Critical Discussion on the Care & Support Nurses can Provide to address Psychological Issues which Patients undergoing SACT may face

NURSING CARE AND SUPPORT
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Care & Support Nurses can provide to address Psychological Issues which Patients undergoing SACT
Introduction
SACT is one of the programs that have been developed by the government of England in the fight against cancer that provides a directed ability to provide stage by stage therapies across England. This has come with many advantages to both the country and the patients among which are the ability to follow up and therefore look after patients correctly, enabling the caretakers choose the right means to provide treatment in addition to the ability to link the development of patients to their data as a means of ensuring effectiveness (NCRAS, 2018). Nurses within this area offer great support for the patients as they help them by ensuring that the patient is safe and being treated right, speak for the patient, check for any errors and even provide support emotionally by encouraging patients in their tough conditions not to talk of ensuring patients receive all the resources needed (Nitzky, 2018). This paper will describe the different psychological problems that come with SACT, mainly focusing on the way the nurses can provide care and support for patients with alopecia as a psychological issue.
Psychological Issues
The diagnosis of cancer is a process that causes fear to all parties within the process and therefore the patient and the family in this case and sometimes even the people within the environment (Mesothelioma Group, 2020). Edwards and Clarke (2003) claim that different issues and reactions come with the diagnosis of cancer, but among the most common to all groups involved are distress, depression, great levels of anxiety in addition to stress. The National Academy of Sciences (2008) as well came to the idea that cancer treatment induces psychological issues such as negative feelings like fear, hatred, confusion, being sad and moody in reaction to distress and worry that may as well be about body image to the patients. The family members are in turn faced with issues that bother them like the torturing fear of death, distress that may equate to that of the patient and these may even develop the inability of the family to provide the support required which may also be mental or psychological (Bush and Gorman, 2018; National Academy of Sciences, 2008).
According to a research carried out by Blanchard (1997), families were also greatly impacted especially direct relationships like spouses that can be caused by the assumption of the care-giver roles that come with the cancer patients, psychological impairment according to the stage of cancer and the ability for the patient to adjust to the treatment. These psychological issues normally show signs and symptoms for both the patients and the families including fatigue, worry, lack of appetite, weight loss, reduced interest, irritability in addition to the inability to recollect thoughts (American Cancer Society, 2016). Gregurek et al. (2010) state that 33.3% of the psychological problems can be treated the most being distress, anxiety and the ability to improve.
Among these issues is the psychological effect that comes with the body image as well as sexuality in the different genders, specifically known as alopecia. This effect can be and is a major problem in both female and male cancer patients being treated. Alopecia usually occurs a few weeks into the treatment and progresses further to one or two months depending on the time of the treatment (West, 2017). This effect occurs due to chemotherapy that usually interrupts the division of cells within that particular body part and therefore the treatment moves hand in hand with issues like worry and stress. However, drug-induced alopecia occurs as a result of either rapid termination of the anagen effluvium or an incomplete change of actively growing hairs into dormant (telogen effluvium) (Tosi and Miscialli, 1994). Research carried out by Can et al, (2012) found out that the mental state of male and female patients with any amount of alopecia was lower than that of those that did not have it at all. This, in turn, means that alopecia affects the psychological well being of patients. This research also found that for women, those with total alopecia felt a lower body image compared to those with no alopecia while for men, body image among patients with either fractional or total alopecia was found to have much lower body image compared to those with no alopecia (Can et al., 2012). This is in agreement with McGarvey et al. (2001), who discovered that women, most especially, faced with alopecia as compared to their fellow patients who have no alopecia, reported much lower self-esteem, worse body images and low life quality that affects their sexuality as women.
Women are greatly affected as most have their beauty, sexuality, and lifestyles most attributed to hair growth (Hunt and McHale, 2005). As such, alopecia being an effect that causes the loss of hair leads to a significant fear of not being accepted in society, reduced self-esteem and all these come with the ability to torture the mind of the patient to their bodies and sexuality. Alopecia has an effect it bears along onto the family of the patient as it comes with the un-comfort-ability of being able to relate in public including family gatherings where the research was done mainly reflected on school children who feel shy and therefore alienated even in families leading to increased distress (Clements and Roscoe, 2017). All these authors agree with Wils et al. (2019) as well that alopecia aligns and is a cause of other psychological issues like distress, anxiety, and even depression to the patients.
Management and Care
Several procedures that are systematically aligned can be used to reduce hair loss or help patients cope with the effect. This may involve studying the patient, evaluating, patient education, referrals and even assessment in addition to providing means that can help reduce the effect both psychologically and physically.
Evaluation
A patient well studied from history can know the cause of the effect using signs like the timing and the pattern of loss (female or male), look or degradation. The diet of the patient, their medical status and even family lines can inform a lot about their condition (Thiedke, 2003, Mounsey and Reed, 2009).
A physical evaluation may be done in phases starting with the scalp to check for the presence of erythema, scaling, or inflammation. Follicular units may appear in non-scarring alopecias while not present in the scarring one (Shapiro and Hordinsky, 2020, Mounsey and Reed, 2009). Then, the thickness and spread of hair are assessed and lastly, the hair shaft checked for caliber, length, shape, and fragility. A “pull test” may be used to assess hair loss with hair between the fingers and the hair is gently and strongly pulled. The negativity of the test would be less than six hairs, positivity showing active shedding with more than six hairs. Steps to check the loss of hair can be followed in figure one as provided below to ensure proper assessment of the hair loss (Thiedke, 2003).

Figure 1 Proposed evaluation process (Source: Thiedke, 2003)
A referral criteria may be followed in a few cases of the effect for example in cases where the diagnosis is uncertain, hair loss is massive, including total alopecia total and alopecia universal is, in pregnant or breastfeeding women, if the secondary care treatments may be required, when alopecia treatment started in primary care may not be applicable or if a wig is required (NHS, 2018).
Patient Education
This is directly aimed at helping the patients through the knowledge, understanding and pushing for the support of oneself to improve self-care with the help of nurses. This process will enhance the chances for the patients’ improvement, alopecia and it will most probably reduce psychological worry and stress (Arkansas, 2018). In the treatment of Alopecia, this stage involves the provision of supportive psychological support from the nurses (Goldstein, 2020). This can be done in ways like; reminding the patient that the condition may not affect the general body strength, improving the care given to their hair through washing, proper diet, checking on the medication to ensure it does not hinder hair growth and finally re-assuring the patients that it does not have to be about the hair loss (Bolduc, 2018). These can be done by destructing patients to ensure that their minds are not focused on the negative but rather the improvement of their bodies through their minds. The psychosocial impact of hair loss will mostly affect women and they could listen to the nurses once they are taught (Goldstein, 2020; Bolduc, 2018). Lastly, the motivation of the patients from the mind can as well rejuvenate their bodies and make them feel better about themselves hence improving their esteem.
Scalp-cooling therapy has long been used right from the 1970s to stop hair loss. Studies have shown that many of the patients that have used this procedure have managed and been successful in controlling alopecia. Kinoshita and Nakayama (2019) studied and found that the therapy prevented alopecia from stage I/II breast cancer patients who have undergone chemotherapy findings that were in agreement with Auvinen (2010) whose study had all patient groups agreeing to the benefit of the scalp cooling cap therapy as an effective procedure. Therefore, this procedure is effective for chemotherapy-induced alopecia.
Conclusion
Nurses, as the most immediate people to patients in the hospital, are therefore a great source of motivation for the lives of the patients. It is, therefore, a role they play in relieving the patients of psychological issues once their work is done right and correctly as it is been found to replenish the mind and therefore sustain the body.
References
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