Asian Journal of Healthy
and Science
p-ISSN: 2980-4302
e-ISSN: 2980-4310
Vol. 3 No. May 5, 2024
The Effect of
Transformational Leadership Style and Conflict Management of the Head Nursing Care for
Mrs. R with a Medical Diagnosis of Mammary Tumors in the Kemuning Room of Waled
Regional General Hospital, Cirebon Regency
Uswatun Khasanahą, Nadia Sindia Devi2,
Indah Mamay Maftuha3, Neneng Rimawati Nurokhman4, Endah
Sari Purbaningsih5
1,2,3,4,5Institut Teknologi dan Kesehatan
Mahardika, Cirebon, West Java, Indonesia
Email: uswatunmisbah@gmail.com1, nindiasindia@gmail.com2,
indahmamaymaftuha@gmail.com3, nenengrimawati40@gmail.com4,
endahsari155@gmail.com5
Abstract
Mammary tumors are abnormalities of cells in the
breast that grow multiple times and then form a mass or lump. Mammary tumors
are among the most common benign tumors in women. Based on WHO data in 2009, 8--9%
of women were diagnosed with breast tumors, with the prevalence of breast
tumors in Indonesia in 2019 estimated to reach 42.1 per 100,000 population with
an average mortality of 7.6 per 100,000. The purpose of this case study is to provide
nursing care to patients who have mammary tumors. Using a qualitative approach
with case studies as the main method, using observation sheets, interviews, and
documentation studies. The case study selected one patient as the study
subject, namely a patient with a mammary tumor in the Kemuning Room, RSUD
Waled, Cirebon Regency. Nursing care management is based on the fulfillment of
patient needs carried out in three days. The results of the case study showed
that after being given nursing care, there was a decrease in pain and an
improvement in breathing patterns. The conclusion is that nursing care is
effective in meeting the needs of patients with mammary tumors.
Keywords: Nursing
Care, Mammary Tumors, Acute Pain.
INTRODUCTION
Mammary tumors, commonly
called breast tumors, are abnormalities in the function and control of cells in
the breast, causing cells to divide faster, accumulate, and form masses or
lumps
Risk factors for breast
tumors can be caused by a history of breast tumors/cancers or descendants of
family members who have breast tumors/cancer, unhealthy lifestyle habits,
obesity, premature menopause, menopause at an advanced age, nullipara and
advanced maternal age at the birth of the first child
The prevalence of breast
tumors in Indonesia in 2019 is estimated to reach 42.1 per 100,000 population,
with an average mortality of 7.6 per 100,000
The high incidence of
breast tumors makes this disease not to be underestimated. Diagnosis and
treatment of tumors can have a negative impact on physical and emotional
aspects, severe pain, anxiety, depression, emotional changes and fear of death.
All of these effects can negatively impact the quality of life of breast tumor
patients
Based on this data and
information, the researcher is interested in conducting a case study by
providing nursing care to patients with mammary tumors in meeting patient
needs. Because it is important for nurses to be able to provide comprehensive
nursing care. In accordance with the background that has been stated, the
objectives of this study include being able to explain the basic concept of nursing
care for Mrs. R with a medical diagnosis of mammary tumors in the Kemuning
Room, Waled Hospital, Cirebon Regency.
A
study by Mursyid et al.
This
study aims to address the gap in nursing care for patients with mammary tumors
by providing comprehensive case management. Specifically, the study will focus
on Mrs. R, a patient with a medical diagnosis of mammary tumors in the Kemuning
Room, Waled Hospital, Cirebon Regency. The objectives are to elucidate the
basic concepts of nursing care for breast tumor patients and to assess the
effectiveness of nursing interventions in meeting patient needs. This research
will contribute to enhancing nursing practices and improving patient outcomes
in the management of breast tumors.
RESEARCH METHODS
This study uses a
qualitative approach with case studies as the main method
RESULTS AND DISCUSSION
Result
The pre-arrival assessment
in this case is a female patient named Mrs. R, 52 years old, who entered on
March 10th, 2024, with a medical
diagnosis of a mammary tumor. At the assessment on March 11, 2024, the patient
complained of pain in the left breast, such as being stabbed. Patients said
there was a lump that pressed on the breast accompanied by swelling and pain,
coupled with complaints of tightness. The patient has no previous history of
disease but has a family history of tumor/breast cancer. Results of vital sign
examination: blood pressure (TD): 130/70 mmHg, heart rate (HR): 113x/min,
temperature: 36oC, SpO2: 96%, respiratory rate (R): 25x/min.
A quick and immediate
assessment on March 11th, 2024, was obtained;
airway: shortness of breath, there are obstacles to the airway, no additional
sounds. Breathing: respiratory rate: 25x/min, SpO2 96%. Circulation: blood
pressure (TD): 130/70 mmHg, heart rate (HR): 113x/min, Glasgow Coma Scale: eye
5, motor 5, verbal 5, 15 (compos mentis), CRT <3
seconds. Installed nasal cannula 4 LPM. Patients received several drug
therapies in the form of cefim 1 g x 12 hours, ketorolac 30 mg x 12 hours, tranexamic acid 500 mg x 8 hours.
From the laboratory results, hemoglobin: 12.2 g/dL, hematocrit: 31.%,
erythrocytes 4.22/uL, leukocytes 11.6/uL, lymphocytes 23%, monocytes 7%, sodium
124 mmol/L, potassium 3.48 mmol/L, and chloride 95.1 mmol/L.
The comprehensive
assessment obtained on March 11th, 2024, included that the
patient still looked painful, like a 6 (moderate) scale prick on the left
breast with a lump, and the patient appeared to be grimacing with pain. The patient's
respiratory status can be seen with irregular breathing patterns with dyspnea
displays. The neurosensory status obtained by compos mentis consciousness with the
patient's GCS was 15, and the patient's body temperature was 36oC. Patients complain of disturbed sleep and restlessness.
From the results of the inspection and palpation, there was a lump with ulcers,
and a swollen and reddish appearance of the skin of the breast, wrinkled like
an orange peel.
In the physical
examination of pain comfort in patients, a pain assessment with PQRST was
carried out where it was found that the patient said pain, the quality of pain,
such as being punctured, the location of the pain felt in the left breast, with
a pain scale of 6 (moderate), and pain felt continuously. Nursing diagnosis is based
on the patient's condition using the Indonesia Nursing Diagnosis Standard
(Working Group Team SDKI DPP PPNI, 2018). There are two
nursing diagnoses, namely acute pain related to the suppression of tumor masses
and ineffective breathing patterns related to decreased lung expansion.
Based on the nursing
action plan that has been made and prepared to overcome the problems of nursing
diagnosis for Mrs. R, the actions taken are carried out according to the plan.
The implementation of nursing to overcome acute pain problems in Mrs. R is by
identifying the location, characteristics, duration, frequency, quality, and
intensity of pain, identifying the scale of pain, identifying factors that
aggravate and alleviate pain, controlling the environment that aggravates pain,
explaining pain relief strategies, and collaborating by providing analgetics if
needed. The implementation of nursing carried out to overcome the problem of
ineffective breathing patterns in Mrs. R, in accordance with the intervention,
namely monitoring breathing patterns, monitoring breath sounds, frequency,
rhythm, and breathing effort, monitoring oxygen saturation, adjusting
respiratory monitoring intervals according to the patient's condition,
positioning semi-fowlers or fowlers, and providing oxygen if needed.
The
evaluation found on Mrs. R after treatment for 3 x 24 hours on March 13th, 2024, acute pain problems related to the suppression
of tumor masses were resolved, in accordance with the planning criteria, namely
the patient's pain was reduced (scale 3), and the intervention was stopped.
Likewise, the evaluation of the problem of ineffective breathing patterns
related to decreased lung expansion has been resolved, in accordance with the
planning criteria, namely increased breathing patterns and the intervention is
stopped.
Discussion
Acute Pain
In this case, Mrs. R's
complaint was found to be a pain in the left breast, like being stabbed, pain
that was felt continuously with a pain scale of 6 (moderate). The diagnosis
that is established is acute pain related to the compression of the tumor mass.
At the time of the subjective data review, the patient said pain in the left
breast. Objective data was obtained from pain scale data and facial expressions
that appeared to be grimacing in pain. This is in accordance with the major
signs obtained from the diagnosis of SDKI (Indonesia Nursing Diagnostic
Standard) (2017), where the major criteria that can be found in the form of
objective data include grimacing, restlessness, increased pulse frequency and
difficulty sleeping while the subjective data that can be found on the major
signs is complaining of pain.
According to the
researcher, there is no gap in pain diagnosis because in the physical
examination of pain comfort in patients, pain assessment with PQRST was
obtained by patients saying pain, the quality of pain such as being stabbed,
the location of pain felt in the left breast, with a pain scale of 6
(moderate), and pain felt continuously. In accordance with research conducted
by Kurtin and
Based on Mrs. R's
planning, the implementation of interventions carried out in accordance with
the acute pain measures that have been prepared for patients is in accordance
with SIKI (Indonesia Nursing Intervention Standards), which includes
observation, therapy, education, and collaboration. The application and writing
of outcome criteria in patients are in accordance with SLKI (Indonesia Nursing Output
Standards). According to SIKI (Indonesia Nursing Intervention Standards) and
SLKI (Indonesia Nursing Output Standards) which are used for the diagnosis of
acute pain with the aim that after nursing action is carried out, it is
expected that the level of pain decreases, outcome criteria: pain complaints
decrease, grimacing decreases, protective attitude decreases, restlessness
decreases, difficulty sleeping decreases, pulse frequency improves, breathing
patterns improve, and blood pressure improves, patients can rest comfortably.
Appropriate pain
management interventions have been carried out observations:
identification of the location, characteristics, duration, frequency, quality,
and intensity of pain, identification of pain scales, identification of
non-verbal pain responses, identification of factors that aggravate and
alleviate pain, monitoring the success of complementary therapies that have
been given. Therapeutics: providing non-pharmacological techniques
to reduce pain (e.g., TENS, hypnosis, acupressure, massage therapy,
aromatherapy, warm/cold compresses), controlling the environment that
aggravates pain, Education: explaining the causes, periods, and triggers of
pain, explaining pain relief strategies, advocating independent pain
monitoring, teaching non-pharmacological techniques to reduce pain, and
Collaboration: administering analgetics if needed.
Ineffective Breathing
Patterns
In this case, it was found that the
patient's complaint was that Mrs. R seemed to be short of breath and had a
nasal cannula attached to 4 LPM; the patient said that she was more comfortable
with the semi-fowler position. This is in accordance with Devi's opinion in
Jati et al.
In Mrs. R, the
enforcement of nursing diagnosis, according to SDKI (2016), is that ineffective
breathing patterns are related to decreased lung expansion characterized by
shortness of breath. Based on SDKI (2016), there are major subjective dyspnea
symptoms and objective data: use of respiratory aids and abnormal breathing
patterns. This
is in accordance with Khasanah's opinion in Jati et al.
There is no gap
in the diagnosis of effective breathing patterns because, according to SDKI
(2016), the symptoms and
signs that support the enforcement of nursing diagnosis of ineffective
breathing patterns are complaints of shortness of breath. Based on the nursing
action plan that has been made and prepared to overcome the problem of
ineffective breathing patterns in Mrs. R, the action is carried out according
to the plan. An ineffective breathing pattern intervention has been prepared
for Mrs. R's patient with the aim that after nursing treatment for 3 x 24
hours, it is expected that the breathing pattern will improve with the outcome
criteria: Dyspnea decreases, breathing frequency improves. The action plan in
respiratory monitoring includes making observations: monitoring breathing
patterns (frequency, depth, breath effort), monitoring additional breath
sounds, and monitoring oxygen saturation.
Therapeutics: adjusting respiratory monitoring intervals according to the
patient's condition, maintaining airway paternity with head-tilt and chin lift,
positioning semi-Fowler or Fowler. Education: informing the
monitoring results. Collaboration: providing
oxygen.
CONCLUSION
Nursing problems in
patients are acute pain associated with tumor mass suppression and ineffective
breathing patterns associated with decreased lung expansion. The implementation
of nursing actions in this case is carried out in accordance with the diagnosis
that has been established, the nursing intervention that has been made and in
accordance with the data analysis with the needs of the patient with a medical
diagnosis of mammary tumors. After the implementation of nursing to Mrs. R with
a medical diagnosis of mammary tumors for 3x24 hours, the final result of the
nursing process is an evaluation of the nursing care provided. In the
evaluation, there were two nursing diagnoses that had been resolved as planned
and the intervention was stopped.
Investigating
the effectiveness of individualized nursing interventions could provide
insights into their impact on pain management and respiratory function in
patients with mammary tumors. Such research could assess long-term outcomes and
patient satisfaction associated with tailored care approaches.
A
comparative study of different nursing care models for managing acute pain and
ineffective breathing patterns in cancer patients would be valuable. This study
could determine which models are most effective in improving patient outcomes
and quality of life.
Exploring
strategies to enhance patient-centered care in oncology nursing could also be
beneficial. Focusing on integrating patient feedback into the care planning
process and evaluating its effect on treatment efficacy and patient well-being
would be a significant contribution.
Lastly,
examining the long-term effects of nursing interventions on both pain
management and lung function in patients with malignant tumors could help in
understanding the sustainability of care outcomes over extended periods.
These
future research directions could contribute valuable insights into optimizing
nursing care for patients with mammary tumors and similar conditions,
ultimately enhancing patient outcomes and nursing practices.
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Copyright holders:
Uswatun Khasanah, Nadia Sindia Devi, Indah
Mamay Maftuha, Neneng Rimawati Nurokhman, Endah Sari Purbaningsih (2024)
First publication right:
AJHS -
Asian Journal of Healthy and Science
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