CHALLENGES FACED BY NURSES IN THE MANAGEMENT OF CANCER WOUNDS IN GENERAL HOSPITAL DOUALA

Abstract

Cancer wounds always present a great challenge not only to the patients and careers but even to the most experienced oncology nurse. Better management of cancer wounds entails; appropriate assessment and management of symptoms (odour, pain, bleeding and exudates), by palliative goals.

Numerous studies have been conducted on the management and challenges of fungating wounds in advanced cancers. But little is known on the management and challenges of cancer wounds of nurses, particularly those in Cameroon as a whole and the General Hospital Douala specifically.

This piece of work aims at identifying cancer wounds based on their presenting symptoms at the General Hospital Douala. It also explored the nurses’ management practices of cancer wounds as well as the challenges faced by nurses in the management of cancer wounds in this same hospital.

A descriptive study was conducted during the month of March 2015. After authorization from the Head of the Department of Nursing and Director of the General Hospital Douala, data was collected from 39nurses in the hospital using convenient sampling. Data was analyzed using Epi info version 7 and results were presented on percentage and frequency tables and pie charts.

Based on the data collected, nurses could adequately identify cancer wounds from bleeding, odor, exudates, slow healing process, pain, and mass effect. Nurses could moderately manage cancer wounds because the standards were not followed due to poor knowledge and lack of equipment in the management of cancer wounds.

Management practices often performed by nurses were; use of systemic antibiotics and topical metronidazole to manage odor, use of tranexamic acid and compressive dressing to manage pain, use of drainage bags, and frequent dressings to manage exudates and administration of scheduled analgesics and additional doses if needed arises to manage pain.

Some of the challenges faced by the nurses were; workload due to frequent dressing change, psychological trauma from patients, pain, and bleeding during dressings. Conclusively, nurses moderately managed these wounds but there are some empty spaces to be filled.

In order to fill these empty spaces, it is recommended that courses on palliative care and oncology be but in the nursing curriculum of Cameroon.

CHAPTER ONE

INTRODUCTION

1.1 Background

A malignant wound is also known as a fungating cancer wound, these terms are often used interchangeably [1].

A malignant wound is infiltration of cancer or metastasis into the skin and afferent blood vessels and lymph vessels that break through the skin to create a wound [2]. Malignant wounds present both physical and emotional challenges not only to the patient and family but also to the most experienced oncology nurse [3].

According to [4], the frequent location of malignant wounds is the breast(62%), followed by the face and head(24%), genitals, groin and back(9%), and others(8%).

Cancer is always the underlying cause of the malignant wound; therefore treatments that reduce the tumor may also decrease the size of the wound. Unless the malignant cells are brought under control through treatment with chemotherapy, radiotherapy or hormone therapy; the fungation may spread outwards as a fungus or cauliflower appearance by local extension and as a consequence it causes damages through a combination of loss of vascularity, proliferative growth and ulceration thereby causing he skin underlying tissue to die(necrosis)[2]. Malignant wounds are characterized with:

• Pain
• Exudates
• Odour
• Bleeding
• Itches
• Rarely heal
• Unsightly appearance

These characteristics adversely affect self-esteem and body image causing the patients to isolate themselves at times when social support is critically needed [3].

Malignant wounds do not heal so and understanding of palliative goals in the care of these patients is essential in developing a treatment plan aimed towards promoting patient’s comfort, confidence and a sense of wellbeing to prevent isolation and maintain or improve patient’s quality of life, thereby leaving the nurse with a lot of challenges.

These palliative goals include managing symptoms such as controlling exudates, odor, bleeding and preventing infection, and optimizing the emotional wellbeing of the patient and family [3] from a holistic approach.

1.2 Problem statement

Malignant wounds present with both physical and emotional challenges not only to the patients but to the healthcare professionals. Due to these physical properties of the wound such as pain, infection, bleeding, odor, exudates and itches, the nurse is faced with a lot of challenges in the management of these wounds.

Effective management of these wounds requires palliative care, which is a new specialty in nursing and not yet in active use in a resource limited country like Cameroon.

1.3 Justification

Malignant wounds are being managed by palliative goals from holistic approach. A correct identification of these characteristics of these wounds by nurses will help them manage the wound as well as reducing the challenges faced, thereby creating a sense of job satisfaction and competence.

Palliative care is not adding days into their lives but adding life into their days which means improving the quality of life of these patients [5].

1.4 Research goal

The goal of this research is to identify the challenges faced by nurses in the management of cancer wounds and to propose remedies to solve these challenges.

1.5 Objectives

Main objectives

To determine challenges faced by nurses in the management of malignant wounds.

Specific Objectives

1. To identify cancer wounds based on characteristics.
2. To identify the management of cancer wounds.
3. To highlight the challenges faced by nurses in the management of cancer wounds.

1.6 Research questions

In a population of nurses working at the General Hospital Douala,

1. What proportion can correctly identify cancer wounds?
2. What proportion carry out palliative goals in the management of cancer wounds?
3. What challenges do they face in the management of cancer wounds?