Health History
Mrs. Laura Appleseed is a 55-year-old retired nursing officer who has spent 32 years working for the Canadian Armed Forces. Approximately six months ago, Mrs. Appleseed was diagnosed with ALS. Amyotrophic lateral sclerosis is a progressive neuromuscular disease that affects the essay writer neurons that control voluntary muscle movement (Mayo Clinic, n.d.). As a result, upper and lower motor neurons degenerate and stop sending signals to muscles. Early symptoms involve muscle weakness that progresses to the inability to move, speak, eat, and breathe. (Mayo Clinic, n.d.).
Laura noticed symptoms when she started to experience muscle weakness when engaging in regular physical activity. Since the onset of her initial symptoms, she has continued to experience a gradual increase of symptoms and muscle weakness such as twitching, cramping, and radiating pain in her legs and upper arms. In addition, Mrs. Appleseed’s colleagues have noticed clumsiness, and they have observed Laura tripping and falling.
Contributing Lifestyle Factors
Laura has spent most of her career deployed abroad in high-stress situations. She worked alongside the Combat Engineer’s Explosive Ordnance Disposal Team in Iraq. A high incidence of exposure to environmental factors such as metals and chemicals and intense exertion are contributing factors that have led to her ALS diagnosis. She is now retired from the military and is working part-time as a companion to seniors at her local long-term care center.
Although the disease symptoms can appear at any age, according to the Mayo Clinic website (n.d.), ALS risk increases with age and is most common between 40 and mid-60s. Laura is 55 years old and, therefore, falls into the period where the symptoms of the disease mostly appear.
Laura has maintained her physical fitness levels throughout her career. She does not smoke, drink alcohol, or participate in recreational drugs. She carries a healthy weight, and there are no concerns with her current BMI.
Family Relationships
Laura has been married for the last 30 years, and they have three adult children. She married her high school sweetheart shortly after the completion of university. Her husband owns a small electrical business, and they live happily on an acreage just outside the city. They enjoy snowmobiling in the mountains in the winter and camping and dirt biking in the summer. Her youngest son still lives at home as he is attending university. The Appleseed family gets together every Sunday night on the acreage to enjoy supper as a family. Laura’s husband and children are all very supportive of her needs during this time of transition.
Psychosocial Dimensions of Chronic Illness
Emotional manifestations affect executive function impairment, leading to behavioural changes affecting ALS patients’ moods (ALS Association, n.d.). For example, Laura has recently been experiencing episodes of crying and laughing uncontrollably during inappropriate times. Laura’s husband stated that she started laughing during a movie after a mother tragically lost their child in a car accident.
Quality of life encompasses multidimensional factors such as physical, emotional, and social well-being that are unique to the individual that establish a set of standards that provide meaning to one’s life (Gates, 2022). Mrs. Appleseed expressed her concerns about depression. The once seasoned outdoors person now faces muscle fatigue that prevents her from enjoying activities. She has lost interest in being physically active and would rather stay close to home. Laura is embarrassed by her clumsiness and does not want others to notice. She also fears going down the stairs, so her husband has recently transformed their home office into Laura’s new bedroom on the main floor. She has recently gone on medical leave from her part-time job at a long-term care center and cannot maintain ADLs.
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Shifting Perspectives Model of Chronic Illness
Illness in the foreground occurs when a patient with a chronic disease will focus entirely on the condition. Illness in the foreground generally occurs when a patient suffers from flaring symptoms. Laura is experiencing the early stages of the grieving process and feels that she has lost herself. She feels immense guilt as she is aware of her burden on her husband and family as her illness progresses. She often feels very overwhelmed by her diagnosis as much planning needs to happen to ensure that her family can effectively manage the disease process.
The progression of Laura’s illness identifies as a barrier to effective self-management. ALS is a terminal diagnosis that reaches the end stages within 2-5 years after diagnosis (ALS Association, n.d). Nevertheless, symptoms such as depression and fatigue continue to plague Laura daily. Physical and emotional symptoms of chronic illness can impede her autonomous control for life.
Nurses Role
A nurse can implement interventions to help a patient living with a chronic illness shift from an illness in the foreground to wellness through health promotion strategies. Incorporating a healthy lifestyle such as being physically active, staying well-rested, and eating a healthy diet can mitigate feelings of uncertainty.
Encourage Laura to continue with physical activities such as attending yoga and aquafit lessons to help keep her muscles moving. Physical activity will help her stay strong, resulting in her ability to maintain independence as her illness progresses.
A nurse can also employ other resources by collaborating with other medical professionals, such as physical and occupational therapists. For example, a physical therapist can help improve mobility in ALS patients with muscle degeneration. Likewise, an occupational therapist can help address the issues surrounding her balance issues by suggesting equipment aids.
Finally, a nurse can unite with Laura’s family members to help promote the importance of maintaining healthy supportive relationships during the progression of family illness. Providing resources for the family will ensure a better coping process for all involved for the duration of her disease management.
PICO Question
(P) For patients living with ALS, (I) how does teaching coping strategies support physical and emotional well-being, (O) reduce the risk for depression and improve quality of life, (C) compared to not teaching these strategies?
Research Articles
Article #1
Oh, J., An, J., & Park, K. (2021). Coping in people with amyotrophic lateral sclerosis and motor neuron disease: Systematic review. Journal of Clinical Nursing, 30(13-14), 1838–1853. https://doi.org/10.1111/j.1365-2702.2010.03509.x
1. Is the study qualitative or quantitative or an evaluation (quality improvement or program evaluation), or is it a theory (concept analysis) or systematic or meta-analysis study, or is it something other than these? (Worth 2 marks)
This study is a “systematic review of previous studies of variables associated with coping strategies in people with … [ALS/MND]” (Oh et al., 2021, p. 1838).
2. Is the study a primary or secondary study, or neither? (Worth 2 marks)
The study is a secondary study, as it is a systematic review of previous studies, and the researchers are presenting no original data or information.
3. Summarize the contents of the article in a short paragraph (5 marks)
This article is a systematic review that examined the outcomes from 21 previous studies. The review focused on findings that demonstrated “significant relationships between participants’ demographics (age and sex) and any coping strategy “that had an impact on “patients’ [quality of life] and mental health outcomes” (Oh et al., 2021, p. 1838). The term coping was broken down into two categories: “problem-focused and emotion-focused” (Oh et al., 2021, p. 1839). It defined coping as “one’s own conscious effort to solve personal and interpersonal problems to try to minimize or tolerate stress and conflict” (Oh et al., 2021, p. 1839). The article divided coping strategies into five categories, compared data from the various studies, and analyzed independently by the three authors. The resulting data was compiled and further discussed to obtain their conclusions. Ultimately the study showed a variation in which coping style was most effective for young people compared to women. Furthermore, “problem-focused coping was generally related to better [quality of life] and mental health, and emotion-focused coping was related to less depression” (Oh et al., 2021, p. 1839).
4. Describe how the article specifically addresses your PICO question (5 marks)
This article directly addresses our PICO question. It presents a compilation of data that examines various coping strategies, their effectiveness across multiple demographics, and their impact on a patient’s quality of life and mental health. This article “could also be used to inform the provision of patient-centred nursing in clinical care” and provides direction as to which coping strategies are most valuable and effective in improving quality of life and mental health outcomes in various groups of patients (Oh et al., 2021, p. 1838).
Article #2
Olsson Ozanne, A. G., Strang, S., & Persson, L. I. (2011). Quality of life, anxiety and depression in ALS patients and their next of kin. Journal of Clinical Nursing, 20(1–2), 283–291. https://doi.org/10.1111/j.1365-2702.2010.03509.x
1. Is the study qualitative or quantitative or an evaluation (quality improvement or program evaluation), or is it a theory (concept analysis) or systematic or meta-analysis study, or is it something other than these? (Worth 2 marks)
This study is a quantitative study; the results report using numbers and charts to illustrate and compare data of the general population with the patients with ALS and their next of kin.
2. Is the study a primary or secondary study, or neither? (Worth 2 marks)
This study is a primary research study, and the original research conducted by the author describes the methodology and results.
3. Summarize the contents of the article in a short paragraph (5 marks)
In this article, the researchers wanted to look at well-being, the standard of living, anxiousness, and despair in individuals experiencing amyotrophic lateral sclerosis and their family members and analyze the outcomes to those of a subgroup of the Swedish population. The researchers looked at 35 pairs of patients with amyotrophic lateral sclerosis and their relatives (Olsson Ozanne et al., 2010, p. 284). As ALS is currently incurable, the “focus in treatment is palliative, aiming to help the individual and the family obtain the best quality of life possible” (Olsson Ozanne et al., 2010, p. 284). This article examined the quality of life from the “perspectives of physical, mental, and social dimensions” (Olsson Ozanne et al., 2010, p. 284). It evaluated how the support of health care providers impacted the “[quality of life] and possible prevalence of anxiety and depression in patients and their next of kin” (Olsson Ozanne et al., 2010, p. 285). The results of this article illustrated that “both the patient and next of kin are affected by [ALS], independent of physical disability,” and the psychological impact of ALS reduces with supportive interventions from various health care professionals (Olsson Ozanne et al., 2010, p. 289).
4. Describe how the article specifically addresses your PICO question (5 marks)
This article addresses our PICO question by examining the risk and prevalence of poor quality of life, anxiety, and depression amongst ALS patients and their next of kin. The results relayed by this article “emphasize the need of support by health care professionals, such as nurses, physicians, and social workers, to both the patient and next of kin … to reduce the risks of poor [quality of life], anxiety and depression” (Olsson Ozanne et al., 2010, p. 289). Furthermore, the article demonstrates the impact the development of coping strategies by health care workers has on the psychological well-being of patients and their next of kin.
Article #3
King, S. J., Duke, M. M., & O’Connor, B. A. (2009). Living with amyotrophic lateral sclerosis/motor neurone disease (ALS/MND): decision-making about “ongoing change and adaptation.” Journal of Clinical Nursing, 18(5), 745–754.
1. Is the study qualitative or quantitative or an evaluation (quality improvement or program evaluation), or is it a theory (concept analysis) or systematic or meta-analysis research, or is it something other than these? (Worth 2 marks)
This study is a qualitative methodological-based study. Participant observation and interviews took place, and data was collected. This study assembles data using “audio-taped, in-depth interviews, electronic correspondence, field notes as well as stories, prose, songs and photographs important to participants” (King et al., 2009, p. 747).
2. Is the study a primary or secondary study, or neither? (Worth 2 marks)
This study is a primary research study, and there is a research design, methodology and results. The article gathers information based on an interview process and requires the participation and communication of patients diagnosed with ALS/MND.
3. Summarize the contents of the article in a short paragraph (5 marks)
This article studies patient behaviour and their ability to cope throughout the progression of an ALS diagnosis. The study used extensive interviewing from seventeen male and eight female participants to illustrate behavioural processes to form a “theory of maintaining personal integrity in the face of ‘ongoing change and adaptation'” (King et al., 2009, p. 747). The model represents the participant’s reaction to a change in their condition. The perception of change centers around internal and external forces that challenge the participants to internalize and then adapt to change individually, impacted by psychosocial elements (King et al., 2009, p. 747). The participant would be able to cope with the progression of their illness through an illness or wellness in the foreground perspective based on their support structure. A participant that was able to adapt positively would command a sense of control over their condition, resulting in prolonged life expectancy. Participants’ inability to adapt to change and cope with the progression of their disease resulted in a loss of control and increased stress levels that negatively impacted their well-being (King et al., 2009, p. 747).
4. Describe how the article specifically addresses your PICO question (5 marks)
The model used in this study identifies individual coping strategies of ALS patients that address the PICO question by determining positive and negative outcomes associated with emotional and physical well-being. The study identifies adaptation methods to establish “periods in which timely interventions” can be implemented within healthcare establishments (King et al., 2009, p. 753). The model can be further used to help nurses form a deep understanding of their patients to assist with the perception of self and well-being to mitigate feelings of hopelessness, resulting in a more positive outlook while navigating the progression of the disease (King et al., 2009, p. 753).
References
ALS Association. (n.d). Understanding ALS. https://www.als.org/understanding-als
Gates, M. (2022). Understanding Chronic Illness. [PowerPoint slides]. Bachelor of Science in Nursing, MacEwan University. https://learn.macewan.ca/webapps/blackboard/content/listContent.jsp?course_id=_100651_1&content_id=_3546499_1
King, S. J., Duke, M. M., & O’Connor, B. A. (2009). Living with amyotrophic lateral sclerosis/motor neurone disease (ALS/MND): decision-making about “ongoing change and adaptation.” Journal of Clinical Nursing, 18(5), 745–754.
Mayo Clinic. (n.d.). Amyotrophic lateral sclerosis (ALS). https://www.mayoclinic.org/diseases-conditions/amyotrophic-lateral-sclerosis/symptoms-causes/syc-20354022
Oh, J., An, J., & Park, K. (2021). Coping in people with amyotrophic lateral sclerosis and motor neuron disease: Systematic review. Journal of Clinical Nursing, 30(13-14), 1838–1853. https://doi.org/10.1111/j.1365-2702.2010.03509.x
Olsson Ozanne, A. G., Strang, S., & Persson, L. I. (2011). Quality of life, anxiety and depression in ALS patients and their next of kin. Journal of Clinical Nursing, 20(1–2), 283–291. https://doi.org/10.1111/j.1365-2702.2010.03509.x
