Models in nursing

Table of Contents

The use of models in nursing provides nurses to focus on the role of nursing and its applications rather than medical practice, it helps patient care to be systematic, purposeful, controlled and effective. Ursavas, Karayurt, & İseri, (2014) used the Roy Adaptation Model in a specific case of breast cancer. In this model, the aim of nursing was to increase compliance and life expectancy; then, it evaluates the patient in physiologic mode, self-concept mode, role function mode and interdependence mode aiming to provide holistic care. In any case of a patients who has been diagnosed cancer the evaluation of the four modes of Roy adaptation model the nursing process should be applied. The utilization of theories will facilitate the situation and will provide a means for the nurses to focus on their profession of nursing and develop a biopsychosocial approach to the patients they are taking care of. It is also suggested that other principal roles of nursing used with this theory, developed by Sista Callista Roy, is to help develop coping mechanisms when the patient response is ineffective or non-adaptive in relation to their health status allowing the individual to accept, manage and overcome their disease-health process in order to contribute to the progress to better their quality of life. For that reason, it is essential that the use of theories in nursing care, should be encouraged and their implementation into practice should be enhanced.

Other model that will be used in this review of literature will be the King’s theory of goal attainment as conceptual frameworks that endorses the research proposal. The Imogene King theory of goal attainment identifies space, time, and learning as concepts that can be used by our interpersonal systems to achieve success. With the help of a nurse, each transaction can help everyone maximize their success. the theory explains about interaction that exist between a nurse and a patient, both arrived at the meeting with expectations and goals. (Woordwood, 2018)Synthesis of the LiteratureCryoablation is a well-established therapeutic regime for the treatment of numerous cancers. At early times it was thought as a simple ablative mechanism relying on primarily physical destruction of cancer cells, cryoablation is now understood to be a sophisticated, combinatorial therapy involving a complex cascade of destructive stresses which include extra- and intracellular ice crystal formation, initial post-thaw necrosis due to partial cellular damage from ice, the activation of a rapid membrane based apoptotic response within the core of a cryogenic lesion, by a delayed mitochondrial-based apoptotic response in the periphery of the iceball due , in part, to severe oxidative stress, secondary necrosis due to hypoxia and then coagulative necrosis due to vascular stasis. Destruction due to physical events is immediate, the rest of the whole process occurs over hours to days.

The cytotoxic effects of vascular damage and inflammation may occur over many days to weeks. Today cryoablation is a highly effective and practical means of treating numerous cancers with the long-term studies (5 and 10 year follow-up) demonstrating outcomes equivalent to or better than those achieved with other ablative techniques such as radio frequency ablation (RFA) and radiation therapy. (Baust, Gage, Bjerklund-Johansen & Baust, 2014)Management of hepatocellular carcinoma (HCC) is best performed in a multidisciplinary setting. Patients should be cooperatively managed by hepatologists, transplant and hepatobiliary surgeons, medical oncologists, interventional radiologists, and palliative care specialists. Specifically, this is crucial to ensure that patients who are candidates for liver transplantation are referred in a timely manner, while their tumors are within the Milan criteria. (Zhu, 2016)Overall, transplantation remains the best option for patients with HCC, however, the supply of good-quality deceased donor organs is limited.

That is the reason that other treatments, like resection, radiofrequency ablation (RFA), and, sometimes systemic therapy with sorafenib or for some cases with regorafenib, nivolumab, lenvatinib, pembrolizumab, cabozantinib, or ramucirumab, should be used to bridge patients to transplant or to delay recurrence . Others patients who experience a recurrence following resection or transplantation, aggressive surgical treatment appears to be associated with the best possible option. (Cicalese, 2019)In cases of absence of effective chemotherapy and insensitivity of HCC to radiotherapy, complete tumor extirpation represents the only opportunity for a long-term cure according to Cicalese, 2019. Stuart and Espat (2018) reported that in the United States, resection is possible in only 5% of patients and that in general, solitary hepatocellular carcinoma lesions confined to the liver without vascular invasion with well-preserved hepatic function will have the best outcomes.

Although there are no strict criteria in terms of tumor size, many surgeons use less than 5 cm as their cutoff. (Stuart & Espat, 2018)Optimum candidate selection is crucial to limit surgical morbidity and mortality as mentioned by Balogh et al (2016), in his review about Hepatocellular Cancer, he considered that in patients with normal synthetic function, the size of the tumor does not necessarily affect the outcome when the volume of remaining liver is adequate and technical aspects of the surgery are achievable. Operative mortality usually is affected by the presence (10%) or absence (5%) of cirrhosis. In previous decades, Child–Pugh classification has been utilized in the guidance of resection candidates but it is known that Child–Pugh classification is far from accurate in predicting postoperative liver failure. In the United States and Europe, selection of ideal candidates for resection is usually based on the assessment of portal hypertension, which is assessed by cannulation of the hepatic vein and calculation of the hepatic portal venous gradient.

Significant portal hypertension is evident when the portocaval gradient is >10 mmHg. Continued improvement in both surgical and nonsurgical approaches has demonstrated significant benefits in overall survival.The extensive review of the article of Cicalese (2019) explained that advances in the technique of liver resection, better patient selection, improved postoperative care, and expert anesthetic management have a dramatic reduction in perioperative morbidity and mortality. Liver resection is the operation of choice for patients with tumors smaller than 5 cm in the absence .