Unspoken Needs Krisnamal

7/31/2019 Unspoken Needs Krisnamal

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Unspoken Needs

Ms. Krisna MuthusamySRN. SCM.NICU.FP. FTC. Bsc. MA

Penang Hospice

Palliative Care Association of Johore Bahru June 2012


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Sexuality Human sexuality is how people experience and

express themselves as sexual beings.

Human sexual activity has biological, physical and

emotional aspects

There are other ways of expressing feelings eg

Close friendship love, holding hands, hugging,

kissing, caressing

People facing a lifethreatening illness feel they arerobbed of past joy & often wish to discuss issues of

sexuality with a trusted health professional


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Barrier in communication

Medical professional often feel

They have no time

The dont know how to begin the conversation Knew little about sexuality

Dont have the right answer


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Age?


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Age and CultureCase Ca breast

Family separated couple

She was moved and nursed in a

separate room

Daughters moved in/slept in

Husband used their own room

Seldom went near wife/ busy

Daughters fussed around her

He was pushed out /was shy

Patient depressed

Did not want to talk or eat


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Ca.Lung with bone mets

Had a girl friend

Wife moved out

Depressed/scolded girl friend

Wife asked to come home

Pain , cough controlled

Breathlessness became lessNo B/T morphine needed

Became cheerful and happy


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How to handle this?

2 CASESFamily members counselledTo accept their friendship and let thembe together

One family

Tell all visitors the other man was ahelper who comes and does thedressing and bathing etc

Another familyClaimed they were childhood friend andhence they are closeHence friend came to be with him as hewas dying


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Ca colon with local spread

Young couple with 3 girls I love her very much

I cant bear to think about the

emptiness without her

I left my job to look after her

I cannot imagine life without her

I wont be able to face the empty

house/our empty bedShe is not just a wife but my friend

Soon all will be gone

I will be alone!


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AstrocytomaYoung couple . No children

Had 3 surgery. He had been with her

all the time main carer

Last op-became bedbound/semicoma

Mother moved in

She is my baby and I am her babyWe love each other very much. I took

care of her and she liked it.

Now the disease is advancing so fast.

I cannot bear to be without her. I

dont know how to care for her now.

She wants me to attend to her. She

will not vomit or fit when I feed or

wash her.


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Family taking over

Ca. stomach with localspread

Young lady--- married less than ayear---no childrenMoved in with mother upondiagnosisFamily took over the careHusband visitsFamily persuaded her to go for

chemotherapyDid not respond to treatmentIn and out of hospitalFamily very caringNo quality of life


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Looking over picture

Very breathless and in pain

1st wedding anniversary spent inhospital

No opportunity to counseled or talkto her


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I want my wife

Rt. ant. Mediastinal teratoma

Young man-divorcedno children. LivesaloneMoved in with mother when sickSisters came from abroad to nurse himWanted wife to be with himMother wanted him to marry someoneelseBrought in a new girl and introducedAngry , annoyed , banged the doors,Refused analgesicSister informed wife

Wife wanted to remarry and renew theirmarriage vows


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MND.Young man, married 3 times . Wives live in Ipohsexuality ignored by

medical carers. Started to have fantasies and looked for sexual partners

amongst maid and carers


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70yrs old lady diagnosed as ca lung with mets to liver and spinegiven 4 month to live. Came home to Penang to die

Husband demanding. Does not understand she is in pain

Husband will be sued for messing with children in the condo

Niece-in law dresses up in an inappropriate manner does not respectthe elders

Quarrels and upsets sisters family

Private nurse inappropriate behavior with husband


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Ca Cervix WithBone Mets

Happy. Lived with daughter and her familyHusband main carerTalked freely about her illnessShared same bed

On CBDWanted to have good daysAgendasons marriageAdvised son to be a good husband like fatherTo have children and be loving and caring just likedaddy


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Ca. scalp

Married with 2 boysMain carerwife(only 49 yearsold)Asked if disease is

contagious?Can they share the sameroom?Used less analgesia when wifedid the dressing


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Ca. Lung

Married with 2 childrenWife main carer

Didnt want hospital bed

Didnt want to stay with in-laws

Asked to be brought back home

Wanted his wife to be near

Wanted his wife to sleep in the

same bed

Had a night nurse oncesent her

back.

Said he did not need a nurse!


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Ca breast with sternal mass

Carer maid.Children did not stay with themHusband had strokeCannot accept diagnosis

Patient wanted to stay away fromhimScared his illness would hinderher recoveryHusband wanted to be near her

He became agitatedHe would cry and hit the bedsideBrought up to be next to his wifeHe became quiet


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Ca. Cervix with bone metastasis

Husband has a strokeMiserable and lonelyDid not want to talkDaughter came from aboardDaughter tried to brighten up the room

Grand daughter drew pictures and pin it on the wallStill quietHusband ex stroke patient .Everyone forgot him and concentrate on patient

Husband brought into the room and leftDaughter closed the door and left them alone


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Next visit

the patient

was such adifferent

person


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My husband is a good man

Wife was the carer.She attended to all his needsEye toilet ,mouth toiletEar toiletNgt feeding--- all done by herHusband enjoyed the care given by his loving wife

He never exhibited any pain or discomfort, although his eyes were red anddischargingHe was unable to open his mouthHe had NPC with brain metastasis

Wife commented that

He may look different now but he was the same loving man she married


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Dont tell I

have a stoma


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Stoma belt Stoma studs


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Crotch less panties


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Papa had been looking after you for so long .He is tired and need a breakI am here now and I will take care of you

I want yourpapa to batheand attend tome


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How to handle this?

?

What a kind daughter

You are rightYou help now

Unspoken Needs Krisnamal

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