Running head: THE DOCTOR

The Doctor
Rajinder Kaur
821-332-236
Humber Institute of Technology & Advanced Learning
NURS 360: Practical Nursing Theory 3
Johanne Hayes
November 19,2013

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The Doctor
Summary of the movie
Dr Mackee is a successful surgeon. For a short period of time he had cough.
Therefore, he sees an ENT doctor. After examining, the doctor recommends for biopsy,
and biopsy confirms that he has laryngeal tumor. He has to go for radiation therapy.
However, he is confident that after radiation therapy his laryngeal tumor will get cured.
So, he continues working until one day when during a surgery he begins to feel sick and
leaves the operation room. While going through the emotional distress and depression
caused by the diagnosis of cancer, he finds comfort in the company of a co-patient.
Comment [HC1]: Summary satisfactory.
Sentences are incomplete which makes it hard' for
reader to follow

Physicalleffect~~!

(;l!l!c~.

~_ _ _ _ _ _ _ _ _ _

Comment [HC2]: Good discussion. Would like

to see greater development of your ideas-in this
section.',

When people are facing a cancer diagnosis and undergoing cancer treatment they have
to cope

tip

with many physical side effects. In the beginning Dr Mackee has swelling and

inflammation in his throat for some period of time. He is always coughing and clearing
his throat. One day when he is coughing blood comes out of his mouth.
Laryngeal cancer begins to affect Dr Mackee's functional ability. One day during a
surgery he begins to feel sick and had to leave the operation room.
Dr Mackee begins to deal with the effects of cancer such as low strength
and fatigue. At home when he is in bed with his wife, he is very tired and falls asleep
immediately. It begins to affect his sexuality and intimacy with his wife.
Psychosocial effects of Icance~
A diagnosis of cancer presents many challenges. Influence of emotional and social
issues is great in a cancer patient. After being diagnosed of cancer when Dr Mackee's
wife supports him by saying that they would beat the cancer, he reacts and says that it not

Comment [HCl]:

Good discussion of ideas

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The Doctor
a theme game that they will win. It is a cancer. A sense of uncertainty takes over him and
he starts feeling like a loser.
In spite of his telling the hospital staff that he is a doctor in this hospital, like any other _
client Dr Mackee has to wait for hours in waiting room, and fill the forms over and
over. Dr Mackee who is suffering from emotional insult provoked by cancer diagnosis
feels powerless and irritated. In addition to that uncertainty about getting his voice back
after surgery makes him suffer from distress.
While struggling with emotional distress and depression, caused by the effects of
cancer, Dr Mackee develops and intimate relationship with a co-patient and finds
comfort in her company. Dr Mackee's wife gets upset, and is unable to understand the
relationship between the two. She wants to be with him in his health crisis, but feels left
out, confused, and lonely.
Area of priority for holistic Inursint C~!~
Dr Mackee, the client looks worried, distressed, and seems like continuously fighting
with his spirit. In order to support these effects of health challenge, a nurse needs to
develop strategies that can help the client in getting cured physiologically as well as
psychologically. On asking Dr Mackee that what prompted his doctor to laryngectomy,
nurse finds out that the client has laryngeal cancer. The initial treatment with radiation
therapy did not show satisfactory results. Therefore, he has been recommended for
laryngectomy. The nurse further asks the client if he is worried after being diagnosed of
cancer and what is his biggest concern regarding it. The nurse finds out that the client is
distressed because he thinks that after surgery whether his voice will return back or not.
Dr Mackee is a surgeon and has a successful career. Unlike many people voice is not just

Comment [HC4]: Good discussion

This section could be more focused and succinct. It
is not clear exactly what the priority for.nursing care
'is as many details are provided.

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The Doctor
a tool for communication for him, but a feature that expresses his personality and
profession. To help the client in seeing cancer as a challenging experience and a

treatment of laryngeal cancer has evolved significantly. With better diagnostic procedures
external partial or organ preservation has become possible through laryngeal surgery.
(Deschler, 2004). Voice is rehabilitated through surgical voice restoration, and initially
after surgery there is total loss of voice. However, there are post laryngectomy
communication options such as oesophageal voice, artificial larynx ( electro larynx) or
communication aid, writing and mouthing. (Evans, Carding, Drinnan, 2009).
The nurse makes the client understand that the main goals of cancer treatment are to
cure the cancer and preserve the functional outcome. He is encouraged to ask questions to
the doctor in order to make his doubts and concerns clear. He is informed about the
community resources from where information can be obtained about the follow up
treatment after surgery, evidence of successful voice rehabilitation, and levels of patient
satisfaction.
Nursing specific ~ntervention~
Fear of losing voice causes high distress in clients with laryngeal cancer who have to
go through surgery. The client, family members, and friends are educated that there is a
systematic preoperative assessment done by the surgeon and the speech pathologist. The
assessment is done to reduce complications and increase the success rate of
tracheoesophageal voice restoration. This assessment is done to identify those candidates
on whom this procedure can be applied, and criteria of selection is based on factors such
as physiologic or structural abnormalities. If these factors have some problem, they can

/_

Comment [HC6]: a lot of the discussion here is

around interprofessional care andreferrals to other
health professionals. Would like to see greater
discussion of nursing specific interventions with
evidence to support.

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The Doctor
hinder in the development of satisfactory tracheoesophageal speech. However, early
recognition and management of these factors can shorten the recovery time to achieve
voice rehabilitation and functional communication. (Deschler, 2004)
The client, family and friends are informed that Tracheophageal esophageal voice
restoration method is the most referred method for voice rehabilitation, and has gained
worldwide acceptance. To build up confidence and trust with Tracheoesophageal voice
restoration method, client is encouraged to make a list of queries and concerns with the
help of nurse, family and friends regarding the rehabilitation of voice after surgery. To
initiate the nurse can give some examples of questions such as
1 Describe your biggest fear about treatment.
2 What are the possible side effects of treatment?
3 How long will I receive the treatment?
4 How will my treatment affect my usual activities?
5 Will I be able to work?
Further, nurse should intervene to find the answers to client's questions with the help of
medical oncologist, surgical oncologist and speech pathologist. Genuine answers will
help in reducing client's distress regarding voice rehabilitation. Easing distress and
behavioural care supports psychological functioning and facilitates lifestyle changes.
There are some common problems that may occur in clients after surgery. Therefore, a
meeting with an oncology social worker can provide variety of services to the client such
as councelling, home care, coping skills and life style changes, support groups, financial
concerns and community resources. The client can obtain information from community
resources regarding treatments and tests, side effects, quality of life, after treatment and

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The Doctor
survivorship, expert information, cancer news and meetings, medical illustrations gallery,
advocacy and policy. Access to information helps the client in coping up with emotional
difficulties such as anxiety, depression, and distress.
Inter professional collaborative care
The diagnosis and treatment of cancer involves a team of health care professionals.
The inter professional collaborative approach combines the skills of different disciplines
and provides best possible care to the client. Hence, the collaborative care approach
includes the three following profesionals.
Medical Oncologist: A medical oncologist is specialized in treating cancer with
medication. The doctor explains the client about the type of cancer and the stage
of cancer. The client is further informed about the treatment if it is surgery or
radiotherapy. The medical oncologist acts as a coordinator of medical
treatment team, and keeps the track of various tests and follow up exams done by
other professional.
2

Surgical Oncologist: A surgical oncologist is a surgeon who specializes in the

surgical treatment of cancer and malignant diseases. The surgeon explains to the
client about laryngectomy and initial loss of voice, and how it can be rehabilitated by
surgical voice restoration. A surgical oncologist does systematic preoperative
assessment with the speech pathologist who evaluates the client's vocal quality,
range of pitch, presence or absence of regional speech area as it helps ill planning
treatment after surgery.
3 Oncology Social Worker: An oncology social worker is an important member of
inter professional collaborative team. An oncology social worker understands that

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The Doctor
effects of cancer affect each person in a different way. The responsibilities of an
oncology social worker's job includes attending the needs of the whole person,
offering advice to family and friends, helping the client in adapting the changes in
role and responsibilities, assisting in adjustment to life after treatment, acts as a
bridge between client and medical care team. An oncology social worker helps people
find resources for practical help such as referral to the financial aid office of the
hospital, how to apply for disability benefits, and explains about the rights that are
covered under Family Medical Leave Act (Cancer.Net, 2012, April).
Community lResource~
1

Canadian Cancer Society

55 St.Clair Avenue West, Suite 500
Toronto, ON
M4V2Y7

Email: toronto@ontario.cancer.ca
Telephone: 416 488 5400
Fax: 4164882872
2

Princess Margaret Cancer Centre

610 University Avenue
Toronto, ON
M5G2M9

Community resources have patient and family education program, support and
services program and emotional support program to help cancer patients.

Comment [HC7]: Need to see a discussion as. to

how these resources will address the chosen priority.

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The Doctor

References

Cancer. Net. (2012, April). The Oncology Team. Retrieved from http://
www.cancer.net!all-about-cancer/newly-diagnosed/find-

oncologist! oncology-team

Deschler, D.G. (2004). Voice following laryngeal cancer surgery. Otolaryngologic

Clinics of North America, 37(3), 507-677.

Evans, E., Carding, P., & Drinnan, M. (2009). The Voice Handicap Index with post
laryngectomy male voices. International Journal Of Language & Communication
Disorders, 44(5), 575-586.
doi: 10.1080113682820902928729

Potter, P., & Perry, A.G. (2010). Canadian fundamentals of nursing (Rev. 4th ed.). (J.C.
Ross-Kerr & M.J. Wood, Canadian Editors.). Toronto,ON: Elsevier Mosby.

The Doctor

Satisfactory paper.
Paper has a very medical focus. Nursing interventions are limited mostly to referrals to
other professionals. Not clear on the specific actions of the nurse to address the client's
distress.
Some evidence provided but would like to see more supportive literature to defend
chosen interventions. Link between community resources and interventions could be
strengthened.
Paragraph and sentence structure needs attention to increase clarity of written work.