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The focus of this assessment will be on a 50 year old lady that is living with Breast cancer.  I have changed the name to Anya in order to maintain privacy and confidentiality according to the Nursing and Midwifery Council (NMC) (2015) guidelines. Anya is a single parent and lives with her children. Anya also works part time and has a good, strong family friend’s network. Anya was diagnosed with Breast cancer 5 years ago which has now metastasised to her bones. Breast cancer is the leading cause of death in women and men. Nearly 1000 women die every month in the UK including 80 from Scotland, and 350 men are diagnosed with Breast cancer every year in the UK including 30 in Scotland (Breast cancer now, 2016a). Studies show that Loss of Breast after mastectomy can result in psychological and emotional problems which may impact on their ability to form or maintain relationships (Kocan and Gursoy, 2016.) Depression and anxiety are common among the oncology patients and this will have an impact on their quality of life (QOL) (Nikbakhsh, N., et al., 2014). Anya will become involved within a multi-disciplinary team (MDT) and they will assist in the treatment and pain management. As her cancer progresses they will also discuss with Anya her preference of palliative care (Breast cancer care, 2017). According to Breast cancer now (2016b) Breast cancer is diagnosed in over 50,000 women in the UK. In June 2016 National institute for care and excellence guideline (NICE) published an updated version to their quality standard for breast cancer treatment and care to ensure breast cancer is diagnosed quickly and patients receive prompt treatment. The updated version comprises of 6 steps as opposed to the older 13 steps (NICE, 2016). In response to annual review in 2017, minor charges were made to ensure consistency with the update to the advance breast cancer (NICE, 2017).  Studies have shown that the loss of a breast after a mastectomy can lead to a loss of self-confidence and self-esteem, depression and their mental health (Heidari, M., et al., 2015).  Anya is vulnerable to some of these issues she is single therefore she will not feel complete as a woman and feels disfigured, which leaves her with low self-esteem due to her body image. This could make Anya become more sociably withdrawn which in turn would lead to depression which makes it hard for her to form a relationship. According to Carl Rogers he states that “self-image is how we see ourselves, which is important to good psychological health” (Sealey, F., 2009).Oxford English dictionary (2017) defines Vulnerability as “a person who is need of special care support or protection because of age disability or risk of abuse or neglect”. Anya will need a lot of support from specialist care services such as MacMillian, who will offer care and support to family and friends. They offer financial help and support for when you are no longer able to keep your work due to the impact of the illness. Other services that Anya will be using are specialist nurses and oncologist. They will be helping Anya with the treatment and medications she will receive and offer information or advice (MacMillian, 2016). So therefore it is vital that the responsibility of all nursing staff keep themselves updated with their skills and development so they are able to offer the best possible evidenced based practice (The Code, NMC, 2015c).  Anyas’ cancer has meant that on occasions she is not able to move or go out due to her radiotherapy treatment as fatigue is one of the side effects (Macmillan, 2015). Her vulnerability is furthermore increased as her breast cancer advances to the bones. She will be reliant on specialised services to operate as her bones become fragile. Although patients with bone metastases have morbidity, including bone fracture and muscle weakness, they can survive for many years but will suffer comorbidity (Vallet-Regi., et al, 2017) therefore she will become reliant on the pain team management to keep her pain under control. Risk and Resilience throughout the healthcare sector and studies show that one cannot exist without the other. In a discussion the panellists state and agree that resilience happens across the lifespan or sudden traumatic event, but this may be enhanced by other factors such as families’ individual cultural beliefs and community (Southwick, Steven, M,. et al, 2014). Part of Anyas’ resilience comes from currently being able to continue a normal life despite her difficult circumstances, she maintains her social life, working life and interactions with family and friends, which can also be seen as a protective factor (Rutter, 2008). However this can also cause a risk as Anya is not expressing how she truly feels that she could slip into depression. Therefore this could impact on her health and QOL (Brenes, G. A., 2007). Other definitions for resilience can be seen as intrinsic factors to the individual, such as positive coping mechanisms or there may be extrinsic factors which are good family support. Either factor can either be temporary or permanent fixture in the person’s life. They may come across these persons later during their illness and offer support. This could be a nurse specialist that has been involved in the person’s illness as she has been helping develop and promote resilience (Bonnano, 2004).Theorists have been involved with psychology for many years. Erik Erikson (1963) theory of development represents the needs of the individual throughout the lifespan. Certain levels are only achievable through good health and accomplishment (McLeod, S. A., 2013).  It does not however discuss the impact of having a long term illness at any time throughout the lifespan. Theorist Kublar Ross introduced the stages of dying in 1969. The model has five stages of grief: Denial, Anger, Bargaining, Depression and Acceptance, more commonly known as DABDA (Kublar Ross, E., and Kessler, D., 2014). This is more fitting of Anyas’ situation and she is currently at the stage of depression and acceptance. Kublar Ross (2014) states that during depression stages there is a sense of helplessness and being over whelmed, which in relation to Anya is the feeling of being sore and the disease is progressive and there is nothing she can do so. At times she will have suicidal tendencies as she thinks there is no point continuing with the pain. However on good days she has come to accept what is happening. She has organised and got things in place when it comes to her end of life care (EOLC). The Scottish involvement in ensuring that all EOLC needs are met is organised via the Strategic Framework for Action on Palliative and End of Life Care (gov.scot, 2016). According to Scottish Government this framework has been put in place in Scotland’s response to the resolution which was passed in 2014 by the World Health Assembly – “the governing body of the World Health Organisation, requiring all governments to recognise palliative care and to make provision for it in their national health policies” (gov.scot, 2016). The World health Organisation (WHO) policy on Health promotion has been defined as “the process of enabling people to increase control over their health and its detriments and thereby improve their health” (WHO, 2017).  Health involves a holistic view with five dimensions, encompassing; physical, intellectual, emotional, spiritual, and social needs (P.I.E.S.S) (John Hjelm, 2010). Social and emotional well-being is important to Anya’s individual needs. Her Emotional state generalises her mood and her self-esteem both of which are linked due to her illness. These have impacted on her accomplishment to continue with her social standing and ability to be involved with her daily activities. With her breast cancer progression she is no longer able to join in her keep fit activities due to muscle weakness. Therefore this has an impact on her emotional well-being as withdrawing from society makes her feel demotivated and depressed (MacMillian, 2014). Communication can be a barrier to effective health promotion especially if the individual cannot understand the jargon commonly used by professionals. Efficient communication is key skill to promoting better quality care and boundaries can be affected by validating good listening skills, talking to individuals in a way that they can understand, offering support can help manage a more reasonable hope. Good body language is also of importance and this is one obstacle that patients will detect on firstly (Norouzinia, Roohangiz et al, 2016). It is very of important for both men and women of all ages to become familiar with how their breast look and feel at different times of the month. The practice nurse or a specialised nurse will offer some supervision and teach patients how to examine their breasts or offer a leaflet which contains all the important information (Cancer research, 2017). The Scottish breast screening has been running since 1988 and the age to be screened changed back in 2003 from 50-64 to 50-70 years of age (gov.Scot, 2015). Treatment given after surgery is known as adjuvant treatment and includes radiotherapy, chemotherapy, hormone therapy and targeted (biological) therapy. Having the knowledge and the fundamental principles of radiation therapy ensures that the oncology nurse provides help to both their physical and psychological needs. This may be done by offering advice on nutritional needs, areas affected by the treatment, side effects, and transportation to the treatment centre should they require it (Cancer.net, 2017). The delivery of chemotherapy is also the responsibility of the oncology nurse. The nurse must have up to date knowledge of the pharmacology of drugs used so that mistakes do not happen. It is also important that the patient is kept up to date with the treatment and all possible side effects. Patients can become very ill because of the side-effects of chemotherapy so it’s imperative that the oncology nurse gives out all the relevant and important information and guidance on who they should contact if any problems occur. Palliative care offers support to the patient to live healthy and actively as possible until death. The palliative care team nurse will offer pain relief and she will assist with advice on how to deal with side effects from the medications, for example vomiting, diarrhoea, and fatigue. They will also advise the patient about how to rest and use relaxation techniques and they will help develop the patient requirements about their diet and nutrition and how this is important to maintain health and well-being. The palliative care nurse will be using all her knowledge and skills and also empathy to guide the patient and their family to the end stage of life by communicating effectively emotionally and physically, planning outcomes with the patient as patient choice over place of death should be a priority (NICE 2016), promoting advice on equipment wound care whilst always focusing on autonomy justice and the spiritual needs of the patient (National council for palliative care, 2015). As healthcare professionals, nurses are often asked about a variety of complementary and alternative therapies as some 30% of women diagnosed with breast cancer visit a complementary therapist (Spencer et al, 2016). Nurses have a duty of care and to be aware of the different types of therapies and in the form of health promotion they must be knowledgeable about certain aspects associated with safety issues, contra-indications and side effects before offering advice to patients about other forms of therapy. The nurse must always follow the NMC in working within their own limits and using practice based evidence to support her actions (NMC, 2015). To conclude, it is noticeable from the information discussed in the essay that early detection of breast cancer can reduce mortality. The care and treatment of both men and women with breast cancer has evolved  over the last few years and as of yet there is no cure for metastatic breast cancer. Evidence has shown that women are able to live longer with the use of different treatments. The Governments’ campaigns such as Breast Awareness are now more accessible clinics, and mobile health units all contribute to a healthier, more active lifestyle. Many of the clinics are now run by nurses and this has proved to provide a warm and caring environment for patients. Cancer provokes stress and anxiety in patients and nurses on the front line can help to soften their fears by offering psychological and emotional support, whilst showing empathy to patients. Communicating well, providing accurate information, listening and having time for the patient enhances the patient journey. It is vital that autonomy is honoured regardless of the patient’s culture, spiritual or ethnicity and that whatever treatment the patient requires is undertaken with the dignity and privacy for the patient. Lastly, end of life care is now firmly established as an important aspect of care delivery and it is an effective means of improving end-of-life care.REFERENCE LISTBonnano,G.(2004) Loss of Trauma and Human Resilience. American Psychologist. 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