Evidence based nursing is defined as the approach associated with the ability of making effective decisions and providing high quality care based on the clinical experience and the most current and relevant evidence provided by the research on the issue (DiCenso, Guyatt & Ciliska, 2014). Hence it is important for the registered nurse to include in the relevant researches in order to find out the current evidences and utilize them in the clinical practice (Parahoo, 2014). The purpose of the assignment is to conduct a nursing research on an issue that I have encountered during clinical practice. In this regards I have chosen the issue of childhood leukemia and this assignment aims to prove the hypothesis that breast feeding could reduce the risk of childhood leukemia.
Leukemia is defined as a kind of cancer that affects the blood and bone marrow. The consequence of leukemia occurs if the bone marrow produces excessive white blood cells or lymphocytes that are the part of our immune system and act as the first line protector from infections (Puumala et al., 2013). The leukemia cells do not acts like a white blood cells for protecting the human body from various infections, rather they occupy majority of the space in bone marrow thus reduce the space for the normal blood cells (Mezei et al., 2014). There are various form of leukemia based on the type of stem cells they affected, however, the acute lymphocytic leukemia is the most common form of leukemia that affects the children and leads to the consequence of childhood leukemia (Rubnitz & Inaba, 2012). In acute lymphocytic leukemia the lymphoid stem cells get affected and the abnormal cells grow quickly and affect the function of normal lymphocytes, which in turn affect the immune response of the body (Puumala et al., 2013). Statistics has indicated that more than 20 children per 100.000 children suffer from leukemia in Australia (childrenscancer.canceraustralia.gov.au, 2018). Various treatment has been introduced in order to help the children with leukemia, however, the initiatives for prevention is less. Rubnitz & Inaba, (2012) have indicated breast feeding could reduce the risk of childhood leukemia in an effective manner. Due to such findings I have focused on the topic of childhood leukemia and evaluate the effectiveness of breast feeding in reducing the incidence of childhood leukemia.
Search strategy:
In order to identify the effectiveness of breast feeding in reducing the incidence of childhood leukemia, I have searched relevant literatures from electronic data bases such as Google Scholar, PubMed and CINAHL. Relevant key terms such as leukemia, prevention of childhood leukemia, breast feeding, leukemia in Australia, effective treatment for leukemia and others. I have selected only the articles published in English language during 2012-2018 and only full text articles associated with breast feeding and childhood leukemia were collected to gather information. The evidence from such previous literatures will be discussed in the following paper.
Evidence for childhood leukemia:
As stated earlier, leukemia is one of the most common form of cancer and acute lymphocytic leukemia is highly prevalent among the children. Approximately 18% children diagnose with acute lymphocytic leukemia per year (childrenscancer.canceraustralia.gov.au, 2018). Different treatment options have been introduced in order to manage the children with leukemia and help them to recover completely from the illness. It has been found that approximately 98% children diagnose with acute lymphocytic leukemia undergo remission within 1 week after their treatment get started and 90% among them can be recovered from the illness, however, the patients considered to be curd completely after 10 years in remission (Rubnitz & Inaba, 2012). However, there is lack of prevention measure for childhood leukemia. Researches have been conducted in order to identify the effective prevention measures that could reduce the risk of childhood leukemia. Leukemia has been identified as the pediatric cancer, thus most of the researches have focused on the nutrition factor of the children (Puumala et al., 2013). In this regards it has been identified by Michie, (2016) that adequate breast feeding during early life could impact positively and reduce the risk of childhood leukemia.
Evidence for association of breast feeding with low risk of childhood leukemia:
According to the literature breast feeding is the low cost preventive measure which is highly accessible and found to be effective not only in decreasing the risk of leukemia but also the infant mortality rate. Amitay & Keinan-Boker, (2015) has described the association between breast feeding and reduced risk of childhood leukemia. The study has aimed to identify the scientific evidence in order to understand the association of breast feeding with childhood leukemia. In order to derive the result the authors have done systematic review of the articles relate to childhood leukemia and breast feeding published between January 1960 and December 2014. In addition meta-analysis has been used. 25 articles have been identified among which only 18 articles have been selected for the study as they met the inclusion criteria. It has been demonstrated that breast milk contains adequate infant nutrition that are essential to intake for healthy growth. On the other hand breast milk is considered as the live substance that contains effective antibiotics produced by the mother’s body that helps the child in order to develop strong immune system. Such antibodies are highly effective for the children as the mother’s body develops them against the harmful substance to which the mother and fetus were exposed during pregnancy. Amitay, Dubnov & Keinan-Boker, (2016) have aimed to identify the association between breast feeding and childhood leukemia and used randomized control trial with 384 participants and found that due to poor nutritious condition the risk of infectious disease increases among children because of their poor immune system which may lead to the risk of leukemia. Hence, adequate breast feeding would provide effective nutrition and antibodies that could help to increase the immunity of the children, which in turn could decrease the risk of childhood leukemia in an effective manner. In addition Ajrouche et al., (2015) has conducted a research using national registry-based case–control study. The study has been carried out in France and 617 ALL and 1225 controls aged 1 year have been recruited. The study investigated the childhood acute lymphocytic leukemia and immune stimulation and identified the effectiveness of breast feeding in such case. It has been reported that breast milk contains oligosaccharides which does not found in the bovine formulas and immunoglobulin (IgA). Due to such characteristics breast milk is considered as probiotic as well. Breast milk is considered as live as it contains T and B lymphocytes and stem cells which can be transferred to the infant through breast feeding in order to improve their immune system. Such effectiveness of breast milk helps to reduce the risk of leukemia in children in an effective manner.
Evidence for effectiveness of breast feeding:
Amitay & Keinan-Boker, (2015) have examined the effectiveness of breast feeding for reducing the risk of leukemia among children. In this regards the authors have included meta-analysis of 17 studies which examined 9650 cases of leukemia and identified that breast feeding for 6 months or more than that has reduced the risk of leukemia by 20% as compared to the cases where breast feeding was not done. On the other hand study conducted by Michie, (2016) has indicated that the breast feeding for at least 6 months could reduce the risk of childhood malignancy by 19%. Even breast feeding for a shorter time may reduce the risk of leukemia for a child. The research conducted by Amitay, Dubnov Raz & Keinan-Boker, (2016) has reported that children with trisomy 21 are highly vulnerable to childhood malignancy and breast feeding could help such children to reduce the risk of malignancy. Hence it can be said that most of the studies have indicated breast feeding as the effective strategy in order to reduce the risk of childhood malignancy. Thus, it is important to promote the effectiveness of breast feeding and encourage the mothers for breast fed their child at least for 6 months (Ajrouche et al., 2016). In this regards Rudant et al., (2015) has conducted a research using international consortium study which aimed to identify the immune stimulation during childhood leukemia. The study has included 7,399 ALL cases and 11,181 controls aged between 2-14 year and recommended that findings of the study required to be communicated with the parents in an effective manner and the parents need to be educated about breast feeding so that they could understand the importance of breast feeding in improving the immune system of the child and reducing the prevalence of childhood malignancy.
Discussion:
Leukemia has been found to be one of the most severe health issue among the children. There are various types of leukemia among which the acute lymphocytic leukemia is the most common form of childhood leukemia (Rubnitz & Inaba, 2012). The consequence of acute lymphocytic leukemia affects the blood and bone marrow. The illness occurs when the born marrow produces huge amount of white blood cells. However, such lymphocytic cells do not behave like normal white blood cells that provides protection from various infections and strengthen immune system. Instead the abnormal lymphocytic cells grow quickly and occupy most of the places in the bone marrow thus reduces the place for normal blood cells. In this way such abnormal cells reduce the immunity of a child with acute lymphocytic leukemia (Mezei et al., 2014). The illness progresses rapidly, however, there is high chance for recovering from acute lymphocytic leukemia. As identified in the literature review 98% children undergo remission after diagnosed with childhood malignancy and 90% among them have been found to be cured (Puumala et al., 2013). As there was less initiatives regarding the prevention of childhood leukemia studies have focused to identify effective public health measure and most of the study have recognized breast feeding as the most effective way that could decrease the risk of childhood leukemia in an effective manner. For example, Amitay & Keinan-Boker, (2015) have identified the association of breast feeding with low risk of childhood leukemia and demonstrated that breast milk contains effective nutrition, antibiotics, oligosaccharides and breast milk is considered as live as it contains B lymphocytes, T lymphocytes and stem cells which helps to improve the immune system of the infants and reduces the risk of leukemia in an effective manner. Similarly Michie, (2016) has reported about the effectiveness of breast feeding and indicated that risk of leukemia could be reduced within children by 19% through breast feeding. In this regards Ajrouche et al., (2016) have recommended to encourage the mothers to breast fed their child and inform them about the effectiveness of breast feeding in improving immune system of infants and provide protection from leukemia and other severe diseases as well.
Conclusion:
In conclusion it can be demonstrated that, in order to provide evidence based nursing care it is required to involve in effective nursing research in order to find out the current and relevant evidence for the nursing issues and use them to provide high quality care. This nursing research based on the effectiveness of breast feeding in reducing the risk of leukemia has identified that, leukemia is one of the most common types of cancer that affect the blood and bone marrow of the patient. There are various kind of leukemia among them acute lymphocytic leukemia is the most prevalent one among children. Treatment could cure the disease in 90% patients, however, it is important to introduce effective preventive public health measures in order to reduce the risk of childhood malignancy and breast feeding has been identified as the effective prevention strategy by most of the studies. This is due to the presence of adequate nutrition, antibiotics, immunoglobulin, oligosaccharide, lymphocytes and stem cells in the breast milk which could improve the immune system of the infants and could provide protection from leukemia and various infectious diseases. Hence I would use the information gathered from this research and would communicate the findings with pregnant women and mothers in order to help them to understand the importance of breast feeding. Such practice could help me to provide evidence based care and achieve improved health outcomes.
References:
Ajrouche, R., Rudant, J., Orsi, L., Petit, A., Baruchel, A., Lambilliotte, A., … & Gandemer, V. (2015). Childhood acute lymphoblastic leukaemia and indicators of early immune stimulation: the Estelle study (SFCE). British journal of cancer, 112(6), 1017. https://www.nature.com/articles/bjc201553
Amitay, E. L., & Keinan-Boker, L. (2015). Breastfeeding and childhood leukemia incidence: a meta-analysis and systematic review. JAMA pediatrics, 169(6), e151025-e151025. doi:10.1001/jamapediatrics.2015.1025
Amitay, E. L., Dubnov Raz, G., & Keinan-Boker, L. (2016). Breastfeeding, other early life Exposures and childhood leukemia and lymphoma. Nutrition and cancer, 68(6), 968-977. https://doi.org/10.1080/01635581.2016.1190020
childrenscancer.canceraustralia.gov.au (2018). Leukaemia | Cancer Australia Children’s Cancers. Retrieved from https://childrenscancer.canceraustralia.gov.au/types-childrens-cancers/leukaemia
DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences. pp. 3-526. https://books.google.co.in/books?hl=en&lr=&id=bHqjBQAAQBAJ&oi=fnd&pg=PR29&dq=evidence+based+nursing+practice&ots=M3IsLbDhSK&sig=7tmlvQ9VUev9xfQgI-r3jPhvD7c#v=onepage&q=evidence%20based%20nursing%20practice&f=false
Mezei, G., Sudan, M., Izraeli, S., & Kheifets, L. (2014). Epidemiology of childhood leukemia in the presence and absence of Down syndrome. Cancer epidemiology, 38(5), 479-489. https://doi.org/10.1016/j.canep.2014.07.006
Michie, C. (2016). Breast feeding could reduce the risk of childhood leukaemias. Evidence-based nursing, ebnurs-2015. https://dx.doi.org/10.1136/eb-2015-102200
Parahoo, K. (2014). Nursing research: principles, process and issues. Macmillan International Higher Education. 3rd edition. pp. 1-216. https://books.google.co.in/books?hl=en&lr=&id=5ti3AwAAQBAJ&oi=fnd&pg=PP1&dq=nursing+research&ots=RBwIWvMjCY&sig=fdK1du4mUPEXn4YOGuSpvocq8Dc#v=onepage&q=nursing%20research&f=false
Puumala, S. E., Ross, J. A., Aplenc, R., & Spector, L. G. (2013). Epidemiology of childhood acute myeloid leukemia. Pediatric blood & cancer, 60(5), 728-733. https://doi.org/10.1002/pbc.24464
Rubnitz, J. E., & Inaba, H. (2012). Childhood acute myeloid leukaemia. British journal of haematology, 159(3), 259-276. https://doi.org/10.1111/bjh.12040
Rudant, J., Lightfoot, T., Urayama, K. Y., Petridou, E., Dockerty, J. D., Magnani, C., … & Kang, A. Y. (2015). Childhood acute lymphoblastic leukemia and indicators of early immune stimulation: a Childhood Leukemia International Consortium study. American journal of epidemiology, 181(8), 549-562. https://doi.org/10.1093/aje/kwu298
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