Evidence-Based Nursing Practice Report: Patient Care Analysis CNA254

This report reflects on a nursing placement in a palliative unit, focusing on the care of an 81-year-old patient with breast cancer, diabetes, depression, GORD, and TIA, who is bed bound and at risk of pressure ulcers. The report analyzes the importance of pressure area care, patient assessment, ...Read More

Running head: EVIDENCE BASED NURSING PRACTICE
EVIDENCE BASED NURSING PRACTICE
Name of the Student
Name of the University
Author Note

1EVIDENCE BASED NURSING PRACTICE
Introduction
I am a nurse in the palliative unit for four weeks placement and responsible for the care
of a patient with breast cancer. The patient is an 81 year old lady and admitted in the unit for
three weeks. At the times of encounter I have seen that she is not mobilizing very much and
basically bed bound. She nodded her head for answering the question asked and do not talk much
and also denies about any pain. Her medical history was comprised of diabetes mellitus type 2,
depression, gastro-oesophageal reflux disease (GORD) and also the transient ischemic attack
(TIA). She was always not fond of very much movement thus she has a history of immobilized
condition. On the other hand when she was provided with air mattress in terms of addressing
pressure area care as she has risk of developing pressure injury or pressure ulcer and she denied
to use that and stated that sleeping on air mattress is not comfortable. On the basis of this case
and the pressure area care concepts the reflection would be discussed in the following section
and also what was absent in the care process also would be discussed as well.
Reflection
In case of pressure area care the need of the assessment of the condition of the patient is a
crucial factor. In order to provide pressure area care the nurse should be able to confirm the pain
and the level of the pain of the patient first. On the basis of the assessment the nurse can be able
to plan the care process. Here, as a nurse I needed to be able to converse with the patient and
needed to convince her about using the air mattress to take the precaution of the pressure in jury
care. However, the patient denied about feeling any pain but I need to take action with the
doctor’s consent in order to address the factor of her pressure injury care. The pressure area or
the pressure ulcer can be formed due to the tissue rupture or the imbalanced blood flow to the

2EVIDENCE BASED NURSING PRACTICE
tissues and formation of the pain in those areas. This can lead to different physiological issues
(Dumville et al. 2015). The factor of the pressure area care needed to be considering of the
patient’s condition and the factors influencing her physical conditions. The pressure area care in
this case needed to be considering the factors of the physiological actions that can be observed.
The patient here does not want to use the air mattress as she faces difficulties sleeping on the air
mattress. Hence, the convincing needed to be done on the basis of prioritizing the health needs of
the patients and addressing the risk of the pressure ulcers as she was not very much motile and
tends to be bed bound for a long time. Here, convincing process would be done with the help of
the doctor and if it would not work then family members of the patient should be working on the
convincing. These approaches can be helpful in reducing the risk of the pressure ulcer
development of the patient as she is bed bound for a long time. Air mattress usage can be stated
as the bed shore prevention process which is the primary concern here. The pressure area care
should focus on the pain management and observing the patient in an acute way (Boyko,
Longaker and Yang 2018). From this situation I can be able to determine the needs of a patient
and also develop the idea of the pressure area care in the context of this type of critical
conditions. The pressure area care of the patient should also consider the factors of the past
medical conditions of the patient that highlights the diabetic condition of the patient along with
the depression, GORD and the TIA. All these factors should be able to develop the pressure
ulcers in the body of the patient as the patient is not mobilized at all and do not cooperating with
the nurses. Here the pressure area care of the patient should be properly done by means of the
assessment of the past medical condition of the patient and the present condition as well that is
the breast cancer she is experiencing. The person is ignorant about pain and always answered
with a negative response to the question about pain (Castro et al. 2016). The nurses tried to

3EVIDENCE BASED NURSING PRACTICE
communicate with the patient and I also tried however, the lesser responses from the patient
made us unable to help her. Although we needed to approach with the holistic policies in order to
engage and empower the patient for the better treatment and attention to the patient. The new
modification in the pressure area care providence the older patient should be helped to tilt in 30
degree angle from her head and after some time the patient should be rotated in 30 degree angle
again and supported by pillow in the back. This process would be done in regular basis in order
to prevent pressure ulcers (Tazkarji et al. 2016). The process can be stated as the lateral
positioning and it would be done in two hours intervals (Bhattacharya and Mishra 2015). I was
lacking the approach of the patient centered care on the basis of the NMBA nursing standards
and should be able to assess the needs of the patient and communicate with her for the needs of
the patient (Nursingmidwiferyboard.gov.au, 2019). However, in order to develop knowledge
from this situation I need to consider the CRC model of nursing and reflect on the situation. The
experience should be assessed based on the evidence based nursing practice and on the basis of
the evidences and the diagnosis the pressure area care should be used to addressed for the
prevention of the pain of the patient. However, the communication skills are the primary need
from the nurses in order to address the nursing standards and the patient centered nursing
practice. In the response of this condition I needed to try to build up the professional relationship
with the patient and let the patient to open up about herself and the feelings of the patient. The
reflection process of the CRC model helped me into the knowledge development about the
factors of the pressure area care and also the factor of the needs of the communication in the
nursing profession (Dalton, Gee and Levett-Jones 2015). The communication skills and the
holistic aspect of the nursing care are factor which were absent in terms of the elderly and the
pressure area care for the patient. The changes should be adapted and the knowledge should be

4EVIDENCE BASED NURSING PRACTICE
applied in the future encounters of the similar kind of cases. The patient on the other hand should
also cooperate with the nurses. Here, although the factor of use of doctor’s help in the knowledge
development about the pain of the patient would be a factor that needed to be used as an alternate
aspect. However, the factors should be helpful in the knowledge about the pain of the patient. On
the basis of that knowledge the pressure area care should be performed. The pressure area care is
the factor that considers the factor of the pain management of the patient and also medication of
the patient on the basis of the past medical conditions and the present condition as well. The
pressure area care also needed to consider the nursing ethics and the conducts as well. The nurse
should be able to develop the treatment planning on the basis of the factor of the good for the
patient. I have gained the knowledge about all these factors of the care planning (Ehrenberg et al.
2016).
Conclusion
Based on the above discussion it can be stated that the pressure area care is an important
factor in the elderly treatment and also in case of the immobilized patients. By means of the
reflection process we can be able to develop the idea about the process of the pressure area care
the conditions that should be considered in case of the pressure area care. The communication
skills and the holistic approach of care should be utilized in case of the pressure area care
providence to the elderly patients and also the assessment of the patients. The past medical
condition along with the present condition should also be assessed in terms of the pressure area
care providence. The medication process and the process of the mobilization of the patient
should be considered in case of the pressure area care providence. Other than these the
convincing process should be done with the help of the doctor and the family members in order

5EVIDENCE BASED NURSING PRACTICE
make her use the air mattress which would help in the prevention of bed shore or pressure ulcer
issue of the patient.

6EVIDENCE BASED NURSING PRACTICE
References
Bhattacharya, S. and Mishra, R.K., 2015. Pressure ulcers: current understanding and newer
modalities of treatment. Indian journal of plastic surgery: official publication of the Association
of Plastic Surgeons of India, 48(1), p.4.
Boyko, T.V., Longaker, M.T. and Yang, G.P., 2018. Review of the current management of
pressure ulcers. Advances in wound care, 7(2), pp.57-67.
Castro, E.M., Van Regenmortel, T., Vanhaecht, K., Sermeus, W. and Van Hecke, A., 2016.
Patient empowerment, patient participation and patient-centeredness in hospital care: a concept
analysis based on a literature review. Patient education and counseling, 99(12), pp.1923-1939.
Dalton, L., Gee, T. and Levett-Jones, T., 2015. Using clinical reasoning and simulation-based
education to'flip'the Enrolled Nurse curriculum. Australian Journal of Advanced Nursing, The,
33(2), p.29.
Dumville, J.C., Webster, J., Evans, D. and Land, L., 2015. Negative pressure wound therapy for
treating pressure ulcers. Cochrane Database of Systematic Reviews, (5).
Ehrenberg, A., Gustavsson, P., Wallin, L., Boström, A.M. and Rudman, A., 2016. New Graduate
Nurses’ Developmental Trajectories for Capability Beliefs Concerning Core Competencies for
Healthcare Professionals: A National Cohort Study on Patient‐Centered Care, Teamwork, and
Evidence‐based Practice. Worldviews on Evidence
‐Based Nursing, 13(6), pp.454-462.
Nursingmidwiferyboard.gov.au (2019). Nursing and Midwifery Board of Australia - Professional
standards. [online] Nursingmidwiferyboard.gov.au. Available at:

7EVIDENCE BASED NURSING PRACTICE
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards.aspx [Accessed 5 Jun. 2019].
Tazkarji, B., Lam, R., Lee, S. and Meiyappan, S., 2016. Approach to preventive care in the
elderly. Canadian Family Physician, 62(9), pp.717-721.