Importance Of Early Diagnosis And Treatment Nursing Essay
The purpose of this chapter is to acquaint the reader with the subject of this study and define the extent of the established knowledge . This chapter will be used to identify any possible gaps in the established literature and hence justify the need for this research. Since this is an IPA study, the literature review will not be used to develop any hypothesis to be tested. In turn, as suggested by Smith, Flowers, & Larkin(2009), as the researcher in conducting an IPA study, I need to suspend the data collected in this chapter, during the processes of data collection and analysis.
This study is relatively important to research, because a holistic picture of the lived experience of Gozitan nurses working with meningitis patients, has never been considered. Research is more commonly found on the treatment used and on the parents’ lived experience. Local research is lacking in this regards, one local study conducted by Carla Borg in 2012 sought to elicit the lived experience of hospice nurses and another study by Rebecca Cassar in 2011 aimed to elicit the lived experience of nurses working in the intensive therapy unit ( ITU). Although the latter study is relevant to the current researh project, it is important to note that meningitis patients, require special attention and revolves around different wards in the hospital. It is also important to note that my participants work at the Gozo General Hospital, which caters for a smaller population. An existential phenomenological perspective underpins the presentation of the literature.
Even though research about the experiences of the survivors and the parents of survivors of meningitis is highly researched, there seems to be no research accounting for the lived experiences of professionals, taking care of such patients. This lack of research in this regard, leads me to research about lived experiences of nurses in treating cases similar to meningitis, that is, critical illnesses which mostly affect children, therefore research presented in this chapter will regard nurses working in an intensive care setting and the paediatric setting.
In order to make up for the lack of research in this area, I will first give a brief backround on Meningitis and the general treatment offered to patients suffering from meningitis, and undermine the main difficulties of such treatment. Then I will present the different issues related to the work of nurses working in intensive care and paediatric wards where meningitis or similar situations are present.
Backround on Meningitis
In this chapter, I will present a brief report of what is Meningitis, and what are the main presentations of this disease. This will help in understanding the decision taking involved in the nurse’s work while taking care of these patients. A brief account of the treatment generally used will be given and the situation in Malta, will also be looked upon.
Meningitis is caused by an inflammation of the membrane surrounding the brain and the spinal cord, called the meninges. It can be caused either by a virus or a bacteria. According to Payling(1994), in cases of viral meningitis, the patient can make a full recovery and sometimes the patient himself may not even be aware of having contracted this disease. On the other hand, Paete(1999), states that "Cases of bacterial meningitis are few and if treated effectively and with urgency can result in full recovery; however, any delay may result in fatal sequelae". This is generally because the symptoms of bacterial meningitis develop rapidly, in a few hours and are usually similar to those of the flu, like vomiting, severe headache, drowziness, fever, dislike of bright light and neck stiffness. Even though these symptoms are confirmed as ‘red flags’ by Haj-Hassan, Thompson, Mayon-White, et al (2011), according to Meningitis (2002), the usual symptoms of bacterial meningitis do not have any order in their manifestation and some of the symptoms may not appear at all. The only clear manifestation of bacterial meningitis, is a rash, which starts as tiny spots but may grow into dark red blotches. One of the most common complications of bacterial meningitis is Meningococcal septicaemia, when the amount of bacteria in the blood multiply uncontrollably causing blood poisoning. This condition can lead to organ dysfunction and further complications which in some cases, may lead to amputations and the loss of a particular organ or death. It is also suggested that people in contact with such patients, also take antibiotics as prevention because meningitis is contagious (BMJgroup, 2012). This implies that professionals in contact with these patients, like nurses also have to take such medication and are at risk of getting infected.
Importance of early diagnosis and treatment
According to the Maltese Paediatric Association (2009), the sooner, the treatment starts, the better the outcomes, with a lot of patients having a full recovery. In Riordan, Thomson, Sills and Hart (1996), they state that the most commonest delays present in the cases of meningitis patients who die are the failure of a correct diagnosis or the failure to recognise that the child is seriously ill. These delays are suggested as the main antagonists which "decrease the chances of survival" of these patients. This is also confirmed by Tacon and Flower (2012), which suggest that the "high index of clinical suspicion is essential". The clinical assessment and the speed of the laboratory investigations were seen as critical in early diagnosis leading to a better chance for recovery. In accordance to this, Tunkel, A., Hartman, B., Kaplan, S., Kaufman, B., Roos, K., Scheld, M., et al. (2004) state that delay in the initiation of the therapy following a CT scan, increases the chance for morbidity and mortality. According to Hodgetts, Brett and Catle (1998), a delay in the diagnosis of meningococcal septicaemia, greatly increases the chances of mortality especially as the management of these cases is "complex and time critical". This research concluded that early treatment by the practitioners may improve the outcome. The nurse’s desire to achieve the best outcome for such patients is seen as limited by their high anxiety levels, their knowledge of the speed of the progression and severityof this disease and the need for time-constricted treatment of the patients (Haines, 2010).
According to WebMD (2010), the treatment given to these patients differs according to the infection present, its complications and the age of the patient. In treating bacterial meningitis, tha patient is given antibiotics to counterattack the infection caused by the bacteria. This is the main treatment given but other medication may be necessary due to sivilar complications which may be present. In cases where the situation is severe, patients are usually transferred to the intensive care unit, where they are monitored closely for further complications.
Stressors present while nursing meningitis
The lived experience of nurses while working with these difficult patients involves an abundance of stressors and emotional challenges. These difficulties faced by nurses working in the intensive care unit and paediatric intensive care is widely studied and is well established in the literature. According to a study conducted by Bratt, Broome, Kelber & Lostocco (2000), showed how job stress resulting from meeting the needs of critically ill children may diminish job satisfaction and incress stress in the workplace. Another study by Fernquist(1999) identified uncooperating coworkers, highly demanding patients and their relatives, a high level of work overload, inadequete staffing and the feeling of being undervalued as the main stressors in the nurse’s job. Nevertheless, Ernst, Messmer, Franco, & Gonzalez, (2004) shows how job stress in inversely but still significantly correlated to age and number of years as a nurse. In this study it was shown that nurses with more experience showed higher levels of confidence, therefore leading to lower levels of stress on the job. Despite this, Cassar (2011) states that even after having gained years of work experience, her participants still identified intensive care as challenging and unpredictable. In this section I will discuss the different stressors nurses face on their job. I will try and focus on stressors that could be present while treating meningitis patients.
Relationship with patient
Due to the amount of time spent by the nurses treating the patients, "nurses are endowed with information that, when shared between all the stakeholders, becomes a powerful tool in the healing process" (Hakesley-Brown & Malone, 2007). According to the same study, this management of information crosses traditional boundaries, redifining the boundary processes. According to Hofa (2005), even though the nurse-patient relationship is seen as important, while going through a stressful situation or experiencing burnout, participants in her study felt that they did not have the power to meet with the patient’s needs and therefore felt the need to take a break from work. In a study carried out by Bergbom-Engberg & Haljamăe (1993), nurses working in the Intensive Care Unit, disclosed that, failure to understand a ventilated patient, evoked feelings of stress, incompetence and despair. The same study suggests that nurses with limited ICU experience, are more frustrated than the other experienced nurses by the initial contact with a ventilated patient.
Close relationships between the nursing professional and the patient might evoke stress, especially for nurses who feel unsupported in building close nurse-patient relationships (Reed, 1992). Nurse-patient relationship often constitute over-involvement , leading to conflict and a higher level of difficulty for the nurse during her job (May, as cited in Stavropoulou et al, 2012, p.483). The over-involvement or under-involvement in a nurse-patient relationship may obstruct helpful interactions (Milgrom,2002).
Relationships with the patient’s family
Nurses build-up close relationships with the patient’s families and these can also be a high source of stress (Froggatt, 1998; Hardicre,2003; Bratt, Broome, Kelber & Lostocco,2000). According to Rubarth (2003) even though the nurse-parents relationship, often grows out of stresful situations, parents are not seen as able to "take in" any information the nurse provides. Caring for the relatives of patients who are critically ill is an essential component of the critical care nurse's role and is also considered a professional obligation (Hardicre, 2003). This in turn may "be a source of considerable stress" (Hardicre,2003). Nurses in the same study disclosed that, they felt ill-prepared to fulfil this role especially as the specialty also requires nurses to have 'people' skills to support their patients' families which might not be included as part of the original training. This was also confirmed in the study conducted by Bratt, Broome, Kelber & Lostocco, (2000) which comments on how dealing with patients' families was the most frequently cited job stressor in the same study. Dealing with the patient’s families in critical situations may be seen as a hindering situation for the nursing professionals and their presence in such situations may not be supported (Agard, Maindal, 2009). This is also confirmed by Stayt (2007) who reports that nurses interacting with families of patients in intensive care units are immersed in personal comflicts between "role expectations and patient care and between professional ideals and being a human" which at the end might cause occupational stress. At the end, getting immersed in the emotional task of facing the feelings of the family is a hard task for the nurse (Molander & Parvianen, as cited in Blomberg & Sahlberg-Blom, 2007).
Compassion fatigue and burnout
As a result of the continous patient-professional relationship in the nursing profession, a phenomenon called compassion fatigue or secondary traumatic stress has emerged. Compassion fatigue is seen as a natural occurence of caring for patients who are in pain, suffering or traumatized (Sabo,2006). Coetzee & Klopper (2010), state that compassion fatigue is experienced through a progression from compassion discomfort to compassion stress ending up in compassion fatigue. Their study has also concluded that if this progression is not stopped in its early stages, compassion fatigue can permanently shift the nursing professional’s ability to feel compassionate.
Compassion fatigue is seen as a common, possible outcome of routinely caring for children in a critical situation (Rourke, 2007). This has been seen as a result of continuos exposure at the place of work to traumatic aspects of child illness, injury, and medical treatment upon care providers working with children on a daily basis. In a study conducted by Robins, Meltzer, & Zelikovsky (2009), it came out that a significant percentage of nurses working in these settings are moderately to extremely high risk for compassion fatigue(39%) and burnout(21%). It was also evident that the greater the amount of years working in direct care and the "greater blurring of caregiving boundaries" were foreboding features of compassion fatigue and burnout. Burnout can be also caused when nurses working in intesive care perceive the treatment as inappropriate(Meltzer & Huckabay, as cited in Piers RD, Azoulay E, Ricou B, et al.,2011) due to personal beliefs or professional knowledge (Schwenzer KJ, Wang L, 2006), delivery of futile care, unsuccessful patient advocacy, and communication of unrealistic prospects to the patients and families (Mobley et al.,2007; Hamric &Blackhall, 2007; Corley et al., 2005; Corley et al.,2001; Gutierrez, 2005). This might also lead nurses in experiencing a "troubled conscience" in these situations (Glasberg, Eriksson, and Norberg, 2007).
After having read and analysed the literature, I would describe the lived experience of nurses working with meningitis patients as a difficult experience, filled with challenges. Even thoguh nurses working with such patients are used to work in difficult conditions, the number of challenges that their environment presents, still puts a lot of pressure on the nurses themselves. Following is the methodology chapter, which will present detailed information on how data was collected and analyed for this study.