NURS2007: Nursing - Integration of theory with Practice - Critical Reflection Assessment Answers

Introduction

This assignment is based on critical thinking and discussing the importance of evidence based practice based on the case study. The role of nurses is very important in delivering quality care and improving patient outcomes. The paper discusses the case study of a 9 years old girl, Jenny. She is diagnosed to be suffering with acute lymphoblastic leukemia. She had taken an aggressive treatment of ALL since last 18 months, under which she had gone through marrow biopsy (BMB) and lumber puncture. These treatments are very complex for a child and can cause loss of energy. In spite of her aggressive treatment, her health deteriorated and she remained unwell. She has now been diagnosed with fungal pneumonia.

This paper will discuss the healthcare concerns for Jenny. The four choose perspectives would be home based Palliative care for children, patient centered care, role of evidence based practice and Pathophysiology of the disease. The ongoing condition of jenny requires great attention from professionals and family. She is being provided with home based palliative and supportive care. The role of nurse becomes very crucial while providing home based palliative care to the patient. Thus paper will discuss the perspective in reference to the role of nurse in providing quality care to Jenny.

Pathophysiology of Acute lymphoblastic leukemia and Fungal Pneumonia

Acute lymphoblastic leukemia is a bone marrow cancer found in children. This kind of cancer can occur in any individual of any age. This kind of cancer is characterized by over formation of immature lymphocytes (white blood cells). Palates, red blood cells and white blood cells can be affected by Leukemia (Inaba, Greaves, & Mullighan, 2013). The risk of this disease is increased with genetic conditions and past history of cancer. This cancer can get worse if it not treated on time. With this disease the anatomy of the bone is mainly involved, where the bone marrow is filled with excessive white blood cells. The cancer starts growing in the cells that are responsible for forming new blood cells. These cells are found in the bone marrow. Cancer starts growing when these cells begin to grow in excess and uncontrollable manner (Zuckerman & Rowe, 2014). ALL cancer can be caused by exposure to radiation, exposure to some chemicals, infection by some virus and inherited syndromes. When a child suffers from ALL, too many stem cells turn into lymphoblasts, B lymphocytes, or T lymphocytes (Inaba, Greaves, & Mullighan, 2013). These cells are considered as the cancer cells. Due to the increase of these cells in the bone marrow, very less space remains available for the healthy cells.

Fungal Pneumonia is a kind of lung infection, which is caused fungi. The type of fungi could be opportunistic or endemic. The major reason behind occurrence of this disease is due to the lack of immunity. Jenny is suffering from fungal pneumonia, as she is immune-deficient and her ability to fight the infection is very low. This fungal infection is caused due to the inhalation of the spores of fungi. By flowing in blood stream, these spores enter the lungs (Jain, Jain, & Rawat, 2010). Due to the treatment of cancer, the infection fighting white blood is reduced in the body and it becomes very difficult to fight the infections. The degree of fungal infection is very high in patient’s suffering with leukemia.

Nursing Perspective: The role of home based palliative care nurse includes ensuring the safety of the patient. For ensuring the progress of the patient, a nurse may have to consider few risks associated with patient’s condition.

1. Regulating Respiration: ‘Fungal Pneumonia’ is an infection of lungs; this affects the flow of gases and respiration process in the patient (Infections in People With Cancer, 2016). The first nursing perspective based on the palliative home based care is to monitor and report the respiratory rate of the patient. It is important to ensure that respiration is proper. Respiratory status must be monitored in terms of depth, rate, irregular breathing, diminished sound of breath,

Rational: This nursing intervention is very important for a patient in palliative care. It is vital to monitor the respiratory rate, level, quality and sound, because it informs about the airway resistance, severity of the disease and air movement. This intervention is also important to understand if there is any need of supplementary oxygen.

1. Importance of Hygiene: Hygiene is very important for the cancer patients. Often people forget to wash their hands before coming close to the cancer patient. After the therapies of cancer, it is important to maintain the hygiene and clean environment. So the second nursing perspective would be to ensure that patient receiving palliative care at home must also receive germ free and safe environment. The skin and mucus membrane of the cancer patient are damaged by the chemotherapy, radiation therapy or surgeries. Thus it becomes easier for the germs to enter the body (Infections in People With Cancer, 2016).

Rational: People gone through the treatment of cancer, do not have strong immunity like normal people. These patients are at the higher risk of getting infected by various fungal and bacterial diseases. The infection enters the body through unsafe environment (Jain, Jain, & Rawat, 2010). It is important for the visitors to wash their hands before providing any support or care to cancer patient. This will help to reduce the chances of infection and will also help in turning the ongoing infection towards serious conditions. Family and friends should also acknowledge the importance of hygiene. It is important for patient to keep hygiene of mouth as well. If any signs of infection are seen than family must immediately consult with doctor.

1. Professional Communication: It is very important to home based palliative care nurses to report every change in the patient’s condition to report to the doctor and healthcare professionals. The medical care must be given in collaboration with the physician. The nurse may risk the patient’s safety by not communicating important information to the physician. Communicating with physician regarding the changes is vital for making changes in medication and care plan. For evaluating the effectiveness of the care plan will also depend upon effective communication among nurse and practitioner.

Rational: It is the duty of the home based support nurse to monitor changes in the condition of the patient and note them. Professional communication among the nurses and physicians is important for the safety and well-being of the patient. Jenny is at home based palliative care and require regular visit by the support nurse. Nurse will evaluate and note the changes in her condition, which will help the physicians to identify the effectiveness of the treatment. Due to the fungal infection, the condition of the patient may deteriorate and may require change in medication. Physician should be immediately informed about this situation.

1. Poor Nutrition and Risk of Infection: Having a balanced and nutritional diet is very important for the cancer patients. Due to different treatments and chemotherapies, the cells inside the body are damaged and body becomes very weak. Nutritional diet and lot of fluid is important to for cells to grow and work normally (Ligibel et al, 2014). Nurse may have a concern related to the diet of the patient. Inadequate diet may reduce vitamins, minerals, protein and calories in the body, which may further weaken the immune system and risk of infection increases. The cells become weaker and destroying the germs also become difficult (Ligibel et al, 2014).

Rational: Children gone through cancer therapies and treatment often have weak immune system and due to the damage of skin the risk of getting infections become high. After cancer treatment, it is important to provide nutritional diet of the patient. Nurse must inform the family members and care givers to understand the importance of balance and nutritional diet. Cancer can make it difficult for the patient to eat, but eating food and taking more fluids is important to fight infections (Ligibel et al, 2014). Loss of appetite is common after radiation therapies and chemotherapies, but patients must be taken care with the help of their family members. Nurse must monitor the eating pattern and nutrition intake of the patient, so that she could inform the doctor or dietician about any changes in diet. It is also important, because in some cases children may require tube feeding or intravenous feeding.

Importance of Evidence Based Practice

Evidence based practice (EBP) is a new approach that enhances the nursing care quality and clinical practice. For the patients under palliative care, evidence based practice can help to improve the patient quality of life (Buysse et al, 2012). Patients like Jenny, who is under palliative care, display many changes is their physical and mental health. Evidence based practice allows the nursing professionals to identify these evidences and provide the care according to the condition of patient. The psychological function of a child suffering from chronic illness can be affected; the psychological functioning and medical disease have a relation, which id defined through Medical-psychiatric co-morbidity (Schneider & Whitehead, 2013). Evidence based practice allow the nurses to maintain the balance between two different conditions.

Chronic illness like cancer poses a great challenge to psychosocial adjustment for the patient and the family (González-Valderrama et al, 2015). Jenny’s family is also facing the same issue. This condition also affects the treatment, effectiveness and management of the disease. Some of the common psychosocial issues could be anxiety, depression, lack of coping skills and cognitive difficulties (Neu et al, 2014). The main goal of the evidence based practice is to provide appropriate clinical information and generating effective care interventions for the patients. For addressing the psychosocial interventions for the patient with chronic illness, evidence based practice becomes very crucial.

It is important to support the patient as well as the family members and help them to cope with the situation. If the patients do not receive quality care, their condition may further worsen. EBP helps to identify the behavioral, educational and psychological issues related to the patient’s condition (González-Valderrama et al, 2015). This helps nurses to apply critical thinking and improve the quality of the nursing practice. EBP is also helpful in providing the future basis for the research of the patient’s care study and allow other healthcare professionals to understand the effectiveness of the treatment.

Importance of Critical Thinking in Nursing Practice

Nursing profession is the profession of those people, who possess natural abilities to nurture and provide care to others. It is also important to have a desire to help others. Another skill that professional and successful nurses share is the ability to think critically. Critical thinking can be defined in various ways, but it is mainly the ability that allows the nurses to identify the problem, finding the best approach, and applying the correct method to achieve the desired outcome (Chan, 2013). Nurses, who use critical thinking process execute a plan and think critically to figure out the effective way to achieve desired outcomes.

The critical thinking ability of the nurses is put to test in various ways while providing care to the patient. Providing care to the patient under palliative support becomes a complex situation for a nurse. The nurses have to act cortically for providing the correct and appropriate care to patient. Nurses are required to challenge their limits of thinking and appraising the correct solution. Critical thinking also helps the nurses to be prepared for the real life scenarios and make the correct choices for ensuring patient’s safety and well-being (LoBiondo-Wood et al, 2013).

Conclusion

The paper is drawn on the case study of Jenny. She is suffering from acute lymphoblastic leukemia and has gone through aggressive treatment of different cancer therapies. She was an active child, but her medical disease deteriorated her condition and she had to withdraw from her daily activities. Currently she has been diagnosed with Fungal Pneumonia. The paper provided the Pathophysiology of acute lymphoblastic leukemia and Fungal Pneumonia. The paper also addressed four important nursing perspectives, which are very essential to be considered in case of Jenny. These four perspectives are regulating respiration, importance of hygiene, professional communication and risk of poor nutrition. Paper also identified the importance of evidence based practice and critical thinking. For a pediatric nurse caring for patients under palliative care, it is essential to make decisions based on critical thinking. This is very important to provide quality care and improve the patient outcomes.