Integrated Nursing Concepts 

Introduction

Essentials of Care (EOP) lets the nurses focus on improving the patient's care and satisfaction. EOP augments the healthcare system by identifying areas that need improvements and providing corrective measures (Essentials of Care, 2020). Primary healthcare can encompass a majority of the individual's health needs from prevention, treatment, and management of palliative care (WHO, 2019). The paper will provide prerequisites information on the essentials of care or health promotion. A case study will be provided to describe the experience in relation to assessments and communications of the Activities of Living (AL).

The paper provides a reflective analysis of the assessments and communications of AL with regard to a patient that we encountered during a study. Additionally, the standard process of provision of essentials care is provided for purposes of future practice as a Registered Nurse (RN). The Burton model of reflection is invoked in applications to delivering the details pertaining to the criteria used in the identification and use of the medical interventions.

Factors that Determine the Activities of The Living (ALs)

Roper-Logan-Tierney or the RLT model of nursing uses nursing activities- assessments, diagnosis, planning, medical interventions, and reflection; serving as a guide to the nurses' conduct for purposes of individual holistic assessments that serve as a prerequisite for health promotion (Williams, 2015). The ALs are scientific, mental, sociocultural, environmental, and economic factors. The AL is myriad depending on the individual and can range from communicating, breathing, dying to eliminate, mobilising to personal hygiene, eating, and drinking. The model, therefore, encompasses all these constructs to provide a framework for the independence and dependence continuum by personalising the nursing practices. Personalised nursing is anchored on the elements of accessing, planning, implementing, and evaluating activities. Hence, the R-T-L model is based on the following concepts: lifespan, Activities of Daily Living (ALs), factors affecting AL, and individualising the nursing practice.

Biological factors are those that pertain to general health or the current injury or illness. It encompasses the whole scope of human physiology and anatomy. For instance, the dietary plans for people with diabetes mellitus are different from those that do not have the disease. Fred had confirmed with Diabetes Mellitus. On the other hand, psychological factors are those that impact not only cognition but also the emotion, spiritual merits, and the ability to comprehend. As postulated by Roper, psychological factors are about knowledge, thoughts, hope, beliefs, and feelings. For instance, how the presence of paranoid thoughts influences independence in the patient's communication. Additionally, the lack of literacy impacts independence in health promotion. Fred was stressed and without close relatives to offer coping mechanisms.

Social-cultural factors are those that impact culture and society that the patient experiences. In contemporary society, values and expectations are based on either the perceived or actual status or social class that is associated with the patient's perceived or actual capacity to their activities of daily leaving health culture in this context refers to the beliefs, values, and expectations that are postulated by the patient pertaining to their autonomy and ability to continue living that is placed upon themselves. For instance, when rendering care to a patient that is advanced in an age like Fred and the counter expectations and presumptions that is present in the society about cognitive decline and infirmity have a significant impact given the need for the sharing decision-making process in personalised healthcare (Cooke, 2015). Even if these factors are not inherently harboured by the patient, they might affect both the independence allowed by those with enough authority and delivery of healthcare.

Environmental factors, as Roper stated, are those that have an impact on the environment because of the impact of the patient’s ALs on the environment, processes, and activities of daily living. For instance, the effects of ALs on the environment can argue if the presence of damp that is close to the patient’s apartment influence independence in respiratory activities. In this case, Fred’s breathing impairments can be associated with the presence of anxiety and pain. According to Roper, these environmental factors should be based upon the bolstering of the green model.

Politico economic implications are those that involve governmental, political, and the economy on ALs problems like funding, government policies, and regulations. Political issues like violence, war, and conflict impact the general availability and access to the merits of government aid and political reforms. Additionally, interest rates and the accessibility to both public and private sources of funding are also under this umbrella factor. For instance, what could be impacts of eligibility for health insurance benefits influence Fred’s independence; specifically, when current housing standards are inadequate or below standards.

Identification of Cues and Applications of the Borton Model

Fred had undergone biopsy and colonoscopy, which had shown a malignant mass. He was anxious and stressed, given readmission. Patients that have experienced colorectal surgery have increased chances of facing postoperative complications. The complications herein prove to have increase risks of limited oncological outcome and declined general quality of life. At an advanced age, the emotional burden that Fred was in is traumatising, given he had lost his wife to diabetes and was transferred to a foster home. Fred's comorbidities, like lack of physical exercise and old age, limit his ability to take care of the stoma. Fred has diabetes mellitus and is increasingly finding it hard to cope. Therefore, the evidence-focused fastened recovery activities target at reducing dysfunction of organs, accelerating postoperative recovery, and stress response by focusing on effective and optimal pain control using analgesics and narcotics. Restoring fluid balance is done via frequent inflow of clear fluids and the utilisation of acid-base regulators that have relatively high amounts of potassium and sodium. Moreover, stress management by using coping mechanisms improve the quality of service, and the recuperation period is expedited.

Justifications and Establishing Future Goals

We used Compazine or Phenothiazine for reducing nausea and vomiting but reflecting; the use of the drug has undesired negative effects on the patient, such as dizziness, anxiety, and insomnia. The negative effects have compounding effects on the biopsychosocial framework that determine the pathophysiology of cardiovascular diseases and other complications. Bismuth subsalicylate or Pepto-Bismol could have provided better efficacy given that the meaning of medicine is specialised in the treatment solution to stomach upset and antidiarrheal.

Although the activity of noting hypotension and monitoring the vital signs was conducted, it was based on the rationale of identification of risks of increasing the fluid replacement and hydration status. The laboratory results were not checked and used for optimal management of electrolytes and hydrochloric acid. The utilisation of this information could have provided the caregiver chances to detect imbalances in homeostasis, thereby helping in the determination of the necessary needs for replacement. In place of this problem, the effectiveness of the solution could have been the intravenous infusion and clear fluids that are necessary for maintaining optimal flaccid nature of the tissue function. A research study by Kapoor et al. (2017) illustrates how stability in primary organs and appropriate individual output via understanding the is the overall desired outcome for postoperative colonoscopy patients.

Another issue is that pertaining to medication adherence. Fred was provided with Controlled analgesia, but monitoring was not provided prior, given that Fred stays in foster care and does not have close relatives. Fred lacked prerequisite education about awareness on the intricacies of the conditions he was facing. Although the medical interventions that Fred was offered were optimal and proved effective, readmission was due to the lack of extended personalised close monitoring on the patient by post-surgical activities. The maintenance of close patient observations by active logging of cues, specifically those involving pain (Aziato et al., 2016; Nursing and Midwifery Council, 2015). The establishment of a rapport with the patient and extended health promotion using technology-enhanced tools such as Electronic Healthcare Records (EHR) could have provided better efficacy of long-term benefits. The necessity for classifying pain types so that specialised or targeted interventions can be rendered critical (Orhurhu et al., 2019).

From a reflective standpoint, if the nurse had prior capacity in Cognitive Behavioural Therapy (CBT) could have been used to provide a non-pharmacologic approach to the cognitive treatment thereby helping in coping and improving quality of service (Saito, Shiraishi, & Yoshinaga, 2019; Philip, Kannan, & Parambil, 2018). Additionally, CBT could have effectively solved the problem of medical adherence by offering a conducive forum for improving monitoring and quality of care through non-pharmacological methods that have significant efficacy levels (Farah et al., 2017). The recuperation period and quality of service could have been improved further by the therapy sessions (Palermo et al., 2018). Information asymmetries inherent between provider-patient relationships posed a significant challenge to the quality of service and reduced chances for health promotion.

Conclusion

To suffice, although it is a fact that postoperative complications are heightened because of prior colorectal surgery. The complications usually range from organs infection, wounded infection, and obstruction of the bowel. The cues that emanate from spiritual and biopsychosocial determinants of the general well-being. In this regard, the use of technology, such as EHR, provides opportunities for more personalised and culturally sensitive interventions. Moreover, patient education, participation, and awareness are improved via the same avenue leading to solving medical adherence issues. Additionally, the efficacy of the medical interventions used could have yielded much output if the nurse was equipped with CBT professional training to offer to the patient

References

Aziato, L., Ohene, L. A., Dedey, F., & Clegg-Lamptey, J. N. A. (2016). ‘I was in real pain’: Surgical nurses’ personal pain experiences in Ghana. International Journal of Caring Sciences, 9(1), 90.

Cooke, M. (2015). 7 Clinical decision making. Foundations of Adult Nursing, 179.

Essentials of Care (2020). Retrieved from https://www.health.nsw.gov.au/nursing/culture/Pages/essentials-of-care.aspx

Farah, W. H., Alsawas, M., Mainou, M., Alahdab, F., Farah, M. H., Ahmed, A. T., ... & Mohammed, K. (2016). Non-pharmacological treatment of depression: a systematic review and evidence map. BMJ Evidence-Based Medicine, 21(6), 214-221.

Kapoor, R., Srivastava, N., Kumar, S., Saritha, R. K., Sharma, S. K., Jain, R. K., & Baranwal, V. K. (2017). Development of a recombinase polymerase amplification assay for the diagnosis of banana bunchy top virus in different banana cultivars. Archives of Virology, 162(9), 2791-2796.

Nursing and Midwifery Council (2015). Professional standards of practice and behavior nurses, midwives, and nursing associates.

Orhurhu, V., Urits, I., Orman, S., Viswanath, O., & Abd-Elsayed, A. (2019). A Systematic Review of Radiofrequency Treatment of the Ankle for the Management of Chronic Foot and Ankle Pain. Current Pain and Headache Reports, 23(1), 4.

Palermo, T. M., Dudeney, J., Santanelli, J. P., Carletti, A., & Zempsky, W. T. (2018). Feasibility and acceptability of internet-delivered cognitive behavioral therapy for chronic pain in adolescents with sickle cell disease and their parents. Journal of Pediatric Hematology/Oncology, 40(2), 122.

Philip, P. M., Kannan, S., & Parambil, N. A. (2018). Community-based interventions for health promotion and disease prevention in noncommunicable diseases: A narrative review. Journal of Education and Health Promotion, 7, 141. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6282482/

Saito, Y., Shiraishi, Y., & Yoshinaga, N. (2019). Cognitive behavioral therapy for anxiety in dementia caregivers: A review of the foreign literature in English. Japanese Journal of Nursing and Health Sciences, 17(2), 28-36.

WHO (2019). Primary health care. Retrieved from https://www.who.int/news-room/fact-sheets/detail/primary-health-care

Williams, B. C. (2015). The Roper-Logan-Tierney model of nursing: A framework to complement the nursing process. Nursing 2019, 45(3), 24-26.

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