MS, an Opportunity for RNs to Shine in Managing Symptoms

Abstract

This paper explores the unique opportunity that MS offers RNs who wish to provide outstanding services to patients in an especially difficult situation. As MS requires intense and repeated testing to verify it is not one of over 100 other diseases that present with similar symptoms, careful and thorough testing is necessary, but exhausting and can discourage patients. MS can only be diagnosed by process of elimination from look-alike diseases, and as treatment is life-long and involved, requiring a perpetual financial and emotional commitment from the patient with MS, this gives the RN an opportunity to use his or her roles as education, advocate, and friend, to help patients keep up their courage, to get an early diagnosis, and to adhere to treatment. MS is a disease that presents a variety of symptoms, and calls for an RN to deliver careful and thorough service to ensure the patience remains hopeful and adherent regarding treatment plans.

MS, an Opportunity for RNs to Shine in Managing Symptoms

As with many diseases that affect the nerves, multiple sclerosis has proven especially difficult to diagnose, and patient compliance with continued treatment depends in part on the ability of the nurse to explain MS and its treatment well.

Since there is yet to be a test diagnose it, doctors must rely on a process of elimination, assuring that the patient isn’t suffering from one of the more than 100 similar diseases. One of the initial symptoms is often in the eyes, as Cackett, of the British Medical Journal noted, “Ocular manifestations are sometimes the first sign of disease” (2006, p. 668). The problem with the eyes is merely a first indication: a barrage of tests must ensue.

Since MS is the most common adult neurological disease, understanding how to encourage the patient to seek treatment is vital. A favorable life trajectory is possible if the patient narrows down her diagnosis early on and then adheres treatment. The patient must expect to adjust his or her attitude, as accounts such as Helen Good Brenneman’s make a keynote of how “coping” and “patience” became central virtues (Brenneman, 1975, p. 1-3). Her account resonates with other accounts: MS requires lifelong patience.

The patient could experience fatigue, loss of sexual performance, pain throughout the body, “The average total cost per year, including equipment, lost wages, and informal and paid care giving,” at “more than $69,000” (Brodkey & Ben-Zacharia, 2011, p. 41-42). Since this is a hefty contribution, patients might lose heart that the therapy is all for nothing.

The disease comes with a host of primary, secondary, and tertiary symptoms, including clinical depression, immobility, and life stress. It is as if the patient were diagnosed with a whole set of diseases. While A.O. Frank was referring to a doctor’s role, the principle also applies nurses: “The initial distress and anger that follow the diagnosis may be minimized by good communication. A sympathetic doctor who understands the illness can encourage patients to plan realistically for an uncertain future while giving hope and helping them maintain a fighting spirit” (Frank, 1992, 1962). The nurse helps the doctor coordinate the team. A psychiatrist can be referred to for the clinical depression; antidepressants might bring the patient out of a deep depression. Immobility comes from skin breakdown or pressure ulcers, or from pneumonia, leaving the patient bed-bound or home-bound. RNs can arrange physical therapy to keep the patient mobile, can arrange in-home long-term care, and order physical therapy to ensure muscle health. Life stress can be handled by a psychiatrist. The same dangers must be faced as many mental illnesses, as Brodkey explained, “The ‘invisibility of the disease, the severity of cognitive and physical impairment, the lifelong duration of illness, a fear of needles, and insufficient understanding of the disease and its treatment also contribute to nonuse of these therapies” (Brodkey & Ben-Zacharia, 2011, p. 46). MS is a disease a patient may be tempted to shrug off and not treat, leading to relapse.

MS is a hydra of a disease that presents multiple symptoms, lifelong in duration, that can discourage most patients. A MS diagnosis is an opportunity for RNs who wish to help patients at their worst. The complicated nature of MS and the involved treatment plan call for the nurse to be more than an administrator of drugs, but to fulfill all the roles a nurse is called for, including counselor, advocate, emotional support, and friend. The nurse must be prepared to work with and entire team of doctors, as the symptoms of MS are varied. Ensuring the patient is not disquieted in moving from one therapist to the next can raise comfort and keep them encouraged.

References

Brenneman, H.G. (1975). Learning to cope. Scottsdale, PA: Herald Press.

Brodkey, M.B., Ben-Zacharia, A.B & Reardon, J (2011, July). Living well with multiple sclerosis. American Journal of Nursing, 40-48.

Cackett, P.D., Cameron, J., Bennett, H, & Masoud, M.T. (2006, March). Diagnosis and treatment of multiple sclerosis. British Medical Journal, 668

Frank, A.O. (1992, June). Minimizing psychosocial disabilities of multiple sclerosis. British Medical Journal, 1962-1963