Sickle Cell Transition Placement - Essay Example

?Sickle Cell Transition Placement Introduction Based on the World Health Organization , about 5% of the world’s population carries the gene traits for haemoglobin diseases, mostly for sickle cell disease and thalassaemia. Over 300,000 babies with these haemoglobin disorders are born each year, and the percentage of individuals who carry genes for this disease is as high as 25% for some regions. Sickle cell affects red blood cells which contain haemoglobin and according to Anon (2009) about 250,000 people are carriers of sickle cell genes. Sickle cell disease also means that if both parents are carriers, then it is more likely for the children to develop either sickle cell disease or to be a carrier of the disease. According to Anon (2009) about 7 percent of patients often die due to the increase of liver iron, and other causes including strokes and infection are also considered causes of deaths among these patients. This essay will be a reflection of my sickle cell placement as a student nurse. This topic was chosen because I wanted to observe what sickle cell nurses do for patients in order to enhance my learning; moreover, I also believe that this learning associates well to my course. I also chose to observe what sickle cell nurses do for patients because I of the likelihood of encountering patients with sickle cell disease in the future. This essay shall first undertake a reflection on the transition activity; secondly, it will demonstrate a detailed knowledge of the transition activity, which in this case is sickle cell disease. This second part will also demonstrate the impact of the topic and the transition activity to my area of professional practice. This second portion shall also discuss the role of sickle cell nurses and shall then provide reasons why the activity was chosen. Thirdly, this essay will analyse how this transition activity has contributed to my own learning and skills development. Lastly, by focusing on this transition activity, this paper will also determine further areas for personal and professional development and how this might be taken forward through future research and further study as a registered nurse. In accordance with the requirements of the Nursing and Midwifery Council (2008), any personal confidential information regarding the patient/s and individuals involved in this placement shall not be disclosed. The Trust where I conducted my placement shall also be kept confidential. Body Reflection on the Transition Activity I had my transition placement on sickle cell disease, and initially during my placement, I had a discussion at the hospital with the patients and later visited them in their own homes. In general, the activities during my placement were varied. I met with the multidisciplinary team regarding patients who suffered from sickle cell and how best to care for them. I also discussed the findings/results of the tests. I also observed how the sickle cell nurses administered care to the patients, addressing their needs physically, mentally, psychologically and emotionally. I also observed how nurses explained the disease to parents and their children, including the consequences of their illnesses as well as its risks/effects. I also observed how the nurses discussed with parents about the loss of their children, discussing with them the possible therapeutic options they can take as grieving parents. The transition activity initially provoked feelings of anxiety. However, in the process of learning, my anxiety soon vanished and I was able to transition gradually into the crucial duties of a sickle cell nurse. Duncan and DePew (2010) discuss that with more experience, the transition process among students of nursing can somehow be eased. In considering what I was able to get from this learning professionally, I was able to learn the qualities of the disease, including the specific role of the sickle cell nurse in ensuring efficient patient care. On a personal level, I was also able to get a specific feel for the nursing practice, including its challenges and benefits (Duncan and DePew, 2010). Personally, this transition gave me the opportunity to evaluate my skills, especially the gaps which are present in these skills. Professionally, as pointed out by Harrington and Terry (2008), the transition experience can give student nurses the opportunity to observe how other nurses carry out specific duties, and how I can learn from their actions and skills. In answering why I chose to do what I chose, I did it because sickle cell nursing represents an unfamiliar territory for me. In answering what made me do that, I definitely wanted to learn more about this field of practice. It was important for me to gain the necessary and practical skills which would arm me with the proper tools to be a clinical nurse. In other words, I knew that my actions will help me with my future practice. This was also pointed out by Chernomas et al. (2010) as they admit that practice tools can help ease the transition process. My actions were supported by my knowledge of the guidelines set forth by the Royal College of Nursing and Midwifery (2011). In answering how my transition helped with the practical skills, and what I gained from these skills, during my transition, I was able to observe sickle cell nurses in action, and as was pointed out by Kaplan et al. (2012), observations help provide actual applications of theories in the care of patients with sickle cell disease. My transition gave me step by step guidelines on the care of sickle cell patients, guidelines which I can apply in my future clinical practice. My actions and choices were based on evidence-based considerations, and based on Zinsmeister and Schafer (2009), these actions helped support theoretical knowledge as well as practical skills. While caring for the patients with sickle cell disease, I often observed sickle cell nurses carrying out blood transfusions. I observed how the procedures were carried out and also asked the nurses to teach me how to carry out the blood transfusions. With their guidance and their supervision, I was able to learn important skills and procedures needed to carry out these blood transfusions. I also helped relieve pain for patients, which was emphasized as a crucial consideration among sickle cell patients by the Royal College of Nursing (2011, p. 4). Many of the patients expressed pain and the doctor’s orders included the administration of pain relievers. I often observed how these medications were administered. Johnson (2005) argues that the administration of these medications may be at regular intervals, and others based on patient pain levels (with doctors’ approval). I also observed vital signs as recommended by the Royal College of Nursing (2011); and I also monitored levels of fatigue for the patients. As recommended by Brewster (2003), I observed patient hydration, encouraging them to drink sufficient fluids, and observing how to regulate their IV. As further discussed by Brewster (2003), patients with sickle cell disease have a high risk of fluid and electrolyte imbalance; therefore, it is important for nurses to monitor the patient for signs of dehydration by measuring the patient’s intake and output. I observed how the sickle cell nurses monitored the amount of patients’ fluid intake as well as their urine output, learning how to take note of major differences which may signal dehydration Detailed knowledge on sickle cell disease/relevance to area of practice/role of sickle cell nurses In the process of my transition placement, I was able to gain more detailed information about sickle cell disease my making additional research and readings on the disease. According to Rees, Williams and Gladwin (2010), sickle cell disease, otherwise known as sickle cell anaemia is a disease which primarily affects the red blood cells with the RBCs forming as abnormal sickle or crescent-shaped cells, instead of disc-shaped cells. This disease is said to be caused by the abnormal manifestation of haemoglobin – known as haemoglobin S. I found out that according to White and Duncan (2002), this haemoglobin changes the shape of the RBCs into crescent-shaped cells. As abnormally-shaped cells, they are not able to deliver as much oxygen as they can to the body’s tissues. Orshan (2007) also points out that with this shape, the haemoglobin flow into the blood vessels would likely be hampered. As such, the haemoglobin may also break into several pieces and interfere with the normal blood flow. Orshan (2007) also admits that these issues may then further decrease the flow of oxygen into the cells. In my research, I came across the discussion by Geller and O’Connor (2008), which declares that sickle cell patients often experience episodes, called crises, where more often than not, extreme pain is experienced and such pain may last for hours, up to days. Research by White (2005) also admits that such pain may manifest at the backbones, the long bones, and in some cases, the chest. Patients may experience one episode per year or every few years; and for some, many episodes for each year. Most of these episodes may require hospitalization and according to Martin (2007), when hospitalized, these patients would usually be cared for by a sickle cell nurse as well as other expert practitioners. Carpenito-Moyet (2008) emphasizes that during extreme manifestations of the disease, sickle cell anaemia may cause fatigue, pallor, increased heart rate, shortness and sometimes difficulty of breathing and jaundice. Carpenito-Moyet (2008) also discusses that most of these symptoms are associated with the compromised delivery of oxygen to the body’s cells. Geller and O’Connor (2008) point out that patients suffering from this disease have to be monitored for the following: bilirubin, blood oxygen, blood count, serum creatinine, and serum potassium. During my transition placement, I discovered in the research by Lee, Piomelli and Granger (2006) that the primary goal in the management of sickle cell patients is to control their symptoms and reduce the occurrence of crises. Sickle cell nurses carry out various functions in order to control and reduce the occurrence of these crises. They further discuss that these patients require constant management and treatment, even when they are not going through any episodes (Lee et al., 2006). These patients are usually under folic acid supplementation since folic acid helps in the production of RBCs. I found out that these patients also go through blood transfusions, often regularly in order to prevent blockage of vessels and eventually, to prevent stroke. Lee et al. (2006) also point out that these patients are usually on pain medications and are advised to take plenty of fluids. Geller and O’Connor (2008) emphasize that for more extreme cases, dialysis or kidney transplants are often needed due to kidney disease being one of the risks associated with sickle cell anaemia. Gall bladder removal is also needed for some patients, including hip replacements and possible leg ulcers (Brawley et al., 2008). Reducing the risk of infection is also an important part of care for these patients. Rosdahl and Kowalski (2007) suggest that nurses, therefore, have to apply sterile techniques at all times while caring for these patients. Medicinal options for patients also come in the form of desferal, which according to Moore and Woodrow (2009, p. 338), helps remove iron in the body. A study by Quinn et al. (2010) also supports penicillin use against infection. In reviewing the guidelines of the Royal College of Nurses (2011), I was able to establish that there are various competencies or roles which sickle cell nurses play. These nurses need to provide empathy and understanding for their patients, working with them as well as their caregivers and treating these patients as experts in their own condition (RCN, 2011, p. 5). Bennett (2005) discusses that in meeting this competency, it is important for the nurses to consider patient preferences in their care and to discuss treatment options with them. These preferences may include specific pain relief medications. Sickle cell nurses comforted and supported patients and their families by advising them about the possible outcomes/results of their illness. These nurses also encouraged patients to exercise regularly, eat a well balanced diet, not to stay in water for too long, and to minimise swimming activities. Thoma and Veronica (2000) suggests that advising and supporting sickle cell patient is an important part of the health care as this increases stability in good health and self esteem. Sickle cell nurses make a difference to patients lives and health well being. From the experience, I learned that if I come across patients that show any signs of crisis then I will be able to call for help to safeguard that particular individual. I also learned that it is important for sickle cell patients to take a lot of medications to prevent themselves from getting infections, and that there is a need to encourage them to be as independent as possible. I gained a lot of important information from the multidisciplinary team in regards to sickle cell diseases and how they discuss the patients’ results. I learned about different types of sickle cells such as anaemia, haemoglobin, beta and thalassaemia disease. Beta sickle cell trait means that a patient carries a different type of sickle cell/carrier but that he/she can pass the disease on to his/her children. I also learned that patients must be advised not to smoke/drink alcohol because this can cause sickling in their lungs and can lead to other problems. Engelke et al. (2008) stated that patients who have sickle cell thalassaemia need blood transfusion to replace the bad cells. Effect of transition activity on learning skills and development In terms of links to my learning, this transition activity has armed me with the tools I need to make a smooth transition to actual clinical practice, most specifically, the management of patients with sickle cell disease. This activity is relevant to me as a student adult nurse, because it has taught me what, how, and when to monitor patients with sickle cell disease. It has taught me specific details which I need to monitor among patients, and these details may be elements which I would not usually consider for other individuals. These details would include the level of hydration, fatigue, and even pallor. This transition activity has also given me the chance to work and collaborate with other nurses and health practitioners. I developed my communication skills by understanding how multidisciplinary teams work. The multidisciplinary nature of the health practice was demonstrated well to me during this transition activity. Artz, Whelan and Freehan (2010) indicate that working within a multidisciplinary team is one of the hallmarks of effective patient care with all aspects of a patient’s condition properly addressed and holistically managed by the health care team. From my transition placement, I understand better now how a multidisciplinary team works, what is required of the team and how the members of the team can communicate effectively and efficiently with each other. Artz et al. (2010) further point out that while working as a team, it is possible to apply holistic care to the patients with various health professionals, addressing all aspects of the patient’s life – physical, psychological, social as well as the spiritual. During my observational visit, I had a meeting with the multidisciplinary team regarding patients who suffer from sickle cell diseases and how to meet their needs. I observed how they discuss the findings/results of the genetic tests. I also observed how nurses cared for patients physically, mentally, psychologically and emotionally. I observed how nurses explained things to parents and their children regarding sickle cell diseases and the consequences of the illnesses, including its risks/effects. I also had discussions with the parents regarding loss of their children and how to deal with bereavements/pregnancies and possible outcomes. I learned about the signs and symptoms I should look out for in sickle cell patients, including symptoms such as tiredness, headache, eye sight problems, crisis, painful erection, high temperature, vomiting, diarrhoea, weakness in the body, loss of feeling, chest pain, difficult breathing, abdominal pain, swelling in legs and toes (Coretta et al. 2011). Numas bacteria, is a common infection, therefore, I also learned about some of the medications used in sickle cell patients including desferrioxamine, drug which gets rid of the excess iron in the body. Penicillin medication fights against infection and ferritin is an iron tablet which some patients would need to increase iron in their body BNF 47 (2004). NHS Screening (2006) recommends sickle cell patients to use ongoing liver iron MRI scans to check for iron levels, especially for those who have had blood transfusions or are about to be transfused. I also observed how sickle cell nurses encouraged patients to increase their fluid intake and to keep themselves warm especially in winter times. Wynter et al. (2000) points out patients that do not have sickle cell diseases will have normal red blood cells (soft and flexible) which are blood vessels that get blocked due to haemoglobin clots of blood referred to sickling in brain. I learned how sickle cell nurses educate and encourage parents to look after their children in relation to a possible crisis later in their life. Patients are also advised to take blood tests due to genetic findings/haemoglobin results. I learned how important it is for sickle cell nurses to discuss related issues on how other sickle cell patients have been able to cope with their life/daily activities. Further areas for personal and professional development In future after having gained experience from sickle cell nurse specialist, I would like to be able to care and provide support to patients with sickle cell conditions, to help them in tough times because their conditions are life threatening. The activities I chose would help provide the necessary skills I would need as a future sickle cell nurse, teaching and enhancing the essential competencies needed by sickle cell nurses. During my future placement, I may come across patients with the sickle cell disease and therefore I would need to be able to care for them. It is therefore important to gain the practical skills in caring for them. My role in the future would include caring for patients by providing support and information to them and to their families, as well as administering their medications, giving blood transfusions, and teaching them healthy food regimens. I might also have to teach them ways to prevent and control infections, and I might also provide them the means to control pain through analgesic relief. In the process, I would likely work with multidisciplinary teams by liaising with other health professionals in the holistic care of patients. In effect, there is a need to provide physical, mental, emotional, and psychological support for families. Conclusion Sickle cell nurses are tasked with various responsibilities, and transition nurses seeking to administer care to patients with sickle cell disease have to make their transition smooth and seamless in order to prevent any untoward effects to the patient. This reflection provided strong and evidence-based data on sickle cell nursing as well as sickle cell disease. The data provided various competencies for sickle cell nurses, which cumulatively serve as the basis for holistic and multidisciplinary care. It was a difficult transition process; however, with the proper theoretical and practical skills, it was possible to acquire the necessary competencies to ensure improved patient outcomes. References Artz, N., Whelan, C. and Feehan, S., 2010. Caring for the adult with sickle cell disease: results of a multidisciplinary pilot program. J Natl Med Assoc, 102, pp.1009–1016. Ashford, H., 2011. 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The exploration of the lived experience of the graduate nurse making the transition to registered nurse during the first year of practice. Journals of Nurses in Staff Development, 25 (1), pp. 28–34. Read More