Essay Reflection on Nursing Philosophy

Essay Reflection on Nursing Philosophy I have now been a nurse for four years and three years since writing my initial nursing philosophy paper, in my very first nursing course at UTA. I initially wanted to become a nurse mostly to honor my mother’s legacy as a nurse and because I had a desire to take care of others. Today I feel my reasons for staying in the nursing field are the same, Essay Reflection on Nursing Philosophy

I still have the desire to care for others, especially the small ones of the world who are just beginning their journey in this world. When I had the incredible opportunity to work in the NICU my love and desire to be a nurse intensified.

In my four years as a nurse Before I started working in the NICU I was starting to have a challenging time with nursing and taking care of people who wouldn’t take care of themselves.

The change to NICU made me really realize my passion and I still feel this when I go to work every day Essay Reflection on Nursing Philosophy

Client Focused Study

This assignment will focus on the patient’s journey and the impact of the chronic illness in their lives. Firstly a rationale for the chosen client and the health deviation will be explained. Secondly, how the deviation has an impact on the patient’s journey throughout the health care will be highlighted and potential influences of on long term well being of the patient and their family will be explored. Finally, the knowledge gained from the assignment and how it can be helpful in the future practice will be addressed.

In accordance with the NMC Code of Professional conduct (2010), the patient chosen for this essay will be named Miss X, to protect her identity and maintain confidentiality. Informed consent will be attached as appendix I.

Miss X is a 58 year old patient who had been diagnosed 3 years ago with COPD related to Emphysema. She had been smoking for 40 years and gave up smoking 3 months after her initial diagnosis. She has currently been admitted care to specialised Respiratory ward in a local London hospital, following an exacerbation of COPD. Her current symptoms are chest pain and shortness of breath.

The rationale for choosing Miss X for this assignment is because during my placement in the respiratory ward, I found the patient having difficulties to perform physical activities due to the breathlessness. As a result, I developed an interest in learning how breathlessness occurs and its affect on the patient’s daily life. Further rationale of The Nice guidelines for COPD (2010) reported that COPD is the 5th biggest killer in the U.K. and also Worldwide. In addition, evidence reports that the main cause of developing COPD is due to smoking. The national statistics General Lifestyle Survey (2008) reported that at least 21% of the U.K’s population smoke which means COPD will remain to be endemic in this Country. The annual cost of COPD to the NHS is estimated at more than £980 million and the figures are rising every year. Beraden (2011) reported that incidence of breathlessness in patients’ with diagnosed COPD is approximately 65% and 90%. These statistics highlights that it is important to be aware of the health deviation of COPD such as breathlessness in order to ensure the patient receives a quality of life.

Evidently, the pathophyisology of breathlessness caused by emphysema is noted to be a physical development of airflow obstruction and impaired gas exchange. Blackler (2007) explains emphysema as a progressive chronic lung disease where the airways are inflamed and the tissue of the lungs and the alveoli are destroyed. The inflammation in the airway obstructs the flow of air in to the alveoli. In addition, the alveoli lose their elasticity and during breathing this loss can lead to the alveoli collapsing and causing breathlessness.

The main factor causing these characteristics of Emphysema is Smoking. Mc Cance, (2010) informs that smoking cigarette activates the neutrophils which subsequently release the enzymes protease and anti protease. As a result of the toxins from cigarette smoking, the chemical activity of the protease and anti protease is imbalanced. The author further explains that a balance is required in order to maintain normal lung function and the derangements of this balance may result in increased destruction and inappropriate repair of the lungs. Inappropriate repair of the lungs can lead to the alveoli being eliminated of the pulmonary capillary bed, causing mismatching in ventilation and perfusion. As a result there is less surface area for the gases to exchange causing decrease of the oxygen levels in the blood (Mc Cance, 2010). Thus any mild form of exercise can raise oxygen requirement leaving the patient breathless. This is evident in Miss X whenever she performs any type of physical activity.

In addition, Damjanov (2006) explains that the destruction in the alveoli and the bronchiole wall also contribute in the reduction of elastic recoil of the airway. This leads to difficulty in expiration as the loss of elastic recoil reduces the volume of air that can be expired . As the air is not effectively exhaled, air trapping occurs causing the chest to expand. Long term air trapping in the lungs causes the chest to have a barrel like appearance. This is because the lungs are over inflated with air and the ribcage mostly remains expanded which gives the chest its barrel shape (Damjanov, 2006). Barrel chest is very noticeable in Miss X.

People who smoke do not necessarily develop Emphysema therefore inherited genetics disorders are believed to contribute to the development of this disease. McCance, (2010) explains that emphysema mainly occurs with patients who have Alpha 1- antitrypsin deficiency (A1AD). In A1AD enzymes such as elastase destroys the elastin and the tissue of the airway which again leads to mismatching of perfusion of gas exchange and ventilation.

Furthermore, Pryor and Prasad (2009) describes the sensation of breathlessness originates when the sensory system activates within the lungs, chest wall and the respiratory muscles raise awareness of breathing discomfort. However, psychological factors can also be associated with breathlessness. It is regarded as a subjective experience in COPD anxiety act as an trigger when the patient sense discomfort in breathing. Some studies show the following sequence of events; aggravation by anxiety and panic attacks leads to breathlessness and so forth a continuous cycle is created (Robert and Stockley, 2007)

The patient’s journey starts when the patient says so or from diagnosis to the end of life. Three years ago before her diagnosis, Miss X went to see her GP when she started noticing breathlessness whilst performing physical activities. The GP diagnosed Miss X based on her clinical features and other tests; Chest Ct Scan, her Blood test and her spirometry reading which was FEV1/FVC < 0.7. Initially she was prescribed with Salbutamol MDI 100 mcg 2 puffs PRN to manage her mild COPD.

Ever since then she has been taking this medication to help her manage with her daily routines and a…………………….

Essay Reflection on Nursing Philosophy