A Case Review of Tony's Testicular Cancer

Introduction

Therapeutic communication is referred as the mode of interaction in which the nurses communicate face-to-face with the patient for advancing emotional and physical well-being of the service user. The lack of effective establishment of this communication leads to hinder the support as well as information required by the patients in improving their health condition. In this assignment, it is seen that Tony is suffering from testicular cancer and in need of therapeutic communication for helping him to cope with the deteriorated health situation. For those in need of specific guidance, nursing dissertation help can provide crucial support in developing effective communication strategies. Thus, a critical review of his case is executed to understand and discuss the best helping skill approaches needed by Tony. Moreover, the lessons learnt while using the helping skill approaches for Toney is also to be informed with critical reflection.

Describing the case scenario and explaining the way of building a therapeutic relationship with the patient

The given scenario informs that Tony is a 19-year-old individual who has been diagnosed with testicular cancer. As mentioned by Stouten-Kemperman, M.M., de Ruiter, M.B., Boogerd, W., Kerst, J.M., Kirschbaum, Reneman and Schagen (2018), testicular cancer is referred to the condition in which the cancerous growth has spread to the testicles that result to hinder the sexuality, fertility and masculinity of the men. This is because the testicles are key reproductive glands of the men which produce androgen and sperm required for men to be fertile and remain sexually active. In case of Tony, as a result of his condition, he would be feeling embarrassed because testicular cancer may cause him to become infertile at an early stage which would lead him to lose his efficiency to reproduce in future to start a family. As argued by Rohleder, McDermott and Cook (2017), many individuals with sexual diseases feel ashamed and worry to talk with the healthcare practitioner which results to avoid early intervention for mitigating the sexual diseases. This is because the condition is related to the patient's private parts of the body which they avoid to expose in front of unknown people or GP. In case of Tony, due to fear and worry of exposing his private parts to get care and medical intervention for his testicular cancer from the GP he may have avoided confronting the healthcare practitioner for the past 6 months. This has resulted in deteriorating his condition making it worse to develop lump and intense back pain as the relapsed symptoms of testicular cancer.

At present, Tony is seen to face nausea and vomiting due to chemotherapy treatment which would make him feel emotionally as well as physically broken down. As stated by Coolbrandt et al. (2016), the condition of vomiting and nausea makes patients feel physically unpleasant and weak to be able to control their daily activities in a smooth manner. This means that the condition would interfere with the eating habits of Tony which would make him feel unpleasant and weak out of his inability to take proper nutrition. This condition informs that Tony requires proper therapeutic communication so as to cope with the current health issues faced as a result of testicular cancer. As asserted by Hall (2015), proper rapport with the patient is required to be built to make the individual believe the nurse or service provider involved in developing effective therapeutic communication. This is because without proper rapport the patient such as Tony would not trust the nurses to interact with them for accessing and implementing strategies and information developed through therapeutic communication to resolve their emotional and physical turmoil due to disease. According to Taplin et al. (2015), effective therapeutic the nurses need to interact in an empathetic way with the patients. This is because it would make the patients feel that their condition and emotional status is properly understood by the nurses and they are accordingly providing services through interaction for improving their health. Thus the nurses to develop therapeutic relationship with Tony would develop rapport and interact in an empathetic way. Moreover, the confidentiality of the patient would be protected and his dignity and rights would be respected to ensure Tony do not feel humiliated or abused in turn helping to form effective therapeutic relationship by the nurses with the patient.

Critically discussing two helping skill approaches to help Tony

In relation to Tony’s case, the two helping skill approaches that can be used are Egan’s Skilled Helper model and Motivational Interviewing approach. As per Riggall (2016), Egan’s model is used to achieve the objective of change as well as empower individuals for managing their personal problems in a more effective way and develop the unused opportunities more efficiently. Thus, using this model would help the nurses allocated to care for Tony be able to empower and change his activities to cope the health problems faced as a result of the presence and chemotherapy treatment of testicular cancer. The first task as per the Egan’s model is that the nurses require to minutely hear the problems and issues being faced by the patients in their own words and reflect the information back to them without any form of judgement (Steven and Redfern, 2017). This is required so that the patients understand that their feelings, emotions, needs and demands are appropriately understood by the nurses to offer them effective care. As per the model, the nurse requires to empathetically communicate with Tony and develop active listening attitude as well as focus on his feelings regarding the health issues he wishes to be resolved at the present faced due to testicular cancer. As argued by Tamadoni et al. (2017), without exploring the needs and demands of the patients from their personal account regarding health issues it is difficult for the nurses to understand the facts to be focussed on in providing successful care for the patients. Thus, the model helps the nurse involved to care for Tony to develop an idea regarding the needs and demands to be fulfilled to help him live a better life.

The second stage of Egan’s model included challenging the existing views of the patients to resolve the raised concerns (Squirrell and Hunt, 2018). This is required to make the patients look to their health problem from different aspect to initiate them to make emotionally strong to cope with the issues. In the case of Tony, at this stage, the nurses require to make him think that his life is more important than his fertility and after chemotherapy when his cancer would be removed his fertility will come back. This would be able to resolve his tension and worry regarding masculinity and sexuality. Moreover, the nurses by making him view that chemotherapy are his way to survive would be able to help Tony become emotionally competent to cope with the unpleasant feeling of vomiting and nausea. The third stage of Egan's model is to develop action plan to resolve the issues faced by the patient in the best way (Burke et al. 2016). The nurses by developing proper action plan would be able to strategically inform and help Tony to cope with his emotional and physical issues experienced as a result of testicular cancer.

In contrast to Egan’s model, where the nurses have the key focus to empower patients to cope with the health issues the motivational interviewing skill includes motivating the patients to deal with the health issues. As stated by Spencer and Wheeler (2016), motivational interviewing is the counselling process that is used by the nurses for patients who have ambivalent ideas about changing. This is because while interviewing them their contradictory ideas regarding health issues are resolved through proper assistance through motivates them to think in a different way, in turn, helping them to cope with the health issue. As argued by Ream et al. (2015), lack of motivation to think in a different way regarding health issues makes the patients unnecessarily worry about health. This is evident as Tony by continuously worrying about fertility and sexuality issues while accessing treatment for cancer may make him feel worried which may lead him to develop isolation and intention to take his life.

The key of motivational interviewing is to show empathy and discrepancy so that the patients are made to feel familiar by the nurses by showing them that the nurses are with them to help them cope with the problem (Braun et al. 2018). The implementation of this aspects would lead the nurses to make Tony feel that he is not alone to fight testicular cancer and the nurses are with him to help in each aspect to resolve his emotional and physical problems faced as a result of testicular cancer. The motivational interviewing informs the nurses to avoid argument and support self-efficacy of the patients (Britton et al. 2017). Thus, according to these aspects, the nurses caring for Tony require to avoid any argument when he reports his worries related to fertility and sexuality and patiently listen to his information. They, in turn, require to support Tony to explore stages of the problem-solving modes related to cope with the reported issues by him as a result of testicular cancer to help him change to resolve the raised issues.

Explaining the reason for choosing the approach

In order to provide effective help to Tony to assist him to cope with his mental and emotional problems experienced as a result of testicular cancer, the Egan's skilled helping model is to be used. As mentioned by Hall (2015), Egan’s helping model provides time and circumstance for the nurses to develop trustful relationship with the client. This is evident as the model in the first step indicates the nurses to explore the health problem being suffered by the patients from the individual’s perspective rather than only thinking on their own the problems that may be suffered by the patients. As argued by Piazza et al. (2017), in motivational interviewing it is seen that nurses often do not have adequate time to listen to the patients to develop an effective therapeutic relationship. This makes them reach conclusions to motivate the patients on their own rather than focusing on what the patient actually needs or demands. Thus, in case of Tony, by implementing Egan's helping model, the nurses would have the scope to understand the needs and demands to be fulfilled to manage the health issues being suffered by Tony as a result of testicular cancer.

In order to make the patients change their perspectives related to health issues, the nurses require to ensure the patients have cognitive clarity. This is required to make the patients understand what they need to do so that their present health issues may be resolved (Siu, 2018). Egan's model by challenging the views of the patients one at a time encourages them to think in a different way towards looking at the issues. For instance, as a result of cognitive clarity developed through challenging the patient's views, Tony would understand the importance of chemotherapy with the help of the nurses. This would lead the nurses to make him continue the treatment even after facing unpleasant feeling due to vomiting and nausea. As criticised by Shumway et al. (2015),the motivational interviewing works only when the client can fully participate in the process. It means that if Tony avoids to interact and participate fully in this process then he cannot be motivated to think differently. However, in case of Egan's model, it is seen that the nurses take personal initiative to make the patients fully participate from the initial stage in the process to change their perspective to cope with the health problems.

The follow-up process is crucial to change or modify the behaviour and thinking of the patient. As mentioned by Papadopoulos, Chow and Zhu (2015), in Egan’s model the nurses are asked to follow-up to understand whether the action plan developed by them is successful or not to resolve the health problem experienced by the individuals. This indicates that the nurses with the application of the approaches under the model for Tony would be able to understand which strategies are working well and which are not that need to be changed to resolve the health issues or problems faced by him as a result of testicular cancer. As argued by Krebber et al. (2017), in motivational interview no follow-up process is executed. Thus, the approach is not applied in case of Tony as the nurses would not be sure whether or not their taking healthcare approaches and information delivery to the patient has actually helped him to cope with the health problems aced as a result of cancer.

Reflecting on the lessons learnt

The application of Egan’s helping skill model is going to help in the initial stage to form a trustful and effective therapeutic relationship with the client (Lamb et al. 2017). This is because it allows the nurses to provide scope to the patients to inform in details from their perspectives the needs and demands to be fulfilled to make them feel healthier. Thus, this model provides the lesson that to form effective relationship with the client they are to be provided scope to interact and take their decisions. As stated by Kay (2018), Egan’s model helps the nurses to empower the patients by creating follow-up process. This leads the nurses to develop the lesson that they are to check their actions after implication to make sure they are actually able to create change in the behaviour of the patients like Tony which is required for them to easily accept chemotherapy treatment and cope with symptoms related to testicular cancer.

Egan’s skilled helping model also leads the nurses to take best decision and determine which decision is to be enacted first to ensure better health improvement of the patients (Guest, 2016). Thus, using the model provides lesson to the nurses regarding how to take proper decision in resolving health issues faced by clients like Tony in the best way. Egan’s model leads the nurses to develop therapeutic strategies by viewing the raised problems from the patients perspective (Burke et al. 2016). This provides lesson to the nurses that there are always two views of a problem one from the patient’s perspective and another from their perspective. Egan’s approach informs that proper attention is to be given to the patients to understand the nature of issues being faced by the patient (Magidson et al. 2019). Thus, it provides lesson to the nurses regarding the way to initiate effective therapeutic relationship with the client. Moreover, the approaches has helped to provide the lesson of importance of empathetic communication with the client in establishing successful therapeutic relationship. In future, I am going to take time to understand and listen to the needs and demands of the client before developing any care strategies for them. Moreover, I would develop follow-up process after implementing any strategies to help patients cope with their health problems.

Conclusion

The above discussion informs that Tony is suffering from testicular cancer which has made him feel insecure about his sexuality and fertility. Moreover, he is feeling unpleasant as a result of vomiting and nausea due to chemotherapy taken to resolve cancer. In order to resolve the problem, the Egan's Skilled Helping model is to be used. This is because it offers time as well as condition for the nurses to develop effective therapeutic relationship with the patient. Moreover, it offers information that follow-up process after implication of care services is to be executed to make sure their care approaches are successful to resolve the health problems faced by the patient.

References

• Braun, A., Portner, J., Grainger, E.M., Hill, E.B., Young, G.S., Clinton, S.K. and Spees, C.K., 2018. Tele-motivational interviewing for cancer survivors: feasibility, preliminary efficacy, and lessons learned. Journal of nutrition education and behavior, 50(1), pp.19-32.
• Britton, B., Baker, A., Clover, K., McElduff, P., Wratten, C. and Carter, G., 2017. Heads Up: a pilot trial of a psychological intervention to improve nutrition in head and neck cancer patients undergoing radiotherapy. European journal of cancer care, 26(4), p.e12502.
• Burke, M.G., Sauerheber, J.D., Hughey, A.W. and Laves, K., 2016. Helping skills for working with college students: Applying counseling theory to student affairs practice. Routledge.
• Burke, M.G., Sauerheber, J.D., Hughey, A.W. and Laves, K., 2016. Helping skills for working with college students: Applying counseling theory to student affairs practice. Routledge.
• Coolbrandt, A., Dierckx de Casterlé, B., Wildiers, H., Aertgeerts, B., Van der Elst, E., van Achterberg, T. and Milisen, K., 2016. Dealing with chemotherapy‐related symptoms at home: a qualitative study in adult patients with cancer. European Journal of cancer care, 25(1), pp.79-92.
• Guest, M., 2016. How to introduce yourself to patients. Nursing Standard (2014+), 30(41), p.36.
• Hall, C., 2015. Introduction to Nursing Theory. Essentials of Nursing Practice, p.157.
• Kay, J., 2018. Using the Chapelhow Framework to Deliver Nursing Care. Links to Health and Social Care, 3(2), pp.4-23.
• Krebber, A.M.H., van Uden-Kraan, C.F., Melissant, H.C., Cuijpers, P., van Straten, A., Becker-Commissaris, A., Leemans, C.R. and Verdonck-de Leeuw, I.M., 2017. A guided self-help intervention targeting psychological distress among head and neck cancer and lung cancer patients: motivation to start, experiences and perceived outcomes. Supportive Care in Cancer, 25(1), pp.127-135.
• Lamb, A.D., Thompson, S., Kinsella, N., Gerbitz, I., Chapman, E., Putt, L., Bennett, S., Thankappannair, V., Geoghegan, L., Wright, N. and Stirton-Croft, A., 2017. Aiming for a holistic integrated service for men diagnosed with prostate cancer–Definitions of standards and skill sets for nurses and allied healthcare professionals. European Journal of Oncology Nursing, 29, pp.31-38.
• Magidson, J.F., Regenauer, K.S., Andersen, L.S. and Safren, S.A., 2019. Chronic physical diseases. In Global Mental Health and Psychotherapy (pp. 259-277). Academic Press.
• Papadopoulos, A., Chow, A.P. and Zhu, Y., 2015. The Portrayal of Counselling on Television and YouTube: Implications for Professional Counsellors. Journal of Behavioural Sciences, 25(2), p.1.
• Piazza, M.F., Galletta, M., Portoghese, I., Pilia, I., Ionta, M.T., Contu, P., Mereu, A. and Campagna, M., 2017. Meeting psychosocial and health information needs to ensure quality of cancer care in outpatients. European Journal of Oncology Nursing, 29, pp.98-105.
• Ream, E., Gargaro, G., Barsevick, A. and Richardson, A., 2015. Management of cancer-related fatigue during chemotherapy through telephone motivational interviewing: modeling and randomized exploratory trial. Patient education and counseling, 98(2), pp.199-206.
• Riggall, S., 2016. The sustainability of Egan’s Skilled Helper Model in students’ social work practice. Journal of Social Work Practice, 30(1), pp.81-93.
• Rohleder, P., McDermott, D.T. and Cook, R., 2017. Experience of sexual self-esteem among men living with HIV. Journal of health psychology, 22(2), pp.176-185.
• Shumway, D., Griffith, K.A., Jagsi, R., Gabram, S.G., Williams, G.C. and Resnicow, K., 2015. Psychometric properties of a brief measure of autonomy support in breast cancer patients. BMC medical informatics and decision making, 15(1), p.51.
• Siu, M.Y., 2018. Empathy in Nursing: Understanding Patient’s Experience through Digital Storytelling. SF Nurs Health J, 2(2), p.2.
• Spencer, J.C. and Wheeler, S.B., 2016. A systematic review of Motivational Interviewing interventions in cancer patients and survivors. Patient education and counseling, 99(7), pp.1099-1105.
• Squirrell, B. and Hunt, J., 2018. A nursing student’s reflective account of decision-making in a school nursing setting. Nursing children and young people, 30(3).pp.90-111.
• Steven, A. and Redfern, N., 2017. Reimagining Healthcare: Egan Mentoring and the Changed Medical Mind-Set. International Journal of Qualitative Methods, 16(1), p.38.
• Stouten-Kemperman, M.M., de Ruiter, M.B., Boogerd, W., Kerst, J.M., Kirschbaum, C., Reneman, L. and Schagen, S.B., 2018. Brain Hyperconnectivity> 10 Years After Cisplatin-Based Chemotherapy for Testicular Cancer. Brain connectivity, 8(7), pp.398-406.
• Tamadoni, M., Janbozorgi, M., Azarbaijani, M., Ali, G. and Tabatabaei, S.K.R., 2017. A study to assess the effectiveness of training package and group counseling with framework of skilled helper model on social, intellectual and occupational wellness of the students. An International Peer Reviewed Open Access Journal For Rapid Publication, p.153.
• Taplin, S.H., Weaver, S., Salas, E., Chollette, V., Edwards, H.M., Bruinooge, S.S. and Kosty, M.P., 2015. Reviewing cancer care team effectiveness. Journal of oncology practice, 11(3), pp.239-246.