Nursing Care in Oncology Cancer is conceptualized as a biochemical disorder, caused by the uncontrolled g rowth of cells that invade the
tissues and organs and can spread in metastasis t o other body regions. This is the third leading cause of death in Brazil with ap proximately 110,000 deaths per year, surpassed only by cardiovascular diseases a nd external causes, such as violence. According to these figures, the care for p atients with cancer have been intensified and more specialized, such care nursin g care provided in a holistic manner. Increasing the number of people diagnosed with cancer inspires special care, as well as the need for qualified professiona ls. For assistance in oncology nursing qualification is required of nurses in ca re to cancer patients through a solid base of technical and scientific knowledge of care for oncology nursing, based on clinical, psychological, social, spiritu al, political and ethical. As well as critical thinking, emotional intelligence, leadership, ability to guide the team to develop and implement research-based m anagement results and more specialized treatment and care at the end of life due to cancer progression. According to INCA, primary prevention is any action aime d at reducing people's exposure to risk factors for cancer, aiming to reduce the incidence of the disease. Already covers the secondary prevention early diagnos is and immediate treatment, increasing the chances of cure, providing improved q uality of life and reducing mortality rates (BRAZIL, 2002). The nurse's role is indispensable to the act of taking care, as among its powers is a direct action in shares of primary and secondary prevention in cancer control, developing the educational actions, legislative measures supporting and aiding in early diagnos is. In addition to the acts of assistance in treatment, rehabilitation, palliati ve care and care to family, and also in the development of integration actions with professi onals of the multidisciplinary team and the identification of occupational risk factors for nursing practice in care for cancer patients. The disease turns man subject of intent for the subject of attention (and Gala Bressi, 1997). The dise ase triggers many reactions in stressful both patient and family, such as anxiet y, denial, shame, guilt and uncertainty, anger, among others. The examinations, diagnosis, treatment, body changes, reaction of family and friends, directly int erferes with the individual's adaptation to the new situation. When ill, it is c ommon to an exacerbation of sensitivity and vulnerability, on the occasion of th e sudden changes which should address and submit. Each individual faces the diag nosis in a particular way because of his personality, whose characteristics are unique to each person, their ability to deal with problems and frustrations, the advantages and disadvantages resulting from the position of the patient. Emphas izing that the state has a strong mental connection with the operation of the bo dy and mind that the patient is active in their recovery or improvement, both as sociated with depression may occur at diagnosis or acceptance. For Biasoli (2000 ), the first emotion that arises is that of guilt, combined with lifestyle habit s. Depression is usually consequent fear and anxiety about the unknown future, f ear of mutilation or permanent scars as a result of surgeries to remove tumors, thus damaging the structure of the body, affecting the appearance and integrity of the individual narcissistic. But there may be the acceptance reaction in most unexpected times due to the same factors that lead to depression, because the p atient accepts more easily the disease, seeking to learn what it is and the proc edures that must be submitted. This makes his relationship with the team which p rovides care, especially with nursing, as it always has closer relationship with patients. Biasoli (2000) also believes that truth should never be hidden from t he patient. Hence the importance of communication in nursing, a fundamental cond ition for there to be significant and positive influence in the treatment of pat ients regardless of pathology. Every procedure performed in Communication is essential, therefore attention to language, avoiding the use of professional jargon or technical terms when communicating with the patient in o rder to have clarity and understanding, this is also a way to show respect.It i
s for nursing, use techniques that help the patient in expressing their problems . To listen and be attentive to what is not revealed verbally, so that there is keen perception to identifying the real feelings, problems and needs. Silence is also important that the patient serves to reorganize your thoughts and evaluate your feelings, and that silence in itself encourages the patient to verbalize t heir thoughts. Humor is a vital skill of communication and a mechanism that can help patients and families, to relieve feelings such as fear, anxiety, anger and depression (BELLERT, 1989, apud Stefanelli, 1993). So it has given importance t o the play, it contributes significantly both in recovery and in the acceptance and encouragement to continue the treatment, especially of children and adolesce nts. It aims at the strengthening of the relationship, avoiding the depersonaliz ation of the individual, an act frequently, so the actual nursing has assumed a posture divergent conditioned by the biomedical model. The concern in valuing th e individual, calling him by name and not mischaracterize it by naming it the nu mber of beds or the disease that presents and treating it so it feels safe and a ccepted without showing indifference or disregard. It was understood that you ca n not define maturity, because there are cases where the patient apparently insp ired short term and lives far beyond what was estimated, as there are cases wher e the opposite occurs. For reasons like these, it is necessary to make a plan ai med at individuals as unique, thereby avoiding comparisons and establishing dead lines. The cancer is no longer death sentence, but the company still ranks as th e stigma. It is labeled as a fatal disease that affects the future and, despite technological advances and resulting media coverage in their therapeutic success es. Nurses assist the newly diagnosed patients who receive therapy or who are fi rst treated appellant, giving you the due explanations already on admission, it makes him come to have an idea of what will confront. Exposing the family, the strategies of the care process and ther apy, because the greater the understanding of the family about the diagnosis and treatment possibilities will be the best contribution to this collaboration wit h the patient and positive therapy. Chronic pain is common in cancer patients ma y be due to the primary tumor or its metastases, the anti-cancer therapy (surger y, radiotherapy or chemotherapy) and methods of diagnosis. In some situations, i t may be related to psychosocial causes, disable it and leads to harmful changes in the organic, emotional, behavioral and social. Currently, the predominant me chanism recognized as the chronic pain of cancer is tumor invasion, with tissue damage and activation of peripheral neuroreceptors (receivers of painful sensati ons). Pain receptors (nociceptors) are nerve endings, free skin that respond onl y to intense stimulation, potentially harmful. This stimulus can be either mecha nical, thermal and chemical industries. Must - take into account these factors i n order to have understanding of the behavior of the patient, pay attention to y our needs, but being aware of limits should be imposed not to make them totally dependent on nursing, because one of the goals to achieve in patients with treat ment in general, is to make them more independent as possible, encourage them to return to his routine, even in a more sleek and avoiding too much stress, or re sponsibilities incumbent on it as well as provide guidance the family about the offer of unconditional support in his recovery. It is important to the presentat ion of the physical space where the unit will do the treatment indicated, and ex planations about the procedure to be used in a language easy to understand for p atients and their companions, thus providing preliminary points are in order to understand the importance of routine for the welfare of the patient. Beware of i nformation overload or lack of them, one must know it balanced them so that does not cause harm to the patient. The dedication of nursing focused on the patient 's family should be in the sense of direction, but should be afforded special at tention, knowing that it is an integral role in health promotion, so you should make it conscious of its role as caretaker. The nursing staff is the link between the pr ofessionals of the multidisciplinary team, which has closer relations with both the patient and with his family, so has the task of paying attention to the memb
ers.Reason for this attention is the fact that the family is a part of extreme importance because it can both cooperate to recovery as it can depress the patie nt, worsening its framework. Thus, it should be noted that the relationship is h armonious and balanced, avoiding the actions of its members to interfere negativ ely in the patient's taking steps in conjunction with the team. The established division of roles between the members is necessary because the family members ac companying their loved one affected by cancer in accordance with its array of we ather and other factors aggregates, delegating tasks as taking financial issues, both in patient follow-up consultations or during the treatment, and even in ca se of hospitalization, among other responsibilities. It is therefore necessary t o advise you not to neglect their health, their social life and your physical we ll being and emotional. This usually occurs for several reasons including lack o f time, tiredness, inability to leave the patient alone and feelings of guilt ab out being amused while the patient is suffering. There are other guidelines to b e transmitted, how to make them understand that it is better to opt for the trut h even when it seems the worst, tell them to listen to what the entity has to sa y, either about their fears, feelings, doubts or any other matter; cry when ther e is a will, make them understand the importance of being collaborators of the m ultidisciplinary team, guiding them to preserve time for yourself and avoid burn out. Hospitalization was the most common indication in care for cancer patients, especially children, however, much focus has been given to deinstitutionalizati on, made possible through the outpatient segment and / or home care (Home Care). It is important that it be made to identify the members of the multidisciplinar y team, for presentations to narrow x professional relationship patient because the patient puts his life at the hands of people who headed even professionals, are unknown as far as their skills. For children, we must understand the particularity of their world in each evolut ionary step, confers the competence of a nurse care awareness, develop entertain ing activities for children and their families. Emotional support for profession als dealing with children is essential. Nursing care in palliative measures defi ned by the actions of physical contact by touch, which brings security and comfo rt for the child, mother and family to enable them to handle the child in her la p, diminishing suffering, often caused by pain, let the child in a comfortable p osition, noting potential regions for the formation of scabs, let the temperatur e warm and friendly environment, using consistent language and tone of voice app ropriate, avoid unnecessary handling, allow the child to express feelings of los s and separation through toys, always keep adequate analgesia for pain and, ther efore, use appropriate techniques to assess pain. Kattlove and Winn (2003) empha size that, especially cancer survivors have needs special care, since all patien ts have the risk of recurrence of primary tumor or may develop a secondary focus as a result of genetic susceptibility or previous treatments, beyond the need o f psychological and social support. Therefore, cancer survivors have different c are needs of many medical areas. The term 'survivor' by U.S. definition, is used from diagnosis to the end of life a person with cancer. According to Patricia A . Ganz, director of prevention research and cancer control at the University of California, the mass of survivors tends to increase due to improved diagnosis an d treatment. He adds that the theme of survival has been neglected by the medica l community and there are few guidelines on how to monitor these people and ensu re them the best start possible. Patients do not have information on the late ef fects of treatment and are lost in the transition of patients to survivors. For nursing, experience in practice and seeing patients in a situation of grave or i mminent death is a big challenge (SANTOS, 1996). The role of nursing is a functi on of explaining that each case is particular, to explain to the family to under stand the condition and understand their treatment, leading to confidence in that team. This disease als o causes fear of imminent death, which is a typical psychological reaction. Ther e are several treatment modalities, and among them, chemotherapy is the most fre quent, with or without radiotherapy, surgery,immunotherapy and hormone therapy.
The treatment protocol is established according to the type of tumor, its biolo gical behavior, location, extent of disease, age and general condition of the pa tient. Traditional chemotherapy fight cancer, but destroys it along with a multi tude of healthy cells. It was the first systemic treatment for cancer. Most ofte n consists of a combination of drugs to be ineffective if used alone, because th ere are subpopulations of tumors cells with different sensitivity to anticancer drugs. The mechanisms of drug action are different, but always end up causing an injury to cellular DNA, as an "iron bar that locks a gear" makes it impossible to function, says Dr. Luciana Holtz de Camargo Barros is a psychologist speciali zing in Oncology and is responsible for Oncoguia site. The toxicity in normal ce lls is the cause of side effects such as nausea, vomiting and decreased immunity , the effect on white blood cells and red. The doctor will need blood test to as sess and plan chemotherapy, and treatment will be administered intravenously (ve in), intra-arterial (artery), intra-vesical (bladder tumors), intrathecal (spina l fluid space in the spine) , intramuscular (muscle), orally and subcutaneously, by professional nursing personnel. It can be done at the Center for Drug Therap y and the Division of Inpatient hospital or clinical oncology, when chemotherapy is an outpatient, returning home is the same day. Among nursing actions are eva luated on a daily basis or for outpatient treatment that is periodic, skin and a ppendages, and the place used for infusion, guide patients as to avoid exposure to direct sunlight, especially during the period from 10 to 14 hours; Targeting use of sunscreens with SPF 15 or more on sun-exposed areas; Gearing use lightwei ght clothing with long sleeves to cover your arms and use of scarves or hats, in struct patient to use mild soap and to take bath with just warm water; Target for not using abrasive solutions to clean the skin or in bath; instruct so as not to expose to extreme temperatures (excessive heat or cold), Offering emotional support for the patient to work with the chan ges in their body image, be aware of the changes in the epidermis of the scalp; observe how the possible changes in the eyeball due to a drop of eyelashes and e yebrows; provide emotional support to patients, assist in adapting to change in appearance and self-esteem. Can be used as primary treatment (in leukemias, lymp homas, testicular cancer), but is usually an adjuvant (after surgery), or before , the surgery (neoadjuvant) or associated with radiotherapy, which is the most w idely used method for tumors that can not be resected completely, or for tumors that tend to return to the same place after surgery. It has side effects, mainly through injury of normal tissues adjacent to the tumor. After the diagnosis and chosen therapy and quality of radiation, determine the amount of radiation to b e used depends on the tumor type and volume to be irradiated. We must explain th at nursing procedures. For example, the use of "detention order", also known as "frame", since the precision is crucial, especially if radiotherapy is applied t o the head or neck. The frame is a special mold of transparent plastic that cove rs the body part being treated and is fixed in the bed of treatment to prevent t he patient from moving during treatment. An additional benefit is that the entry points of the beams of treatment may be marked on the plastic surface without t he tattoos. Tattoos are risks with ink made in the skin, outlining the region to be irradiated, and parts will be protected through the use of lead or specially designed for your treatment. These marks must remain throughout treatment. Afte r marked skin, the guidance given is that it does not wash this region in the fi rst 24 hours as it facilitates the setting of the ink. After this time, the regi on can be washed with mild soap, but without scrubbing. When these marks are wea k, the professional will retouch them so they do not disappear completely. After the treatment, ie the number of applications of radiation, and reassessmen t of the doctor radiotherapist, the marks of the fields in the skin may be remov ed by washing, but be careful not to injure an irradiated skin, which is already irritated . Any injury to heal from that moment and disappear over time.It tak es patience and follow the treatment prescribed by doctors to alleviate the side effects. Palliative Care is the fourth guideline established by the World Healt h Organization (WHO) for cancer treatment, after Prevention, Diagnosis and Treat
ment. But in Brazil this item is still unknown by most patients and, unfortunate ly, by many health professionals. Aims to control pain and other physical sympto ms, psychological, spiritual and social, allowing patients and families a better quality of life. According to Dr.Císio Brandão, medical oncologist specializing in Palliative Medicine in London, England and of the Department of Palliative C are at the Cancer Hospital of São Paulo, what happens today in Brazil, is the pa tchy provision of treatment to patients in palliative care that are not included in most of the time, which can result in a financial burden not only to patient s and institutions, but the very life of the patient. Currently there are insuff icient data [Stanton and Caan, 2003] pointing to the need for devoting attention to the health of health professionals, especially mental health. For France, th e Burnout Syndrome in stress, is characterized by a set of signs and symptoms of physical exhaustion, mental and emotional, as a result of poor adaptation of th e subject to prolonged labor, high stress and intense emotional charge, and may be accompanied by frustration with you and work. Studies have shown that doctors and nurses have higher levels of emotional disturbance than the other high leve l professionals. The mental suffering inherent in work in hospitals [Pitta, 1991 ] is common to all these professionals. This involves factors such as uncertaint y, stress at work because of the importance of dealing with risks, the concern a bout the execution of procedures, noting that the minimum mistake can be deadly, so it gives even low self-esteem. Elisabeth Kübler-Ross, psychiatrist and pioneer in the investigation of death and dying, he created the model of Kübler-Ross proposed in his book On Death and Dying, published in 1969 , which proposes a description of five discrete stages at which people become de aling with loss, grief and tragedy. According to this model, patients with termi nal illnesses go through these stages, they are denial, anger, bargaining or neg otiation, depression and acceptance. Hence we see the need for improving their k nowledge and skills to be able to act safely and effectively in the care of canc er patients and family care, with no neglect and without causing much damage in the emotional sense for both sides and in the professional sense. The best metho d to use against cancer is prevention by adopting simple measures. It is the res ponsibility of nursing, to warn the community to raise awareness about the impor tance of improving dietary habits, education to deal with the stress of daily li fe in a way that identifies when the stress level is affecting your quality of l ife, promotion campaigns prevention and information on the disease and educate s ociety about the importance of it. Thus, it is important to pass this knowledge society, understanding and exercising the same care to you is of high relevance. The relationship between nurses and cancer patients has been rethought and chan ged constantly, as the pattern of disease. The need for renewed vision and criti cal thinking, but encourage more human so there is differential. There is concer n from nurses about the implementation of the systematization of nursing care as a means to improve care to patients with malignant disease and their family. Th e change in scheduling and planning of nursing actions should be done differentl y from the former employee returned to the reference model biomedical, seeking a humanized care, without ignoring the ethical dimensions, cultural, historical a nd religious individual. References: • • • • • • • • • • • • • • • • • • • • • Carvalho, MJMM - Introduction to Psych o-Oncology Book Publisher Full BRAZIL. Ministry of Health National Cancer Instit ute. Breast Cancer. Available at: http://www.saude.gov.br [Accessed 04maio. 2007 ]. FERREIRA, Noeli Marchioro Liston Andrade. The cancer and the cancer patient t hrough the perspective of nurses. Journal of Oncology, Rio de Janeiro, 42 (3), 1 61-170.1996. Bonassa, EMA Nursing Chemotherapy, 1st edition, Ed Atheneu, SP, 199 8, p.76.International Union Against Cancer. Manual of Clinical Oncology. São Pa ulo (SP): Cancer Foundation of St. Paul, 1997. National Cancer Institute (U.S.). Childhood cancer [cited May 20, 1999]. Available from: URL: http://www.inca.org .br. BITTER JR, A; MATHEUS, M. C. Communication. In: CIANCIARULLO, T. I. Basic t ools for caring: a challenge for the quality of care. São Paulo: Atheneu, 1996.
Chapter 6, p. 61-73. GATTI, M. L. B. Interpersonal nurse-patient relationship. R ev. Paul. Enf., São Paulo, v. 4, n. 2, p. 12-18, 1984 GUTIERREZ, M.G.R; MARANHÃO , A.M.S.A. CASTRO, R.A. P.; ADAMI, N.P. - Center for Nursing in Oncology: experi ence related to the care, teaching and research. Minutes Paul.Enf. v.9.n. 1.92 t o 97, 1996. Leshan, Lawrence - Cancer as a Turning Point. A handbook for people with cancer, their families and health professionals. Translation: Denise Bolanh o. Publisher: Summus, São Paulo, 1992. National Cancer Institute (INCA). The rel ief of cancer pain. 2nd ed. Rio de Janeiro (RJ): INCA, 1997. Arruda EM, Marcelin o SR. Caring and comforting. In: Schulze CMN. Dimensions of cancer pain: reflect ions on interdisciplinary care and a new health paradigm. São Paulo (SP): Robe E ditora, 1997. p. 157-89. France HH. The burnout syndrome. BrasMed Rev 1977, 44 ( 8): p.197-99. SCHERING - PLOUGH. Pocket guide for radiation oncology. São Paulo: Schering-Plough, 2000. [Sp] www.saudebrasilnet.com.br/premios/oncologia/premio1 /trabalhos/027c.pdf http://www.unb.br/ip/labsaude/textos/o_papel.html http://www .abcancer.org . br http://www.sbeonet.com.br/ http://www.santarita.org.br/ http: //www.oncoguia.com.br