Managing a Sickle Cell Anemia - Essay Example

REFLECTIVE WRITING ON MANAGING A SICKLE CELL ANEMIA Unit: Sickle cell anemia is characterized by the growth of abnormal hemoglobin, anomalous red blood cells and consequential complications (Olowoyeye & Okwundu, 2010). This type of disorder is more prevalence in Africa, Saudi Arabia, United States and the Caribbean (Centers for Disease Control and Prevention, CDCP, 2011a). About 90,000-100,000 Americans experiences this disorder, hence a major genetic disorder in America. This disease mainly affects the Black Americans, giving instances of 500 births with the traits taking place in about 1 for every 12. The disease is an autosomal recessive disorder affecting males and females equally (Pack-Mabien &Haynes, 2009). Diagnosis is usually made at birth at the time of newborn screening. Disease management is usually focused on pain, hydration and infections prevention and various complications resulting in vaso-occlusive crises (Lee, Askew, Walker, Stephen & Robertson-Artwork, 2012). This paper is a reflective essay and discusses leadership management on the caring of a patient with sickle cell disorder by applying the theoretical concept from Gibbs framework of reflection. The essay is based on the case study of a 25-year old African-Caribbean man who had been diagnosed episode of sickle cell pain. The patient has been admitted in the Lister Hospital six times on the same issue. Though the previous pains were on the abdominal and legs, this time round he came up with chest pain also. Skills, knowledge and attributes linked to leadership are also discussed and change management leadership concept applied. The paper has analyzed my accountability and delegation, ending up with conclusion summarizing the whole paper concept. The reflective model that I have decided to apply is Gibbs model of reflection. This framework is grounded on Gibbs Reflective Cycle developed in 1988 (Gibbs, 1998). The framework is related to Kolbs Learning Cycle, but it covers the principles at large. Every step of the cycle starts with describing the event, then reviewing; reflecting on the experience then ends up with the formulation of a plan to deal with the same experience in the future. This cycle constitutes six steps of which the practitioner is expected to provide answers to various questions each leading to the next step, stressing an adequate event analysis provoking decisive thought. Fresh meanings are developed making the learner come up with an affirmative plan of action (Gibbs, 1988). The six steps involved include: description- what occurred? , feelings-what were you experiencing? , evaluation-the worst and good on experience, analysis- what sense that can be deduced from the situation, conclusion-anything else that can be done and action plan what can be done if the situation comes again. These steps are shown at the end of the essay (Appendix A). I will use this in the theory to enhance critical thinking, linked to theory in practice where it fits. This essay is grounded on the vital occasion that happened at the Lister hospital in my presence. The vital incident can be referred to as a style in learning that groups an event into major compounds to allow for reflective evaluation (Boud, Keogh & Walker, 2013). The essay involves a sickle-cell man admitted to the same hospital and acutely ill of which I will refer to him as John. The incident that occurred had some effect on me, and that is why having decided to use it. I never expected to see my mentor in a situation in which she appeared to be unable to work with, mainly due to inability to communicate. My mentor and I took charge of John and started managing his condition to minimize pain. We struggled with John until the pain he was feeling was minimized. However, I felt that the management of John’s pain could have been done better than how we carried it out with my mentor and other colleagues. This poor management was all due to poor communication when handling John’s condition. This is issue of poor communication when handling a patient is what I have decided to reflect on. My feelings and thoughts concerning the occasion showed that I was under fear, as this was the first time of handling a client who is seriously ill and I was surprised why my mentor needed much from me than I was able to deliver. I was under pressure as things were supposed to be carried out faster, and I never wanted my mentor to think I was unable to work in a serious condition. I also never wanted the patient to have the feeling I was unable to assist him and that he was in unsafe hands. Patients who are critically ill usually experience various frightening and events that are unpleasant; therefore the application of sincere communication and supportive gestures always enhances the comfort of the client (Rhoney & Murry, 2003). My mentor began being anxious and was never calm which was what was required in a condition like this. To minimize the pains especially on the chest that was more, the patient was put to sit with the left hand to the back of the hip and bending to the left side and allowed to breath deeply in and out, which he did with a lot of difficulties. According to me these methods were carried out hurriedly and not applied in the way required despite the conditions pressure. My mentor was trying to carry out all the procedures herself, and there was no communication between us the patient and other staff members. Staying calm when under pressure will always lead to a person coming up to good decision making better judgments and in a position to deal with the patients better (Rochester, Kilstoff & Scott, 2005). I was trying to consider and table in advance for Johns care, but I was unable to achieve it because communication was lacking between us. My mentor was doing all the things by herself without involving us. She was attending to the patient without the consideration of how much pain the patient was experiencing. As my mentor held John’s hand and told him to breathe in and out deeply, John did it with tears coming out of his eyes, showing how much pain he was enduring. This was all done to ease the painful tension that existed at the trigger points on the chest. To minimize the pain, John also needed reassurance and kept cool during the hours of treatment, and I was able to see that we had not attained this, and he appeared troubled as no one was reassuring him to cope up with the pain. Communication that is patient centered is crucial to persuading and prop up both the nurse and the patient in a critical condition (Holden, Harrison & Johnson, 2002). Patient-centered communication is a strong advocate for the improvement of communication with clients (Little, Everitt, Williamson, Warner, Moore, Gould & Payne, 2001). I administered aspirin drugs to John in smaller doses to reduce pain by preventing prostaglandins through inhibition of enzyme producing them. I gave the drugs once and the patient had the feeling of reduced pain after some minutes. Administering started as blood cultures were taken to determine the extent to which the disease has affected the body. The client finally stabilized, and critical signs started to improve which a great reprieve was all now felt the condition being under control. At that time, my mentor started giving good care when it came to wiping the client’s chest with hot bath to remove the painful tension that existed within the chest, and I began to table in advance what would be required next. When a person has an affirmative approach, he or she can handle the situation better, and that being affirmative exhibits your strength to conquer negative conditions (Callaghan & Thompson, 2002). I never went to the situation with affirmative attitude as I have never been in the same situation before and at first had fear and stressed. Despite this, I will make sure I show a positive attitude in the future as it will compose huge effect and great results for those involved. John was being managed of acute chest syndrome. The therapy of drugs to reduce pain should have been carried out earlier but due to my mentor not consulting the doctor faster, delayed faster stabilization of the client. My mentor was impatient, handling the patient in a hurry without considering how much pain he was undergoing. If my mentor could have stayed cool enough, then she could have been in a position to prioritize her methods. To provide the high level of care, I was required to have the skill of coming up with priorities on what should be carried first (Kihlgren, Nilsson & Sørlie, 2005). I take this to be a negative part of my familiarity as I was convinced that we had not prioritized and that that the drugs should have been given early enough to prevent further chest pain and febricity. However, the experience also had positive aspects as I learned to be cool and was in a position to provide reassurance to the patient when I think I was unable. On analysis of the situation, it was like a short exercise as I come to learn more on how to act when handling a critical condition. I never wanted to behave like my mentor who was anxious and due to my fear I did not think appropriately; hence I experienced how this affected the condition. Due to the occurrence of this crucial event, I gained valuable skills to apply in other situations in case of any. Skills such as remaining calm with no fear, having some communication with the client in the process of reassuring him or her and communicating with the family members of the client to find out more concerning the client. I have also learnt how to act fast during emergency especially when a patient is undergoing an uncontrolled pain. Like in John’s condition the first thing that was supposed to be done is to give the aspirin doses to minimize pain prior to other things. If such conditions take place any other time, I am prepared to conquer them and would not experience the same feeling of fright and fret, as I am aware of the expectations and would be able to do what may be requested. To make sense concerning the situation, I discovered I am courageous in all the situations that are coming onwards in the hospital. In the event of the repetition of such situation, my first step will be affirmative attitude resulting to more organized and cool management of a crucial occasion. Bringing a situation under control makes onward planning simpler to carry out, and good nursing care provided. To do this I would ensure distribution of tasks to all nurses handling the same patient so us to allow for easy communication. This would be easy since everybody will have a role to play and contributes to the patient’s healing. The clients gain more as compared to a hasty unorganized setting. Minimum mistakes will be made, and the easy task not skipped as the nurse in charge would be concentrating more. Organized communication is a great factor on how every situation comes out. Communication breakdown can result to poor results. Hence, bad communication with the client and the families should be discouraged (Greenberg, Regenbogen, Studdert, Lipsitz, Rogers, Zinner & Gawande, 2007). Lack of communication may mean there is no trust, and, therefore, the future communication may as well be overlooked. The body and face are more communicative (de Gelder, 2009), and concerning this condition the client realized my mentors fear and ambiguity without even verbal communication making him worried. Communication is significance in the establishment of the relationship with the client, hence forming trust. Communication through understanding forms a rapport with both the relatives and patient. The practice that I identified in the hospital was the lack of better communication within the Lister Hospital setting especially between the nurses when handling a client. The effective communication among the health workers is a challenging practice due to various reasons. Health care is multifaceted and not predictable with professionals from various disciplines are equipped with provision of care at several times throughout the day, always dispersed over various locations developing spatial gaps with limited chances for regular synchronous interaction (Vincent ,2010). Furthermore, care providers always have their personal disciplinary observation of the needs of patients with every provider giving priorities to the activities that he or she acts independently. Also to that, the facilities for health care historically had got a hierarchical organizational structure with important power gaps between doctors and other health care professionals. This subsequently causes the culture of inhibition and hold back communication other than an open safe communication. The difference in training and level of education among professionals also leads to the difference in communication techniques; this makes the scenario complicated making communication inefficient. Furthermore, despite the significance of effective communication and teamwork in the provision of safe care to client, education curricula for many health care professionals concentrates majorly on personal technical skills, limiting communication skills and teamwork (Stephenson, 2002). For better communication, I will come up with communication strategies for handling each condition. This will at least form a common communication technique to be adhered to by all professionals despite the difference in personal technical skills. For example, my communication strategy will constitute all the nurses participating in a certain condition answerable to one nurse or doctor who is the team leader. For promotion of good communication between the staffs and patients in Lister Hospital, I will proceed with making various changes are supposed to be made. One is the application of Situational Briefing guide (SBAR), which I will use as a situational briefing channel for nurses and giving communication on changes in the status of the client (Haig, Sutton & Whittington, 2006 ). This format is effective in the narrowing the gap of differences in communication techniques and assists to bring all the team members in the same situation. I will also ensure application of team huddles. Staff and provider team huddles provide simple ways of sharing information subsequently with the team earlier within the shift. Team Huddle is a swift meeting of a practical group to put a day in motion through the commentary with core personnel. Multidisciplinary rounds using Daily Goals Sheet is also another way of improving communication in the Lister Hospital. Rounds are grounded to clients and could involve any provider giving the patient care (Narasimhan, Eisen, Mahoney, Acerra & Rosen, 2006). I will apply these changes mostly in ACU and MICU. The most effective way to ensure communication and teamwork is however through the distribution of the work before starting working on a patient. This will ensure everyones contribution thus effectiveness in the handling of the client. The leadership concept I can apply in my practice is the transformational leadership. This theory was formed by McGregor Burns in 1978 (Rebora & Minelli, 2012). I will prefer this leadership because of its effectiveness in encouraging adaptation to change. This style will allow me to recognize major areas that need change, and it also acts as a guide to change through the inspiration of followers and creation of the sense of commitment. This system also allows me to feel more contented and certain when engaging into aspects of healthcare technology. This system leads to the promotion of teamwork within staffs which is a step towards effective communication. It promotes a healthy setting for both the staffs and the clients and can lead to improved staff satisfaction and retention and also clients satisfaction. This theory will enhance my effective communication and a leader who communicates effectively concentrates closely on what other people are trying to convey and what points are of importance to such people. An effective communicator is in a position to cope with individuals communication style and can understand the relations (Doody & Doody, 2012). Communication lacked during the management of John’s condition. This model usually brings patient-centered interactions. This method will allow me to restore communication as its key changes require better communication between the patient and the caregiver and the patient’s family. I will therefore explaining each procedure I take when managing the patient to make him understand what is being done. Improvement in communication in the health setting is beneficial towards the health of an individual. The Lister Hospitals vision is to provide a quality health care to the patients at an affordable cost. Once there is a good communication between me and client, the client will leave the Lister Hospital satisfied with the service. A good communication will also allow the client to be open as he or she will trust me, hence making it easier to handle his or her situation. This will in turn improve the image of Lister Hospital. A good communication needs every staff to be equal during handling of a client. However, the profession at the high hierarchy usually feels superior and the feel they know more as compared to their colleagues. Such people will not involve their colleagues in the making of decisions concerning patients hence high chances of making mistakes due to assumptions. Such profession may feel at ease in the implementation of change that makes every staff to equal. The skills of the colleagues will be improved as they will be in a position to communicate well with the clients and there fellow colleagues. As a health practitioner I am accountable and responsible for judgment evaluation and scheduling of typical care and for delegation work to provide support to staff (Arford, 2005). The team members are accountable to their actions. In the Lister Hospital, the staffs have legal, social, ethical and contractual accountabilities and are answerable for the tasks that they undertake. This, therefore, requires that the staff members to be keen when managing the patient as at the end he or she will answerable to the outcome after the management. Anything that therefore happens to the patient at the end of the health care will be my responsibility. I am therefore required to provide the best healthcare to prevent worsening the condition of the patient. The change that I am supposed to implement to assist in the provision of best services to my clients is on communication. Implementation of this change required is the most crucial part of the process of coming up with the change in the in way I manage patients. The implementation process follows various stages for the change to become effective in the improvement of my management. The implementation process constitute six stages, and the stages are shown in the at the end of the essay (Appendix B) To conclude, leadership has shown to be critical in the management of a sickle cell anemia patient. This disorder has shown to be prevalence and genetically modified thus management is the only solution especially management of pain. Gibbs framework has shown to be vital in the steps towards the provision of change to Lister Hospital. The framework has provided the analysis of the situation in the Lister Hospital that promoted the need for change. I have learnt a lot from the event of the reflection in the Lister Hospital. In situations coming into future, I will make sure an organized communication between all those that are involved, most so the patient to ensure they feel secure and assure them that we nurses we know what we are doing. Now that I have passed this experience and got some learning out of it, I received more confidence on how to deal with the client in the same condition. A nurse being courageous is an assurance to the client that all is under control thus putting them at ease. I would learn not to expose fear as there was nothing to fear and the final thing the client expected was to feel nervous he was in risky hands. Communication is critical in the handling of patients in the Lister Hospital and hence has formed the center for the change. Transformational leadership theory has shown to be significance in the implementation of the change in patient management. Various tools have also been shown that can lead to improved communication in the Lister Hospital. This equipment has shown to be effective in enhancing nurse-client communication thus a way forward for Lister Hospital. REFERENCES ARFORD, P. H. (2005). Nurse-physician communication: an organizational accountability. Nursing Economics, 23(2), 72. BOUD, D., KEOGH, R., & WALKER, D. (2013). Promoting reflection in learning A modeli. Boundaries of adult learning, 1, 32. CALLAGHAN, G., & THOMPSON, P. (2002). ‘We recruit attitude’: the selection and shaping of routine call centre labour. Journal of Management Studies, 39(2), 233-254. CENTERS FOR DISEASE CONTROL AND PREVENTION (2011a). Data and statistics. Retrieved fromhttp://www.cdc.gov/NCBDDD/sicklecell/data.html DE GELDER, B. (2009). Why bodies? Twelve reasons for including bodily expressions in affective neuroscience. Philosophical Transactions of the Royal Society B: Biological Sciences, 364(1535), 3475-3484. DOODY, O., & DOODY, C. M. (2012). Transformational leadership in nursing practice. Top of Form GIBBS, G. (1988). Learning by doing: a guide to teaching and learning methods. [London], FEU. HAIG, K. M., SUTTON, S., & WHITTINGTON, J. (2006). SBAR: a shared mental model for improving communication between clinicians. Joint Commission Journal on Quality and Patient Safety, 32(3), 167-175. HARBER, M. (2014). Practical nephrology. http://dx.doi.org/10.1007/978-1-4471-5547-8. Page 331. HOLDEN, J., HARRISON, L., & JOHNSON, M. (2002). Families, nurses and intensive care patients: a review of the literature. Journal of Clinical Nursing, 11(2), 140-148. Bottom of Form GREENBERG, C. C., REGENBOGEN, S. E., STUDDERT, D. M., LIPSITZ, S. R., ROGERS, S. O., ZINNER, M. J., & GAWANDE, A. A. (2007). Patterns of communication breakdowns resulting in injury to surgical patients. Journal of the American College of Surgeons, 204(4), 533-540. KIHLGREN, A. L., NILSSON, M., & SØRLIE, V. (2005). Caring for older patients at an emergency department–emergency nurses’ reasoning. Journal of clinical Nursing, 14(5), 601-608. LEE, L., ASKEW, R., WALKER, J., STEPHEN, J., & ROBERTSON-ARTWORK, A. (2012 Adults with sickle cell disease: An interdisciplinary approach to home care and self-care management with a case study. Home Healthcare Nurse, 30, 172-183. doi:10.1097/NHH.0b013e318246d83d. LITTLE, P., EVERITT, H., WILLIAMSON, I., WARNER, G., MOORE, M., GOULD, C. & PAYNE, S. (2001). Preferences of patients for patient centred approach to consultation in primary care: observational study. Bmj, 322(7284), 468. PRONOVOST, P., BERENHOLTZ, S., DORMAN, T., LIPSETT, P. A., SIMMONDS, T., & HARADEN, C. (2003). Improving communication in the ICU using daily goals. Journal of critical care, 18(2), 71-75. NARASIMHAN, M., EISEN, L. A., MAHONEY, C. D., ACERRA, F. L., & ROSEN, M. J. (2006). Improving nurse-physician communication and satisfaction in the intensive care unit with a daily goals worksheet. American Journal of Critical Care, 15(2), 217-222. OLOWOYEYE, A. & OKWUNDU, C.I. (2010). Gene therapy for sickle cell disease (review). Cochrane Database of Systematic Reviews, Issue 8, 1-8. Art. no: CD007652. doi:10.1002/14651858.CD007652.pub2. PACK-MABIEN, A. & HAYNES, J. (2009). A primary care provider’s guide to preventive and acute care management of adults and children with sickle cell disease. American Academy of Nurse Practitioners, 21, 250-257. doi:10.1111/j.17457599.2009.00401.x REBORA, G., & MINELLI, E. (2012). An Integrative Conceptual Framework of Organizational Change: A “Triple Helix” Model. Research in organizational change and development, 20, 183-221. RHONEY, D. H., & MURRY, K. R. (2003). National survey of the use of sedating drugs, neuromuscular blocking agents, and reversal agents in the intensive care unit. Journal of intensive care medicine, 18(3), 139-145. ROCHESTER, S., KILSTOFF, K., & SCOTT, G. (2005). Learning from success: improving undergraduate education through understanding the capabilities of successful nurse graduates. Nurse Education Today, 25(3), 181-188. STEPHENSON, P. (2002). The Double Bind and the Double Burden: Implications for the professional education and practice of Indigenous environmental health practitioners (Doctoral dissertation, University of Technology, Sydney). Top of Form VINCENT, C. (2010). Patient Safety. New York, NY, John Wiley & Sons. http://nbn- resolving.de/urn:nbn:de:101:1-201410083183. Bottom of Form APPENDICES Appendix A: Gibbs Cycle (Gibbs, 1988) Description Action Plan Feelings Conclusion Evaluation Analysis Description Appendix B: Change Implementation (Pronovost, Berenholtz, Dorman, Lipsett, Simmonds & Haraden, 2003) Inform Staff about Changes Training of Staffs Distribution of Tools and Incorporation of Key Principles into Practice Assessment of Implementation Feedback form Staffs Refining the Process Read More