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Use of Illness Narratives of Patient/Client Journey

Narratives are personal accounts about the experiences of illness and health told inform of stories to other people. Narratives play an important role in health care system, especially in psychotherapy and psychiatry. Many clients have provided their individual accounts about their experiences in illness and health. Narratives provide an inquiry tool for ethical, social, and therapeutic practice in the care of clients. Narratives provide useful interpretation and exploration means as well as formation of consensus between the practitioner, families, and clients. The subjective role of client’s narratives in health has drawn the attention of scholars and clinicians. Studies have shown that personal accounts of experiences in illness are important in developing more equitable and ethical practices in health care. Narratives play the role of therapeutic tool in guiding nurses in clinical practices. The role of client narratives in therapeutic procedures has been examined in different populations like survivors of traumatic conditions and patients of cancer (Mishler et al. 1981, p. 68).

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Biomedicine

According to the National Research Council Staff (1998, p. 15), the branch of medical science that utilizes natural science and biological principles in clinical practices is referred to as biomedicine. Physiological processes that use methods from physics, chemistry, and biology are also studied in biomedicine. The aim of the approach is to understand the process and consequences of molecular interaction. The aim of studying physiological processes is to invent new diagnosis and treatment methods. New products aimed at improving the quality of heath care have been invented by private and public research organizations over the world. Some of the new products are in the process of manufacture while others are on sale in markets. These innovations have great impacts on the system of heath care. However, the safety, benefits, and risks associated to use of these methods is an issue of major concern.

Biomedical Model

Models have been developed to look at health-related theories but biomedical model brings out an interesting coverage of the topic. Biomedical model looks at health from an individual point of view. In this case, the body is a machine with constituent parts that could be repaired or manipulated. Biomedical model helps people to understand the functions of the body, both normal, and abnormal. These functions range from genes to phenotype. This model also seeks to provide preventive solutions or therapeutic practices to human ailments (National Research Council Staff 1998, p. 23). Biomedical model notes that age, genes, and behavior can lead to diseases. Biomedical model focuses on the organic symptoms that the disease shows. In some cases, the medical practitioner tries to match the symptoms with medicines. The biomedical model also focuses on the perception that proper treatment can be offered only in medical centers. This perception at times proves challenging to patients. In the case of Mrs. Summer, breast cancer is found in the history of the family because it is the same diseases that caused the death of her grandmother. The most important thing for Mrs. Summer and the whole family is to carry out earlier examinations to determine if other members of the family may be carrying the genes that cause breast cancer. Early detection and treatment will minimize death from breast cancer. This information should be passed across generations to ensure that females go for frequent checks early enough (Birn, Pillay & Holtz 2009, p. 89).

Health and Illness behavior

Health behavior refers to positive and preventive measures that people take to promote physical well-being. Traditionally, health behavior focused on methods of preventing the occurrence of diseases such as hypertension screening, prophylactic dentistry, immunizations, and medical checkups. It also included research behaviors such as nutritional practices, substance abuse, adherence to medication, and smoking cigarettes. The main focus of health behavior is the origin and modification of risk behaviors that endanger human health. There are various factors that influence health behavior. Individuals and societies vary in ways of diagnosing, treating, and explaining illness. Some people may rest and seek treatment at home, get advice from a relative, neighbor, or a friend, while others may seek for help from a folk healer, doctor, or a priest (National Research Council Staff 1998, p. 30).

Importance of illness narrative

Narratives have played a major role in the history of nursing and its use will continue. Narratives have for long been used as clinical notes in nursing by practitioners to communicate the health condition of patients among themselves as well as between practitioners and patients. A portion of the history of the patient is derived from information gathered from the narrative. The purpose of illness narrative is to transform illness events and create a world where illness in not viewed with a negative perception. It helps individuals to reconstruct their lives history in case they are chronically ill. Illness narratives help an individual to understand the condition of his or her illness. There is an increase in need to carry out patient narratives. Changes in disease patterns and medicines have contributed to creation of these narratives. Increased illness has led to the increased demand for chronic illness narratives.

Mrs. Summer’s Narration

Mrs. Summer realized a lump in her breast that triggered her to go for a medical check-up. She did not seek self-prescription like some patients do when they realize they have certain symptoms. Her cognitive recognition of the symptoms as signs of breast cancer made her go for the check-up. In her mind and from what she had heard and read, she developed fears that the lump in her breast could be a sign of breast cancer. She had concerns for her family and the emotional implications that the cancer will cause. She, however; realized that going for the tests was a necessary step.

The first testing did not go well because of miscommunication between the different medical practitioners at the health centre. During the time of diagnosis, there was a communication breakdown between pharmacists and the patient service coordinators. Relevant information about the symptoms that Mrs. Summer was experiencing were not clearly shared between the two specialists. This action led to an improper medical prescription to Mrs. Summer. The assumption was that the lump was nothing serious. According to Strom, Buzdar, and Hunt, “the services involved in breast cancer care require the patient to visit several centre’s” (2008, p. 2). The discomfort that the lump created in Mrs. Summer, clouded with psychological unrest, caused her to seek an alternative medical check-up in a different health care.

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Naturally, according to Kaelin and Coltrera (2005, p. 4) the breast symbolizes “beauty and admiration.” The breast is also a source of milk for babies. However, when affected with cancer, the breast becomes a risk to other parts of the body and the only way to prevent the cancer from spreading is by elimination of the breast. According to Kaelin and Coltera (2005, p. 1), women who have been diagnosed with breast cancer find the news “shocking and dreadful.” This was not different with Mrs. Summer who had gone to get the results with her long time family friend Naomi Thompson. Mammogram tests similar to x-ray, were carried out. The mammogram exposes various interior tissues of the breast. Features similar to symptoms of cancer were present in her breast. The doctor told Mrs. Summer that she had breast cancer. Further tests had to be done to confirm this result. Mrs. Summer could not believe what she heard; she decided to go for an ultrasound. An ultrasound is a test for breast cancer. It is carried out when a person suspects the results found from a mammogram (Kelman & Coltrera 2005, p. 9). It visualizes small areas of the breast accurately. Mrs. Summer’s breast had cysts, which appeared as black holes.

The third test involved carrying out a biopsy to verify the presence of this disease. According to Kelman and Coltrera (2005, p. 15.) a biopsy involves “removing a tissue sample for further testing using a microscope.” The tests carried out confirmed that Mrs. Summer had breast cancer. The worst was yet to come. The cancer type was Invasive Ductal Carcinoma (ID). According to Kelman and Coltrera (2005, p. 10), this cancer “breaks the duct walls and invades surrounding tissues of the breast.” This cancer spreads through the blood vessels. These vessels facilitate blood flow to and from the breasts. The cancer had widely spread in her breast. The diagnosis made the narrative take a turn; the disease could not be cured. Management was, therefore, the appropriate move making it long-term condition. Primary care was, therefore, the vital step to take in this case as the disease could not be treated (Bury 2001, p. 36).

The only solution was to cut off the breast to stop it from spreading. This solution is an outcome of a meeting between the medical practitioners without the inclusion of Mrs. Summer. Other than Invasive Ductal Carcinoma (ID), Kaelin and Coltrera (2005 p. 11) highlight “Ductal Carcinoma in situ (DCIS) and Invasive Lobular Carcinoma (IL) as other common forms of breast cancer. Medullary Carcinoma, Tubular Carcinoma Papillary Carcinoma, Paget’s disease of the Breast and inflammatory Breast Cancer (IBC) are the uncommon forms.” Bury (2001, p. 267) states that a doctor should be the first person to console and comfort a patient because he or she “understands what the patients feels.” This move, however; did not work with Mrs. Summer, who remained fixed on the spot for more than five minutes without moving an inch. She silently went through the causes of breast cancer as highlighted by Christopher Li. These causes, according to Li (2010, p. 111), include “hormonal contraceptives.” Ovarian hormones also cause breast cancer. Estrogen, for instance, induce tumors to the mammary gland.

In line with the NMC code or professional conduct, which champions for confidentiality, the patient’s identity in this narrative is withheld. This is meant to safeguard her privacy. The name used here in, is not the real name of the cancer patient. This story results from a direct narration of events by the patient to the writer. Family history analysis is also one way of predicting breast cancer occurrences among women. The doctors did not involve Mrs. Summer in the decision-making as is advised in the NMC Code of Professional Conduct. An adherence method was used as she was just briefed of the treatment she will need.

According to the National Centre for Complimentary and Alternative Medicine (NCCAM), Complementary, and Alternative Medicine (CAM) refers to health care systems, products, and practices, which are not part of conventional western medicine. These are preventive and treatment measures based on techniques and philosophies used in non-western countries. These practices are referred to as complimentary or alternative because they are used in place or together with western medicine. Mrs. Summer was given a couple of Complimentary and Alternative Medicines (CAM). Her friend in Africa brought her herbs that could cure breast cancer. She was to use these herbs for two weeks. This however could not cure her. Religious leaders from her church also visited her in the hospital to pray for her. This form of CAM was allowed by the doctors as stipulated in the NMC Code. This action aimed at giving her courage and strength to withstand the hard times ahead (Li 2010, p. 115).

Demographic Information and diagnosis

Peshkin (2007, p. 69) says that it is necessary for people to undergo genetic counseling to help them “understand and adapt to the condition they are in.” In this situation, an analysis revealed that Mrs. Summer had inherited the breast cancer. This is because by reviewing the family history, it was discovered that Mrs. Summer’s grandmother died of breast cancer. The grandmother’s cause, however, was negligence because the discovery was late. These findings led to the testing of Mrs. Summer’s daughter to prepare early treatment or prevention of breast cancer. Luckily, she was negative.

Socioeconomic issues have for long been related to various causes of poor health. Psychological stress, poor diet, and genetic differences are the significant socioeconomic factors that cause diseases. The environment that one lives in and his childhood lifestyle could also lead to a person being sick in his or her adulthood (Bury 2001, p. 66). Issues of poverty, poor relationship, and poor achievements were unheard in Mrs. Summer’s life because she had a perfect childhood. Age was also a factor because there is a difference between biological and historical age. Breast cancer often occurs in mid-aged women compared to the young ones. Mrs. Summer’s life had taken a turn, and she had to adapt to it. Smith, however; states that the lifestyle linked with the wealthy people, for instance, much travelling, and interaction with different people would lead to health infections. Despite access to food, the aristocrats are still vulnerable to sickness. The wealthy, however; have access to resources that could help them solve health issues compared to the poor. This was the case with Mrs. Summer.

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Mrs. Summer did not experience much discrimination and stigma because of her wealth. Most of her friends stood with her and supported her both psychologically and emotionally. Mrs. Summer joined a professional group to help her deal with mental stress. The mental stress could be caused by medical diagnosis (Collier & Kalathil 2011, p. 85). In this case; the wealthy have the power to get the kind of treatment they want. Mrs. Summer did not have any difficulty in seeking medication because she was financially stable. With the vast wealth at her exposure, Mrs. Summer got proper medical attention. Mrs. Summer received support from her caring husband and children. Her friend stood with her even in times of difficulties for instance, during diagnosis in the United States.

The behavior of taking medicine is not permanent. It is influenced by environmental and external factors, such as interaction with health professionals as well as societal practices and policies. The degree to which a patient follows medical advices correctly is known as compliance. Compliance means following doctors instructions when taking medicines.

According to Erickson at al. (2009, p. 112), there was a switch from “using the word compliance to adherence.” This is because compliance shows that the patient is passively taking prescription given. In this case, the patient takes the medicine according to doctor’s directives. This comes into play mostly when the patient is incorporative. Adherence stands for a situation in which a patient takes a medical prescription as advised by the doctor (Eriksson 2009, p. 36). Adherence requires the patient to cooperate with the doctor and take the prescription given. In concordance, there is a clinical encounter involving the patient and the doctor. In this case, the patient’s view is considered, and a consultation is made to satisfy the patient’s needs.

Physician/patient relations refer to interaction between a patient and his or her physician. Confidence and mutual and mutual trust is very important in such a relationship. The relationship begins the minute the physician takes the responsibility of providing care to the patient. It is the duty of the physician to inform the patient about his or her condition, and provide necessary care to the patient. Sometimes doctors make abrupt decisions concerning treatment of patients without patient involvement because of various reasons. Some physicians tend to think that discussing with patients is a demanding and time-consuming activity. Other physicians are frustrated in life. Failure of doctors to handle patients carefully contributes to a feeling of stigmatization and rejection. The quality of services offered to patients depends of the relationship between the patient and the physicians. Even if the patient adheres to doctor’s prescription, wrong diagnosis and medication will have negative effects on health. In the case of Mrs. Summer, the clinicians did not involve her in decision making on treatment matters. Mrs. Summer was discriminated against by doctors by failure to involve her in decision making a mistake which made her condition worse (Pozgar 2011, p. 63).

The Life Course theory

In 1960, an approach known as life course theory was developed to examine the lives of people within cultural, social, and structural contexts. It is also referred to as life course perspective, or life course theory. The approach is used to examine the history of individual’s life as well as examination of past events and the effects they have on future events and decisions like divorce, marriage, incidence of diseases, and participation in crimes. The main focus of the theory is the link between history, socioeconomic factors, and individuals. The approach covers a wide range of observations such as public health, biology, demography, developmental psychology, economics, and history (Smith 2003, p. 56).

According to Smith (2003, p. 65), the number of breast cancer cases is on increase. For instance, more than 230, 000 women were diagnosed with breast cancer in the United States in 2011. Environmental exposure is a predisposing factor for the prevalence of breast cancer. According to Institute of Medicine (IOM) most of the studies have concentrated on breast cancer and its related risk factors rather than its causes and preventive measures. A life course approach is necessary in the study of breast cancer because current studies show that the chances of contracting this chronic disease at mid-life are high. According to IOM, some of the environmental factors that increase the chances of contracting breast cancer include ionizing radiation, weight gain after menopause, and combination of progesterone-estrogens hormone therapy. Increased physical activities reduce the chances of contracting breast cancer. According to IOM, women can reduce risks of cancer through avoiding smoking, reducing consumption of alcohol, increased physical activity, and minimizing weight gain to prevent breast cancer after menopause. Apart from application of life-course approach to the study of breast cancer, equipments of carrying out tests should be improved; effective preventive interventions should be developed as well as improvement in communication and necessary approaches to risks factors related to breast cancer (Smith 2003, p. 70).

Sick role refers to social behaviors portrayed by the sick and other members in the society. The term “sick role” was invented in 1950s by Talcott Parsons a sociologist in America. Parsons outlined rights and obligations entitled to the sick in the society. He argued that the sick should be excluded from the normal duties. He argued that the sick should make efforts to get well. This includes seeking cooperating and seeking for medical assistance from professionals. Mrs. Summer efforts to get well can be seen from the action of leaving her business to her husband to avoid stress as well as following doctor’s medication. In her narration, Mrs. Summer believes that everyone should take the matter of health seriously. She says that we cannot say we are healthy just because we are not ill. She agrees that health is “a complete, physical, mental and social well-being.” Romano reiterates this by defining health as the “ability of an organism to maintain a life balance that is free from pain” (Mishler et al. 1981, p. 3).

Mrs. Summer also advices every person to carry out regular medical examinations to make sure all is well. Concerning the biomedical model, she insists that there should be dialogue and negotiation between medical practitioners and patients. This action will make everyone in agreement with the medical decisions taken. The biomedical decision should also focus on alternative treatments to fight a disease instead of relying on one resort. Mrs. Summer says that she was not given the chance to choose her medication. As days pass by, Mrs. Summer’s strength seems to leave her. The skin of Mrs. Summer is pale and her eyes are dull. Evidently, Mrs. Summer’s breath is leaving her slowly as she clearly states, “my money cannot save me anymore, am living by faith and hopes for tomorrow (Strom, Buzdar &Hunt 2007, p. 100).

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Conclusion

Chronic diseases like breast cancer have increased death rates in the modern world across all countries. Breast cancer is especially common in mid- ages. The reason why many people are dying is ignorance. Most of these diseases are detected when it is too late making treatment impossible. People should be taught to understand the importance of visiting clinics frequently for checkups so that in cases of such diseases, they are detected, and treatment administered in the initial stages. This will help reduce death rates caused by chronic diseases.

List of References

Beckwith, S & Franklin, P 2011, Oxford handbook of prescribing for nurses and allied health professional, Oxford University Press, New York.

Birn, A, Pillay, Y, A & Holtz, T 2009, Textbook of international health: global health in dynamic world, 3 edn, Oxford University Press, New York.

Bury, M 2001, Illness narratives: fact or fiction? Sociology of health & illness, Blackwell Publishers, London.

Collier, B & Kalathil, J 2011, Recovery & resilience: African, African-Caribbean and South Asian women’s narratives on recovering from mental distress- mental health foundation & survivor research, Mental Health Foundation, London.

Eriksson, T et al. 2009, Drug related problems in the elderly, Springer + Business LLC, New York.

Jasper, M 2007, Professional development, reflection, and decision-making, John Wiley & Sons, New York.

Kaelin, C & Coltrera, F 2005, Living through breast cancer: what a Harvard doctor and survivor want you to know about getting the best care while preserving your self-image, McGraw Hill Companies, New Jersey.

Li, C 2010, Breast cancer epidemiology, Springer Science+ Business Media, New York.

Lupton, D 1994, Medicine as culture, Sage, London.

Mishler, E et al. 1981, Social contexts of health, illness, and patient car, Press Syndicate of the University of Cambridge, New York.

National Research Council Staff 1998, Biomedical models and resources: current needs and future opportunities, National Academy Press, New Jersey.

Peshkin, B 2007, Genetic counseling in breast cancer, IOS Press, Amsterdam.

Pozgar, G 2011, Legal aspect of health care administration, Jones & Bartlett Publisher, California.

Riggar, TF & Maki, D 2004, Handbook of rehabilitation counseling, Springer Publishing Company, New York.

Smith, G 2003, Health inequalities: life course approach, The Policy Press, London.

Strom, E, Buzdar, A &Hunt, K et al. 2007, Breast cancer, 2 edn, Springer Science, New York.

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