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Personal Narrative Chemotherapy in Cancer Practice: Neutropenic Sepsis (Case Study Sample)

Instructions:

Service Type: Essay / Reports / Papers
Academic Level: Undergraduate
Subject Area: Health Sciences / Nursing
Deadline: 8/05/2016 - 12:05:00
Subject Title: Nursing case study
Word Count: 3000 Words 
Additional Details: see attached document
Referencing Type: Harvard Referencing
1. ASSESSMENT OF THE MODULE
Theoretical Assessment: 3,000 word assignment. This assignment consists of two elements:
I. Gaining permission and obtaining a patient narrative whilst on a twelve week host trust placement.
II. Constructing and annotating the narrative using psychological and sociological theories.
Both elements are important. In order to write an assignment there is requisite to have acquired a patient story and can demonstrate an understanding of how health and illness has impacted on their lives. 
Formative Assessment: Student will be asked to write up to a 1,000 words of the patient story without any annotation. The students will share their stories in groups and discuss the theories from the module that best explores the narrative. This formative piece of work will take place in week four of the module.
Summative Assessment: 
The assessment method will involve the student in interviewing a patient / client / carer with consent and then writing a patient narrative that explores the patient journey. The narrative will be annotated using the theories espoused in the module to explicate the patient’s circumstances and their perspective of their condition.
1. What is a narrative
Basically a patient narrative is the retelling of a story of events that have lead them to where they are now. While a story is just a sequence of events, a narrative recounts those events, whilst emphasising some aspects of the account and leaving out others is they are irrelevant or unimportant. 
Visit: http://www.eng.niu.edu/wac/narr_how.html for more information on what a narrative is.
2. Why is patient / client narratives important
Patient /client narratives are important because it introduces the patient’s perspective into our understanding illness. It allows us to adopt a more patient / client approach to the delivery of health care. Conversely it helps us in the recognition that other individuals have perspectives and values which differ from our own. Example: A family’s story of their thoughts, feelings and fears bound up in their 10 year old daughter having type 1 diabetes may elicit an understanding that it is not just about the condition. It is how it represents an entire way of living in which their lives are consumed by choices, risks and restrictions that diabetes has imposed upon the family.
Visit: http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1800.2007.00331.x/abstract
http://www.survivor-research.com/index.php/component/content/article/24-highlights/82-black-women-recovery-and-resilience
To find out why narrative are important to nursing care
3. How to write a narrative
The basis for this assignment begins with the selection of a patient, carer, client or parent who is willing to tell you their story. You will need to seek consent and show in the assignment that the person’s / child’s anonymity has been respected. 
It might be daunting task to ask a specific person or family to tell you their story but discuss this with your mentor on placement who may be able to advise the best patient / child / client/ family to approach.
Visit: http://www.sciencedirect.com/science/article/pii/S1361311104000731#sec1
This web site will give you ideas on how you might elicit a patient/ client / parent / child’s narrative.
4. Interpretation of the narrative.
How you interpret the narrative will be the subject area explored in the Social Sciences for Nursing module however preparatory reading is given below.
Visit: http://onlinelibrary.wiley.com/doi/10.1111/1467-9566.00252/pdfOn how to interpret a patient narrative.
Submission Date for electronic submission:
Prior to submission the course team will be able to read 500 words or a draft proposal of your assignment. Please note that feedback on drafts will only be given if the drafts are received before the 08.05 2014. 
Submission Route: 
• All assignments will be submitted electronically in a drop box on Moodle. 
• All assignments must have been through Turnitin.
• The assignment submitted through Moodle is the only assignment that will be marked.
• The submitted assignment in Moodle must have a front page in the house style. An example is below.
• The submitted assignment must have a footer which includes page numbers and student number. 
• The Module Co-ordinator will set up the site to open two weeks before the hand in date and the site will close at midnight on the submission date. 
• Please ensure that your completed assignment is available before midnight of the submission date. The site will close at midnight and no further submissions will be accepted.
• Students who have special dispensation to submit after the published submission date will be able to access an alternative site. This site will open on the 0900 the day after the published submission date and close midnight two weeks after the published submission date. This service is available for first attempts only.
• Subsequent attempts are not bound by a two week extension.
• Please be mindful that if you are planning to submit your assignment close to the midnight deadline that this will be a busy period and might result in missing the deadline. 
House style front page
Module Title: Social Sciences and Nursing
Module reference Number: HAP_4_004
Module Leader: Lesley Bedford
Student Number: 2534567
Assignment Title: Patient Narrative
Field: Children’s Nursing
Cohort: September 2013
Word Count: 2897
External Examiner: Frances David Marshall
Email: 

source..
Content:

Personal Narrative: Chemotherapy in Cancer Practice: Neutropenic Sepsis
Name of Student
Institutional Affiliation
Instructor
Course
Institution, State
Date of Submission
Formative Assessment
Our societies have several people who suffer from various types of diseases and conditions. However, very few of them open up about it for fear of embarrassment. These diseases and conditions are acquired through different ways. As such, the impacts that they have on the patients also differ. Most of such patients prefer keeping their conditions a personal and private affair that they never discuss with anyone outside their family. On some rare cases, some respond to requests to share on their disease or condition. In most cases, they do so especially when there is a promise of medical assistance to follow their story. A similar case happened in the case of collecting data for this report. The patient was also assured that his identity would be protected as it would be kept anonymous throughout the compilation and presentation of this report.
The primary aim of this narrative was to identify a patient and interview them on their disease or condition. I was also required to collect data from the interview and compile it so that I would present it later. It was also necessary to ensure that the data collected could be used to help in improving patients of a similar disease or condition in the future. As such, I came across one patient who had acquired Nutropenic sepsis as a result of cancer treatment through chemotherapy. As such, she had been receiving home healthcare from her relatives who appealed for medical assistance.
I visited her home on a chilly Tuesday morning. I found that she had been left in the care of her granddaughter. Unfortunate, there was no other adult family member to authorize my interview with the patient. I did this because I knew it was illegal to interview her in the absence of the carer. As such, I left to return later.
In the evening, I found that the carer had returned from work. I introduced myself as a student and used my school identification card for proof. I also stated my purpose of the visit and why I wanted to interview the patient. After a few minutes, I was given the green light to continue with my interview. The carer offered to participate and help the patient respond to some of the questions.
The first thing I wanted was to know what the patient was suffering from. She explained that Neutropenic sepsis is a complicated type of anticancer treatment that is potentially fatal. The carer also added that doctors had informed them that mortality rates of chemotherapy ranged between 2% and 21% of the adult patients. However, the mortality and morbidity rates have been significantly reduced by the use of intravenous antibiotic therapy. That has reduced the need for intensive care management of the patients to around 5% in the case of England.
The only worry that patient had faced in the process of chemotherapy was that the bone marrow could be suppressed by the therapies used to treat cancer so that it responded to the infection. As such, it occurred as one life-threatening ordeal for the patient. However, from my knowledge in class, medical practitioners and researchers have proven that this case is common in the case of chemotherapy, although such suppression can still be caused by systematic radiotherapy. As such, I shared this information with the patient and carer and gave them hope that there was still a chance of survival for the patient.
The patient also explained that she had frequent cases of fever and potential sepsis because she was an outpatient. There is also need to explain to the patients who receive chemotherapy that there are several associated dangers that could rise after the therapy has been administered to them. The most common that each patient needs to be educated on is the risk of suffering from neutropenic sepsis. As such, they also need to be taught the symptoms and warning signs that they should watch out. There is also need to evaluate ways of improving the outcomes of chemotherapy. That can be done by establishing recommendations that are evidence-based on how the life-threatening condition of cancer treatment can be prevented, identified, and managed.
As the interview progressed, I inquired to know how the patient had acquired the condition. The carer explained that it all started as a case of cancer treatment using chemotherapy. The body of the patient had been forced to produce White Blood Cells at a rapid rate because they were replenished at a fast rate during chemotherapy. That forced the bone marrow to produce more of the WBCs to replace their level in the blood. Medical research studies have shown that the ability of the bone marrow to regenerate WBCs is affected by chemotherapy. That leads to a drop in the levels of neutrophil, causing a condition known as neutropenia.
It was also worth asking the signs and symptoms that the patient had developed that suggested that she could have been suffering from neutropenic sepsis. She explained that the initial symptoms of the condition had not been recognizable because they were mild. Some of these symptoms that she faced included malaise, fatigue, fever, sweats, urinary complications, and chills. She also complained that the condition had increased her chances of suffering other infections and fever. She was taking medicine to reduce fever at the time I carried out the interview.
I also learnt the challenges, effects, and ways of managing the condition. The carer explained that the condition had cost the family financially. The patient required special medication and diet to keep healthy. It had caused her trauma and depression because of losing her job and having to live with a fatal condition. She had also been put under special medical care as required by NICE guidelines. This management care was prescribed by qualified medical personnel.
Summative Assessment
This section presents a narrative on the journey of the patient. It was compiled using the data that was obtained from the interview. It was critical to understand fundamental knowledge before engaging in the review and analysis of the data obtained from the interview.
The National Confidential Enquiry conducted an investigation into the Patient Outcome and Death (Holmes, 2015, p. 207). The results were used by the National Chemotherapy Advisory Group to compile a report on the challenges that adult patients face in managing neutropenic sepsis when receiving chemotherapy at the same time (Holmes, 2015, p. 207). One of the primary problems associated with the condition is that it leads to unavoidable, untimely deaths of the patients. The report also revealed that there are no proper systems to conduct urgent assessment of the condition. Further still, most organizations lacked proper policies to deal with neutropenic sepsis (Holmes, 2015, p. 207). As such, this narrative also presents a summary of the recommendations and guidelines that have been issued by National Institute for Health and Clinical Excellence (NICE) on how to identify, prevent, and manage neutropenic sepsis in cancer patients undergoing chemotherapy (Kelly, Morgan, Ellis, Younger, Huntley, and Swann, 2010, p. 1056). The guidelines are the most recent and apply to all patients regardless of their age.
How Chemotherapy Causes Neutropenia
One of the lessons from the interview was how the patient had contracted neutropenia. White Blood Cells are constantly replenished because they survive for only three or four days in the blood circulation (De Naurois, Novitzky-Basso, Gill, Marti, Cullen, Roila, and ESMO Guidelines Working Group, 2010, p. 256). That bone marrow is thus forced to produce more of them to replace their level in the blood. The ability of the bone marrow to regenerate WBCs is affected by chemotherapy. That leads to a drop in the levels of neutrophil, causing a condition known as neutropenia (Freifeld, Bow, Sepkowitz, Boeckh, Ito, Mullen, Raad, Rolston, Young, and Wingard, 2011, p. 93). Neutropenia is a condition that is normally silent, but it is the most common condition that patients develop as a result of undergoing chemotherapy. The initial symptoms may not be recognizable because they are usually mild. They include malaise, fatigue, fever, sweats, urinary complications, and chills. Chemotherapy-Induced Neutropenia increases the patient’s chances of suffering other infections and fever (Aapro, Bohlius, Cameron, Dal Lago, Donnelly, Kearney, Lyman, Pettengell, Tjan-Heijnen, Walewski, and Weber, 2011, p. 31). These are the symptoms that the patient had been experiencing before she was di
Implications of Neutropenia to the Patient
There were several implications that the condition had on the patient. I noted that Chemotherapy-Induced Neutropenia had led to a condition that is known as febrile neutropenia (Bow, 2011, p. 545). Febrile neutropenia requires the patient to be hospitalized so that the condition may be evaluated and antibiotics such as broad-spectrum are administered if there is a need. The resulting conditions may be severe and sometimes lead to death. Individuals who have neutropenia also have to delay undergoing chemotherapy (Bow, 2011, p. 545). The clinical outcomes of chemotherapy may even be compromised if the treatment is not reduced. In such situations, medical practitioners can use the so-called Prophylactic Granulocyte-Colony Stimulating Factors (G-CSFs) to ensure that the dose of chemotherapy is maintained and that the severity and duration of neutropenia are reduced significantly (Lambertini, Del Mastro, Bellodi, and Pronzato, 2014, p. 118). These implications were evident on the patient. The patient was on a prescribed Prophylactic Granulocyte-Colony Stimulating Factors (G-CSFs) to manage the condition.
Identification/Recognition of Neutropenia
The interview revealed...
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