Promoting Healing and Resilience in People with Cancer: A Nursing Perspective Mary Grossman 123 Promoting Healing and Resilience in People with Cancer: A Nursing Perspective Mary Grossman Promoting Healing and Resilience in People with Cancer: A Nursing Perspective Mary Grossman, PhD (Retired) Retired, Ingram School of Nursing McGill University Montreal, QC, Canada ISBN 978-3-031-06100-4 ISBN 978-3-031-06101-1 (eBook) https://doi.org/10.1007/978-3-031-06101-1 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 This work is subject to copyright. 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Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland To my family and to all families who have traveled cancer’s pathways, and to nurses and doctors who have paved their way with compassion and competence Preface Hope is a dimension of the soul…It is an orientation of the heart; it transcends the world that is immediately experienced, and it is anchored somewhere beyond the horizon. Vaclav Havel Nursing and medicine are the two pivotal healthcare professions with complemen- tary and overlapping scientific knowledge and clinical skills which inform the care and treatment of patients with cancer across all its stages including the transition to survivorship. Shared professional goals include helping patients (with their loved ones) to tolerate their treatment to completion, live a healthy life disease free or live well with cancer, and or experience a peaceful end of life. As scientific evidence in cancer healthcare has mounted exponentially, it is almost axiomatic that both pro- fessions base their practice on this expanding repository of scientific knowledge, albeit filtered through the distinct perspectives of each profession, enabling both to complement one another in the shared goal of helping patients with cancer, and their loved ones. Yet despite academic advances in the Nursing discipline since the latter half of the twentieth century, my professional observations over an academic career, are of a clinical practice too often bent toward the prevailing medical model of practice at the expense of exercising clinical expertise based on theoretical and empirical nurs- ing knowledge of the whole person in the face of health-related adversity. It is my hope that in some very small way this book may encourage more nurses, particu- larly in the field of cancer care, to broaden the scope of their practice of the whole individual and loved one within a comprehensive scientific perspective. The Gap Between Research Findings and Clinical Practice Although the curriculum of university-prepared nurses consists of courses from the biological and psychosocial sciences, integrating this knowledge into a comprehen- sive understanding of the human experience of cancer, including the effects of diverse stressors on the whole person has proven challenging to actualize in clinical vii viii Preface practice. Indeed, the process of incorporating the latest research findings into clini- cal interventions so that the people we care for receive timely clinical benefits based on the latest scientific evidence has been an uphill struggle throughout the health- care field. Despite Nursing’s purported legacy of caring for the whole person and promoting healing of both the mind and body, dating from Nightingale’s papers [1], clinical practice in the majority of hospital centers has not fully embraced relevant research findings from related disciplines such as psycho-neuro-immunology nor developed a scientific body of stress-reducing and healing-inducing nursing interventions. The panoply of psychological stressors that patients and caregivers are likely to experience along the clinical pathway to survivorship is an essential component of clinical care. Yet practice guided by scientific knowledge of the devastating effects of prolonged stress on neuroendocrinal and immune functions which adversely impact healing and resilient capabilities, and ultimately, the long-t erm health poten- tial of cancer patients, appears to be lacking [2]. For instance, nursing tends to conceptualize resilience mainly from a generic psychological perspective (e.g., cog- nitive and behavioral coping efforts in response to psychological stress). Clinical interventions typically center around active listening and reframing that usually offer an important yet temporary clinical benefit. Because harmful stress-i nduced effects on the neural biology of the patient can threaten long-term survivability a multimodal, multitargeted nursing approach, is required. The point of transition from a resilient (allostatic) to a toxic neurobiological response to stress is still unknown [3, 4]. However, evidence indicates that restored behavioral indicators of resilience in the aftermath of prolonged stress are not nec- essarily reflected by the underlying neurobiology [5]. This discrepancy can occur in individuals with a history of prolonged emotional distress in which the normal brain’s architectural flexibility was compromised by previous chronic adversity. The brain’s potential capacity for flexible neural remodeling in response to environ- mental stressors will determine how successfully the whole being may adapt in the future resulting in greater or poorer resilience. For this reason alone, it is a clinical imperative to leverage scientific knowledge of the spectrum of stress effects through- out the biology and behavior of the whole person, in order to mobilize relevant healing- and resilient-promoting interventions to alleviate their ill effects [6]. Knowledge of possible stress-related neurobiological impairments enables the nurse to identify meaningful biological and behavioral end points so that the effec- tiveness of tailored healing-inducing psychosocial interventions may be evalu- ated [3]. A case in point: A growing body of scientific evidence shows that clinical inter- ventions which activate the dopaminergic reward circuitry strengthen resilience [3]. Positive memories through storytelling, cognitive expectations of a clinical benefit, promoting meaning and purpose in life, and strengthening supportive relationships have been empirically shown to trigger dopaminergic pathways that downregulate the stress response system (decreasing cortisol, catecholamines, and emotional dis- tress). Despite the scientific evidence, these nursing interventions have not been regularly brought to clinical prominence, yet would provide a deep, purposeful Preface ix therapeutic benefit to patients and their family caregivers. These healing promoting interventions are in keeping with nursing’s domain of practice and should be mobi- lized to promote the resilience of patients and their caregivers across the continuum. Many are time efficient and easy to implement within the context of the nurse- patient relationship. The Clinical Need for a Conceptual Model of Practice Nursing’s theoretical underpinnings were enriched by many conceptual models that flourished in the latter half of the twentieth century. Part of today’s clinical chal- lenge is to identify practice models with a patient-centered focus that promote the interrelated biological and behavioral health-related concepts that constitute the whole person with or without a chronic illness. A conceptual model is distinguished by a set of interrelated concepts, goals, desired clinical outcomes, and relevant inter- ventions that delineate the scope, depth, and direction of the nurse’s practice. Such a model may be used to evaluate the effectiveness of proposed psychosocial inter- ventions by helping to interpret the significance of relevant clinical and research findings. Stress, healing, coping, resilience, meaning, lifestyle behaviors, and health have been widely investigated as evidenced by a plethora of research findings. These results have led to the development of a few clinical interventions aimed at strength- ening resilience, health, and overall well-being of patients and, to a lesser extent, their caregivers. This book offers a conceptual framework predicated on these indis- pensable human concepts which are embedded in the thoughts, beliefs, emotions, behavior and neurobiology of patients and their caregivers, so that scientifically justified nursing interventions may be purposefully developed and evaluated across the disease and recovery continuum, and results interpreted within a meaningful framework of practice. It is hoped that research findings may serve as stepping stones for further critical inquiry and evidentiary clinical practice shaped by the model of practice. This hope is made all the more probable when nurses experience their practice through a shared prism of goals, desired outcomes, and scientific evidence. Without a coherent scientific context it is extremely challenging to establish meaningful goals and objectives of practice as well as to develop or implement rel- evant clinical interventions that complement rather than simply conform to medical goals and objectives. There continues to be a clinical disconnect between the biol- ogy and psychology of the person, when in fact both are integrally interrelated and taken together provide a deeper more comprehensive basis for understanding the dynamics of the whole person within the stressful context of living with cancer. A comprehensive nursing approach across the different phases of the cancer trajectory would be enhanced and made more purposeful by the use of a relevant conceptual model of practice that is grounded in a growing body of interrelated scientific findings. x Preface Why This Book The latest books on the nursing care of cancer patients and families tend to be orga- nized around the latest medical research, principles of care, patient and family needs, procedures and/or techniques, and ethical considerations that are all impor- tant determinants of good nursing care. In contrast this book puts the whole person at the center of that care, meaningfully integrating the latest research findings within a conceptual model of nursing practice that delineates the extent and scope of humanistic practice within the clinical field of cancer. Because this book leaves the necessary component of the latest procedures and medical techniques to other excellent nursing’s references, it may be argued that this book is ironically self- limiting. In deliberately doing so, its main message is that the core of the nurse’s practice is the whole human being whose healing and resilient capabilities in the face of stress need to be amplified through a more comprehensive humanistic approach. For that to occur we need to explicate adaptive processes of the whole person which dynamically interact with one another and are influenced by social, physical, and psychological environmental factors that either enhance or debilitate the health potential and long-term survivability of the patient [7]. In other words, the whole person (and the family) is the key clinical context of care, and the latest techniques, procedures, and related issues are valued as instruments that support but are not the defining focus of humanistic nursing care. This is only possible when a conceptual model of nursing is the predicate of practice. A model’s delineated scope of practice enables the further development and eval- uation of theory and practice findings with clear relevance to the clinical care, qual- ity of life, and survival of the whole patient. A nursing approach is derived from the clinical goals and concepts, and related findings delineated by the model. This prac- tice-driven model facilitates the mobilization of relevant nursing interventions aimed at the patient’s healing and resilient capabilities. In so doing, the nurse’s clinical interventions also support the goals of medical treatment; and together are critical to the patient’s ability to successfully adapt to cancer-related threats, tolerate the treatment to completion, live healthily in survivorship, or find acceptance and meaning at the end of life [8, 9]. What the Handbook Offers For clinical researchers in the field of cancer, the conceptual model serves as a theo- retical and empirical predicate for the development, evaluation, and interpretation of clinical interventions guided by the stated goals and objectives of the model. The model is meant to be a dynamic framework that both informs and is informed by research findings. It is hoped that research findings lead to modifications within the proposed relationships among the variables across the phases of the continuum. A growing repository of empirically demonstrated clinical interventions may Preface xi eventually determine the optimal combination of conventional and complementary practices to consider for patients across varying phases of the disease and survivor- ship, and for their family caregiver. In other words, multimodal, multitargeted clini- cal strategies with shared and unique biological and behavioral endpoints may become the standard of nursing care, by effectively countering the corrosive effects of stress while also optimizing resilient capabilities of the person even in the absence of a cure. As a clinical practice model it is hoped that the nursing goals, objectives, desired outcomes, delineated concepts, and proposed clinical approaches to patients and family caregivers may advance the practice of clinical nursing toward a more com- prehensive understanding of the whole person with cancer and of loved ones. With a patient-centered humanistic focus anchored by the quality of the nurse patient (family caregiver) relationships, the nurse’s technical, procedural, and medical expertise complements rather than defines the nurse’s approach to patient and fam- ily care. Because the Handbook delineates a contextual field of relevant theory and known findings based on its model of practice in cancer, it serves as an effective organizing framework for the nurse practitioner, nurse specialist, and student nurse. It can facil- itate the purposeful acquisition of knowledge and skills that guide nursing approaches to the care of patients and the family caregiver. It also serves as a delin- eated context for seeking up-to- date research findings that continue to inform the goals and objectives of one’s practice. In summary, it is hoped that the nurses’ Model of stress, healing and resilience based as it is on a practice model may serve as a scientific stepping stone toward providing informed, comprehensive nursing care to patients with cancer (and family caregivers) across all phases of the illness and recovery continuum. It is also hoped that in some small way, this book contributes in placing the patient with cancer (with his family caregiver) so that in optimal health in order to tolerate the treatment to completion, thrive in survivorship, live well with cancer, or experience a com- forted, peaceful, and meaningful end of life. Although the subject of family is beyond the scope of this book, it is an important component of the patient experience. How to Use the Handbook The handbook is designed to describe the main concepts of the conceptual model of practice from theoretical and clinical perspectives. Each chapter highlights learning objectives and uses clinical and personal anecdotes, tables, and figures to illustrate the concepts under discussion. The Handbook is divided into five main parts, each part predicated on a specific theme with an introduction followed by corresponding chapters. Part I is entitled The Stress, Healing and Resilience Nursing Model of the Whole Person Chapter 1 provides a review of the underlying theoretical tenets of the model, acknowledging the importance of preceding theory and concepts