including thoracic surgery, medical oncology, primary care, radiology, pharmacy, and nursing. Tran et al. (2014) explain that health-associated stigma usually results from medically unwarranted judgments about an individual’s health. For instance, lung cancer is often perceived as an unavoidable, self-inflicted condition brought about by smoking, and whose victims ought to receive little or no sympathy. Lung cancer is also often viewed as a disease that cannot be cured. Such stigma and nihilism may often result in low self-esteem, self-blame, feelings of guilt and shame, as well as reluctance to seek medical intervention, thereby complicating the patient’s psychological and overall wellbeing (Tran et al., 2014). Essentially, much of the concerns faced by patients with lung cancer are psychosocial in nature. These concerns may hinder adjustment and adaptation.
The psychosocial concerns experienced by lung cancer patients may further be compounded by treatment-related side effects such as fatigue. A study of 252 patients with lung, colon, breast, or prostate cancer found that the fatigue associated with diagnosis and treatment limited the participants’ ability to socialise, function, and take part in fun activities (Borneman et al., 2012). The study’s major strength emanates from the large sample used, though its qualitative nature limits its generalisability. Other problems associated with lung cancer include disrupted sleep patterns, insomnia, anorexia, dyspnea, and pain (Dickerson et al., 2012; Serena et al., 2015). Despite the remarkable incidence of physical and psychological distress amongst lung cancer patients, health professionals provide little or no informational and psychological support to patients (Spichiger et al., 2012).
Physical and psychological distress implies that lung cancer substantially affects patients’ quality of life. This is particularly true for patients with advanced lung cancer. In their longitudinal study, which involved interviews with 80 patients with stage IIIb or stage IV lung cancer, Hermann & Looney (2011) established that the distress and depression associated with the condition significantly influenced their quality of life. In particular, owing to the uncontrollable nature of symptoms at advanced stages of the disease as well as symptom distress, patients experience reduced functional status and a great deal of emotional suffering, which affects virtually all areas of their life. A major shortcoming of Hermann’s & Looney’s (2011) study was the high participant attrition. In fact, 50% of the participants died prior to the final round of data collection. This may have affected the magnitude of scores for quality of life. Even so, the study adds valuable knowledge to the area under investigation.
A study by Eustache, Jibb & Grossman (2014) also explores the experiences of patients with stage IIIb and stage IV lung cancer. The study, which involved semi-structured interviews with 12 patients at a lung cancer centre in Montreal, Canada, found that patients experienced diminished hope or total hopelessness following diagnosis. The patients particularly reported overwhelming uncertainty, emotional paralysis, as well as a loss of sense of self. This in turn negatively affected their physical, social, and spiritual wellbeing, as well as quality of life in general. This may result in reduced compliance with treatment, further reducing chances of survival (Eustache, Jibb & Grossman, 2014). A major limitation of the study, however, is that participants were required to reflect upon their experiences – a longitudinal design would have enabled the researchers to conduct a more comprehensive follow-up of the patients’ experiences, thereby facilitating a better understanding of changes in hope over time.
Hopelessness may be felt after not only diagnosis, but also treatment. This may make coping difficult. In a phenomenological study of three patients with non-small-cell lung cancer at a Danish university hospital, Petri & Berthelsen (2015) found that the patients’ hope for recovery significantly helped them cope with side effects following radiotherapy. In other words, hope was important for navigating day to day life throughout the course of treatment. The patients’ belief in recovery was portrayed by their acceptance of the disease as well as determination to complete radiotherapy sessions despite awareness of the discouraging facts relating to prognosis. Though the size of the sample in a phenomenological study may not be a significant concern given that every experience counts, discretion should be exercised in generalising the findings of the study since only three subjects were included.
In another study, which involved open-ended interviews with 26 patients with newly diagnosed lung cancer, Dickerson et al. (2012) further demonstrated that participants directed their trust to the treatment irrespective of side-effects such as disrupted sleep patterns. Furthermore, some of the participants strongly believed that the condition was controllable. This allowed the participants to remain focused on their life priorities, further demonstrating the importance of keeping hope alive during the healing process. Even so, there is need for more research to investigate the link between ho...