Taha tinana: Impact on Physical Health
Discuss about the Impact of a Life-Threatening Illness on an Individual Their Family and Community.
When an individual has cancer, it also tends to enter the lives of their family members and close friends. Research evidence shows that cancer affects the physical, social, emotional and spiritual well-being of not only the patient but also their family (Cormack, Robson, & Purdie, 2005). Cancer presents a major crisis for the family and the patient. The Maori population bears a significantly higher burden of cancer compared to the general population (Ministry of Health, 2014). The impact of the same is further influenced by the diversity of this group. The impact of the patient is affected by the Maori perspectives of health and well-being. According to the Maori models of health, health is a multi-dimensional, and multi-faceted concept, and this is covered in one of the health models known as ‘Te Whare Tapa Wh?’ (Ahuriri-Driscoll, Reid, Kirk, Christchurch, & Forest Taane Morton, 2014). It is one of the outstanding models in the understanding of Maori health. This model encompasses four sides of Maori health. These include Taha wairua (spiritual health), Taha hinengaro (mental health), Taha tinana (physical health), Taha whanau (family health) (Ahuriri-driscoll et al. 2014). Each of these dimensions is crucial to a Maori well-being and if anyone of them misses out or happens to be damaged, an individual or a collective is termed as ‘unbalanced’ hence unwell (Ministry of Health, 2017). As a result, evaluating the impact of Mrs. Puke’s lung cancer diagnosis focuses on the impact of the condition on her physical health, mental health, spiritual health, and family health.
The realm of Taha tinana encompasses the chemical and other changes that occur in Mrs. Pukes body. The patient’s diagnosis presents changes in her functional status as a result of the biological symptoms of the disease and the side effects of the treatment. Changes in physical health are the leading culprits when it comes to affecting the quality of life in patients (Ellis, 2012). At the initial stages, the impact on the patient’s physical health is manifested by respiratory symptoms and often include shortness of breath, coughing or blood with coughing. As the cancer metastasizes and progresses into advanced stages such as the one Mrs. Puke presents, she may present with other issues such as weight loss, neurological symptoms, seizures, loss of appetite and other complex complications (Courneya & Friedenreich, 2011).
Taha hinengaro: Impact on Mental Health
Taha hinengaro is the mental/cognitive side, and the perception of emotional and mental wellbeing, which is evidenced by the patient’s ability to communicate, feel and think, and the inseparability of body and mind (Durie, 1998). Cancer diagnosis and treatment is associated with an emotional burden on both the patient and their families. Ill mental health often takes the form of depression and anxiety. Depression and anxiety is a predictor of the quality of life in cancer patients. Mrs. Puke may experience psychological distress for the rest of her life. There is evidence linking co-morbidity of depression in cancer with physical morbidity and mortality (Lloyd-Williams, Shiels, Taylor, & Dennis, 2009).
Taha wairua refers to the patient’s spiritual side, and the notion of wellbeing (Durie, 1998). It is perceived as one of the essential requirement for health among the Maori. It is perceived as the patient’s capacity for faith and wider communication, and her capacity to understand the linkage between the presentation and the environment (Ahuriri-driscoll, et al., 2014). The diagnosis of a life-threatening condition such as in Mrs. Puke often causes enormous distress. The condition is life threatening and this may challenge her beliefs regarding life and the sense of well-being. Spirituality is a greater contributor to health, especially in palliative care (Egan, 2010). According to Egan, the impact on spiritual health may be manifested in aspects such as physiological process such as cardiovascular function, and psychological functioning.
Taha whanau is the family/social dimension, and wellbeing as a result of family and other relationships in the wider society wellbeing (Durie, 1998). Further on, Durie claims that the element of one’s capacity to belong, share and care. Mrs. Puke’s condition may impact this in the sense that her loved ones may be negatively impacted. In the process of caring for her, her family (especially her children and children) are bound to bear feelings of loss of control, alterations in relationships, and disruption in the family organization. Her family members may feel uncertainty, and a sense of vulnerability and awareness of their inability to protect her, and as a result breeding a sense of helplessness (Ripia, 2013). Her children and grandchildren may also feel distressed when they see her as vulnerable and fearful. The family may also experience changes in family roles, and disruptions in schedules so as to take on the new roles of caregiving for the ailing Mrs. Puke. In addition, financial demands for palliative care may also create concerns for her family. Cumulatively, these factors negatively impact the health of Taha whanau.
Taha wairua: Impact on Spiritual Health
Multidisciplinary care is the cornerstone of best practice in the care of patients with cancer (National Lung Cancer Working Group, 2016). The multidisciplinary team for lung cancer often consists of professionals whose specialty is to treat and support people with the condition. Typically, the team often consists of a respiratory physician, a pathologist, a cardiothoracic (chest) surgeon, a radiologist, oncologists (medical and radiation), cancer nurses and care coordinator, a physiotherapist, palliative care doctors and nurses, an occupational therapist, a dietitian, a pharmacist, and a GP (Cancer Society NZ – Canterbury-West Coast Division, 2017). In addition, pastoral care/spiritual care workers and wh?nau may be availed as per the patient’s request. However, since Mrs. Puke has opted to discontinue treatment, the composition of this team may be limited to professionals specializing in the management of her presentation, and those for palliative care.
They are also known as cancer nurse coordinators (CNC), and they provide the patient with nursing care, information, coordination, support and assistance through their ailing journey (Lung Foundation Australia, 2014). Roles played by lung cancer nurses include providing the patient with information pertaining to their diagnosis and treatment, providing emotional and social support to the patient and family, assisting with communication between the patient and the healthcare teams, providing continuity in care, assisting the patient through the healthcare system, as well as answering the patent’s questions pertaining to any element of care and treatment pathway (Lung Foundation Australia, 2014). It is the responsibility of lung cancer nurse coordinators to ensure that patients and their carers understand the complexity of cancer care.
A GP is responsible for the patient’s general health and referral for specialist treatment in any event that a complication arises. GPs are necessary for the continuity of care in a patient, especially in Mrs. Puke’s case. In the continuity of care, GPs help in the management of the patient’s pre-existing conditions, as well as managing the side effects of the treatment (Kane et al., 2016). Lung cancer patients may experience symptoms such as dyspnoea, anorexia, depression, anxiety, pain, cough and fatigue (Yates, Schofield, Zhao, & Currow, 2013), which will call for the intervention of a GP. These patients may also present with malignant spinal cord compression, superior vena cava obstruction, neutropenic sepsis and hypercalcemia which will require immediate admission.
They work in close coordination with the GP to provide Mrs. Puke with supportive and palliative care to enable her to cope better with the impacts of the cancer. These professionals also assist the patient with difficult medical decisions, guide then in developing a plan for better living based on the patient’s needs, concerns and care goals, and lastly provide the patient and her family with emotional and spiritual support and guidance (Ministry of Health, 2001). They may also help Mrs. Puke get into a hospice program to help her achieve quality time.
The role of Wh?nau
Taha whanau: Impact on Family and Social Health
Members of the team should also consider the role played by Wh?nau (referring to the extended family members) in end of life care. There is an immense value placed on their role towards holistic caring (Johnston Taylor, Simmonds, Earp, & Tibble, 2014). The support of whanau is recognised as an asset, and has been used to model the Maori’s model of hauora (heath). Research evidence from studies indicates that patients and their families emphasise on the critical importance of involving whanau in palliative care (Ministry of Health, 2014b).
M?ori spiritual needs during end of life care are of much significance as the whanau. First, staff spirituality in an important aspect in the continuum of care (Egan, 2009). According to the Maori, all living thing poses a life force known as mauri and a spirit, and as one grows closer to death, they must be preserved as one moves towards ?rai (veil) (Moeke-Maxwell, 2015).
References
Ahuriri-driscoll, A., Reid, K., Kirk, R., Christchurch, & Forest Taane Morton. (2014). Understanding the M?ori experience of palliative care in Canterbury, (April).
Cancer Society NZ – Canterbury-West Coast Division. (2017). Multidisciplinary Care Team (MDT). Retrieved May 18, 2017, from https://canterbury-west-coast.cancernz.org.nz/en/cancer-information/cancer-types/lung-cancer/multidisciplinary-care-team-mdt/
Cormack, D., Robson, B., & Purdie, G. (2005). Access to cancer services for Mäori. Wellington: Ministry of Health.
Courneya, K. S., & Friedenreich, C. M. (2011). Physical activity and cancer. Springer.
Durie, M. (1998). Whaiora: Maori health development. Oxford University Press.
Egan, R. (2009). Spirituality in New Zealand hospice care. Distribution, 4(July), 99–130.
Egan, R. (2010). Health Promotion and Spirituality: making the implicit explicit, (34).
Ellis, J. (2012). The impact of lung cancer on patients and carers. Chronic Respiratory Disease, 9(1), 39–47. https://doi.org/10.1177/1479972311433577
Johnston Taylor, E., Simmonds, S., Earp, R., & Tibble, P. (2014). Maori perspectives on hospice care. Diversity and Equality in Health and Care, 11(August), 61–70.
Kane, P., Jasperse, M., Egan, R., McBain, L., McKinlay, E., Pullon, S., & Herst, P. (2016). Continuity of cancer patient care in New Zealand; the general practitioner perspective. The New Zealand Medical Journal, 129(1440), 55–63.
Lloyd-Williams, M., Shiels, C., Taylor, F., & Dennis, M. (2009). Depression–an independent predictor of early death in patients with advanced cancer. Journal of Affective Disorders, 113(1–2), 127–132. https://doi.org/10.1016/j.jad.2008.04.002
Lung Foundation Australia. (2014). Lung Cancer Nurses. Retrieved May 18, 2017, from https://lungcancernetwork.com.au/posts/lung-cancer-nurses/
Ministry of Health. (2001). The New Zealand Palliative Care Strategy.
Ministry of Health. (2014a). New Zealand Cancer Plan: Better, faster cancer care 2015–2018. Ministry of Health. Wellington: Ministry of Health.
Ministry of Health. (2014b). Palliative Care and Maori from a Health Literacy Perspective. Wellington: Ministry of Health.
Ministry of Health. (2017), M?ori health models – Te Whare Tapa Wh?. Wellington: Ministry of Health.
Moeke-Maxwell, T. (2015). Growing closer to death M?ori spirituality and ageing. Auckland.
National Lung Cancer Working Group. (2016). Standards of Service Provision for Lung Cancer Patients in New Zealand (2nd ed.). Wellington: Ministry of Health.
Ripia, L. M. (2013). He kupenga mate pukupuku uu mo ng ? w ? hine M ? ori. Te Whare Tapa Wh?: A multidimensional exploration of the impacts of breast cancer among w ? hine M ? ori. Massey University.
Yates, P., Schofield, P., Zhao, I., & Currow, D. (2013). Supportive and palliative care for lung cancer patients. Journal of Thoracic Disease. https://doi.org/10.3978/j.issn.2072-1439.2013.10.05
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