Health Promotion: Prevention of Disease Case Study

Stresses management


Sandra, a 47-year-old divorced woman, received a diagnosis of stage 3 ovarian cancer 4 years ago, for which she had a total hysterectomy, bilateral salpingo- oophorectomy, omentectomy, lymphadenectomy, and tumor debulking followed by chemotherapy, consisting of cisplatin (Platinol), paclitaxel (Taxol), and doxorubicin (Adriamycin). She did well for 2 years and then moved back to her hometown near her family and underwent three more rounds of seconding chemotherapy. She accepted a less stressful job, bought a house, renewed old friendships, and became more involved with her two sisters and their families. Sandra developed several complications, including metastasis to the lungs. Then she could no longer work, drive, or care for herself. She had been told by her oncologist that there was nothing else that could be done and that she should consider entering a hospice. She met her attorney and prepared an advance directive and completed her will. She decided to have hospice care at home and, with the help of her family, set up her first floor as a living and sleeping area. She was cared for by family members around the clock for approximately 3 days. Sandra observed that she was tiring everyone out so much that they could not really enjoy each other’s company. At this time, she contacted the Visiting Nurse Association (VNA) to seek assistance. Her plan was to try to enjoy her family and friend’s visits. After assessment, the VNA nurse prioritized her problems to include fatigue and caregiver role strain. Other potential problem areas that may need to be incorporated into the care plan include anticipatory grieving and impaired comfort.

Reflective Questions

1. What are some of the stresses on Sandra’s middle-aged sisters and their families?

2. What resources are available to manage these stresses and support the sisters while caring for their dying sister Sandra?

3. Describe Sandra’s feelings about dependency and loss of autonomy because she is unable to do her own activities of daily living any longer




Health Promotion: Prevention of Disease Case Study




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Health Promotion: Prevention of Disease Case Study

Stresses management

“Time and health are two precious assets that we do not recognize and appreciate until they have been depleted.” (Denis Waitley). Health promotion is a crucial element of disease prevention involving strategies and activities positioned at improving the health of individuals and communities (Edelman & Kudzma, 2021). Stress management is a fundamental part of health promotion, which is crucial in preventing disease and overall well-being promotion. By promoting stress management, individuals can have a blooming lifestyle leading to better health outcomes and disease prevention. Health promotion affairs should aim at strategies enabling individuals and communities to handle stress, promoting overall health and well-being. This essay will explore a case study on Sandra, a 47-year-old divorced woman diagnosed with stage 3 ovarian cancer four years ago. From the case study, the essay will discuss some of the stresses on Sandra’s middle-aged sister and the family, available resources to manage the stress and support the sister while caring for their dying sister Sandra, and feelings of Sandra about dependency and loss of autonomy as she is unable to do her activities of daily living any longer.

Some of the Stresses on Sandra’s Middle-Aged Sisters and their Families

Caring for the loved one is illuminating as it is a core value, with everyone wishing to provide. Sometimes it can be intimidating and twisting even to the most flexible people. Sandra’s middle-aged sisters may experience both physical and emotional stress as a result of the overwhelming responsibilities.  To start with, the sisters are immensely fatigued because of the long hours of taking care of their sister with shiftless emotions and roles. The outcomes for prolonged and engaging roles are social isolation and lack of choice in being a caregiver (Morelli et al., 2019). Sandra’s sisters are also struggling to balance their caregiving roles and jobs, as the caregiving role is demanding, hence the sisters are likely to minimize their working hours which may affect their salaries hence encountering financial difficulties. Although the sisters may lack knowledge on how the caregiving responsibility affects them, too much strain and stress anguish an individual’s health as an individual is likely to encounter anxiety and depression. Sandra’s sister may also encounter anticipatory sorrow due to the fact that their sister’s illness is terminal, and they have to prepare for the ultimate loss of their sister. Caring for an ultimately ill loved one can be a complicated and emotionally taxing occurrence. Caregivers need to get support and resources to overcome such challenges.

Available Resources to Manage Sandra’s Sisters’ Stresses and Support the Sisters while Caring for their Dying Sister Sandra.

The stress of caring for a dying loved one can be shattering, so the caregiving family requires support to manage it. One of the essential help that Sandra’s sisters require is palliative care necessary for providing quality care and comfort for the patient (Hallenbeck, 2022). Sandra’s sisters may not have technical experience in managing symptoms like pain, shortness of breath, and the side effects of medication, where a qualified clinician or physician can be needed to help the family. Another vital resource being overlooked is the visitations of friends and family members. Members of the family and friends can have a significant role as they provide spiritual and emotional support to the relatives of the dying patient. Physical presence and listening, holding hands, and talking with family members are soothing and can relieve stress. The effort of visiting and sitting quietly and sharing memories with family members can also be reassuring (Haugdahl et al., 2018). In addition, agencies like visiting nurse associations can help as they can assist the family by offering qualified practitioners. Even though palliative care is usually offered in clinics and hospitals, arrangements can be made for Sandra to receive it from home. Sandra’s sisters having professional support and connection with family and friends could be essential resources for them to manage the stresses of caregiving. Such resources can help Sandra’s sisters manage the stresses of caring for their dying sister, providing comfort and support in difficult times.

Sandra’s Feelings about Dependency and Loss of Autonomy as she is Unable to do her Activities of Daily Living any Longer

After discovering numerous complications that were related to the course of their illness, which included metastasis to the lungs, all of a sudden, Sandra lost her autonomy. As she could no longer work, Sandra depended entirely on her sisters for everything. This made Sandra feel a loss of independence as she was limited to the house. Sandra also feels burdensome to her sister, compelling her to seek assistance from the visiting nurse association. Even after the visiting nurse association nurse examined Sandra’s condition and recommended some interventions, she was still affected by a sense of hopelessness, powerlessness, and helplessness. The imagination that she has suddenly turned from an independent person to a wholly dependent person makes her feel disturbed, which can easily lead her to depression. The imagination of her dignity and the sudden loss of autonomy made Sandra feel she was an annoyance and disruption to her sisters.


Sandra’s case study indicates the necessity of health promotion and disease prevention, specifically for middle-aged women at high risk of developing ovarian cancer. Sandra’s cancer eventually developed, requiring hospice care at home, despite undergoing treatment and chemotherapy. This circumstance caused stress and strain on her family members whore provided ceaseless care. Resources such as Visiting nurse associations can be essential to minimize some of the burdens on caregivers prioritizing patient needs. Sandra’s feelings of dependency and loss of autonomy indicate the requirement for patient-centered care addressing physical and emotional needs.


















Edelman, C., & Kudzma, E. C. (2021). Health promotion throughout the life span-e-book. Elsevier Health Sciences.

Hallenbeck, J. L. (2022). Palliative care perspectives. Oxford University Press.

Haugdahl, H. S., Eide, R., Alexandersen, I., Paulsby, T. E., Stjern, B., Lund, S. B., & Haugan, G. (2018). From breaking point to breakthrough during the ICU stay: a qualitative study of family members’ experiences of long‐term intensive care patients’ pathways towards survival. Journal of clinical nursing27(19-20), 3630-3640.

Morelli, N., Barello, S., Mayan, M., & Graffigna, G. (2019). Supporting family caregiver engagement in the care of old persons living in hard to reach communities: A scoping review. Health & social care in the community27(6), 1363-1374.

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