Turnitin®This assignment will be submitted to Turnitin®.
Instructions
For this assignment, you will complete a worksheet on cultures and artifacts.
To complete this assignment, review the following documents:
Prompt: Follow the directions in the Cultures and Artifacts Worksheet
In this essay I will be using the
Driscoll Model of Reflection
, Driscoll 2011. Reflection in nursing is when we are consciously looking and thinking about our experience’s, actions, feelings and responses. We typically do this whilst asking ourselves about what we did, how we did it and what we learnt from it and that reflection should be used throughout all nurses’ careers. The Nursing and Midwifery Council NMC (2018) requires that all nurses use their feedback as an opportunity for reflection and learning as it can improve their practice. Nicol and dosser (2016) states that reflection should be used at all stages of an accident or situation and that it’s important to understand what reflection is and how it can be done successful. Reflection helps us develop skills and knowledge and also helps us maintain and develop throughout our career. Reflection occurs after an event occurs in practice. Throughout this essay I’ll be researching the
ethics in nursing care
.
I believed that quality nursing care is about caring for your patients at a good quality standard. Nurses themselves have some values and know what values are. I feel for good quality nursing care you should be approachable to talk to and professionally and personally to your patients. To be confident with your patients and you wouldn’t want them to feel that your nor confident in what you’re doing or helping them with. Be respectful, patient, and caring making it a safe place for patients if they feel like they need to speak to you about personal stuff 1-1. Good nursing quality care should be companionate, smile when talking to them, making good relationships with others so when needed they have you there for a pat on the back. Being aware of their behaviour changes even if your busy. Ethical be truthful and honest to them don’t sugar coat any issues they need to know about. Your body language is important too don’t fold your arms, don’t zawn when talking to them, don’t give poor contact and open arm posture. They will feel like their boring you and you’re not interested and won’t build a steady professional relationship with you.
Through studying at university, I now feel I have a better understanding that having a professional relationship with patients are important to have as you will achieve a more successful patient and family centred care. Person – centred care and family centred care is a high priority in all health care professions. It’s all about making sure that people are involved and is central to their care and needs. McCormack and McCance (2017) suggest that that creating relationships its essential when creating person centred care. These relationships are not only with the patient or families it’s also about the relationship you have with other healthcare professionals. KS Dunham (2018) gives out suggestions that Communication is also key when it comes to colleagues as a nurse or any healthcare professional you will probably communicate most with them. Having professional relationships with colleagues’ help set the groundwork for successful inter-learning which is critical to delivering care. Person-centred Practice in Nursing and Health Care is a comprehensive and practical resource for all nurses and healthcare practitioners who want to develop person-centred ways of working.
Communication is essential in health care, it wouldn’t be person centred care without it. RCN (2018) say ‘having a good communication with patients will reduce their anxiety and build their confidence’. It’s common for patient to feel anxious about their care, treatments or even tests they are getting whilst in your care. It can sometimes lead to the patient to speak out of character, be rude or even aggressive as they are unsure what the future holds for them, this is just down to them being scared and not sure what is happening. Communication with the nurse or health care professional will prevent this if you let them know what’s happening and if you don’t know tell them and they will find out as soon as you do. It’s hard for patients in hospital or care homes because they are usually in control of their everyday tasks and as an elderly person, they might have dementia or just not as able as they used to be and don’t like that they need someone to help them out of bed, help them when they wash or even eat. Losing control can make them feel helpless or hopeless. But good communication can avoid these feelings if the patient is able to still take charge of their own life. It can help people to see that they still have a say and are still in charge of their own lives. Patients that get good communication with healthcare professionals often feel more valued than the patients that don’t. Giving patients our time and spending time with them, getting to know them and listening to them, we’re showing that we value what their saying and communicating with them will help us achieve the best person-centred care they need.
The department of health (2011) state that personal values are your own individual beliefs. Attitudes, behaviour, life experiences and decision making. Everyone has their own values and attitudes in life but as a nurse you have to put your own values and attitudes aside for the care of your patient. Journal of Professional Nursing (2005) states that our values are hierarchy based and therefore nurses should recognize that another’s personal values might differ from their own. Being brought up in different generations can cause conflict with as the older generation may think that they but as a nurse you have to put values to the side to care for your patient. NMC (2018) say in the national care standards, ‘Treat people as individuals’ as you must not discriminate in any way against those in your care. Nurses practise in diverse cultural environments and must take care not to offend patients’ values and beliefs.
One of the values I have in life is Health, I think health is very important because if we didn’t have our health, we wouldn’t have a normal standard of life as having bad health would stop that. As a nurse I have to be professional and put my attitudes and opinion aside as not everyone thinks the same. I’ve also got to be very supportive with my patients and help them regardless of their issues and thought progress. As a mental health nurse I know I am going to come across patients that don’t want help regarding their health due to substance abuse, suicidal attempts and then on the other hand I will come across an elderly patient with the first symptoms of dementia and they don’t have a choice in life regarding their health but try their best to get back to a normal life as possible. Alzheimer’s Scotland (2018) state that dementia is progressive meaning that the symptoms start out slower but gradually get worse. For people with dementia this means their memory becomes worse and their health can start to deteriorate which upsets them and their family around them.
In relation to elderly patients I have put my own values about health aside as not everyone has the same values and attitudes about health. Family care givers (2017) say caring for the elderly is one of the toughest challenges because some of them don’t want help with health and care because they feel like they have already lived their life. With working with the elderly before I feel confident that I will be able to work with them even if I don’t agree with them about their values on their health. My personal development below describes the methods I will use to develop this skill.
Personal Development Plan
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To be able to put your own values on health aside when providing personal and family centred care to people who have their own option about their health. |
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By keeping my own values and opinions to myself, such as the one I mentioned about health being important to me. Respecting patients and their family’s values regarding health and other values they may have as everyone has different values and it’s important to keep a good relationship with patients and their care shouldn’t be affected if you have different values. |
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January 2019 |
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April 2019 |
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I will feel more confident when speaking to patients about their values without thinking about mine or what values I would use in their situations. |
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My mentor will know as I will keep professional whilst with the patient and their family but once we have time to have quiet time, I will confine in them if I felt difficult in the situation and what I can do different next time if they have any solutions for me to try. |
Conclusion
In reflection of completing the quality care nursing module, it has let me see that I wasn’t far off with my original thoughts of what the module was about. Over the last couple of months learning about quality nursing it has helped me think as a student nurse what to expect and how to deliver care to patients when I go out on placement. I have also learned that not every patient I care for will have the same needs or same values as me and have to adapt to the patient and their needs accordantly to their care plan. The patient could be elderly, young adult or have specific needs and it’s up to me as a student nurse to value their needs. Reflecting back on the last couple of months before starting my quality nursing care module and what I thought I knew, I now know there was bits I didn’t know and what I’ve learned can help me to carry on with my learning during my placement and throughout my work when I qualify. So, I am able to give my patients the best care for their needs and up to date care they require.
Reference List
Is it possible to distinguish testicular torsion and other causes of acute scrotum in patients who underwent scrotal exploration? A multi-center, clinical trial
ABSTRACT
Objectives:
We assessed the importance of the clinical presentation of boys who underwent surgical exploration for acute scrotum.
Materials and Methods:
We retrospectively analyzed the records of 97 boys (≤25 years old) who underwent surgical exploration for acute scrotum between May 2007 and July 2013. Diagnosis of acute scrotum was confirmed by physical examination, colour Doppler ultrasound (CDUS) and laboratory findings.
Results:
In total, 97 scrotal explorations were carried out for acute scrotal pain. 74.2% (n=72) had testicular torsion (TT), 25.8% (n=25) had other pathologies included torsion of testicular appendage (n=13), epididymo-orchitis (n=8), testicular trauma (n=2), and Henoch-Schönlein purpura (n=2). In the TT group, 32 cases (44.4%) presented to hospital within the less than 6 hours after pain onset, and more than half (64%) others group cases presented >24 hours after pain onset. Fever and pyuria appeared more frequently in the others group than in the TT group, and the results reached statistical significance. Patients with TT had more testicular tenderness compared to the others group (p<0.001). Our testicular salvage rate was 59.7% and missed testicular torsion rate was 40.3%.
Conclusions:
CDUS was largely predicted the diagnosis of TT (sensitivity, 98.6%). Clinical findings such as testicular tenderness, fever and pyuria may be helpful in making the differentiation in TT and others (nonsurgical) group.
Key words:
surgical acute scrotum; non-surgical acute scrotum; testicular torsion; torsion of testicular appendages; epididymo-orchitis; scrotal exploration.
INTRODUCTION
When acute scrotal pain is experienced by a child or teenage boy in his adolescence, one should always treat this condition as an emergent condition, whether or not it is accompanied by swelling. Torsion of the spermatic cord, epididymo-orchitis, torsion of testicular appendages, trauma, tumor, hernia, idiopathic scrotal edema vasculitis and cellulitis are signs looked for when diagnosing acute scrotum. Although the majority of these conditions are non-emergent, when torsion of the spermatic cord occurs, it is vital that it be immediately diagnosed and treated. If it is not, the testicle could suffer permanent ischemic damage (1). The most common causes of acute scrotum in young people are testicular torsion (TT), epididymo-orchitis (EO), torsion of testicular appendage (TTA), and epididymo-orchitis (EO) (2-4). Because of the possible risk of permanent damage to the testicle, it is vitally important to determine whether the acute scrotal pain is caused by testicular torsion or something else. In the past, medical professionals have used sonography and clinical findings to help determine the cause (5,6).
This study examines the results of scrotal exploration, the symptoms and signs of acute scrotum and ways to distinguish whether testicular torsion or other factors are the cause of acute scrotum in young patients.
MATERIALS AND METHODS
97 patients underwent exploration of scrotum for acute scrotal pain between May 2007 and July 2013. A retrospective review off all boys up to the age of 25 years. Data were obtained retrospectively maintained hospital databases of all patients who underwent scrotal exploration in four tertiary referral centres (Suleyman Demirel University Faculty of Medicine, Isparta, Haydarpasa Training and Research Hospital, Istanbul, Tepecik Training and Research Hospital, Izmir, and Fatih Sultan Mehmet Training and Research Hospital, Istanbul).
Patient selection
The case notes of all the operated patients with acute scrotum were selected for evaluation. All participants were examined physically by a resident or the consultant of Urologist. Physical findings included scrotal erythema, swelling, tender scrotum was recorded. Patients’ ages, clinical findings, the affected side, pain duration, previous history, fever (>38°C), nausea-vomiting, final diagnosis, and type of surgery were evaluated. In all cases, a white blood cell (WBC) and urinalysis (pyuria) were requested.
Patients with a recent surgery of the external genitalia, an incarcerated hernia, tumor and extravaginal neonatal spermatic cord torsion were excluded from the study.
Colour Doppler ultrasonography (CDUS) was performed in all patients. Because of an assumed unreliability of CDUS the decision for surgical exploration was mainly based on the clinical findings because of the implications of missing testicular torsion. Torsion of the testis was managed by either orchidopexy or orchidectomy. The contralateral testis was also fixed. Torsion of the appendix testis was treated by excision. In cases of epididymo-orchitis the ipsilateral testis only was fixed. Orchiectomy was performed in two patients with testicular rupture and hematoma after trauma. Two HSP patients who had not got torsion, underwent bilateral testicular fixation. This study was approved by the Local Ethics Committee of the Suleyman Demirel University, Faculty of Medicine.
Statistical analysis
Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS) for Windows, version 19.0. A significance value of p<0.05 was accepted as statistically significant. Data are expressed as a mean ± standard deviation for continuous variables, and as a number and percentage for categorical variables. Categorical data between groups were compared using χ2 test or Fisher’s exact test while continuous distributed data were compared using either Mann–Whitney U test or analysis of variance.
RESULTS
A total of 97 patients were included in this study and divided into two groups. Seventy-two patients had TT (74.2%), 25 patients had other acute scrotal pathologies (25.8%). Other pathologies included torsion of testicular appendage (n=13), epididymo-orchitis (n=8), testicular trauma (n=2), and Henoch-Schönlein purpura (n=2). Table 1 presents final diagnoses after exploration.
The characteristics of the two groups are presented in Table 2. The mean age of patients with TT (17.9±4.5 years) and other group (16.6±7.3 years) were similar. In TT patients, the left testicle was more often affected than the right one (58.3% vs 41.7%). The left testicle was more affected in both of the two groups. In terms of pain onset time, the TT group than in the other group referenced in the early hours was observed. (p=0.003). In the TT group, 32 cases (44.4%) presented to hospital within the less than 6 hours after pain onset, and more than half (64%) other group cases presented >24 hours after pain onset.
Clinical features and physical examination findings are presented in Table 3. Fever and pyuria appeared more frequently in the others group than in the TT group, and the results reached statistical significance (p<0.05). Patients with TT had more testicular tenderness compared to the other group (p<0.001). The prevalence rate of nausea/vomiting, scrotal erythema and swelling among the two groups were not significantly different. Patients in the others group had a higher WBC count than the TT groups, but was not statistically significant.
Scrotal exploration was performed in all patients (100%). Viable testes were found in 43 of 72 patients with TT during operation. Detorsion and fixation of testes were performed. The other 29 patients received orchiectomy for nonviable testis and orchiopexy for unaffected testis to prevent further TT. The salvage rate of TT was 59.7% (Table 4). Only one case was performed manual detorsion before scrotal exploration and fixation.
All patients underwent CDUS (Table 5). Importantly, 71 of 72 TT (98.6%) were correctly identified as torsions.
DISCUSSION
For young people, the most common causes of acute scrotum are TT, EO and TTA (2,3,4,7). Of these three, TT is the cause for 25%-35% of acute pediatric scrotal disease and is found in .025% of males under 25 years of age (8). In our study, values of TT, TTA and EO were found to be 74.2%, 13.4% and 8.2%, respectively. This result is compatible not only with clinical studies (6,7,8,9,10) in which only scrotal exploration was evaluated, but also with clinical studies (11,12,13,14,15) in which surgical and medical treatments were evaluated in terms of three clinical entities. The most common reason for acute scrotum is TT in five of the studies (6,7,9,12,15), TTA in three of them (8,11,13) and EO in 2 of them (10,14). Interestingly, there are studies which find a strangulated inguinal hernia responsible within these most common 3 clinical conditions (16). In our study, TT is discovered to be the cause for most of the cases of acute scrotum. Also, the condition that is most often reported in Turkey is TT.
Ideally, though sometimes clinically impossible, there should be a distinction between TT and other causes not requiring surgery (17). Studies have been made to distinguish TT from other acute scrotal pathologies and reduce the ratio of negative exploration. In these studies, clinical findings such as a pain duration <24 h, nausea/vomiting, a high position of the testis, and an abnormal cremasteric reflex are found to be predictive of TT (18,19). In our study, a comparison is made between the “TT group” and an “others group” consisting of patients not requiring surgery other than two trauma cases who underwent orchiectomy due to testicular rupture. According to our findings, there were no statistically significant differences in the way that the two different groups of patients reacted as far as scrotal erythema/swelling, nausea/vomiting and other clinical presentations. Whereas testicular tenderness was found to be high in the TT group, pyuria and fever were high in the other group both significantly and statistically. This difference observed in pyuria and fever in the other group may be related to urinary system infections which are more common in EO (20).
Over the past 20 years, medical professionals have frequently used the Colour Doppler ultrasound (CDUS) to determine the presence and extent of TT. This machine is helpful in determining when surgical exploration of the scrotum is unnecessary, cutting down the number of unnecessary explorations (21). Nevertheless, the information provided by the CDUS is affected by how the user uses the machine and should be compared with the medical history of the patient and the results of a physical exam (22). In the diagnosis of TT, CDUS is reported to have 69.2-100% sensitivity and 87-100% specificity ratios (23,24). Only in one patient, a false negative result was achieved in the diagnosis of TT, and CDUS sensitivity was found to be 98.6%. It is known that CDUS causes complexity in making diagnosis of ATT and EO cases and causes over diagnosis in EO (20). Although it is reported that CDUS doesn’t deviate in HSP, which is the nonsurgical cause of acute scrotum, asymmetrically reduced blood flow and absence of blood flow in CDUS could not be clinically differentiated from TT due to scrotal hyperemia and edema (25). Bilateral testicular fixation was applied in cases not presenting tortion in scrotal exploration. Although scrotal trauma is usually taken care of with minimal intervention, when the testis is ruptured traumatically this is a signal that immediate surgical exploration is necessary (21). We performed orchiectomy in two trauma cases in which hematoma developed and was followed by traumatic rupture.
The success rate of preserving the testicle in the case of TT closely depends on early admission. Cimador et al (25) reports that testicular infarction initiates after the 2
nd
hour of ischemia and that complete infarctus occurs in 6 hours and the irreversible loss of the testicle would develop in 24 hours. Also, it is reported that a non-viabile testicle is a very specific symptom in admissions after 10 hours and that this characteristic would require orchiectomy in all cases. The ratio of preserving testicles varies between 37 to 88% in literature (9,10,13,14,15). In our study, it was observed that the TT group was admitted significantly earlier (55.5% < 12 h) than the others group (p=0.003). In accordance with that, the rate of preserving the testicle was found to be 59.7% (43/72). This result suggests that more TT cases are admitted with the sudden onset of pain when compared to nonsurgical acute scrotum cases.
In our study, non TT acute scrotal pathologies are used for the comparison group. The lower patient number in this group and 2 trauma cases not leading to a 100% homogeneous study can be counted as study restrictions.
Conclusion
In order to avoid the loss of the testicle and unnecessary surgical interventions, it is important to distinguish TT from other acute scrotal pathologies. Thus, CDUS, which presents more specific findings for TT, and clinical findings such as testicular tenderness, fever and pyuria may be helpful in making the differentiation. Again, it should be remembered that TT cases are mostly admitted earlier with the sudden onset of pain.
Conflict of interest:
None declared.
REFERENCES
1. Gatti JM, Patrick Murphy J. Current management of the acute scrotum. Semin Pediatr Surg. 2007;16:58-63.
2. Lewis AG, Bukowski TP, Jarvis PD, Wacksman J, Sheldon CA. Evaluation of acute scrotum in the emergency department. J Pediatr Surg. 1995;30:277-81.
3. Burgher SW. Acute scrotal pain. Emerg Med Clin North Am. 1998;4:781-809.
4. Kadish HA, Bolte RG. A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendage. Pediatrics. 1998;102:73-6.
5. Beni-Israel T, Goldman M, Bar Chaim S, Kozer E. Clinical predictors for testicular torsion as seen in the pediatric ED. Am J Emerg Med. 2010;28:786-9.
6. Nason GJ, Tareen F, McLoughlin D, McDowell D, Cianci F, Mortell A. Scrotal exploration for acute scrotal pain: A 10-year experience in two tertiary referral paediatric units. Scand J Urol. 2013;47:418-22.
7. Jefferson RH, Perez LM, Joseph DB. Critical analysis of the clinical presentation of acute scrotum: a 9-year experience at a single institution. J Urol. 1997;158:1198-200.
8. Waldert M, Klatte T, Schmidbauer J, Remzi M, Lackner J, Marberger M. Color Doppler sonography reliably identifies testicular torsion in boys. Urology. 2010;75:1170-4.
9. Hegarty PK, Walsh E, Corcoran MO. Exploration of the acute scrotum: a retrospective analysis of 100 consecutive cases. Ir J Med Sci. 2001;170:181-2.
10. Cavusoglu YH, Karaman A, Karaman I, Erdogan D, Aslan MK, Varlikli O, et al. Acute scrotum – etiology and management. Indian J Pediatr. 2005;72:201-3.
11. McAndrew HF, Pemberton R, Kikiros CS, Gollow I. The incidence and investigation of acute scrotal problems in children. Pediatr Surg Int. 2002;18:435-7.
12. Molokwu CN, Somani BK, Goodman CM. Outcomes of scrotal exploration for acute scrotal pain suspicious of testicular torsion: a consecutive case series of 173 patients. BJU Int. 2011;107:990-3.
13. Mushtaq I, Fung M, Glasson MJ. Retrospective review of paediatric patients with acute scrotum. ANZ J Surg. 2003;73:55-8.
14. Lyronis ID, Ploumis N, Vlahakis I, Charissis G. Acute scrotum-etiology, clinical presentation and seasonal variation. Indian J Pediatr. 2009;76:407-10.
15. Moslemi MK, Kamalimotlagh S. Evaluation of acute scrotum in our consecutive operated cases: a one-center study. Int J Gen Med. 2014;15:75-8.
16. Erikci VS, HoÅŸgör M, Aksoy N, Okur O, Yıldız M, Dursun A, et al. Treatment of acute scrotum in children: 5 years’ experience. Ulus Travma Acil Cerrahi Derg. 2013;19:333-6.
17. Kalfa N, Veyrac C, Baud C, Couture A, Averous M, Galifer RB. Ultrasonography of the spermatic cord in children with testicular torsion: impact on the surgical strategy. J Urol. 2004;172:1692-5.
18. Boettcher M, Bergholz R, Krebs TF, Wenke K, Aronson DC. Clinical predictors of testicular torsion in children. Urology. 2012;79:670-4.
19. Boettcher M, Krebs T, Bergholz R, Wenke K, Aronson D, Reinshagen K. Clinical and sonographic features predict testicular torsion in children: a prospective study. BJU Int. 2013 ;112:1201-6.
20. Yin S, Trainor JL. Diagnosis and management of testicular torsion, torsion of the appendix testis, and epididymitis. Clin Ped Emerg Med. 2009;10:38-44.
21. Gronski M, Hollman AS. The acute paediatric scrotum: the role of colour doppler ultrasound. Eur J Radiol. 1998;26:183-93.
22. Pepe P, Panella P, Pennisi M, Aragona F. Does color Doppler sonography improve the clinical assessment of patients with acute scrotum? Eur J Radiol. 2006;60:120-4.
23. Zini L, Mouton D, Leroy X, Valtille P, Villers A, Lemaitre L, et al. Should scrotal ultrasound be discouraged in cases of suspected spermatic cord torsion? Prog Urol. 2003;13:440-4.
24. Lam WW, Yap TL, Jacobsen AS, Teo HJ. Color Doppler ultrasonography replacing surgical exploration for acute scrotum: myth or reality? Pediatr Radiol. 2005;35:597-600.
25. Cimador M, DiPace MR, Castagnetti M, DeGrazia E. Predictors of testicular viability in testicular torsion. J Pediatr Urol. 2007;3:387-90.
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Testicular torsion |
72 (74.2%) |
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Other causes of acute scrotum |
25 (25.8%) |
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– Torsion of testicular appendage 13 – Epididymoorchitis 8 – Testicular trauma 2 – Henoch-Schönlein purpura 2 |
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Table 1. Final diagnoses after scrotal exploration.
Table 2. Characteristics both of two patient groups.
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Age (yr) |
17.9±4.5 |
16.6±7.3 |
0.707 |
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Location |
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Right |
30 (41.7%) |
11 (44%) |
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Left |
42 (58.3%) |
14 ( 56%) |
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Duration of pain (hr) |
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≤6 |
32 (44.4%) |
2 (8%) |
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6-12 |
8 (11.1%) |
2 (8%) |
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12-24 |
12 (16.7%) |
5 (20%) |
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>24 |
20 (27.8%) |
16 (64%) |
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TT, testicular torsion; Others, other acute scrotal pathologies
Table 3. Clinical findings and laboratory data both of two patient groups.
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Clinical findings |
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Fever |
1 (1.4%) |
8 (32.0%) |
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Scrotal erythema/swelling |
19 (26.4%) |
19 (76 %) |
0.52 |
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Testicular tenderness |
63 (87.5%) |
12 (48.0%) |
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Nausea/vomiting |
11 (15.3%) |
3 (12.0%) |
0.487 |
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Laboratory data |
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WBC counts (/μL) |
10.590±3.173 |
11.396±3.387 |
0.455 |
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Pyuria |
8 (11.1%) |
7 (28%) |
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TT, testicular torsion; Others, other acute scrotal pathologies
Table 4. Treatment types and salvage rate of patients with testicular torsion.
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Detorsion and fixation |
43 |
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Orchiectomy |
29 |
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Total |
72 |
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Salvage rate |
59.7% |
TT, testicular torsion
Table 5. Results of color Doppler ultrasonography both of two patient groups.
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CDUS Absent/decreased flow |
71 (98.6%) |
9 (36%) |
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Increased/normal flow |
1 (1.4%) |
16 (64%) |
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TT, testicular torsion; Others, other acute scrotal pathologies; CDUS, color Doppler ultrasonography
The purpose of this assignment is to critically reflect upon on aspect of my professional practice and development that arose whilst out in clinical practice. The paper will show emphasise based on communication. This reflection has been chosen to highlight the need for nurses to have therapeutic communication skills in order to provide holistic care and encourage a good nurse-patient relationship. Gibbs (1988) reflective cycle has been chosen as a framework for this paper. To satisfy the requirements of the Data protection Act (1998) as well as the NMC (2007) code of professional conduct, all names have been changed to protect identity in concordance with confidentiality purposes.
Reflection is a way of analysing a past incident in order to promote learning and development. Gibbs (1988) reflective cycle can be seen as cyclical in nature which incorporates six stages to enable me to continuously improve my learning from the event for better practice in the future. The six stages are: 1. Description 2. Feelings 3. Evaluation 4. Ananlysis 5. Conclusion 6. Action plan.
Whilst out in placement I witnessed both positive and negative communication. During handover I was informed ‘Maisey’ has dementia, deafness, aggression and short term memory loss. During handover Maisey approached the nurses int he office who appeared to look very anxious and upset. The staff nurse raised her voice and in a fixed tone told Maisey to return to her bedroom, shouting ‘we are to busy now, go back to your room.’ The nurses and health care assistants present in handover giggled amongst themselves, exchanged knowing glances and mimicked Maiseys voice saying she can be such a nuisance. Having not previously met Maisey I offered to assist her with her personal hygiene needs and to make her bed. I knocked on her bedroom door to which I then entered. Maisey stood up defensively and appeared to be very agitated and irate. She shouted that she wanted answers. I explained that I came to help her and would do my best to help her. Maisey then explained that no one had explained to her why she was in hospital nor did she know the where abouts of her daughter (main care giver). Reviewing Maiseys care plan I found out she had a fall at her daughters (Barbara) house and her son informed me that Barbara was away on holiday for a week. After the discussion with Maisey I documented it in her notes so that other members of the Multi-disciplinary team would acknowledge that Maisey was uncertain about the situation she was in.
After speaking to my mentor and being more knowledgeable on Maiseys situation, I returned to her with my mentor close by. I pulled up a chair next to her and in a calm, reassuring, comforting manner explained the reason why she was in hospital. However Maisey appeared to look confused and asked me to speak to her in her left ear as she was deaf. I patiently repeated what I had said, she looked brighter after I mentioned her daughters name. Maisey asked a few more questions and I tried to answer them accurately and confidently. Maisey smiled and confided she is aware that she can be forgetful but feels that she is being ignored and that no one cared to what she had to say. She also said she could not sleep as other patients were disturbing her. After the discussion I gave Maisey assistance with her personal hygiene needs to which she thanked me for taking the time and ‘just talking.’ Maisey had said she felt a lot better that someone took the time to listen to her concers and explain what was going on instead of being ignored and ‘left in the dark.’
I felt very angry and disappointed that the staff easily agreed as a team that Maisey was just confused and describing her a as nuisance, without investigating as to why she seemed upset. I was in complete shock that as nurses they could be so quick to dismiss Maisey the way the did. I was highly annoyed that they all felt it was alrite to mimic and laugh at a patient. I felt a bit disheartened how no one took the time to explain what was going on to Maisey. Once I helped Maisey I felt happy that I took the time to get to know her and in turn see a different side to things. I felt proud I was able to reassure and relax Maisey so she could rest properly.
I feel I have learnt a lot from this experience with Maisey and how the nurses responded to her when she was at a very vulnerable time. It was not a nice encounter as I feel things like this should not happen in practice, however in terms of a learning prospective it was good as it taught me that it is paramount to be sensitive towards a patient who is feeling distressed. It went well as I have learnt how important it is to be patient, to take the time to listen to a patient as this can have cumulative effects on that persons well being and the outcome as to how they are feeling. The way the staff nurses reacted was not in the best interests of the patient. I did not like their approach, as they did not make an effort to show support or any understanding as she was known as a ‘difficult’ patient. Stockwell (1972) wrote the infamous book “The Unpopular Patient” where she explains that studies of communication in nursing demonstrate inadequacies in nursing practice. Stockwell (1972) describes the nurse-patient interaction, insisting that such interaction is not always satisfactory, especially when dealing with a ‘difficult’ or ‘unpopular’ patient. I feel the nursing team were ignorant to the fact that Maisey had difficulty in hearing which must have made it irritating for staff to keep repeating themselves. This could have been part of the reason as to why Maisey was considered an unpopular patient as she was seen as demanding.
There was no interaction between nurse and patient as Maisey approached the nurses’ station, and to be mocked then dismissed must have been a terrible experience for her. Davis (2008) explains how hectic times of the day such as handover, mealtimes and ward rounds leave insufficient time to help patients who need it. However, if the nursing team had engaged in a little conversation with Maisey, she might have felt valued and understood, instead of upset and belittled. The NMC Code (2008) clearly states many standards of conduct which a registered nurse should be trusted to do, these including “You must treat people kindly and considerately” and “You must listen to the people in your care and respond to their concerns and preferences”. If as nurses we should comply with The Code (2008), a lot of work is required to raise the awareness of the importance of communication in the delivery of care. In 2007 the NMC introduced Essential Skills Clusters. These Essential Skills are to be delivered by all registered nurses’, one of these clusters containing Care, Compassion and Communication. The NMC introducing these clusters show the importance of interpersonal skills in nursing care, and significance of communication in the nursing profession. On this occasion, the nursing team did not show care or compassion for Maisey, and certainly did not engage in therapeutic conversation.
As a student nurse I felt I had the knowledge and skills to approach the patient to appropriately calm and reassure her. Heyward and Ramsdale (2008) explain that a patient who thinks his nurse is not listening to them will lose faith in the service a nurse provides, and in the nurses’ willingness and ability to do as they have promised. They explain that sympathising with a patient shows willingness to understand their anxieties and make the patient feel more comfortable. As I entered the room the patient stood up with a defensive posture, which I assumed was using non-verbal communication to inform me that she was suspicious and distrustful of me. This was caused by the nursing team’s disability to make the patient their first priority and to listen and respond to her concerns. Santamaria (1993) tells us that nurses must deal with the full range of human behaviour, and at the same time deliver the highest quality of care. I acknowledged that Maisey was upset and gave her the opportunity to ask questions and voice her concerns, and in turn made her feel special by giving her my time. As Maisey asked me to speak loudly into her right ear I wondered if her history of deafness had been accurately assessed, as she was definitely not deaf but having communication difficulties. Eradicating this problem with help of a speech and language therapist or a hearing aid would have helped Maisey and the impatient staff enormously in this situation.
Although I had been informed that the patient could be aggressive, I managed the situation by relating to her position and understanding her point of view. Leadbetter and Patterson (1995) explain the prevention and management of aggression should be dealt with by showing empathy and respect for the patient’s individuality and being genuine, utilising an open and honest manner. Finally, integrity, and being aware of ones own competence to handle the situation. Egan (1990) considers non-verbal communication to prevent violent situations such as considering body posture, nodding to show interest and making eye contact, but not as though to threaten the patient in any way. Fortunately, empathy and respect for Maisey helped her to trust and confide in me.
The reason for analyzing this particular section of the scenario was to answer the question, “Why did the nurse not feel efficiently equipped to approach the patient herself, instead leaving the potentially aggressive situation with an unsupervised student?” In the NMC Code (2008), advice for a registered nurse is to recognise and work within the limits of your competence, but also to have the skills and knowledge for safe and effective practice. I believe communication skills within the nursing team must be rigorously developed and maintained as one professional alone cannot meet a patients requirements. We need to work collaboratively to provide maximum care delivery.
Maisey felt more relaxed, valued and safe, after we identified and resolved her concerns. Older people generally have more barriers to communicating effectively. These barriers are worth investigating, as the acquisition of a little understanding and basic skills is a simple and rewarding exercise. (Myerscough, 1992) The barriers Maisey faced, was the time the nurses had to spend with her, and the fact that she was deaf. Myerscough (1992) explains that this is overcome by speaking loudly and clearly, using clear lip movements to assist lip reading. Through actively listening to the patient and encouraging conversation we managed to focus on the problem that was causing unease. I do believe that Maisey was discriminated against because of her conditions and illness, as she was not given the time and energy that was given to other patients. The Human Right’s Act (1998) Article 14 explains that every person should be treated equally without any discrimination on any ground. This section of the act was broken when the staff failed to treat Maisey as they would the other patients. Maisey was confused and upset that she had not been given time to adapt to her surroundings, and was in fear due to the separation from her main caregiver. Most patients do suffer a degree of anxiety and apprehension and admission to hospital is in particular a disturbing experience for anyone. (Lloyd and Bor, 1996) They offer explanations for these anxieties, such as being in an unfamiliar environment and separation from family and friends. Loss of personal space is a factor mentioned, as is loss of independence and privacy. One that closely relates to the scenario is uncertainty of diagnosis and management. Maisey was uncertain of what was going on. By providing her with the information she required, she could understand a purpose for her admission and the decisions being made.
The reason for Maisey being upset, and the nursing team’s reluctance to help her, all stem from the same thing. As we have discovered communication and ones ability to reflect on practice have enormous effect on the capability to provide the highest possible quality of care. Additionally time and commitment to our patients is priceless as it can never be taken away from them. We also need to realise that ones own values have effects on interaction with our patients, so appreciating that our client has different values and beliefs to ourselves help us gain insight into the reasons they think and behave as they do. Some consider interacting with others as hard work, but we as nurses need to understand that communication is the gateway to successfully helping our patients and improving our skills.
On reflection I saw first-hand how easily communication can break down, if not between nurse and patient, then within the multi-disciplinary team. I will take the experience with me throughout my nursing education, remembering the importance of effective communication, and also the ability to look back at an experience and break it down to discover what really happened. Taylor (2000) defines how reflection on action occurs perfectly. He explains that only when details of events are recalled and analysed, unpicked and reconstructed considering all aspects of a situation, can one gain fresh insights and amend actions. He quotes “Critical thinking is essential for safe practice”. (Taylor, 2000) This should be an ongoing and extensive process for all nurses in practice. I will be more aware of my interaction with others and will constantly reflect on my experiences to see the whole package of care delivery.
Becker, E.L. (1991) Churchill’s Illustrated Medical Dictionary. 3rd Edition. USA: Churchill Livingstone
Data Protection Act 1998 London: HMSO
Davis, C. (2008) Tea and Empathy: discussing a project focusing on patient centred care. Nursing Standard. Vol 22, no. 32, p.18
Elliss, R.., Gates, B., & Kenworthy, N. (2003) Interpersonal communication in Nursing. 2nd Edition. London: Churchill Livingstone
Egan, G. (1990) The Skilled Helper: A systematic approach to effective helping. 4th Edition. USA: Wadsworth
Gibbs, G. (1988) Learning by doing: a guide to teaching and learning methods. London: Further Education Unit
Human Rights Act 1998 London: HMSO
Heyward, T. & Ramsdale, S. (2008) Interpersonal Skills. Chapter 1 IN Richardson, R. (Editor) (2008) Clinical Skills for Student Nurses. UK: Reflect Press
Lloyd, M. & Bor, R. (1996) Communication Skills for Medicine. New York: Churchill Livingstone
Myerscough, P.R. (1992) Talking with Patients: A Basic Clinical Skill. 2nd Edition. Oxford: Oxford University Press
Nursing and Midwifery Council (NMC) (2007) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. London: NMC
Nursing and Midwifery Council (NMC) (2008) Essential Skills Clusters for pre-registration nursing programmes. London: NMC
Santamaria, N. (1993) The Difficult Patient: An Important Educational Need of Registered Nurses. Unknown
Stockwell, F. (1972) The Unpopular Patient. London: Royal College of Nursing
Taylor, B.J (2000) Reflective Practice: A guide for nurses and midwives. Buckingham: Open University Press p.64
Timby, B.K (2009) Fundamental Nursing Skills and Concepts. 9th Edition. London: Lippincott, Williams and Wilkins
Weller, B.F (2002) Baillieres Nurses Dictionary. 24th Edition. London: Elsevier
Jennifer, the owner and manager of a company with ten employees, has hired you to take over the HRM function so she can focus on other areas of her business. During your first two weeks, you find out that the company has been greatly affected by the up economy and is expected to experience overall revenue growth by 10 percent over the next three years, with some quarters seeing growth as high as 30 percent. However, five of the ten workers are expected to retire within three years. These workers have been with the organization since the beginning and provide a unique historical perspective of the company. The other five workers are of diverse ages.
In addition to these changes, Jennifer believes they may be able to save costs by allowing employees to telecommute one to two days per week. She has some concerns about productivity if she allows employees to work from home. Despite these concerns, Jennifer has even considered closing down the physical office and making her company a virtual organization, but she wonders how such a major change will affect the ability to communicate and worker motivation.
Jennifer shares with you her thoughts about the costs of health care on the organization. She has considered cutting benefits entirely and having her employees work for her on a contract basis, instead of being full-time employees. She isn’t sure if this would be a good choice.
Jennifer schedules a meeting with you to discuss some of her thoughts. To prepare for the meeting, you perform research so you can impress your new boss with recommendations on the challenges presented.
1. Point out which changes are occurring in the business that affect HRM.
2. What are some considerations the company and HR should be aware of when making changes related to this case study?
3. What would the initial steps be to start planning for these changes?
4. What would your role be in implementing these changes? What would Jennifer’s role be?
The stakeholders in the Town of Evergreen include parents, nurses, school administrators, health care providers, the public health department, the government, religious congregations, the Tourism Bureau, the business community, and elected representatives from Cedar and Fir County. The new legislation to remove the exemption for firmly held religious beliefs from the current immunization requirements affects each stakeholder in different ways. Each of these stakeholders have their own needs and interests related to the immunization requirements and they will need to come together to find out which legislation is the best for the whole entire community.
The State of Evergreen would need to look at current healthcare laws and policies that are relevant to the immunization issue in order to reach the best possible outcome and appease all of the stakeholders. The U. S. Constitution reserves the primary power to regulate the public health and safety for the common good, often known as police power and can include laws authorizing community vaccinations if deemed necessary for the safety of the public (Hoke, n.d.). States can require all children (except those with medical contraindications) to be vaccinated before going to school or day care and in 1944 the court proclaimed that religious freedom “does not include the liberty to expose the community or the child to communicable disease (Parmet, 2019). Therefore, states do not have to have allow exemptions for religious reasons if it is in the best interest of the public health of the community. Although, all 50 states grant exemptions to children for medical reasons, 45 states and Washington D.C. grant religious exemptions, and 15 states allow philosophical exemptions for those who object to immunizations because of personal, moral, or other beliefs (Skinner & Garcia, 2019). Understanding community public health needs in the State of Evergreen requires implementation and coordination of a wide range of public-policy, health systems, and community-based interventions (Groom, Hopkins, & Pabst, 2014)
It is also important to consider the financial ramifications of the childhood immunization policy considering the financial constraints of the public-school system and primary care physicians. Two sources of federal funds pay for approximately 95 percent of all publicly funded vaccinations and include the Vaccines for Children Program (VFC) and Section 317 of the Public Health Services Act (Johnson & Garcia, 2019). The VFC provides free vaccines for children 19 years of age and younger who are uninsured, Medicaid-eligible, underinsured, Native American or Alaska Native while Section 317 is a federal program administered by the CDC and provides grants to states and territories, commonwealth trusts, and several cities for vaccine purchase and programs such as outreach and disease surveillance (Johnson & Garcia, 2019). The Affordable Care Act also requires new health plans to cover preventative services (which includes immunizations) with no cost share to individuals of all ages.
Stakeholder value conflicts exist because there is insufficient communication with different needs and interests among all of the stakeholders. Health care organizations, doctors, and scientists agree that vaccines are safe and effective; however, despite this, there are a growing number of parents choosing not to vaccinate their children due to myths, misconceptions, and misinformation that they receive (Burgess, 2019). Some myths and misconceptions include vaccines weaken a child’s immune system, cause autism, and contain unsafe toxins (Burgess, 2019). In regards to weakening a child’s immune system the opposite is actually true as vaccines expose the body to a small, weakened version of a disease and it prompts the body to produce antibodies to fight off the infection, teaching the immune system how to fight off the disease (Burgess, 2019). According to research by the Centers for Disease Control and Prevention (CDC), there is no valid scientific evidence linking the MMR vaccine to autism (Burgess, 2019). It is true that some vaccines contain substances that are harmful to the body in high amounts—such as mercury, formaldehyde, and aluminum, but the quantities of these substances in vaccines is so low that they cause no harm to the body (Burgess, 2019). Since there are so many articles out there based on very limited evidence and not enough research parents are receiving incorrect and inaccurate information and choosing not to vaccinate their child based on these findings.
Another value conflict includes the freedom of religion and thoughts among individuals. Dutch Protestant-Christian congregations refuse vaccinations because they consider it contrary to their religious conviction (Pierik, 2017). They believe that God has predestined the fate of all human beings, including the health and the prevalence of diseases, and conclude that vaccinations are an inappropriate meddling in the work of God (Pierik, 2017). Some Christian Scientists argue that disease is a spiritual phenomenon that should be healed through prayer instead of medication and refuse vaccines because they believe that physical illness is an illusion of the material world and that prayer can help correct the false beliefs that give rise to illness (Pierik, 2017). Taking away the religious mandate in the State of Evergreen would create a lot of backlash from parents, religious leaders, and other state officials because they believe in the freedom of religion amendment and hold very strict beliefs regarding their religions.
The State of Evergreen will have to be careful in accounting for the potential legal risks and malpractice issues that they may face depending on the outcome of the legislation. The citizens of the State of Evergreen can hold the state accountable if there was an outbreak of a disease because some people were not vaccinated and caused other people to contract the disease. These individuals can bring a civil lawsuit to the State of Evergreen demanding money for damages that were caused due to them contracting the disease. If an unvaccinated person contracts a preventable disease and infects another person there may be cause for a possible tort lawsuit (Reiss & Naprawa, 2014). Additional potential civil lawsuits include an unvaccinated child suing their parents for not vaccinated them and the child ends up contacting the disease (Reiss & Naprawa, 2014). Infected individuals can also sue the anti-vaccine organization or doctor for negligence of misrepresentation caused by physical harm if they promoted anti-vaccine misinformation (Reiss & Naprawa, 2014). Non-vaccinated individuals who cause an outbreak may be sued under public nuisance laws (Reiss & Naprawa, 2014). Under state statue or local ordinances, the appropriate government entity can sue for the behavior of one person that can, be injurious and can cause harm to an entire community, which becomes a public nuisance and allows the state to be able to sue the individual (Reiss & Naprawa, 2014).
Medical malpractice may occur when a child goes to their primary care physician and they refuse to administer the vaccine because they don’t have the vaccine in stock. This is when they would refer the patient to the public health department to get vaccinated. However, every doctor is supposed to act in the best interest of their patient and their own primary care physician should be able to administer the vaccinations. The current practices of primary care physicians and the public health department exposes them to medical malpractice litigation due to the primary care physicians not retaining an adequate supply of vaccines for public administration over costs and refusing to administer the vaccinations altogether and instead redirecting the patients to the public health department without a proper referral. This delays the immunization as parents have to face an additional, unnecessary step by having to go to another facility after seeing their own child’s primary care physician. The National Childhood Vaccine Injury Act of 1986 established the National Vaccine Injury Compensation Program (VICP) as a federal “no-fault” compensation system for individuals who may have been injured by specific covered vaccines (Evans, 1996). Healthcare providers can also be involved in civil lawsuits and penalties if parents decide to pursue for more damages which can award both compensatory and punitive damages to parents and healthcare providers who can still be at risk for criminal punishments as well, including suspensions of their license to practice medicine (Freed, Kauf, & Freeman, 1998).
References
Gottlieb’s threat of federal vaccine mandates: questionable legality, poor policy
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Type 2 diabetes is the most common form of the disease. Diabetes mellitus is where the body cells cannot use glucose properly for lack of or resistance to the hormone insulin, which is produced by the pancreas. Diabetes can lead to serious complications over time if left untreated. The high blood sugar levels from uncontrolled diabetes can cause serious long-term diabetic complications. Eventually, they damage the insulin-producing beta cells of the pancreas, reducing insulin output.
Type 2 diabetes is also known as the non-insulin dependent diabetes and is the most commonly found type of diabetes in the world. Type 2 diabetes is a lifelong chronic disease in which there are high levels of sugar in the blood. Diabetes is caused by a problem in the way your body makes or uses insulin. Insulin is needed to move blood sugar into cells, where it is stored and later used for energy. Patients suffering from type 2 diabetes tend not to respond effectively to insulin and their fat, liver, and muscle cells do not respond correctly to insulin either, which is called insulin resistance. As a result, blood sugar is not able to get into these cells to be stored for energy. And when sugar cannot enter the cells, high levels of sugar build up in the blood. This is called hyperglycemia. Hyperglycemia is the technical term for high blood glucose (sugar). High blood glucose happens when the body has too little insulin or when the body can’t use insulin properly.
Type 2 diabetes usually occurs slowly over time and most people with type 2 diabetes have no symptoms at first or it may even take years. Some early symptoms of diabetes may include; bladder, kidney, skin, or other infections those that are more frequent or heal slowly. You may experience some fatigue, hunger, and increased of thirst. Other important symptoms like increased urination, blurred vision, erectile dysfunction, and pain or numbness in the feet or hands. A hormone produced by the pancreas called insulin helps sugar in our blood get into the cells of our bodies.
There are several tests that can be done in order to confirm the diagnosis of type 2 diabetes. The doctor can order a fasting plasma glucose test or casual plasma glucose. The fasting plasma glucose test (FPG) is the preferred method for diagnosing diabetes, because it is easy to do, convenient, and less expensive than other tests, according to the American Diabetes Association. Before taking the blood glucose test, you will not be allowed to eat anything for at least eight hours. They can also use the oral glucose tolerance test, for this test you have to fast overnight, and the fasting blood sugar level is measured. Then you have to drink a sugary liquid, and blood sugar levels are tested periodically for the next several hours.
Routine screening for type 2 diabetes is normally recommended at the age 45, especially if you are overweight. If the results are normal then you should repeat the test every three years. If the results are borderline, your physician will tell you when you should come back to retest. Screening is also recommended for people under 45 and overweight especially if you have heart disease or a family history of type 2 diabetes, or blood pressure above 135/80.
There is no cure for diabetes but it can be controlled, but it does require a lifelong commitment to blood sugar monitoring, healthy eating, regular exercise, possibly, diabetes medication or insulin therapy. The main goal of treatment is to first lower high blood glucose levels and the long-term goal of treatment is to prevent problems from diabetes. The main treatment for type 2 diabetes is to exercise and diet. Type 2 diabetes can basically be controlled by following a few steps; As long as you test and record your blood glucose, know when to eat and when to eat, how to take your medications if any are needed, and how to recognize and treat low and high blood sugar. It can take several months to get the hang of these basic skills but as everything else it will become second nature.
There are several types of medication that can be prescribed by your doctor if diet and exercise does not keep your blood sugar at normal or near normal levels. Some of the drugs prescribed help lower your blood sugar levels in different ways, so therefore your doctor may have you take more than one drug. Some of the most common types of medication are as follows: Alpha-glucose inhibitors (such as acarbose), Biguanides (Metformin), Injectable medicines (including exenatide, mitiglinide, pramlintide, sitagliptin, and saxagliptin) Meglitinides (including repaglinide and nateglinide), sulfonylureas (like glimepiride, glyburide, and tolazamide), and Thiazolidinediones (such as rosiglitazone and pioglitazone). Rosiglitazone may increase the risk of heart problems, so before you take this particular medication make sure to discuss any possibilities of heart problems with your physician. These drugs may be given with insulin, or may be used alone. You may need insulin if you continue to have poor blood glucose control. It must be injected under the skin using a syringe or insulin pen device. Insulin cannot be taken by mouth. Women who have type 2 diabetes and become pregnant may be switched to insulin during their pregnancy and while breast-feeding because it is not known whether hyperglycemia medications taken by mouth are safe for use of pregnancy.
Although long-term complications of diabetes develop gradually, they can eventually be disabling or even life-threatening. Diabetes can lead to more serious problems after many years. You can develop eye problems, including trouble seeing especially at night, and light sensitivity, and you can even become blind. Your feet and skin can develop sores and infections. After a long time your foot or leg may need to be removed. Diabetes also makes it harder to control your blood pressure and cholesterol. This can lead to a heart attack, stroke, and other problems. It makes it harder for the blood to flow to your legs and feet. The nerves in your body can get damaged and cause pain, tingling, and loss of feeling. And because of nerve damage you could have problems digesting the food you eat. You could feel weakness or have trouble going to the bathroom. Nerve damage can also make it harder for men to have an erection. High blood sugar and other problems can lead to kidney damage. Your kidneys may not work as well and they may even stop working. In order to prevent problems from diabetes, you should visit your health care provider or diabetes educator at least four times a year and discuss any problems you are having.
You should always pay close attention to the symptoms of Type-2. If you have a dry mouth, increased hunger, blurred vision, headaches, fatigue, and unexplained weight loss, then you have the most common symptoms. Do not ignore any of these symptoms and get medical attention as soon as possible. Type 2 diabetes can be easy to ignore, especially in the early stages when you’re feeling fine. But diabetes affects many major organs, including your heart, blood vessels, nerves, eyes and kidneys. Controlling your blood sugar levels can help prevent these complications. Good management of your type 2 diabetes includes using your medicines exactly as your doctor prescribes them, making smart food choices, and being physically active. Always remember one thing “your body is your temple” and we must learn how to take care of it and treat the body right so the body can be good to us in return.
The aim of this essay is to explore and demonstrate understanding of how Patients with chronic illness adapts to change. Chronic illnesses are defined as illness that are permanent or last a long time or frequently recurring health problems (Smith 1997).Chronic illness commonly applies to conditions that can be treated but not necessarily cured. It may get slowly worse over time. It may cause permanent changes to the body. It can increase stress and certainly affect the person’s quality of life.
Living with chronic illness has a profound impact on one’s life and creates a lot of grief in responses to the loss. Patients are likely to endure multiple losses. There are many types of chronic diseases such as diabetes, stroke, and cancer and end stage of renal failure and so on.
In this essay I will discuss how patients with renal failure adjust to the change and the effect of chronic illness. It includes psychosocial perspective of chronic illness. It also contains theoretical models of loss and adjustment. I used a patient case and library resources such as journals, books and web sites to get the relevant information.
People are living longer and advances of modern medicine may prolong life. It is important to maintain life quality. Patients may have difficulties when they are faced with life threatening diseases or trauma. They may experience fear and loss of confidence, often making rehabilitation slow.
I worked in a rehabilitation (rehab) ward for eight weeks. I followed a patient case to understand chronic illness and adjustment. Anne is in her forties and she has been married for fourteen years. She has two children age 20 and 19 years. They moved recently in to new house with a big mortgage commitment. Anne felt generally unwell for several weeks. Then she began to feel weak and breathless and very itchy. Over one weekend she developed a great sense of weakness. Then by Monday she felt very ill and was admitted to hospital. After a few tests the doctor informed Anne that she developed a chronic renal illness. After her initial treatment she transferred to rehab ward. Anne’s chronic illness affected her physically and psychologically as well as socially.
Anne was admitted to the hospital in January 1999 with one week of history of increasing severe pain in right thigh and slightly less pain in left thigh. She had a long history of hypertension. Her reduced kidney function was due to Atheroembolic disease. Atheroemboilic disease (AERD) refers to an inflammatory reaction in the small blood vessels of the kidney.
It occurs when cholesterol crystal lipid plaques in the walls of blood vessels (Brundage 1992). Anne’s temperature on admission was 38%. Blood pressure 170/80mmHg, pulse 110. Blood cultures were negative on several occasions, but she was receiving vancomcin (antibiotic to treat infection). Her physical examination revealed, and she been found acutely distress.
According to Smith and Speck (1982) P .7. “chronic renal failure is a result of a number of pathology processes causing irreversible damage to kidney tissue”. Chronic renal failure is caused by a slow progressive kidney disease over a course of 10-20 years (Smith and Speck 1982). At this stage there is mass destruction of nephrons, so that the kidneys are unable to maintain fluid and electrolyte balance and excrete waste products from the kidney.
In end stage of renal failure the maintenance of life can only be ensured by haemodialysis or renal transplantation (Schmid et al 1998) Haemodialysis is a term that is used to describe the removal of waste product and water from the blood through a filter dialyser (Paul and John 1998). Anne needs a dialysis treatment three times a week. Living with a dialysis has a profound impact on Anne’s life. It is difficult to come to terms with the feelings of devastation and total loss.
From the earliest days of haemodialysis, it was noted that patients go through a recognisable series of stages following the start of treatment (Abram 1970). These may overlap, or fluctuate. Anne showed various emotional signs: – tears, anxiety and irritableness. Illness is a process and like all process it has different stages with different characteristics. Each stage of illness involves loss, grief and acknowledgment of internal pain.
Loss can be the experience of losing something. Ann’s kidney failure can be a loss; the illness involves loss of kidney function. The emotional trauma of chronic physical illness is caused by loss. In the face of such loss to experience fear, anger, desperation and anxiety is normal. Anne’s emotional trauma is normal, in fact it would be abnormal to deny her health and her life style had changed for the worse. In chronic illness patients are likely to endure multiple losses that may include the loss of control and personal power which is important contributor to self esteem, as well as loss of independence, loss of identity, loss of financial status, and loss of life style ( Clark 1993). Perhaps the most difficult of these transitions is the loss of the identity one held before becoming sick. Ferguson (2004) cited by Goffman’s theory (1963) described how individuals with impairment could be stigmatised and labelled as failed members.
Ann’s irreversible internal illness can creates further grief and frustration. Anne’s kidney failure caused grieving. Grief is a reaction to significant loss. It is most frequently an unhappy and painful emotion triggered by the loss of loved one (Baldree et al 1990). These same emotions can also be experienced by someone with chronic condition who must deal with loss of autonomy. Grieving is a process of adjustment to the loss and it is universally recognized across all culture (Clark 1993).The process of grieving usually occurs when the loss involves death but it can also coming to the terms with health through an illness.
Kubler- Ross (1970) proposed 5 stages of grieving, Such as denial, anger, depression and acceptance. Since her idea was published Kubler- Ross’s work has been applied to the many situation of change people experience in a life time, including chronic illness. There is no limit set for each stage, as every person progresses toward acceptance of their illness at their own time. Some people may experience more than one stage a time or in alternative order.
She presented them as an attempt to summarise what we have learned from our dieing patients in terms of coping mechanisms at the time of terminal illness (Kubler-Ross E 1970).
Clark (1993) cited by Averill (1968) also identified shock, despair and recovery as the relevant stages of grief. Additionally Parkes (1972) identified numbness, pining depression and recovery stages which followed the loss.
Despite the work of Averill and Parkes being highly important to describe grieving patient, it was Kubler-Ross work which was essentially received and continues to receive the most attention. Her work is one of the several stage/phase types of analyses which were cited concerning the experience of both dying and bereavement in 1960’s and early 1970’s.
Critics argue that the steps are too rigid (inflexible) and not applicable to the grieving processes, yet people all over the world have found her work to be useful. In fact most research said that we are going through this process numerous times a day. Any change of circumstance can cause us to go through this process. But we don’t have to go through the stage sequentially. The intensity and duration of the reaction depend on how significant the loss is.
According to Clark (1993) the most significant criticisms of Kubler Ross work come from Kastenbaum (1975), Germain (1980) and Charmaz (1980). They address the problem of stage theories in general. Kastenbaum said using the term “stage” implies a set order of set conditions. He asserts that there is no evidence that a bereaving patient goes through the exact Kubler Ross stages in their proper order. He also said a Patient with chronic illness could experience the stage in a different order or could experience emotions not even mentioned in the Kubler Ross stages.
Clark (1990) cited by Kellehear (1990) P72 “indicate that cultural differences in coping may be interpreted in terms of personal inadequacy” “there is a risk that professionals may misread description as prescription” (Lttlewood 1992). The theory should be used as an example for particular image but not as a command other wise it can cause misunderstanding for professionals. Clark (1990) P72 cited by Kellerhear also said “the sociology of death, dying and bereavement is still in its infancy”.
From the earliest days of haemodialysis, it was note that patient go through a recognizable series of stages following the start of treatment. The stage can be identified by care givers and patients (Abram 1970).
Initially Anne was relieved. It could be for several reasons. First she felt good because of the benefit of the treatment. And secondly the experience of haemodialysis is usually less traumatic then normally expected. She accepted her chronic illness and denied the consequences. Anne showed two stages at the same time which is acceptance and denial.
The second phase is depressive reaction. In this stage Anne showed anger as well as depression. Ann was depressed most of the time. In this stage Ann’s aware that dialysis can not make her fully well. Her tiredness, lack of energy, irritability and poor sleep make life on dialysis hard to tolerate. As I mentioned earlier Ann and her husband were committed to a big mortgage. The effort to continue to work while under these pressures may seem to be too much. That can cause fear, financial and family consequences.
The third phase is realistic adjustment. This period normally takes time for the patient to adjust. Anne not adjusting to the change, she was in the second stage. During adjustment period it is not surprising to observe patient in low mood, irritableness and quick to take offence and so on (Harwood et al 2005).Many patient experience intense helplessness before they adjust to the change (Abram 1970).
I didn’t observe Anne’s final adjustment. Because my placement was finished before I observe her final adjustment process. Some people cope more easily than others psychosocial and emotional aspects of kidney failure (Gordon et al 2003). Coping can be defined as efforts to manage, which allow the word to include any of the person’s thoughts regardless of how well or badly they work. Individuals with renal failure are likely to appraise aspects of their environment as damaging or potentially threatening (Adrian 2004).
Adaptation and coping are often treated as synonymous terms, but they are distinct from each other. Adaptation is a broader concept that includes routine actions. Adaptation in a psychosocial sense refers to individual survival as well as to the capacity to sustain a high quality of life and function on social level.
Anne’s coping strategies show slow progress. One Scandinavia study examined coping strategies and sense of coherence and this research indicates that an individual’s ability to cope with illnesses is influenced by a range of factors such as illnesses related factors, age, personality, social and culture factors and support (Harwood et al 2005).
Anne’s become more uncomfortable with her illness. It can be several Reasons one she became more afraid of the consequence of kidney failure and also she developed side effect from her medication. The more a patient feels threatened by their illness, the harder they will find to cope (Bolton and Owen 2002).
Aspects of a patient’s personality can affect their ability to cope with their illness (Gurklis and Menke 1995). Anne’s personality is not resilient personality which was not allowed her to see good in difficult situation.
The amounts of quality of support available to the patient are further influence on how well they cope with kidney failure. For many patients the immediate family is the main source of psychological support. Anne’s husband and children were visiting her twice in a week. That might not be enough for Anne recovery. Hospitals do not always provide kidney patients with the support they need. Hospital is a dull place for patients; therefore it can cause depression and mood change. Churchill et al (1999) recommended that each dialysis centre provides an established multi-disciplinary team for chronic kidney disease care, to deliver adequate medical and psychosocial preparation.
Several studies have demonstrated that early referral to nephrologist’s clinic decreases morbidity, mortality and health care cost.
Anne’s illness has a massive impact on her life. Her illness is a long term or life threatening illness, which can be extremely stressful. The treatment of kidney failure enforces major changes in life style. Ann has to adapt the new life routine. She also has to change her eating and drinking habits. In general Ann needs to adjust to the new life style. The work of
Kubler Ross has been of great value in terms of promoting our understanding people with chronic illness. A close supportive relationship between the nurse and patients is vital to create a climate of trust and support. From this assignment I learnt how chronic illness can affect people’s life. Patients are not the only ones who suffer when they have a chronic illness but significances others and family members also suffer. As I already mentioned chronic illness causes a stress, it requires a constant adaptation and challenging to get a better quality of life. As a nurse we all have to understand and meet the needs of the family as well as the patients.
Abram H.S. (1969) The psychiatric, the treatment of chronic renal failure and prolongation of life. 126:57
Adrian P.C.(2004). Creating a successful haemodialysis program. Nephrology Nursing Journal, 31(6), November/ December P677-679
Baldree,K., Murphy s, and Powers M.(1990). Stress identification and
Coping patterns in patients on haemodialysis. NursingResearch,31(2), p107-112.
Bolton W.K and Owen W.K (2002). Preparing the patient for renal replacement therapy. Post Graduate Medicine,111(6),P 97-108.
Brundage D.(1992) Renal disorder.St Louis:Mosby
Costello J.(2004) Nursing the dying patient. New york: Macmillan
Churchill D.N, Blake P.G, Jindal K.K, Toffelmire E.B and Goldstein M.B (1999). Clinical practice guide line for initiation of dialusis. American Journal Of Kidney Disease. 10(1),P 287-321.
Clark D. (1993) The sociology of death. Cambridge: Blackwell
Ferguson J (2004) Third semester sociology lecture. Cited by Goffman’s theory spoilt identity.
Gordon E.J, Leon J.B and Sehgal, A.R.(2003). Why are haemodialysis treatments shortened and skipped?Ovid: Priester Coary:Nephrology Nursing Journal,31(6)P674-678
Gurklis J.A and Menke E.M (1995) Chronic haemodialysis patient’s perceptions of stress, coping and social support ANNA Journal.22 (4) P 381-390.
Harwood L, Locking C, Heather S, Joan W and white Sharon.(2005) Preparing for hemodialysis patient stresses and responses . Nephrology nursing Journal, 33(3), may/June 2005, p 295-303.
Kubler-Ross,E (1970) On death and dying.London:Tavistock
Lawler J.(1997) The body in nursing.Singapore:Churchill
Paul C, John S. (1998) Principle and renal nursing.London:Redwood
Smith T. (1997) Renal nursing. London: Baillier
Smith I and Speck P.(19982) Caring for the dying and bereaved. London:Longdunn press.
Stein A and Wild J. (2000) kidney failure:Slovenia:Princes Risborough
Schmidt Rj,Domico J, Sorkin MI, and Hobbs G (1998). Early referral and its impact on emergent first dialysis. America Journal of Kidney Disease, 32(2), 278-283.
Assignment
Adjusting and adapting
The content for this week focused on applying nursing theory to research and education.
Select one area which is either research or education,select a nursing theory and then apply the selected nursing theory to the area. For example, how could theory be used to select a research topic? How nursing theory would be used within the classroom or clinical setting?
Be sure to provide an example that demonstrates the application to either research or education. Don’t forget to include a scholarly reference.
Do you want a quality paper free from plagiarism, you are at the right place where quality is guaranteed. We have a team of writers with a wide range of experience in writing. We assure you a quality paper that meets your expectations.
Heart Failure
The heart is a diverse organ and the diseases associated with it are caused by many different organs when they become dysfunctional or diseased. It is for this reason that heart failure is more diverse than just the stopping or failure of the heart as there are many types and causes of heart failure. Therefore, this essay will discuss the subject heart failure in the human body by addressing its aetiology and pathophysiology, the signs and symptoms associated with it, as well as the risk factors and causal agents linked to heart failure, and lastly, the relevant tests and treatment options available to heart failure patients to improve their quality of life.
Aetiology:
Heart failure, sometimes called congestive heart failure, refers to when the heart isn’t pumping blood as well as it should (American Heart Association, 2014). It is a chronic disease characterised by the failure of the heart as a pump and is the result of any structural or functional cardiac disorders (Butler, 2012). This doesn’t mean that the heart stops beating, however, the American Heart Association (2014) warns that heart failure can get worse if it’s not treated. The heart does not stop altogether but keeps working, despite the fact that the demands of blood and oxygen of the heart and body far exceed supply (Butler, 2012). This is caused a variety of disorders such as coronary artery disease, heart attacks, cardiomyopathy, and congenital birth defects (Butler, 2012).
Coronary artery disease (CAD), as stated by Butler (2012) is a disease characterised by a narrowing or blockage of the arteries which restricts blood and oxygen supply to the heart, resulting in a reduced preload in the ventricles and reduced ventricular stretch. When low ventricular stretch occurs it results in a decreased force of cardiac contraction and a low stroke volume. The effects of low stroke volume include low blood pressure and can lead to the body’s organs and tissues becoming deprived of adequate oxygen and nutrients which may cause the body to go into a state of shock.
The second cardiovascular disorder which can cause heart failure is a heart attack. A heart attack according to the Heart Foundation (2015) occurs when ‘a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle’. Damage to the heart muscle occurs during a heart attack, and becomes scarred, the damaged area does not function properly, resulting in a reduced cardiac output and low blood pressure. When this happens the heart compensates by undergoing a remodelling process where it changes in size, shape or structure, and according to Butler (2012) the remodelling is more likely to occur in the left ventricle as it has a thicker muscle mass.
The third form of heart failure mentioned above is cardiomyopathy, which is caused by infections, alcohol abuse, or pregnancy and is characterised by damage to the heart muscle. The type of cardiomyopathy which presents during pregnancy is called peripartum cardiomyopathy (Demir, Tufenk, Karakaya, Akilli, & Kanadas, 2013). It is a form of dilated cardiomyopathy and involves systolic dysfunction of the heart. Onset is usually around the last month of pregnancy and five months postpartum, hence the name. One common symptom of peripartum cardiomyopathy is sinus tachycardia which according to Demir et al. (2013) can be treated with a drug called Ivabradine. This brings me to the next section which is the pathophysiology of heart failure.
Pathophysiology:
Heart failure is a complex problem and is characterised by many signs and symptoms. Symptoms include; shortness of breath, orthopnoea, paroxysmal nocturnal dyspnoea, fatigue, reduced ability to exercise, peripheral oedema, loss of appetite and more (Nicholson, 2014). Signs include; Tachycardia, tachypnoea, an abnormal pulse, and displaced apex beat, third heart sounds, a raised jugular venous pressure, lung crepitation, weight changes, hepatomegaly and more (Nicholson, 2014).
The common symptoms which will be focused on here include shortness of breath (S.O.B), paroxysmal nocturnal dyspnoea, fatigue, and a lack of appetite (Butler, 2012). The American Heart Association (2014) states that S.O.B during activity, at rest, or while sleeping, can have a sudden onset, often causing the patient to wake. They describe S.O.B as being caused by the blood when it “backs up” in the pulmonary veins because the heart can’t keep up with the supply. The result is stated to be that the kidneys develop a reduced capacity to dispose of sodium and water, and that excess fluid leaks into the lungs causing a pulmonary oedema and around the lungs causing pleural effusion. The clinical sign which indicates that this has occurred, aside from S.O.B, is the presence of lung crepitations (Butler, 2012). A lung crepitation, according to Butler, is a crackling sound produced during inhalation and exhalation due to fluid accumulation inside the lungs and predominantly occurs in the lower lung fields. The American Heart Association states that peripheral oedemas can also occur as a result of the venous blood backing up and is characterised by swelling in the ankles, feet and abdomen resulting in ill-fitting shoes and weight gain due to the excess fluid accumulation.
The build-up of fluid which causes S.O.B also leads to paroxysmal nocturnal dyspnoea (PND) (Butler, 2012; Nicholson, 2014). PND usually occurs at night, according to the American Heart Association, and is characterised by sudden awakening from sleep after only a few hours, with a feeling of breathlessness, suffocation and severe anxiety. On chest auscultation, the bronchospasm associated with a heart failure exacerbation can be difficult to distinguish from an acute asthma exacerbation (Dumitru & Baker, 2014).
Other symptoms of heart failure included fatigue. Fatigue and weakness according to Dumitru & Baker (2014) are often accompanied by a feeling of leaden limbs and are generally related to poor perfusion of the skeletal muscles in patients with a lowered cardiac output. Essentially the heart produces a decreased volume of blood and cannot meet the needs of body tissues so the body diverts blood away from less vital organs, particularly muscles in the limbs, and sends it to the heart and brain (American Heart Association, 2014). The American Heart Association (2014) and Nicholson (2014) both link this diversion of blood to vital organs to the loss of appetite and feelings of nausea often experienced by people with heart failure due to the fact that the digestive system receives less blood and cannot function correctly.
The common signs that will be discussed here are hepatomegaly, third heart sounds, tachycardia and a displaced apex beat. Hepatomegaly, an enlargement of the liver which can occur with right heart failure (Nicholson, 2014), and is caused by the blood backing up from the heart into the inferior vena cava, such congestion increases pressure in the inferior vena cava and other veins that carry blood to it, including the hepatic veins (Orfanidis, 2013).Once this occurs the pressure may build to a point where the liver becomes engorged with blood and malfunctions. The common symptoms of hepatomegaly are nausea, abdominal pain or fullness, swelling of the feet and legs, and shortness of breath, all of which are also seen in heart failure (Butler, 2012).
The third heart sound (S3) is a low-pitched sound that occurs when the ventricles fill rapidly and is one of the more specific signs of heart failure and auscultating to determine the presence of it can help healthcare professionals to diagnose heart failure (Santhosh, 2009). S3 is commonly present in conjunction with tachycardia, which is a high resting heart rate and is common as a haemodynamic compensatory response (Nicholson, 2014). The final sign of heart failure listed above is a displaced apex beat. A displaced apex beat means ‘the point of maximal impulse on the precordium can be displaced down and to the left laterally and commonly occurs when the heart is dilated (Nicholson, 2014, p. 33)’. Each sign and symptom of heart failure is linked to a causal agent such as a previous history of Myocardial Infarctions (MI).
Risk factors/causal agents:
The term ‘heart failure’ includes many conditions and disease, thus it has many causal agents including; Family history, narrowed arteries, high blood pressure, coronary artery disease, myocardial infarctions, valve disorders, peripartum, ischemic heart disease, diabetes, obesity, kidney disease, hypothyroidism, toxins (alcohol), and infection (Butler, 2012; Nicholson, 2014). The causal agents which will be discussed here are narrowed arteries, high blood pressure, obesity, diabetes and infection.
Family history is an important indicator of increased risk in relation to heart failure, it is however not to be considered on its own but in relation to other risk factors such as narrowed arteries (Goldberg, 2014). Narrowed arteries can refer to vasoconstriction or atherosclerosis. Atherosclerosis is a plaque formation is medium or large sized arteries in response to damage of the tunica intima (National Health Council, 2014). These plaque formations cause increased resistance to laminar blood flow resulting in turbulent flow and high blood pressure (Foss & Farine, 2013). Blood pressure alone is characterised as the force exerted on blood vessel walls by a volume of blood as it passes through (Heart Foundation, Blood Pressure, 2010). High blood pressure on the other hand is known as hypertension, and is defined by the Heart Foundation (2010) as chronically elevated blood pressure resulting in stain on the heart and blood vessels. Hypertension is visually manifested by jugular venous distention on the right side of the neck (Nicholson, 2014). Foss & Farine (2013) state that the elevated blood pressure is detected in the blood vessels by baroreceptors located in the carotid sinus and aortic arch. The baroreceptors are said to then stimulate vasomotor nerves to increase the diameter of the blood vessels to increase blood flow and reduce blood pressure.
Another cause of high blood pressure is obesity. This is due to the fact that overweight or obese people have a greater the volume of tissue and fat that requires a constant blood supply, this results in an increase in blood vessel length (Foss & Farine, 2013). Foss & Farine (2013) state that the longer the blood vessels become the more distance the blood will have to travel which increases the resistance, the body will compensate for this by increasing the blood pressure throughout the body by increasing the stroke volume of the heart. This increase in blood pressure is to ensure both adequate blood supply to all blood vessels and adequate venous return. If the high weight threshold is maintained then high blood pressure will continue, causing hypertension and heart strain (Heart Foundation, Blood Pressure, 2010).
A second effect that obesity can have on the heart is diabetes mellitus. Diabetes is a disorder of the metabolism where the glucose produced from the breakdown of food is no effectively absorbed into the cells for fuel. Diabetes is characterised by an inadequate production of the hormone called insulin which is produced in the pancreas and must be present to allow glucose to enter the cells (Goldberg, 2014). When insulin production is low the glucose remains in the blood and has many effects, such as increasing the susceptibility to infection (Foss & Farine, 2013). The long term effects of low insulin and high glucose levels in the blood include atherosclerosis, which is an increase in deposits of fatty materials on the insides of the blood vessel walls (Goldberg, 2014). These deposits affect blood flow by reducing the diameter of the blood vessels and raising blood pressure, increasing the chance of clogging and hardening of blood vessels (Goldberg, 2014).
Relevant tests:
There are many tests which can help determine if a patient has heart failure or is at risk, such as; checking blood pressure, chest x-rays, blood tests, 12-lead electrocardiogram and respiratory function tests. Checking blood pressure regularly is part of a standard visit to the doctor or nurse, because it helps to establish a pattern of high, normal or low blood pressure. Long term high blood pressure has been linked to heart strain, and in conjunction with other health issues such as atherosclerosis can result in heart failure. (Heart Foundation, Blood Pressure, 2010).
Another test which can contribute to the diagnosis of heart failure is a chest x-ray. Chest x-rays may be performed to look for signs of a pulmonary oedema which can cause symptoms such as S.O.B and paroxysmal nocturnal dyspnoea (Butler, 2012). A pulmonary oedema is commonly caused by a disrupted flow of blood to and from the heart. Respiratory function tests are also performed, to exclude respiratory causes for dyspnoea, such as asthma and chronic obstructive pulmonary disease (COPD) (Butler, 2012).
Another direct test of the heart is via a 12-lead electrocardiogram (ECG), the results of an ECG may show evidence of left or right ventricular hypertrophy, CHD, or arrhythmias commonly associated with heart failure such as atrial fibrillation (Butler, 2012). If no abnormality is present then the patient is unlikely to have heart failure (Nicholson, 2014). Further tests for signs of heart failure include blood tests for glucose (Butler, 2012; Nicholson, 2014). Checking glucose levels can be performed at home and is a vital component in the management of diabetes because if the blood glucose level remains high it can lead to atherosclerosis, and later, heart failure. High glucose levels are managed by first testing the blood then administering the appropriate amount of insulin to help absorption of the glucose into the cells and thus lower the blood glucose levels.
Treatment strategy:
Education on self-management strategies is a vital aspect of patient empowerment and care both at hospital and in their own home (Cockayne, Pattenden, Worthy, Richardson, & lewin, 2014). Heart failure patients require education how they can manage their symptoms and to ensure they can recognise the warning sign associated with acute situations (Nicholson, 2014). Patient education commonly includes information on how to maintain good control of comorbid conditions such as diabetes. Control of diabetes at home begins with the monitoring blood glucose levels and commonly results in injecting oneself with insulin (Goldberg, 2014). Cockayne et al. (2014) state that ensuring patients understand the importance of adhering to the medication regime designed for their optimal health is a vital part of patient education.
Another important aspect of patient education and self-management is providing an explanation on how to improve health habits and adopt a healthier lifestyle (Nicholson, 2014). The most commonly required lifestyle change to improve health outlooks for patients is to advise that they limit any consumption of alcohol and tobacco smoke as both produce detrimental effects on the heart, such as, causing pulmonary blockages and narrowing of airways, which will affect the oxygen supply to the blood, tissues and organs (Nicholson, 2014). Other important lifestyle changes according to Nicholson (2014) and Butler (2012) include advice on losing weight if the patient is obese, because obesity results in long, narrow blood vessels and high blood pressure which increases the patient’s risk of heart failure. The management of weight for patients with heart failure includes recommendations for specific dietary changes such as a low sodium intake or a low refined sugar intake (Butler, 2012). It may also include guidelines for increased daily exercise which is shown to have positive effects on heart failure symptoms according to Nicholson.
Butler (2012) states that for women there is another important lifestyle factor to consider in the self-management of heart failure symptoms, the use of contraception. Contraception is important for women who experience heart failure and its symptoms because if a woman with heart failure were to become pregnant it would increase her risk of heart failure and morbidity during pregnancy and birth.
The use of pharmacology in the management and treatment of heart failure symptoms is multifaceted. The use of angiotensin-converting enzyme (ACE) inhibitors is said to be one of the most valuable drug therapies in heart failure according to Butler and is intended to decrease the effects of compensatory mechanisms which are maladaptive so as to improve heart failure symptoms and increase the rate of survival, particularly when taken in conjunction with beta-blockers. Beta-blockers work by reducing heart rate and the myocardial oxygen demand (Nicholson, 2014). The use of ACE inhibitors means that it is important to closely monitor the blood chemistry of the patient, and that the side effects are commonly limited to a dry, persistent cough (Butler, 2012). If the patient cannot tolerate ACE inhibitors due to the dry, persistent cough then the use of angiotensin-II receptor blockers (ARBs) will be considered as this drug has similar properties to the ACE inhibitor and will also require the monitoring of blood chemistry. (Butler, 2012).
Other pharmacological treatments include the use of vasodilators and diuretics. Vasodilators are used to improve cardiac output and often used in cases of heart failure where the patient cannot tolerate ACE inhibitors or ARBs (Butler, 2012). Diuretics are used to increase fluid loss in order to reduce the size and occurrence of peripheral oedemas and pulmonary oedemas, resulting in a reduced level of breathlessness (Nicholson, 2014).
The last treatment option to be discussed here is the use of device therapy. Device therapy as stated by Butler (2012) refers to an implantable cardiac defibrillator (ICD) and a biventricular pacemaker. Biventricular pacemakers are implanted to restore ventricular synchrony and reduce symptoms in the event ventricular failure. ICDs on the other hand addresses the problem of cardiac death by delivering an electric shock to the heart to restore normal rhythm and function.
In conclusion, heart failure is a complex and multifaceted health problem which encompasses many heart problems like coronary artery disease, heart attacks and cardiomyopathy. Because heart failure is such a large problem it has many symptoms including S.O.B, fatigue and oedemas, and also many signs like tachycardia and lung crepitation. Each sign and symptom of heart failure is associated with a causal agent or risk factor such as hypertension in relation to obesity and diabetes. Heart failure cannot be cured, however the symptoms can be managed through patient education and self-management, pharmacology, and as a last resort, device therapy.
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