NURBN 3020 Context Of Practice
Question:
This assessment task requires you to submit a refective journal documenting an experience that you have had on clinical placement with regard to caring for a person living with chronic illness.
This will include critically analysing the student’s individual opinion on the chronic illness, identifying the needs of people living with chronic illness, their caregiver, family and wider community.
Reflection is a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform your learning about practice, building on your personal/professional knowledge base.
As a nursing student you see and experience many things both positive and negative when caring for patients.
When faced with a negative situation, re?ection and journaling can be useful to work through the feelings that it has evoked. It is often from these notations that positive changes in practice occur. Though on the other hand, often we forget to re?ect on the positive practice, those special moments when all went well, they also need to be recorded.
In your journal, you need to critically re?ect on your involvement with the person living with chronic illness, your initial opinion regarding how to care for a patient su?ering from a chronic illness, including their carers/family/signifcant others, and how this experience has impacted on you both personally and professionally.
Your reflection should incorporate legal and/or ethical considerations, awareness of your role as a student in relation to the holistic nursing approach to the person with chronic illness and their signi?cant others.
Answer:
According to Caffery and Pasero (1999), the definition of pain is highly unpleasant physical sensation which is suffered by a person due to an injury or illness which also include mental suffering. The nurses have to explore the thinking and feelings of the patient who is in pain to help them appropriately (Nurwidya, Syahruddin, & Yunus, 2016). The nurse is the person who helps the patient in dealing with the pain by using different methods. This essay will focus on pain of a 60-year-old patient named Mrs Drew. In this case, the reflective style GIBBS will be used in order to support the framework and structure of the essay.
Description: I visited Mrs Drew a few times within the month when she was torn by knowing that she had “lung cancer” and she did not want to take the oral opiates regularly as recommended. Mrs Drew had taken Chemotherapy for ten months but cancer came again and spread on her spine area, and this is the area where she felt most pain (Ferrell, 2011). There have been many bad days and nights when she woke up in the middle of the night haunted by this chronic illness. She became nauseous several times; she also felt a lot of pain and to lower such pain she was taking painkillers on a regular basis. While taking these medicines, she becomes dependent on them, and she realised that her life is not going the way she wanted. After listening to her issues, I explained to her that these are negative implications of this disease. Mrs Drew was worried that she would become addictive to the drugs or medicines that she was taking. I explained to her that people with the disease usually do not get addictive to the medicines to relax her. Mr Drew was worried that her wife wanted to sleep for the whole day, but he continued to support her. I helped them out to ensure that they are able to perform their day-to-day operations while fulfilling Mrs Drew’s requirements.
The major issue which was necessary to be taken care was the spine pain of Mrs Drew. Her husband used to massage her when she complains about the pain. I assured them that she would be in charge of the analgesia, and she would be able to decide according to her wish (Gwyther, 2014). Mrs Drew said that she did not want to use Morphine and rather use the heat packs during the day so that she spent the day with her husband. I listened to her requests and assured her that I understand her situation and needs. Mrs Drew was in constant pain, yet she did not want to rely on the medicines and did not want to stay at home all day doing nothing. Instead, she wanted to do things normally (Temel, Gallagher, Jackson, & Blinderman, 2010).
Feelings: I remember the mixed feelings which I had during the whole journey with Mrs Drew. There was anger, surprise and confusion at different times. I was surprised by the way she explained things that she was experiencing. She was agitated, and at the same time, she was trying to seek help. Agitation is something which nurses know that might become a part of the patient’s lifestyle, yet I never expected this in the case of Mrs Drew. While using the heat packs, she becomes very rigid due to which I had to debate with her to assure her that all the things will be done according to her needs (Greer, 2011).
I was angry at first when Mrs Drew become rigid with the whole process, and it was at that time when my initial anger started. Later, when I was reflecting on the whole scenario, I realised my mistake of being angry at the time (Murray, 2005). I was angry with myself because of my frustration and the image which I set of Mrs Drew while helping her. I had a process in my mind regarding how I wanted to proceed with Mrs Drew. I had a fixed agenda, and all I wanted to do is to comply with the agenda. I told her that I knew the process and convinced her somehow to follow the same.
During this period, I also felt impotence and confused due to my lack of patience in the whole process and for the prompt action which I took to make the patient comfortable. Sometimes I become unaware of my actions due to which Mrs Drew had felt bad.
Evaluation: My experience with Mrs Drew raised various questions in my mind regarding my nursing skills. I felt many issues while helping the patient to deal with the disease. I also realised that the assumptions which I had regarding analgesia and the strategies to control pain were wrong (Haile & Desalegn, 2015). A good experience that I had during this incident was that patients did not want to feel pain. Therefore, all nurses should focus on reducing the pain of the patients while dealing with them. This is significant learning which I learned during this process. Mrs Drew had lots of questions about the analgesia practice and many times I had to look into my textbook to answer her questions correctly. Overall this was a new learning experience for me.
Analysis: This incident made me a little uncomfortable because my prior approach with pain management was theoretical rather than practical (Effiong, 2012). This incident was not related to the application of heat and morphine; instead, it related to the choices which were made by the patients regarding the whole process. I realised that all the facts should be given to the patients and then their preference should be asked to find a solution that works for them. I also felt bad that I did not listen to the patient carefully. Mrs Drew elaborated her condition and how she was feeling, and I did not pay much attention to what she had to say. In the end, I learned that a patient should be heard carefully and clearly so that the patient becomes comfortable with us (nurses) because then it becomes easy for the nurses to create a bond with patients based on trust.
Conclusion: There are three conclusions which can be made from the above case. Firstly, it is not easy for the nurse to take actions as per the requirement of the patient. The nurse must have the skill of patience and effective listening while dealing with all patients. Secondly, the nurse should cherish every experience he/she has with each patient because they learn in each case and every new experience teaches them something new. The real experience is completely different from the theoretical knowledge collected by nurses by reading textbooks (Glidewell, 2008). Lastly, the nurse should listen to what the patient has to say. The patient is the one who suffers the pain, therefore, only he/she has the ability to define the pain, and it assists the nurse in helping them.
Action Plan: It is not right to recommend that the patients are not looking to remove their pain. Mrs Drew just wanted to remove her pain so that she can enjoy her life like a normal person. Appropriate support should be given to the patients when they say that they need to remove their pain in any way possible so that they can die peacefully with dignity (Henry, 2015).
References
Effiong, A. (2012). Palliative care for the management of chronic illness: a systematic review study protocol. BMJ Open , 2 (3).
Ferrell, B. (2011). Palliative Care in Lung Cancer. Surg Clin North Am , 91 (2), 403-409.
Glidewell, L. (2008). The Self in Health and Illness Patients, Professionals and Narrative Identity. Health Expectations , 11 (1), 96-97.
Greer, J. A. (2011). Effect of Early Palliative Care on Chemotherapy Use and End-of-Life Care in Patients With Metastatic Non-Small-Cell Lung Cancer. Journal of Clinical Oncology , 30 (4), 394-400.
Gwyther, L. (2014). Palliative care in chronic disease. SAMJ , 104 (2).
Haile, M., & Desalegn, N. (2015). International Journal of Medicine and Medical Sciences Practice of regional anesthesia and analgesia in Ethiopian hospital. International Journal of Medical and Medicine Sciences , 7 (8).
Henry, L. M. (2015). Respect and Dignity: A Conceptual Model for Patients in the Intensive Care Unit. Narrative Inquiry in Bioethics , 5 (1), 5A-14A.
Murray, S. A. (2005). Palliative care in chronic illness. BMJ open , 330 (7492), 611–612.
Nurwidya, F., Syahruddin, E., & Yunus, F. (2016). Pain management in lung cancer. Researchgate , 84, 331–336.
Temel, J. S., Gallagher, E. R., Jackson, V. A., & Blinderman, C. D. (2010). Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer. The New England Journal of Medicine , 363, 733-742
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