Case Study of Asthma UK Nursing Essay; This essay writing as a case study referring to a patient from my practice area. As I will exist reflecting on my practice about the case study; use will stand made of first-person writing where appropriate. Hamill (1999) supports the use of first-person writing in academic essays; such as case studies and suggests it develops self-awareness, reflection, analysis, and critique.
Here is the article to explain, Asthma UK Case Study Nursing Essay!
As this essay exists focused on a specific patient from my practice area; it is important to consider issues of confidentiality. Therefore, neither my practice area nor the patient’s name will exist identified. However, to be able to discuss key issues about the patient; I will refer to their age, gender, and lifestyle, and use a false name to aid the flow of writing.
Introduction to Asthma;
Asthma affects 5.2 million people in the UK; 1.1 million children and 4.1 million adults according to Asthma UK in their 2004 report. However, depending on which report one reads, this number can almost double to 10.1 million. This wide variation of prevalence may exist explained by the different studies; and, reports used to gather the data, and the different inclusion criteria used. There is nevertheless agreement on the fact that the number of cases of asthma is increasing.
Asthma UK (2004) reports a 400,000 increase in the number of adults with asthma in the UK between 2001 and 2004. The rising patterns of asthma prevalence however exist not explained by current knowledge of causes of asthma; but, stand paralleled by increases in other allergic conditions such as eczema and rhinitis.
There is currently no agreed definition of the disease. Widely documented in the literature, however, is the National Heart, Lung and Blood Institute (1992) definition describes it as; “a chronic inflammatory disorder of the airways causing widespread but variable airflow obstruction…Obstruction is often reversible, either spontaneously or with treatment”. The severity of the condition varies significantly from mild intermittent asthma to a distressing disabling condition; which results in time off work or school, disturbed sleep, restriction of social and leisure activities, and anxiety. The main aim of asthma management is to control symptoms, minimize asthma exacerbations and optimize quality of life.
As a student of the Acute Care Pathway Degree, one of the specific learning outcomes for my pathway is to be able to manage programs of care for patients with chronic diseases. Hyland (1998) states that the Advanced Nurse Practitioner has become a major provider of asthma care in the UK. Watkins, Edwards, and Gastrell (2003) agree, and suggest that currently the management of long-term conditions, including asthma, is a core component of an Advanced Nurse Practitioner’s work.
Therefore I must have an understanding of this condition and be able to review patients effectively using evidence-based guidelines and have the confidence to provide advice on the management of their condition. I aim to improve my understanding and asthma management skills through critically reviewing key issues of patient care as a case study. The key issues I intend to focus on relating to a specific patient are:
- Treatment of Asthma in the Emergency Department
- Patient education
- Patient concordance
Initially, this essay will examine my current practice about asthma management through reflecting on my present level of knowledge and understanding, discussing the level of care I can provide for patients with asthma at the moment. I then intend to give a brief outline of the patient chosen for this study; explaining the reasons for that choice and the rationale behind the key issues highlighted for discussion. A critical review of the key issues will follow using up-to-date evidence-based literature and considering relevant policies. The conclusion will summarise the main points, reflect on what I have learned from; this module, and consider ongoing learning requirements about asthma management.
Reflection on current practice;
At the time of writing, I have so far completed 16 hours in practice; Therefore my first few days in practice existed spent adjusting to this new and very different area of nursing. Nevertheless, I have had the opportunity to observe my mentor assessing patients with asthma and recently have become more involved in the review of these patients, with supervision.
Before starting the course I did feel I had some understanding of the disease process of asthma from working in the Emergency Department, albeit very fundamental, and some basic knowledge of the management. Some of this understanding comes from personal experience but also through my previous experience working in dermatology. Often patients presenting with atopic eczema would also be asthmatic, there is a well-known link between these conditions. Some of the advice given in eczema management, for example, allergen avoidance, will also be relevant in asthma management.
Using Benner’s (1984) novice to the expert model I would classify myself at present as an advanced beginner. This is someone who has a marginally acceptable performance with some background experience but who still requires supervision. I feel this accurately describes my current ability in practice asthma management. With supervision, I can undertake an assessment using a template for guidance, check medication usage, check symptoms and carry out peak flow assessment.
However, I still find the array of inhalers confusing and don’t feel confident in interpreting the information gleaned during assessment into planned care within the time constraints of the clinic. When I have the time to reflect on the information and review the guidelines away from the patient I feel more confident. I need however to be able to make the transition from an advanced beginner to a competent practitioner, increasing my level of proficiency to no longer requiring supervision but being aware of my limitations. I feel with more experience in practice and by working through this case study I should be able to achieve this.
The rationale for the choice of the patient and key issues;
Rolfe, Freshwater, and Jasper (2001) suggest that choosing an event or incident to reflect upon or analyze is concerned with anything that happens to us that we want to write about for some reason. It is the significance of the experience within our daily lives which helps us choose one experience over another. Having decided to focus on asthma as the topic for my case study; when I looked back at the patients I had seen with asthma; it was the above episode of care that held the most significance for me.
The pharmacological management of asthma aims to control symptoms, prevent exacerbations and achieve the best possible lung function; while minimizing side effects and long-term sequelae. National clinical guidelines developed in 2003 by the British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) existed produced in collaboration with, amongst others, Asthma UK and the Royal College of Physicians of London, and have more recently existed updated in 2005. They exist widely accepted as the ‘Gold Standard’ of evidence-based asthma care for health care professionals working in the UK.
Patient education and concordance;
The issues of education and concordance will exist discussed together as they exist inextricably interlinked. It is difficult for the health professional to achieve concordance with the patient without providing education about their disease and its management. It exists estimated that one-quarter of asthma patients in the UK have a compliance rate of 30% or less. The term compliance in health care has become less fashionable recently due to it implying that a patient is perhaps ineffectual and hasn’t followed the health professionals’ instructions.
Whereas in reality, the reasons for non-compliance are complex and not necessarily the fault of the patient; for example, not existing shown how to use their inhaler device properly. Nevertheless, non-compliance exists thought to contribute to between 18% and 48% of asthma deaths. Concordance exists the term used to describe a negotiated agreement between health professionals and patients about the management of their condition. However, even when concordance seems to have existed achieved a patient still may not adhere to the agreed plan of care for many reasons.
Ensuring patients exist well informed about how their medication works have existed shown to improve adherence and control. They need to be aware of the risks of taking and of not taking their medication. The latter is of particular concern in asthma in that persistent inflammation of the airways may lead to irreversible obstruction. Written personalized asthma action plans have been shown to improve outcomes of care. They reinforce verbal education and set out for patients what to do if their symptoms worsen.
Asthma is a frequently seen chronic condition in the Emergency Department; and one that Advanced Nurse Practitioners are expected to be involved in the management of. Therefore as an Acute Care Pathway Degree Student, I need to develop my knowledge; and skills in this condition to enable me to provide a high standard of evidence-based care for patients. Throughout this essay, I have endeavored to demonstrate my understanding of asthma, especially about the pharmacological management and issues of education and concordance.
These issues have been discussed and have shown to be interrelated; without achieving concordance, adherence to prescribed medication cannot be achieved and without patient education, concordance cannot be realized. Although I have been unable to discuss all aspects of asthma management due to word limit constraints; my understanding of asthma medications and the use of the stepwise; guidelines have increased significantly to the point where I now feel more confident in practice.
More recently when seeing patients with asthma I have been able to visualize; which ‘step’ they are on which has helped me to decide whether they are on the correct medication about the severity of their disease. Reviewing the issues of concordance and education has made me realize how important these aspects of management are; however the time needed to address these issues in practice often doesn’t correlate to the time allowed for appointments.
To enable me to become a competent practitioner in asthma management I need to consolidate the increased knowledge I have gained from writing this essay with more experience in practice. I need to increase my knowledge in areas not discussed in this essay, such as non-pharmacological management through self-directed study, and perhaps consider further education through an accredited asthma diploma course, on completion of my degree course.