Transforming Nursing Practice - Part 1

Patient Care Team

Primary treatment goals: The main aim of primary care is to improve the health of the patient by ensuring that there is improved and effective access to the medical care services (Shields et al., 2020). Liam should be referred to as general practitioners, pharmacists, and physicians. The pharmacists will provide medications like corticosteroids, anti-inflammatory drugs, or others as prescribed by the doctors for asthma or another medical issue of patients. The general practitioners and asthma nurses will perform diagnostics and treatment of asthma and they will perform allergy tests. The general practitioners and physicians will evaluate and assess the fractured bone areas for pain, swelling, deformity,tenderness, prescribe medications, conduct and interpret diagnostic tests, examine patients, and take a medical history. The nurses and physicians will assess the signs and symptoms of arthritis and depression or stress in the patient. If the physician or nurses observe that the patient is not involved in self-management then he will be referred to specialists for secondary care and treatments. According to Van Mason et al. (2020),in health care, the primary team involves services by general practitioners and nurses who provide primary care to the patients like assessments and refer the patient to specialists for secondary care if needed. This treatment of care never provides hospitalization.

Secondary treatment goals: The patient and his family members will be educated about asthma, fracture, depression, medications, and arthritis if severe complications of these health issues are observed. If there is an unstable bone fracture and prolonged pain then orthopedics will be referred. The patient shouldbe asked to X-ray and tested for rheumatoid factor and the physiotherapists will be visited for betterhealing of the fractured bone. The psychiatrists will also be referred to because the patient is not interested in his self-management and getting more socially withdrawn (Katkin et al., 2017). So, for that treatment sessions will be organized. If the patient is not under control then therapies like pharmacological therapy or allergen-specific immunotherapy will be conducted for asthma with the involvement of a multidisciplinary team. Other facilities like hydrotherapy, pharmacological therapy, or other treatments for arthritis. Moreover, the multidisciplinary health care team should encourage the parents, teachers, friends, and the patient himself for more involvement in social activities, social gatherings, and physical activities. According to Katkin et al. (2017), secondary care is provided by a specialist for a specific disease condition. Such care is always provided in specialists’ clinics and hospitals. It may include planned surgeries, operations, or other therapies. It is a high level of care whereas primary care is a low level of care.

Patient’s Barriers to Care Goals

There are few factors that act as barriers to patient’s cafe goals like poor understanding of the patient and the family about the complications and the limitations of treatment and management care plans, lack of capability of decision-making in the goal of care, and many others (Shields et al., 2020). Liam has a good relationship with his family members as both, the parents are working all day long and there is no one for the care of a 15 years old male child. Moreover, the child himself is reluctant in his self-management, shows signs of social isolation. So, in such cases, these factors act as barriers in care goals for the patient. As both, the parents are busy in their jobs so it also becomes difficult for them to manage time for the sessions of psychiatrists, physiotherapists, or other health care management plans. As per the case study, due to the pain of arthritis and issues of asthma the child is unable to live a normal life as that of other normal children. This also makes the patient feel more depressed because of his medications and visits to physicians for general check-ups. Due allergy to dust and pollen, the patient cannot play many outdoor games he has to do light physical activities at home, but being a child of 15 years which is a very proactive stage it becomes difficult for the child to remember about his medication times, take precautions for his asthma and manage his health issues with self-management. Taking medications in school also leads to less attention or skipping periods that affect the studies of the patient. According to Lee et al. (2020), self-management is involved in managing the emotional and practical issues and coping up with long-term health conditions. If the patient is provided education about self-management then it can result in improved. The self-management strategies includeinternal strategies - self-reinforcement, self-evaluation, and self-monitoring, social interaction, and others. These will affect the behavior of the patient in a positive manner and the patient will feel compassionate about his health, follow the care plans effectively to get well soon, get involved in his care or treatment plans, and decision making (Lee et al., 2020).

According to Roth et al. (2020), health literacy is also important in health care, because if the patent is unaware of the complications or serious consequences of skipping of his medications or his diseases then it can act as a barrier to care goals. Therefore, the patient should be the signs, symptoms, unexpected results, positive results, and their related information of his disease; so that if there is an improvement in health or if there is any deterioration in heath then the patient can monitory and assess it and inform his doctors. Moreover, the team goals also help in eliminating the barriers in the patient care goals. If there is coordination in the health care team then there will be effective care plans and no conflicting elements in management plans with fast and effective patent recovery. However, poor management if team goals can result in a lack of management of patient’s health, the risk to patent safety, and negative outcomes (Shields et al., 2020). As in this case, Liam is a school student frequent visits to doctors or sessions by specialists can lead to loss of his studies in school. So with effective team goals, it will easy for him to manage all the things together with no or minimum barriers.

Transforming Nursing Practice - Part 2

Nursing Practice

According to Clark et al. (2020), the care process involves documenting, monitoring, nursing interventions for long and short term care, diagnosis, feedback, and assessments of the patients. For these factors,the registered nurse plays a very important role. In this case of Lima, the registered nurse should take frequent assessments for each of his health complications like arthritis pain, asthma, isolation signs, fracture issues, and others. The registered nurse (RN) should perform effective communication with the socially isolated patient so that Liam can trust the nurse and share brief feedback. The RN should also ensure that the patient does not miss any of his therapies or treatments as perthe care plans. The RN should ensure that the patient is provided with patient-centered care and the family is also involved in care plans.

According to Luton et al. (2018), the RN should perform assessments for risk factors, evaluation for improvement, fulfilling of physical and emotional needs, educate the patient, set achievable goals, document the information of the patient, and many others. If there is improvement or deterioration, every detail should be reported to the senior associate health care team professionals so that actions for the improved plan are taken as soon as possible for the treatment and management plans of the patient. For example, if the RN finds that the patient is allergic to a particular drug then this information is to be documented and transferred to the physicians and another team so that medications are accordingly managed. This reduces the risk of patient safety. The RN should conduct brief face-to-face or telephonic interviews with the patient to support him in his care plans and ensure the coordination of health care teams as well (Norful et al., 2017).

An RN not only provides primary care but also assists the senior doctors at the time of surgeries or therapies of the patients; thereby ensuring secondary care as well. The RN needs to have a nonjudgmental temperament, critical thinking, a high sense of humor, compassion, alertness, effective communication, and team-building skills for a continuum of care with high quality and cost-effective services. The RN should ensure that the patient’s doubts are acknowledged properly and the patient is involved in speaking so that social isolation can be reduced. According to Harif et al. (2017), empathy, time management skills, and active listening skills of RN are required to achieve the goals of improved patient outcomes and promote a continuum of care for the patient. The RN should ensure that the rights of the patient like privacy, confidentiality, and others are not violated while he is treated for social isolation during the psychiatrist sessions. So, skills like advocacy, professionalism, code of conduct, and ethics should be maintained throughout the care of the patient.

Identify Strategies

According to Simpson(2020), in Australia, there is a free education program of Asthma and Respiratory Education Program, in which the people are educated regarding asthma, respiratory issues management, and other related issues. An e-Health SaaS company named Respiri Limited which helps in supporting respiratory health management. This technology helps to optimize how the physicians and their asthma patients monitor and manage their asthma. The treatment standards are set as per the National Council of asthma in Australia. There is a charitable not-for-profit organization in Australia for arthritis named Arthritis Australia, this helps in organizes support groups and providing education to people about arthritis. These programs are conducted at school levels or at higher levels like in colleges, so that children are aware of such health issues and can manage to prevent them by self-management. The patient should be encouraged for volunteering into social works so that the chances of social isolation can be reduced. Voluntary socialization and participation in community organizations can help in reducing the feelings of loneliness. The patient should be made aware of all these programs, sites, technologies, and other resources so that quality care is delivered and the patient is satisfied with health care services. According to Luton et al. (2018), with the help of intensive family support services enables the focus on the child’s health, nutrition, and safety. The Australian government has also implemented the Children Contact Services to focus on self-management of their parenting time arrangements so that the child gets complete care. This organization also helps in protecting the child if self-management is poor and negatively affecting the child. Many organizations help in supporting the care of small children or adolescents and the patient or his family members should be told about these, few of them are as follows: Children’s Health Queensland Hospital and Health Service, Queensland PaediatricHaematology Service (QPHS), Association for the Wellbeing of Children in Healthcare (AWCH), Children's Hospital Foundation, Children's Healthcare Australasia, Child and Family health nursing, Australian College of Nursing, and many others. These organizations are actively involved in ensuring quality care services delivered to children. The mychild.gov.au is an Australian government website that provides information about the children’s well-being and health. The NECS Ombudsman is an organization that receives all the complainants or requests if the patient did not get appropriate care services or if the patient is cheated in an unfair manner in health care (Van Mason et al., 2020). Moreover, the patient’s family, peers, and teachers should be encouraged to communicate with the child as much as possible whenever they get time to that they get a chance to know about the issues faced by the childlike his arthritis pain, depression issues, and others.

References for Transforming Nursing Practice

Clark, R. R., & Lake, E. T. (2020).Association of clinical nursing work environment with quality and safety in maternity care in the United States. Journal of Maternal/Child Nursing45(5), 265-270.https://doi.org/10.1097/NMC.0000000000000653

Harif, M., & Stefan, D. C. (2017).Nursing care principles in pediatric oncology.Pediatric Care,  349-355.https://doi.org/10.1007/978-3-319-17936-0_28

Katkin, J. P., Kressly, S. J., Edwards, A. R., Perrin, J. M., Kraft, C. A., Richerson, J. E., & Wall, L. (2017). Guiding principles for team-based pediatric care. Pediatrics140(2).https://doi.org/10.1542/peds.2017-1489

Lee, J., Clarke, S., & Lynn, F. (2020).Understanding the causes of work-related stress among registered nurses working with children at home: An integrative literature review. Comprehensive Child and Adolescent Nursing, 1-32.https://doi.org/10.1080/24694193.2020.1745325

Luton, A., Estrada, N., Barrientez, K., McGinnis, J., Pitlik, J., Carter, A., & Davies, J. (2018).Nursing considerations and interdisciplinary coordination in the care of conjoined twins.Seminars in Perinatology,42(6), 340-349.https://doi.org/10.1053/j.semperi.2018.07.012

Norful, A., Martsolf, G., de Jacq, K., &Poghosyan, L. (2017). Utilization of registered nurses in primary care teams: A systematic review. International Journal of Nursing Studies74, 15-23.https://doi.org/10.1016/j.ijnurstu.2017.05.013

Roth, C., Brewer, M. A., Bay, R. C., &Gosselin, K. P. (2020).Nurses' experiences of “being swamped” in the clinical setting and association with adherence to AWHONN Nurse Staffing Guidelines.  Journal of Maternal/Child Nursing45(5), 271-279.https://doi.org/10.1097/NMC.0000000000000643

Shields, A., Cole, A., Mikulis, A., & Colvin, E. L. (2020). Nursing care of the pediatric cardiac patient. Critical Care of Children with Heart Disease, 131-132. https://doi.org/10.1177%2F1043454216631472

Simpson, K. R. (2020). Implications of missed care, nurse staffing, and the nursing work environment on patient outcomes in maternity, neonatal, and pediatric inpatient settings.International Journal of Nursing Studies.https://doi.org/10.1097/.0000000000000652

Van Mason, J., &Portnoy, J. M. (2020).Immunologic strategies for prevention of asthma. The Journal of Allergy and Clinical Immunology: Practice8(3), 834-847.https://doi.org/10.1016/j.jaip.2019.11.029

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