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CASE STUDY: Caregiver Role Strain: Ms. Sandra A.

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 second-line 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

Sample Solution

The ‘young Marx’ had been relatively disregarded by academics until recently as his early work was considered ‘philosophical’, and not ‘scientific’ in economic terms as Das Kapital was, for example. The French sociologist Louis Althusser, however, notes that Marx’s works shouldn’t be read and interpreted as a coherent whole; rather, Marx’s work contains an ‘epistemological break’, representing a shift to a different theoretical framework, breaking with ideology to enter into the domain of science (Althusser & Balibar, 1970 [1965]). Therefore, it can be seen to be relevant to analyse both the ‘young’ and ‘mature’ Marx’s critiques of capitalism. Marx asserts that capitalist civil society (the economy) is alienating in that it destroys the collective organisation of economic life and makes us a ‘plaything of alien powers’ (Marx, 1994). Free markets cause us to be subjected to powers outside of and seemingly independent of us, such as ‘the invisible hand’ (Smith, 1822 [1759]); which Marx describes as socially created powers. In this arrangement, the individual ‘… acts as a private individual, regards other men as a means, degrades himself into a means, and becomes the plaything of alien powers’ (Marx, 1994). In this way, individuals are pitted against each in a competitive economic system in which there must be winners and losers, by which competition isn’t only necessary, but inevitable. Marx further denounces capitalism in context of the state, which he also asserts as alienating in that the majority don’t participate in deliberation and decision-making; and ‘condemns class society, in which control over production, over political decision-making, and over intellectual norms is in the hands of a minority’ (Browning, 2015, p. 2). In this sense, capitalism is denounced in that it destroys the collective organisation of economic and social life and thus resulted in a class struggle between bourgeoisie and proletariat, which will be explored later in greater detail. Therefore, the young Marx proposed democracy as the cure for such civil alienation. The participatory democratic control of all aspects of social life would abolish the capitalist split between polity a
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