Introduction: My Clinical Experience
The instances of brain tumors have increased in number over the past few decades, which is a serious reason for concern. An eight-year-old Teresa had to undergo a surgery due to the severe case of a third ventricular ependymoma, which is a very frequent condition, especially in children (The Childhood Brain Tumor Foundation, n. d.).
Unlike the treatment of a purely cortical anaplastic ependymoma (Rosenstengel, Baldauf, MĂĽller & Schroeder, 2012), the lumbar laminectomy has to be performed on the given specimen of tumors (Wang, Wang, Zhou, Zhan & Wan, 2013), which was exactly the case with Teresa. After the child had undergone surgery, it was crucial to monitor her, so that no further issues might possibly emerge and that the steps for further therapy could be defined.
First intervention: monitoring
One of the first and the most obvious things that need to be done in the case described above is conducting unceasing monitoring of the patient, especially her “recent memory, attention span, past memory, mood, affect, and behaviors” (NIC: Nursing intervention classification definition and activities, n. d., p. 42), as the NIC standards declare.
One might argue that for a patient, who has undergone the surgery of the type specified above, it is crucial to retain “level of consciousness” (NIC: Nursing intervention classification definition and activities, n. d., p. 42) and “level of orientation” (NIC: Nursing intervention classification definition and activities, n. d., p. 1).
However, it is worth keeping in mind that in the course of the therapy, patients “often report significant problems with reading, math and short-term memory” (American Brain Tumor Association, 2012, p. 11). Thus, it will be reasonable to expect from the patient to have difficulties restoring her memory and regaining spatial orientation.
Second intervention: using stimuli
According to what the NIC instructions (CNC, 2014a) on NEURO state, it is also important to control the patient’s responses to stimuli. As it has been stressed above, the patient is most likely to experience repeated vertigos, a temporary loss or deterioration of spatial orientation, and other side effects triggered by the surgery on the area known as posterior fossa, particularly on the cerebellum (American Brain Tumor Association, 2012, p. 4).
These side effects are supposed to wear out several weeks after the surgery was performed; however, to make sure that the patient’s motor functions are being restored, it will be required to carry out monitoring of the responses to stimuli, as the NIC NEURO section prescribes; in other words, it will be crucial to “monitor muscle tone, motor movement, gait, and proprioception” (NIC: Nursing intervention classification definition and activities, n. d., p. 42).
Third intervention: careful observations
It would be wrong to assume that the patient will get rid of headaches on the first day after the surgery was performed. The process of recovery will take very long, since not only do the bones of the skull must knit after the twist drill trepanation (Lumenta, Rocco, Haaze & Mooij, 2009, p. 87) but also the area, on which the surgery was performed, will have to recover.
Therefore, though headache monitoring is important, relying on the headache-related reports will not deliver accurate results concerning the patient’s recovery. Hence, the necessity to “monitor response to stimuli: verbal, tactile, and noxious” (Neurologic monitoring (NEURO), n. d., p. 42) appears.
Fourth intervention: responses to medication
The last, but definitely not the least, careful and very close monitoring of the patient’s response to medications, as NOC (CNC, 2014) suggests (NIC: Nursing intervention classification definition and activities, n. d., p. 42), must be conducted. Although some of the therapy elements, such as the physiotherapy during the postoperative state, are fully unavoidable, the patient may also have to take a range of additional medications, including the ones that prevent seizures, facilitate the antineoplastic therapy, etc. (Khaled & Shmidt, 2013).
Therefore, it is imperative to “monitor response to medications” (Neurologic monitoring (NEURO) NIC: Nursing intervention classification definition and activities, n. d., p. 42), as the authors of NOC put it.
NANDA Diagnosis for the Clinical Encounter
As the evidence provided above shows, my clinical encounter was very specific and required a very diligent and careful approach. It was crucial that the patient should be able to restore her mental, behavioral, and physical functions after the surgery; more importantly, it was essential that every probability of the patient developing ependymoma in the future should be driven to zero. Therefore, several objectives were pursued, and Teresa’s case was viewed from different perspectives.
While the NOC nomenclature allowed for defining the nature of the patient’s state and, thus provide the directions concerning the means to address her post-operational state rather precisely, the NANDA diagnosis method can be viewed as a rather general way to approach the situation.
For example, the NANDA diagnosis method does not allow locating the origin of the problem and, instead, provides a rather generic commentary on the problem (American Psychological Association, 2010), such as “delayed surgical recovery” (The complete list of NANDA nursing diagnosis for 2012-2014, with 16 new diagnoses, 2014, p. 6). Nevertheless, the NANDA classification is very helpful in terms of locating a general way of dealing with the problem.
In addition, the NANDA system helps split the issues of risk and concern in the domains, to which particular types of interventions are related to.
For example, the postsurgical concerns can be related to the Safety/Protection domain (The complete list of NANDA nursing diagnosis for 2012-2014, with 16 new diagnoses, 2014, p. 5), whereas the patient’s fears of a possible instance of recidivism, or the inability to regain the skills that the patient had prior to the surgery, etc. can be related to the Coping/Stress Tolerance domain (The complete list of NANDA nursing diagnosis for 2012-2014, with 16 new diagnoses, 2014, p. 5).
Thus, the methods for addressing the concerns specified above can be located immediately, and an efficient intervention becomes possible.
It should be noted that, applied to the given case, not only the postsurgical recovery, but also the stress overload, which the patient is likely to suffer from and which can be related to the Coping/Stress Tolerance domain, should be mentioned., Therefore, in Teresa’s case, it will also be required to provide the patient with psychological support and put a very strong emphasis on her integration into society.
To be more exact, it will be required to make sure that the girl should be able to be socially active not only after the postsurgical period but also in the course of her recovery. The given goal can be achieved with the help of new media. For example, Teresa’s participation in an activity in a social network can be used as an efficient tool.
Conclusion: NIC Implementation in My Nursing Setting
There is no need to stress the significance of NOC and NIC. Allowing locating the source of the problem, these classifications are crucial to any nursing processes (American Nurses Association, 2008). To start with, the introduction of NOC and NIC will help nurses classify the cases; as a result of a quick and efficient classification, the nature of the problem will be located fast (McGonigle & Mastrian, 2009). Therefore, nurses will be able to obtain instructions on the actions to be undertaken faster than they would without NOC and NIC.
The introduction of NIX and NOC certainly has its disadvantages as well. First and most obvious, it will be quite hard to spread awareness about the use of new tools among all members of the staff quickly. More to the point, it will take a considerable amount of time for the staff to learn to apply new rules to practice.
Finally, the people introducing the NOC and NIC principles may face resistance among conservative members of the staff, who will be unwilling to change their habitual actions and, therefore, will resist the NOC and NIC concepts.
Being admittedly “useful for clinical documentation, communication of care across settings” (CNC, 2014a, para. 1), it will require the introduction of new technology, which may also cause concerns of the financial department of the healthcare services. As a result, the head of the hospital may also reconsider the implementation of new principles because of the lack of funds. Alternatively, the healthcare services will have to search for investors.
Reference List
American Nurses Association (2008). Nursing informatics: Scope and standards of practice. Silver Spring, MD: American Nurses Association.
American Psychological Association (2010). Nursing informatics: Scope & standards. In American Nurses Association (ed.), Publication manual of the American Psychological Association (6th ed.) (7–9, 29–33). Washington DC: American Psychological Association.
CNC (2014). CNC – Overview: Nursing Outcomes Classification (NOC). Web.
CNC (2014a). CNC – Overview: Nursing Interventions Classification (NIC). Web.
Khaled, K. M. & Shmidt, M. H. (2013). Tanycytic ependymoma: A challenging histological diagnosis. Case Reports in Neurological Medicine, (170791), 1–5. Web.
Lumenta, C., Rocco, C. B., Haaze, J. & Mooij, J. J. A. (2009). Neurosurgery. New York, NY: Springer.
McGonigle, D., & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge (2nd ed.). Sudbury, MA: Jones and Bartlett.
NIC: Nursing intervention classification definition and activities. Web.
Rosenstengel, C., Baldauf, J., Müller, J.-U. & Schroeder, H. W. S. (2012). Sudden intraaqueductal dislocation of a third ventricle ependymoma causing acute decompensation of hydrocephalus. Journal of Neurosurgery, 116(5), pp. 154–157.
The Childhood Brain Tumor Foundation. Ependymomas. Web.
The complete list of NANDA nursing diagnosis for 2012-2014, with 16 new diagnoses (2014). Web.
Wang, M., Wang, H., Zhou, Y., Zhan, R., & Wan, S. (2013). Myxopapillary ependymoma in the third ventricle area and sacral canal: dropped or retrograde metastasis? Neurologia Medico Chirurgica (Tokyo), 53(4), 237–241.