Guideline for postoperative care
Case study
Biological discussion
Chantelle presents an inguinal hernia, which is an ailment characterised by internal or fatty tissue squeezing through the weaker spot of a connectivity tissue or muscle to cause fascia. There are different types of hernia depending on the cause and the area of occurrence, each with subsequent names and characteristics. According to Vacca (2017), inguinal hernia (IH), which is manifested in Chantelle, occurs when tissue like intestine protrudes through the weaker spot of the abdomen muscles (Yoong, Duffy and Marshall, 2013). The resultant effect of IH is a burning sensation of a bulge that occurs on either side of the pubic bone and painful feeling on the groin when bending or coughing. The symptom extents to pressure or heavy dragging on the groin and sometimes pain or swelling on the scrotum when the intestine descends in males (Berger, 2016). According to Robinson et al. (2006), this defect is caused by adnominal weakness in the abdominal wall due to muscle weakness or deterioration, strenuous physical activity, or strained bowel movement.
Research evidence suggests that, rather than reduction of risk factors in the prevention of IH, surgery the most prescribed mode of treatment. The surgery entails correction and repair of weakened tissues or muscles and restructures the protruding intestine (Berger, 2016). After the completion of the surgery, Chantelle will be left under the care of nurses who will monitor her healing process and report directly to the doctor. According to Malley et al. (2015), after surgery, the nurse monitors and addresses any sign of distress in the patient, which is likely to be caused by infection after surgery bleeding or shock. The nurses will need to assist her in dealing with after effect of surgery through counseling, provision of pain management procedures, and wound dressing. Nurses, at the same time, will need to ensure that the patient is comfortable and provide a guideline for postoperative care after discharge.
Psychological discussion
The pain and discomfort associated with IH before surgery and surgery associated pain can have a profound effect on the life of the patient resulting in depression and anxiety to Chantelle. Kurina et al. (2001) postulate that surgery associated pain and dependence result in an increased level of depression in the patient. In the case of Chantelle, the surgery procedure required her to undergo a pregnancy test, which she disclosed that she was sexually active a fact she was not willing to disclose to her parents. This requirement creates a pre-surgery depression which can be transmitted to after surgery. Research by Powell et al. (2012), depression before surgery can result in chronic depression after surgery. The after surgery depression is manifested in the form of difficulty in decision making, irritability, low mood, suicidal thoughts, and feeling of despair. These feelings and the manifestation of depression have been shown to result from a reaction to medication/ antibiotics, reaction to pain, reaction to anesthesia, and impact on the quality of life after recovery (Ghoneim and O’Hara, 2016).
Nurses spend considerable time with patients before and after surgery, and therefore they play a critical role in the management of pre and post-surgery depression management. The role of nurses in the management of depression in both before and after surgery varies from one patient to another. According to Westwood and Pinzon (2008), before surgery, the patient receives much instruction, which can exert pressure resulting in depression. Therefore there is needed for nurses to reiterate these instructions like in the pregnancy test in the incidence of Chantelle. The nurse needs to inform the patient of the importance of these instructions and answer all questions from the patient in order to create a connection that can play a profound effect on healing. Nurses, at the same time, need to identify and report any form of depression or signs of depression after surgery. For the identification to be effective nurses, need to provide comfort to the patient after surgery to create a psychological connection that hastens the process of healing.
Social problem
According to the case study, Chantelle perceives that the surgery will result in a scar on her body, which will affect how she looks. This is likely to make her look different from her peer and render her lonely. Loneliness, which is defined as the internal perception of inadequacy, plays a critical part in self-acceptance and the surgery healing process (Mullen et al., 2019). The level and severity of loneliness have been shown by different scientific studies to affect one’s physical and mental health. Tiwari, (2013) postulate that loneliness is not physically being an alone but mental illusion of lack of meaning to life; pathognomic of depression. After undergoing surgery to remove IH, Chantelle is likely to be rendered lonely due to the perceived physical indifference from her peers and lack of self-esteem. The pain from the surgery and prolonged recovery time can be the primary cause of loneliness and thus the need for nurses’ intervention (Rokach, 2017). To reduce the incidence and prevalence of loneliness in a post-surgery patient with IH, burdens need to implement different interventions. These interventions may include but not limited to physiotherapy, lifestyle counseling, among others. The role of the nurse can be directly or indirectly detection of loneliness and prevention of progression. The prevention measures can be the implementation of different intervention measures as those mentioned above (Murphy, 2006).
Ethical
Chantelle being under 16 years and sexually active, confidentiality is critical for the nurses in order to maintain trust and foster the success of the treatment. Nurses are legally obliged to provide high-quality care concerning patient rights and dignity without regard to the patient’s age, type of disease, and principles of the parents (Beltran-Aroca et al., 2016). In this case, Chantelle is Gillick competent, where she can be able to ethically give consent to the treatment and medical examination mainly if she can show the required maturity levels. She is needed to be in a position to show the required intelligence in understanding the nature of the treatment will bring about if administered. According to The United Nations Convention on the right of the children, article 3 gives care providers the right to protect the interest of the child. Gillick competence is the ability of Chantelle to be able to make the correct decision regarding the attainment of a given health goal in terms of management. In such a case, the nurse is obliged to protect her confidentiality and allow her to decide whether to go on with the surgery. According to the principles of beneficence and nonmaleficence, there is a need for the nurse to make a balance between the benefit of the surgery while avoiding causing harm to Chantelle. Keeping autonomy of Chantelle’s sexual activity and ensuring she undertakes the pregnancy test, which is a condition for the surgery can be difficult in aligning to her decision. Despite attaining Gillick’s competence, the principle of beneficence and nonmaleficence may force the nurse to decide on what is best for despite Chandelle’s desire (Jahn, 2011). This means that despite the nurse’s desire to protect Chantelle’s sexual activity, she might be forced to ensure she took the pregnancy test and undergo surgery. Although this can be unpleasant, uncomfortable, and painful for Chantelle, its repercussion will be less harmful to her later in life.
Legal
Chantelle revealed to the nurse she is sexually active; thus, there is a higher affinity when she can be pregnant, which poses a risk to her life during the surgical procedures. Her mother is against pregnancy test procedure, unaware of Chantelle’s sexual activities. This begs the question of confidentiality on the side of the nurse on whether to inform her parents or keep the information as a secret. The nurse needs to consider the legal provisions of different acts that need to be considered when handling this information and the right of the child-like Chantelle (Jackson and Lim, 2010). According to NMC (2018: 5.4), nurses should “share necessary information with other health and care professionals and agencies only when the interest of patient safety and public protection override the need for confidentiality.” Chantelle is suffering from a life-threatening condition that can affect her life later in life, and despite being sexually active, she is not willing to take a pregnancy test a requirement for the surgical procedure. In this case, she has to decide whether she is legally protected and authorised to reveal such sensitive information to Chantelle’s parents, who are likely to contravene such procedures (Blightman, Griffiths, and Danbury, 2014). She will also be likely to measure the impact of the revealing to the on the healing process or ability to cause a depression that is likely to later the healing.
Communication
Patients at the age of Chantelle are trick to handle and communicate with sometimes. Despite this, communication is a critical component in nursing activities as well as all other healthcare services. In the healthcare setting, nursing offers both bio-psychosocial and spiritual nourishment in a patient with different nursing needs. Therefore nurses need to perfect social and interpersonal alongside scientific knowledge in order to offer high-quality services to the patients (Abbaszadeh et al., 2014). Communication is one such social and interpersonal skill that can be used to exchange information, feeling, and thoughts between the patients and nurses. For a patient in the age gap of Chantelle, nurses need to effectively understand patient needs and experience in order to gather concise and precise information. Such information should be based on sincerity, and mutual trust in maintaining the confidentiality of the information shared and structuring the response in the right manner (Kourkouta and Papathanasiou, 2014).
Health promotion
The need to have appropriate health care for the patients with an inguinal hernia where this will help in the management of different challenges that might be believed to be upcoming hence this, they will be made easy to control. There is a need for regular check-ups that the patient aligns with the stable health conditions and responds positively to the treatment. Patient like Chantelle needs to have proper ways which will bring along the management from the routine exploration and better ways addressing the occurring condition. The health management should encourage the use of anesthesia, which mainly blocks the ilioinguinal nerves from sores and pain hence bringing along a healthy and proper healing way for the patients involved (Gómez-Ríos, López-Calviño, and Vizcaíno-Martínez, 2014).
Conclusion
The ultimate decision of the nurses in the strive to inscribe medical treatment to the patient need to be guided by the rule of law and ethical consideration. Patient like Chantelle is 16 years of age and is in her sound mind to decide on the kind treatment that best suits her. Her decision to open up to the nurses about her sexual activeness should be treated with the utmost confidentiality in order to increase her confidence in the nurses and mode of treatment prescribed. The final decision on the model of health care to be provided should be based on legal structures and should be communicated to the best abilities of the nurses.
Reference list
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