Running Head: SCHOLARLY ASSIGNMENT

Scholarly Assignment
Morayo Uzaka
822 206 132
NURS 209 0NC
November 20th 2014
Humber College Institute of Advanced Learning and Technology

Vivian Bearing is a 48-year-old woman who is an English Professor that is

extremely passionate about literature. She has just been diagnosed with advanced

SCHOLARLY

ASSIGNMENT
metastatic ovarian cancer that was not detected in stage I, II or III. Vivian undergoes
chemotherapy with an experimental combination of drugs designed for primary site
ovarian cancer at a full dose. She has no relatives and lacks a strong support system and
is being treated by Dr.Kelekian, clinical fellow Jason Posener who is one of her former
students and a nurse named Susie Monahan. She establishes a therapeutic nurse-client
relationship with Susan who turns out to be her support for the rest of her time in the
hospital. Throughout the movie, Vivian explains how she feels about both the disease and
treatment and recalls moments in her life. She reflects on how she treated people and how
literature was her life. Vivian decides she does not want to be resuscitated and later dies.
Pain in cancer patients can be direct pain from the cancer itself or pain caused by
the chemotherapy. It is evident that Vivian was experiencing severe pain because she was
curled up in a ball holding her abdominal area and gripping the sheets. Vivian went on to
say Im in terrible pain, (Wit 2011). The pain caused Vivian to be physically drained.
Towards the end of the movie, Vivian was no longer physically active; she just lay in bed
and moaned while she gripped the sheets. Due to the fact the Vivian was in so much pain,
she was unable to get adequate rest and she was emotionally drained. Pain is a significant
health challenge because it reduces the quality of life.
Nausea and vomiting were a significant effect of the health challenge for Vivian
because she continuously felt nauseous and often vomit. Vivian stated, Im going to barf
my brains out, (Wit, 2001). Nausea and vomiting cause discomfort and can also cause
patients to loose appetite. When Vivian was seen vomiting she stated, Whats left? I
havent eaten in two days, whats left to puke? (Wit, 2001). The nausea and vomiting
can be a result of the release of serotonin in the GI tract, which stimulates the

SCHOLARLY

ASSIGNMENT
chemoreceptors triggers, and the vomiting center in the brain and direct injury to the
epithelial cells, (Lewis et al, 2013). Someone has to come and measure this emesis and
record it on a chart of my intake and output. (Wit, 2001). Vivian made this statement
after she finished vomiting. It is important that intake and output is recorded to ensure
volume adequacy. Assessing for signs of dehydration is also important.
Fatigue is a significant effect on health for Vivian because we can see throughout
the movie she was drained. Fatigue is a common complaint of patients with cancer, and
91% of those who experience fatigue report that it prevents a normal life, (NHMRC,
2003). Vivian would lay in bed, barely moving and not wanting to engage in anything.
When Susan came to the room for Vivian to go for an ultrasound, Vivian was frustrated
and her voice was drained when she said, No not now ... No more tests weve covered
that I do not want to go now! (Wit, 2001). Fatigue is common amongst cancer patients
and can be caused by either chemotherapy, pain, weight loss or other factors, (Lewis et al,
2013). It is evident that Vivian is experiencing fatigue by her body language and the tone
of her voice. It was clear to see that Vivian is both physically and mentally drained.
The fear of death/unknown is common for any cancer patient to experience. In the
beginning of the movie, Vivian stated, I have stage IV metastatic ovarian cancer, there is
no stage V. Oh and I have to be tough, it appears to be a matter, as the saying goes, of life
and death. (Wit, 2001). At this point, Vivian was very nonchalant and did not seem
bothered. She went on to say that she was tough. It is clear to say that Vivian had hope
that the chemotherapy would cure the cancer. It was not until later on during her
treatment process that she began to really fear that she might be dying. Im scared, I
don't feel so sure of myself anymore,(Wit, 2001). Vivian made this statement to Susan

SCHOLARLY

ASSIGNMENT
while she was weeping in tears. Fear is a common feeling associated with dying.
Specific fear associated with drying may be fear of the unknown, (Lewis et al, 2013). It
is evident that Vivian came to the realization that she was not in control of her life and
she may be dying, I want to hide, I just want to curl up in a little ball. (Wit, 2001). After
making this statement, Vivian went under her covers, curled up and began to cry.
As time went by, regrets began to set in. Vivian constantly reflected on who she
was and what she valued as an individual. It is common for dying patients to review their
life as it comes to an end. They review their intentions during life, examining actions
and expressing regrets on what might have been. (Lewis et al, 2013). It is clear that
Vivian experienced regrets, Now I suppose, we shall see how the senior scholar
ruthlessly denied her simpering students the touch of human kindness she now seeks,
(Wit, 2001). Vivian was thinking about how her student asked for an extension on his
paper because his grandmother died and she was very unsympathetic. Now that she is the
one dying, she wants to be cared for and receive the affection she never showed to her
students. She realized she favored research over humanity. Jason displayed the same
mentally towards her that she regrets showing her students.
It is evident that Vivian is experiencing anxiety related to the new diagnosis of
cancer. Symptoms of anxiety can be heightened physical arousal, sleep disturbance,
impaired concentration and even generalized worry, (NHMRC, 2003). Vivian is
consistently thinking about the fact that she is in the hospital because of cancer. Vivian
generally worries about the cancer putting an end to her life. The pain that she
experiences makes it surreal to her.

SCHOLARLY

ASSIGNMENT
The area of priority for holistic nursing care is pain. Pain causes suffering and
reduces quality of life, (Lewis et al, 2013). It is important for Vivians pain to be
managed so that she can receive quality-nursing care. Pain will cause increased suffering
for the patient. Consequences of untreated pain include unnecessary suffering, physical
dysfunction, psychosocial distress (which manifests in such forms as anxiety or
depression), impairment in recovery from acute illness and surgery, immunosuppression,
and sleep disturbances, (Lewis et al, 2013). Vivian is already experiencing anxiety and
we can see before she dies she is crying and weeping about how much pain she is in. If a
client is in pain, they will not be able to engage in the care. Pain can result in impairment
of vital systems in the body. To promote healing, the clients well being is significantly
important.
With a thorough pain assessment, the nurse is able to get a better understanding of
the pain the client is experiencing. A thorough assessment includes gathering vital data
from the patient. Pain is subjective. With the acronym PQRSTU, the nurse is able to
gather a sufficient amount of data. P stands for precipitation; this is what causes the pain,
an exercise, watching TV? This information can help HCP have an idea on when and why
it starts and preventative measures. Q is for quality; this in regards to what the pain feels
like to the client. Characteristics such as throbbing, aching, stabbing, sharp or however
the patient feels it is to them. R is for radiation. It is important for the patient to inform
the nurse whether the pain goes from one location to another. S is for scale. The patient
rates the pain from 1-10 with 1 being the least painful and 10 being the most painful. T is
for time, this is when the pain starts, whether It be in the morning or evening. U is for

SCHOLARLY

ASSIGNMENT
understanding, an understanding of what the pain means to the patient is very important.
The patient knows their body best.
Drug therapy is important for the pain to be controlled. I would ensure Vivian
receives patient controlled analgesic (PCA). Opioids such as morphine and
hydromorphone are administered through the PCA. It is important for the nurse to do a
thorough assessment after the medication has been administered such as a complete set of
vital signs. It is very important for the nurse to monitor the respiratory rate as well as
LOC because these opioids result in respiratory depression as well as sedation. Patient
education should be provided on how to use the pump and an assessment of whether the
PCA achieved the therapeutic outcome should be noted. Proper documentation of how
much medication was administered should be provided.
Effective communication between the patient and the nurse are essential because
most patients are uncomfortable with reporting pain to their nurse because they may feel
they are complaining or will not be believed, (Lewis et al, 2013). If a patient does not
communicate the pain they are experiencing, the nurse will not be aware and the pain will
be left untreated. This will cause the patient to suffer. Vivian should be ensured that the
nurse is there to promote her well being so communication is important.
Radiation therapy is one of the most common treatments for cancer. This therapy
can be performed by oncologists and will help in pain and management of tumors. The
goals of radiation therapy are cure, control and palliation. Radiation therapy can be used
in combination with surgery, chemotherapy and biological therapy. With surgery it helps
to loosen the size of the tumor so it can be removed and it also helps in killing the

SCHOLARLY

ASSIGNMENT
remains of the tumor after the tumor has been removed. Radiation therapy is good in
relieving the pain of the patient.
A psychologist or psychotherapists can perform relaxation therapy; it helps the
patient to free the mind, which helps in distracting the pain. It is a way for the patient to
fall into a deep sleep and relax the body. There are different types of relaxation therapies
but for Vivian I would focus on breathing, meditation and imagery. Relaxation breathing
is when the patient controls their breathing in a rhythmic pattern. It prevents tension from
being built and relaxes the body. Meditation is a process of escaping mentally. You block
out whats going on around you and focus on your mind. Imagery is being creative with
your mind and producing images that have a calming affect on your body. (Lewis et al,
2013). It is very effective for stress reduction and pain relief.
Physiotherapist performs heat or cold therapies, where they apply heat or cold to
your skin. Both heat and cold therapy are used to relieve pain. I would specifically use
cold therapy for Vivian. Cold therapy is said to be more effective than heat therapy,
(Lewis et al, 2013). Cold therapy helps in numbing the pain.
Wellspring Chinguacousy is an organization set up for cancer patients and their
families to support one another and to gain support. Different programs are offered that
can dedicate to ones needs. A support system is very important in a cancer patient
because they need the emotional support. Perceived lack of support from family and
friends may be associated with greater psychological distress. (NHRCR, 2003) Support
is essential in coping with new diagnosis.

SCHOLARLY

ASSIGNMENT
Canadian Cancer Society is an organization set up to provide assistance to a
person with cancer. The society provides transportation, support, further information and
referrals for patients. This will help keep Vivian informed and receiving help if needed.
Vivian does not have to feel alone and put the burden on herself. Canadian Cancer society
is there to lend a helping hand.

SCHOLARLY

ASSIGNMENT
References
Canadian Cancer Society. (n.d.). Our Mission, Vision and Values. Retrieved September
29, 2014, from http://cancer.ca
Canadian Cancer Society. (n.d.). Our Mission, Vision and Values. Retrieved September
29, 2014, from http://cancer.ca
Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2013).
Medical-Surgical Nursing in Canada: Assessment and Management of Clinical
Problems. Elsevier Canada.
National Health and Medical Research Council. (2003). Clinical Practice Guidelines for
the Psychosocial Care of Adults with Cancer. Camperdown, New South Wales, Australia:
National Breast Cancer Centre.
Nichols, M. (Director). (2001). Wit [Motion Picture]. Unites States of America.
Wellspring. (n.d.). About Us: Wellspring Chinguacousy. Retrieved September 29, 2014,
from www.wellspringching.ca