Evidence-based Practice: Nursing care after a total Laryngectomy - Essay Example

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This is a mutilative procedure where patients are at least for a temporary period forced to remain voiceless due to extirpation of voice box or tongue. As…
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Evidence-based Practice: Nursing care after a total Laryngectomy
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Evidence-based Practice: Nursing Care after a Total Laryngectomy Introduction There are certain clinical conditions where the patients have no options other than total laryngectomy as a treatment. This is a mutilative procedure where patients are at least for a temporary period forced to remain voiceless due to extirpation of voice box or tongue. As indicated by Dobbins et al. (2005) this is particularly true at least in the early postoperative period when nursing care depends on mainly vocal communication between the patients and nurses. Apart from loss of voice, due to innate nature of the conditions for which this surgery is offered, there are certain postoperative complications associated with total laryngectomy that can be severely distressing, associated with suffering and discomfort, and would need close care of the patients which nursing can only offer. This demands specialized knowledge, skill, and experience on the parts of the nurses who are in charge of care of such patients (Dobbins et al., 2005). In one sense, the patient experience in the postoperative period is large unknown due to issues related to communication failure largely arising from induced loss of voice and most of the patients being those of cancer, they remain voiceless politically speaking. De Santana et al. (2008) commented that these patients must receive care that is dictated by evidence of scientific knowledge and practice surrounding these patients must be based on evidence (de Santana and Sawada, 2008). In such complicated cases, the nurses must attempt to apply the principles of Quality and Safety Education for Nurses which help the nurses to gather knowledge, skills, and attitudes so the quality and safety in care of these patients improve. This can be achieved through employment of the evidence-based practice (QSEN, 2009). This is an imperative for the nurses since the nurses hold key positions in ensuring and improving the quality through patient safety, and all quality assurance models of nursing care highlight accomplishment of quality and hence safety through evidenced based practice (Hughes, 2008).
Review of Literature
Review of literature has been accepted to be one of the methods to search available evidence, and hence it was decided that available literature from databases such as Cochrane, Pubmed, Sagepub and others will be searched with the key words “nursing”, “care”, “nursing care”, and “total laryngectomy.” It was surprising to note that there is a paucity of literature on this topic. However, the findings from the available literature have been presented below.
The review article of Santana et al. (2008) demonstrated that pharyngocutaneous fistula is one of the commonest complications of total laryngectomy that needs quality nursing care. They reviewed 37 articles which demonstrated evidence that most of the conservative treatments that are commonly offered to these patients are based on nursing care. These include intensive hygiene and wound treatment. This leads to the evidence that conservative treatment executed by nurses could be one management modality with effectiveness, and all nurses must use these in care of such patients (Santana et al., 2008). In her article Sigler (1989) also indicates that nursing care holds the pivotal position in postoperative care of these patients with total laryngectomy. These care may include acute and intensive care nursing educating patients, general and medical surgical nursing, rehabilitative nursing, and psychological counseling. These multidisciplinary forms are achievable only though knowledge, eye on patient safety, and coordination of care through different disciplines involved and patients and their families (Sigler 1989). Orgill et al. (2002) indicated the importance of pain management in the postoperative patients with total laryngectomy and the role of nurses in accomplishing adequate pain management (Orgill et al. 2002).
Summary and Conclusion
This brief review indicates that nurses can ensure safety in care of the patients with total laryngectomy and this would qualify enhancement of quality of care. It has been known that evidence based care can achieve quality through application of evidence in nursing practice. Many complications following total laryngectomy can be effectively treated by the nurses, the most dreaded of which are pharyngocutaneous fistula. These are amenable to conservative care offered by the nurses such as dressing of the wounds. Pain management can be also effectively offered by the nurses. There are several aspects of care of such patients which can be effectively coordinated by the nurses.
de Santana, ME. and Sawada, NO., (2008). Pharyngocutaneous fistulae after total laryngectomy: a systematic review. Rev Lat Am Enfermagem, 16:772-8
Dobbins, M., Gunson, J., Bale, S., Neary, M., Ingrams, D., and Brown, M., (2005). Improving patient care and quality of life after laryngectomy/glossectomy. Br J Nurs., 14:634-40
Hughes, RG. (eds) (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. U.S. Department of Health and Human Services. Rockville, MD p 1-22.
Orgill, R., Krempl, GA., and Medina, JE., (2002). Acute Pain Management Following Laryngectomy Arch Otolaryngol Head Neck Surg; 128: 829 - 832.
QSEN (2009). Quality and Safety Education for Nurses. Available from accessed on November 27, 2009.
Sigler, BA., (1989). Nursing care of patients with laryngeal carcinoma. Semin Oncol Nurs.;5(3):160-5. Read More
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