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How Illness Narratives Shape Patient Experiences
Preamble and Rationale
The definition of health considers diverse elements and factors. Some of these include the physical, mental as well as the social aspects of individuals (Edlin & Golanty 2010, p. 5). It is obvious that the mere absence of infirmity does not guarantee the proper health of an individual. Breast cancer is one of the prevalent long-term conditions. This complication is predominantly evident in the females. Indeed, it is evident that diverse lifestyle practices may increase or lower the susceptibility of individuals to this condition. There is an eminent significance of the utilization of patient narratives in such contexts.
Narratives might portray the aetiology and prognosis of a particular disease. The analysis of the health belief model is vital. Many people may not entirely achieve the state of well-being during all times. Most people present the relativist or maturity perception of personal health. A majority of health professionals uphold the biomedical model as applicable in disease process (Hurwitz, Greenhalgh & Skultans 2004, p. 11). The model potentiates that any health complication is identifiable and may be categorized. In this model, there is recognition of diverse disease classifications. There exists an assumption that bacteria, defective genes, and viruses may be the potential precursors of various health complications.
Other non-physical factors lead to the development of various long-term conditions. The biomedical model also indicates that the identification of various illnesses is a sole preserve for the medical experts (Klugman & Dalinis 2008, p. 16). In this perception, the indulgence of laypersons in the disease identification remains negligible. The recognition of basic disease symptoms is critical. In the process of this identification, there is a correlation of the importance of discourse between the client and the medical expert. The biomedical model emphasizes on the fact that there should be minimal or no discussion between a medical expert and the relevant patient. In this presentation, the biomedical model indicates that this discussion remains fruitless. Consequently, this can never result into an appropriate agreement. However, this conviction remains largely fallacious in some instances.
There is an urgent need to develop an appropriate conversation and narrative between the patient and the doctor. This concept denotes the basic theme in this discussion paper. A bio-psychosocial model presents an alternative explanation on the concept of illness and nurse-patient relation. It indicates that the current health care provision mechanism largely depends on curative. This is relative ton preventive approaches (Charon 2006, p. 22). There is minimal attention for the preventive mechanisms for disease management. These mechanisms might involve behavior change practices. These focus on a progressive transformation of individual lifestyles. Indicatively various approaches are applicable in this process. Some of these might include the application of personal confessions. These are usually attainable with personal narratives. This model emphasizes the significance of lifestyle and its consequent influence on the health of individuals.
It is appropriate to indicate that the bio-psychosocial model presents a more rational way of dealing with health complication. This is evident in the intricate situations in life. However, the reinforcement of the practice of this model with elements of interactions and personal narratives remain critical. Specifically, this relates to the comprehensive management of the particular disease conditions. The bio-psychosocial model criticizes the importance of pure medicine in the minimization of prevalent public health challenges. Analytically, the application of biomedical model excludes the basic social causes related to notable health complications (Taghian & Halyard 2012, p. 18). There is an eminent significance in the development and utilization of information pertinent to any disease condition in humans. The application of narratives is an important strategy in the accomplishment of this objective. Narratives refer to individual presentations on the encounters of diseases and well-being. These presentations occur between the patient and nurse or doctor through stories.
Presently, there is an evident application of these narratives in the practice of psychiatric medicine. Accordingly, it is observably important within other medical fields. From narratives, vital lessons about the patient care are evident. These might concern issues relating to medical ethics, legal issues and the general social concerns on patient health. The fundamental interactions between the patient, nurse as well as other care providers offer critical instincts into the disease prognosis. Presently, there exist eminent intensive research and clinical assessments based on the narrative concept and the practice of medicine (Pathak & Sinha 2008, p. 27). Particularly, these relates to the contribution of individual narratives to the essential developments in the process of medical law or ethics. The medical professionals including nurses might also apply the narrative approach in diverse ways. For instance, it might be applicable in guiding them during their therapeutic practices.
The narrative approach remains widely applicable in the examination and therapeutic management of cancer patients. Breast cancer is one of the long-term illnesses in which the strategy remains appropriate. Individual lifestyles play a momentous role in an individuals acquisition, development and susceptibility to any infection. Particularly, behavior change remains crucial. Individuals adopt healthy behaviours to be able to live less susceptible lifestyles. There is an increasing emphasis on the utilization of healthy behavior (Taghian & Halyard 2012, p. 31). Principally, this is observable within the present globalized society. Behavior change initiatives help to enhance the general health of individuals. Apart from this, they also strive to prevent peoples susceptibility to infections. These include chronic diseases such as cancer. The concept includes daily life practices. These might encompass activities within the household and in other external environments.
Evidently, there exist dangerous behaviours and lifestyle activities within the general population (Edberg 2010, p. 22). This is because they increase the level of susceptibility of these persons to notorious infections. Health institutions associate specific behaviours to certain diseases and health conditions. This trend is also indicated within different investigations. Some of these include cigarette smoking, drug and substance abuse, lack of appropriate physical exercise and excessive body weight. The dietary practices are important lifestyle events that may determine the occurrence of diseases. There are treatment believes pertinent to the customary and modern societies. These directly dictate individual practices and convictions about healthy behaviours. In addition, they can also influence the therapeutic procedures applicable for specific disease types. The significance of the relationship between narratives and medical practice is unavoidable. Particularly, this relates to nursing practice and care (Charon 2006, p. 32).
Generally, narratives contribute in the creation of awareness about the clinical prognosis and path of a particular infection. Through narratives, nurses are able to obtain the relevant disease history from the patients. The process aids in the elevation of communication and feedback mechanisms among the patients, nurses, caregivers and other important practitioners. The patients historical presentation in the narrative is critical. This is because there is a comprehensive presentation of all issues relating to the development of the disease (Hurwitz, Greenhalgh & Skultans 2004, p. 27). The concept is very important in the rejuvenation of the lives of relevant individuals. Apart from this, there is a possible communication of a positive lifestyle and healthy behavior. The present globalized society has diverse cases or incidences of chronic illnesses. Consequently, there is need to apply more patient narratives concerning these chronic diseases.
Talcott Parsons demonstrated the significance of the sick role in patient-doctor relationship and in the healing process (Edberg 2010, p. 31). According to the structural functionalist, the operations of notable social practices remain vital. The role of every sick individual is critical within the social system. Therefore, the sick-role behavior may define the rational extension of sickness behavior. The processes enhance a patients capacity to comply with and adopt the required behavior during the treatment procedures. The exclusion of sick people from conducting particular chores or duties is vital. Individuals within the sick-role lack an explicit obligation for their predicament. Because they face persistent pressure to get well, the stage appears abnormal and deviant. Those undertaking this role must to cooperate with the appropriate medical care providers. Unlike the biomedical model, the sick-role indicates the social significance of the medical caregivers.
The Narrative
At the age of 54, Mrs. Tonner tells her breast cancer narrative. The female elementary school teacher was also a Christian. Her ethnic orientation was African-American. Presently, she lived a better part of her life in the UK. However, Mrs. Tonner indicated that she spent most of her earlier lifetime in the United States. This included her earlier primary and secondary schooling. It also entailed her university and a huge part of the professional life as an elementary school instructor. It is evident that Mrs. Tonner led the typical middle class level of life while in the U.S. Having an engineer as a husband, Mrs. Tonner was able to afford basic amenities. These also included some leisure activities and secondary needs. She grew in a culture predominated with western practices and civilization.
Indicatively, these played a remarkable role in the dictation of her dietary practices. Apart from this, the culture had significant influence on her health-seeking pattern and the general behavior. The middle social class has a typical way of life. This is observable within most of the westernized nations globally. In this perspective, it is critical to note that Mrs. Tonner faced the challenges and benefits associated with the middle class. Her religious life was purely Christian. This means that she practiced the fundamental believes of the Christian society. Despite several campaigns and predominant communication on the media about breast cancer, Mrs. Tonner never took heed. In her imaginations, breast cancer was a unique health complication that rarely occurred within populations (Edberg 2010, p. 52).
Personally, she attributed the condition to negative and deviant lifestyles and practices. She indicated that she never had any potential worries on the issue of breast cancer. This was notable from the time of her early childhood through the puberty and adolescent age. As a young youth, Mrs. Tonner provided less attention to basic health messages. These were predominant in the media and college environment. Indeed, she refuted these health communication messages up to her later lives in marriage. Partly, she admits that during these periods, these health messages were never comprehensive. They never included pertinent information regarding the breast cancer disease, its diagnosis, and consequent treatment and management (Charon 2006, p. 68). However, the turning point was during the launch of a major breast cancer campaign. The campaign occurred within the elementary school in which Mrs. Tonner was an instructor. Through this campaign, Mrs. Tonner was able to gain critical information on the issue of breast cancer.
It was unknown to her that at the age of fifty-two and when almost retiring, she started developing breast cancer. Later, she sought to attend medical diagnostic procedures from a qualified medical practitioner. She denoted that relatively low level of health assistance for the female patients within the public health care facilities. Particularly, she indicated that the trend was worse for the American-Whites. The breast cancer enabled Mrs. Tonner to conduct a personal breast examination. This formed the basis of the reason for seeking expert medical advice. With limited knowledge on the issue of breast cancer, Mrs. Tonner underwent immense mental torture. To her, the family was an important unit. She feared that her family could be impaired by the incidence (Edberg 2010, p. 81).
She also developed a considerable level of depression and anxiety. This was because of her negative anticipations as a future cancer patient. The limitations and lack of proper information on breast cancer within the public health facilities she attended had severe consequences. One of these included the notable delay in her knowledge about whether she had the disease or not. For a remarkable period, Mrs. Tonner had to visit many different health care institutions to seek for the appropriate information. It was after some six months that she sought for the services of a cancer expert. This was a private consultant. Many investigations indicate the role of complementary and alternative therapy for chronic conditions amongst diverse populations. Others also emphasize on the importance of seeking expert knowledge and services for chronic conditions such as breast cancer (Taghian & Halyard 2012, p. 41).
The tormenting period and uncertainty pushed Mrs. Tonner to seek for an expert advice on the breast cancer situation. Breast cancer has severe implications on the affected persons. A part from destruction of an individuals beautiful look, the person also suffers huge loss of food nutrients in the entire body. The development of metastatic cancer is, particularly, dangerous for most body cells. These carcinogenic forms are likely to spread to other potential sites within the body (Charon 2006, p. 72). Therefore, a cancerous anatomical location of the body must undergo total elimination. The private consultant offered to Mrs. Tonner more advanced and precise diagnostic processes. These involved an initial orientation into the possible causes of cancer. Apart from this, she underwent basic orientation on the types of cancer, their critical stages and the ultimate management procedures.
The consultant applied the mammogram in the initial identification processes. However, as a confirmatory test, the next diagnostic procedure entailed the use of the contemporary ultrasound (Hurwitz, Greenhalgh & Skultans 2004, p. 81). These had adequate competency in the provision of reliable diagnostic information about the state of cancer. Most cancer experts reiterate on the detrimental impacts of cancerous anatomical body parts. In such contexts, they provide amputation as the basic method for preventing further or extensive spread of the cancer to other body parts. The consequent diagnostics after the ultrasound involved the use of tissue biopsy. This refers to a simple surgical process in which there is tissue siphoning and application of microscopic techniques. The basic aim of the procedure was to assess the presence of timorous cells.
The confirmation tests revealed that Mrs. Tonner suffered from severe Invasive ductal carcinoma (IDC). This breast cancer is very popular (Taghian & Halyard 2012, p. 45). Further revelations indicated that the cancer managed to invade various tissues within her breasts. The condition remained incurable. Therefore, the private consultant indicated management as the most preferable and rational option. This meant Mrs. Tonner had to seek transformative health care option. To make it worse is that the revelation emerged at a time when she was on the verge of relocating to the UK for a two-year long holiday. This was important in many ways. For instance, it meant that she could not enjoy the care provision from most of her family members. A series of consultations carried out by the private consultant enabled him to draw an appropriate cancer schedule.
Mrs. Tonner was inducted on other basic forms of breast cancer. Some of the highlighted forms included the recurrent and metastatic cancer. Other highlighted forms were the ductal carcinoma in situ (DCIS), invasive lobular carcinoma (ILC) and the cribriform carcinoma of the breast (IDC) among other forms (Kasper & Ferguson 2002, p. 67). After a thorough coaching on all these cancer forms and their pathogenesis, the cancer expert resorted to psychosocial support strategies. This involved an induction on the negative causes of the particular breast cancer. These included the use of hormonal contraceptives. It is critical to note the various ethical concerns pertinent to the management of cancers. The recognition of confidentiality remains important (Pathak & Sinha 2008, p. 77). This explains why this narrative uses a hypothetical name. This helps to hide the overall identity of the real breast cancer patient. Furthermore, it is important to indicate that the full informed consent of the patient was necessary prior to the beginning of the narrative.
Notably loopholes are evident in the process of this diagnosis. For instance, there is lack of adequate information on all the forms of breast cancer. Additionally, the patient was not part of the decision processes and consultations made by the doctor. Observably, these undertakings are largely against the ethical and professional conduct provisions stipulated by the national health policies on cancer management. During the clinical management processes, Mrs. Tonner also sought for other complementing interventions. The spiritual counselling processes had significant implications to the patient. The clinical management process took place in a consecutive manner. The patient underwent the processes of chemotherapy ((Edlin & Golanty 2010, p. 89). Moreover, the cancer specialist also advised the patient to undertake the radiography processes. These were very critical steps in the life of the patient. However, following the one year of undergoing all these processes, it was sad that Mrs. Tonner suffered a serious hearing and weight loss.
She needed comprehensive care from her children. Generally, there is diverse lifestyle factors associated with different disease conditions. Other than these individual factors, the external factors including socioeconomic issues have potential health impacts. Poverty might also lead to the development of certain health conditions. Since Mrs. Tonner came from a middle class, it is notable that poverty had minimal influence in the development of the disease condition. The importance of nutritional counselling is eminent in this scenario (Rice 2000, p. 107). After a long duration of nutritional counselling and assessment, it was notable that the patient developed the breast cancer out of her dietary practices. However, it is important to recognize that unlike the poor persons, she was able to access quality medical attention.
Patient monitoring and close observation is critical during any therapeutic processes (Lundy & Janes 2009, p. 111). There are several cases where patients fail to adhere to their prescriptions. On the case of Mrs. Tonner, many factors led to the development of non-compliance to various drug therapies. Foremost, the use of other complementary and alternative healing methods was an important factor. Lack of close observation and monitoring by the private medical consultant was another contributory factor. There are extensive investigations on the issue of various sociological, cultural and individual influences on the health of personalities.
The experiences of Mrs. Tonner were very important. She stressed on the need for people to transform their health seeking behavior. She also advocated for impartiality in the quality of health service provision. Moreover, Mrs. Tonner advised everyone to adopt healthy dietary practices. She indicated the importance of engaging in discussions (Edberg 2010, p. 122). Specifically, this concerns the people suffering from long term conditions. There are loopholes in the management of long-term conditions. Evidently, this necessitates the need to launch more strategic and empirical investigations. This is vital in the reduction and management of the high incidences of breast cancer.
References
Charon, R 2006, Narrative medicine: honoring the stories of illness, Oxford University Press, Oxford.
Edberg, C 2010, Essential readings in health behavior: theory and practice, Jones and Bartlett Publishers, Sudbury, MA.
Edlin, G & Golanty, E 2010, Health & wellness, Jones and Bartlett Publishers, Sudbury, MA.
Hurwitz, B Greenhalgh, T & Skultans, V 2004, Narrative research in health and illness, BMJ Books, Malden, MA.
Kasper, S & Ferguson, J 2002, Breast cancer: society shapes an epidemic, Palgrave, New York, NY.
Klugman, M & Dalinis, M 2008, Ethical issues in rural health care, Johns Hopkins University Press, Baltimore.
Lundy, S & Janes, S 2009, Community health nursing: caring for the publics health, Jones and Bartlett Publishers, Sudbury, MA.
Pathak, K & Sinha, K 2008, Bio-social issues in health, Northern Book Centre, New Delhi.
Rice, H 2000, Handbook of stress, coping, and health: implications for nursing research, theory, and practice, Sage Publ, Thousand Oaks, CA.
Taghian, G & Halyard, Y 2012, Breast cancer, Demos Medical Pub, New York, NY.
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