Evidence-Based Nursing Care. Professional Standards
The assignment presented is based on the author’s recent placement experience within the community setting, selected for using for the Evidence Based Nursing Care case study, with the view of high importance of providing a holistic person-centred care to patients for a professional qualified nurse. Building therapeutic relationship with patient in frames of this approach implies using values of respect, empathy empowerment, and being genuine. The case describes a care study to exploring patient assessment, engagement of nursing assessment tool and characteristics of plan of care implementation – the Faces Pain Assessment tool/scale, suggested by Donna Wong and Connie Baker (Kumar and Tripathi, 2016). Patient confidentiality was observed according to the Nursing and Midwifery Council (NMC) code (2018); thus, pseudonym has been adopted the patient’ consent was received to use the case information for the purposes of students learning.
The patient is William Brown, 59-year-old, with the diagnosis of Oesophagus Cancer. The patient manifests symptoms such as persistent vomiting, pain in chest and back, persistent cough and chronic fatigue, as well as sleep disturbances. The assessment objective was to clarify and comprehend how the patient was feeling and to reveal whether his care could be complemented with any other assistant in frames of the nursing process. The universal pain assessment tool was used, leading to enabling earlier interventions (Gregory and Richardson, 2014). The assessment was carried out by using the universal pain assessment tool. The tool implies using the scale of 1 – 10, with the most severe pain being 10 and the absence pain indicated by 1. William specified number four on the scale, which indicates the presence of moderate pain; however, as the patient claimed, this level of pain represents an obstacle for him in certain task he fulfils, thus worsening his quality of life. Moreover, based on the data collected during the vital observation, the patient has confirmed dysphagia, representing accompanying symptom of oesophagus cancer (Schlottmann, Molena and Patti, 2018). In general, initial assessment showed that there are pain management problems in the patient, and his vital observation fluctuates on time, with the difficulties in swallowing, thus further analysis is needed.
According to The National Institute for Health and care excellence, an analgesia drug should be prescribed to patients with the diagnosis of cancer, who experience pain (Davies, 2012). Thus, opioid drug Oxycodone was prescribed to William, with administration through continuous subcutaneously infusion via a syringe driver, in the amount of 40mg in 24 hours. Before administration of a drug, William was informed and advised about potential side effects. Appropriate subsequent assessment showed that after administering Oxycodone medication led to release of pain. Williams’ case was considered and discussed at MDT meetings an important way of making decision by inter-professional team involved in the patient care (Housley, 2017; Pillay et al., 2015). Each professional had opportunity to take part in the discussion of opinion on William state and suggest options to enhance care provided to him.
After discussing William’s case during the MDT meeting, it was stated that there is expediency for applying oesophageal stent with the aim of opening his oesophagus. It was suggested that it will help him hold fluids down and eliminate vomiting. Moreover, the syringe driver helped in controlling the patient’s pain. The patient reported about relief after the injection for at least several hours. The stent contributed to diminishing patient’s swallow issues – it became less frequent and showed tendency to disappear. The use of chosen medication also allowed to taken under control nausea in patient.
The case described above gave the author as a student nurse the opportunity of experience of practice working in the Community Hospital and taking part in MDT meeting in frames of interprofessional care, giving the opportunity to take care of a patient with oesophagus cancer diagnosis. In frames of attending weekly multi-disciplinary team meetings, the author as a student nurse was able to inform the team about pain status of the patient and suggest recommendation to physician on reviewing prescribed pain relief medication, changing it for stronger one, however, with a swallow test or an x-ray. The author’s work as part of the team facilitated the development of nurse professional skills.
Reference List
Davies, P. (2012) Compact clinical guide to cancer pain management: an evidence-based approach for nurses. New York, NY: Springer.
Housley, W. (2017) Interaction in multidisciplinary teams. UK: Routledge.
Kumar, P. and Tripathi, L. (2016) ‘Challenges in pain assessment: pain intensity scales’, Indian Journal of Pain, 28(2), pp. 61-70.
Gregory, J. and Richardson, C. (2014) ‘The use of pain assessment tools in clinical practice: a pilot survey,’ Journal of Pain Relief, 3(140). Web.
Nursing & Midwifery Council. (2018) The code: professional standards of practice and behaviour for nurses, midwives and nursing associates. London: Nursing & Midwifery Council.
Pillay, B. et al. (2015) ‘The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: a systematic review of the literature’, Cancer Treatment Reviews, 42, pp. 56-72.
Schlottmann, F., Molena, D. and Patti, M. (2018) Esophageal cancer: diagnosis and treatment. New York, NY: Springer.