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Nursing Competency Standards in Primary Health Care

Contents

1 Introduction:

2 Primary Admission Diagnosis:

2.1 Key Findings:

2.1.1 Past Medical History.

2.1.2 Medications.

3 Nursing Problems:

4 Nursing Management

4.1 Nursing Problem 1:

4.1.1 Nursing Assessment:

4.1.2 Nursing Intervention:

4.1.3 Role of RN and Medical Management:

4.2 Nursing Problem 2:

4.2.1 Nursing Assessment:

4.2.2 Nursing Intervention:

4.2.3 Role of RN and Medical Management:

5 Discharge Planning:

5.1 Aim for discharge planning and the importance of using a multidisciplinary approach:

5.2 Role of the Registered Nurse and Team Work:

6 Conclusion:

7 Sources:

1 Introduction to Mr. Ian Dury Case Study

The 58-year-old male Mr. Ian Dury lives in rural South Australia. A long battle with cervical cancer took place eighteen months ago in his wife Elizabeth. He was moved to Adelaide South Australia for examination of chest pain to the Sisters of the Mercy Memorial Hospital (SMMH), where he is supposed to undergo a coronary angiogram using an iodinated radiocontrast medium. A long history of Ischemic Heart Disease, also known as Coronary Heart Disease (CHD) was diagnosed with Mr Dury.

Mr. Dury admits he often has problems knowing when to take his medications. He said he didn't want to take his fluid pills when he left since he so much went to the bathroom. Mr Dury tends to be alert and focused, but rather nervous when acknowledged. However, he observed the pitting oedema in both legs of his vital signs, with the corresponding decreased pedal rhythm, during his admission examination. He claims that he gets respiratory during exercise and uses GTN spray about 4 times a day on average. He admits he didn't speak to his son about his hospital admission. The next morning, Mr Dury was expected to have a coronary angiogram.

2 Primary Admission Diagnosis

2.1 Key Findings:

2.1.1 Past Medical History

  • Type 2 diabetes mellitus
  • Hypercholesterolaemia
  • Chronic Kidney Disease stage 3b
  • Hypertension
  • Current smoker 25 cigarettes a day
  • Obesity
  • Coronary Artery Bypass 5 years ago
  • Anterior myocardial infarction 6 years ago
  • EtOH 50grams daily

2.1.2 Medications

  • Aspirin (300mg daily)
  • Losartan (50mg daily)
  • Atenolol (100mg bd)
  • Atorvastatin (80mg daily)
  • Hydrochlorothiazide (25mg daily)
  • GTN spray as needed

Coronary artery disease occurs as the heart 's key blood arteries become compromised or ill. Deposits of cholesterol (plaques) in the coronary arteries and inflammation are generally responsible for the condition in coronary arteries. Heart blood, oxygen and nutrients are provided by coronary arteries. Plaque development will decrease the blood supply to the heart by narrowing these arteries. Eventually, diminished blood pressure may result in chest pain, shortness of breath, or other symptoms and signs of coronary artery disease. A full block can be responsible for a heart attack (Parry & Grant, 2016).

Heart Disease and Hospitalization

Owing to age, higher survival rates after myocardial infarction and new HF management methods, total HF cases have risen. Patients with HF may unexpectedly exacerbate their symptoms during life and may need emergency room treatment and admission into the hospital as a result of acute HF syndrome. This often decompensated heart activity and quality of life steadily deteriorating. HF-admitted patients have a high incident rate (>50%), death rates of 10 to 15% and rehospitalization rates of 30-40% within 6 months of discharge. The enhancement of HF post-discharge findings continues to be a significant priority of clinical practice needs. Improved awareness of the strategies that intensify HF hospitalized patient prognoses and directly influence rehospitalization will offer improved treatment and minimised hospital readmission.

3 Nursing Problems

The heart disease will cause various complications, depending on which part of the heart is affected: Where the right side of the heart is affected, the blood is building up in the veins, which usually brings blood back from the liver and tissue to the heart. The elevated pressure inside the veins will force fluids into the surrounding tissue from the veins. Edema in the legs can occur and edoema in the lungs and liver can occur if cardiac insufficiency occurs. Pressure builds up in blood vessels that carry blood away from the lungs if heart failure impacts the right side of the heart. This can lead to shortness of breath, particularly in harder activities. Even simultaneous left and right heart attacks occur. The severity of cardiac failure can vary considerably. No or only minor symptoms can occur, or they may have a significant impact on your health. Symptoms such as fatigue, shortness of breath, chest pain and palpitations of the heart are likely. Extreme heart disease makes regular daily activities impossible to carry out, such as a pair of steps or a stroll (Halcomb et al., 2016).

Damaged arteries do not properly absorb blood. Kidney has nephrons that pump the blood like little fingers. Each nephron gets its blood from the smallest of all blood vessels by small hair-like capillaries. The nephrons are not provided with essential oxygen and nutrients if the arteries are compromised and the renal blood lacks the capacity to absorb and change the fluids, acids and salts in the body. Damaged kidney blood pressure cannot be controlled. Safe kidneys manufacture the body's blood pressure hormone, which is known as aldosterone. The negative spiral triggers each of the kidney losses and excessive high blood pressure.

4 Nursing Management

4.1 Nursing Problem 1:

4.1.1 Nursing Assessment:

Assessment is a vital aspect of medicine, important for patient and family healthcare preparation and service. "Prompt a thorough and structured nursing review, coordinating health services in consultation with individuals / groups, significant others & the interdisciplinary health care team and reacting appropriately to circumstances that are unforeseen or change quickly, according to the National Level of Competence for Registered Nurses.

Current disorder / injury records, related medical experience, infection and response, drugs, immunization record, implants and family and social backgrounds should be discussed by health-care providers. It is worth exploring and recording recent travel abroad. The Apgar ratings, resuscitation criteria in childbirth, and Newborn Screening Test, if any, include maternal background, fetal background, the childhood form and complications.

4.1.2 Nursing Intervention:

Prevention should begin right after an ischemic event; it should commence throughout the acute stage and proceed throughout the post-acute period and even proceed for the remainder of the life of the patient. In addition to initial diagnosis, IHD patients are encouraged to take different preventive steps. A discharges plan, in compliance with the patient's specific wishes and desires, to identify and coordinate next stage of healthcare facilities and treatment, encourage proactive patient and family problems, schedule follow-up and ensure the reconciliation of prescription, should be created to facilitate consistency of health care and prevention (Parry & Grant, 2016).

4.1.3 Role of RN and Medical Management:

The main task of the advanced practical nurses is among several attempts under way to pursue creative solutions to reinforce the workforce, leading to the growing demands on better treatment of chronic diseases and enhanced patient health quality. In order to help patients, understand complex treatments in ACS and to develop a strategy to encourage opioid acceptance, compliance and better health, they have been shown to have a solicit able function as a counsellor and mentor for an acute CAD case. All health providers have understood the essential role in bringing curriculum into the recovery cycle. Learning is the practice of learning information and skills that can contribute to human behaviour improvements that are necessary to preserve or enhance health. More on, education should include identifying expectations for patients that optimally favour them, assessing patients' interests, improving the patient's behaviour towards more self-regulation, constructive involvement in decision-making, establishing self-care and potential risks, assessing clinical risk factors, meeting practical targets, and promoting the implementation of disease control.

Furthermore, the nurses' priorities for the transfer of CAD patients included the readiness of a patient for routine operations. Both practises provide an understanding of the importance of improving the environment and risk factor as well as minimizing risks, including weight gain, exercise, avoidance of smoking, health and physical activity. Nurses have been playing a key role in the management of single and various risk factors for CAD for more than four decades, including high blood pressure, diabetes, smoke and lipid control.

4.2 Nursing Problem 2:

4.2.1 Nursing Assessment:

Careful blood pressure monitoring at regularly scheduled periods may be included in the care review. Blood pressure is tested to assess safety and the identification of increases in blood pressure while the patient is taking antihypertensive drugs. A complete history of signs and symptoms suggesting target organ injury should be collected. The following should be given. Be mindful of the apical and peripheral pulses pace (Parry & Grant, 2016).

4.2.2 Nursing Intervention:

The goal of nursing is to minimised and monitor blood pressure without side consequences or excessive costs.

  • Encourage patients to visit a dietitian to create a plan to improve their absorption of foods or to reduce weight.
  • Promote salt and fat restrictions
  • Enhance fruit and vegetable eating.
  • Perform physical exercise on a daily basis.
  • Counsel patients to restrict their use of alcohol and tobacco control.
  • Help the patient to develop and adopt a suitable exercise scheme.

4.2.3 Role of RN and Medical Management:

In the last 50 years, the role of the nurse in improving control of hypertension has improved and complemented and augmented that of the specialist. The role of the healthcare providers has begun with the measurement and control of blood pressure (BP) and patient education.

The role of nurses and nurses in managing hypertension now includes (1) detecting, referring and monitoring; (2) diagnostics and medication management; (3) patient education, counselling and capacity building; (4) care coordination, (5) care management in the hospital or the office; (6) health management in the population; and (7) the measuring and quality impairment of hypertension (Ossenberg et al., 2019).

The multidisciplinary, patient-orientated team is a key component of effective care models that improve treatment outcomes and reduce ratios. In addition to clinical positions, nurses conduct clinical and community based trials that expand the disparity in the consistency of hypertension and racial inequalities through a systematic review and implementation of culturally sensitive treatments for hypertension outcomes and social, cultural, economic and psychological determinants.

5 Discharge Planning:

5.1 Aim for Discharge Planning and The Importance of Using a Multidisciplinary Approach:

Discharge planning is an interdisciplinary approach to service sustainability, including defining, assessing, developing priorities, organizing, initiating, managing and reviewing procedures. The system of discharge planning is defined as: (1) informal (ordinary) discharge plan and (2) structured (specialized, organized) discharge planning. Effectual discharge plan ensures the quality of health care; it's referred to as "critical link between services rendered at the hospitals by the patient and care given after discharge at the community." Many studies have found that discharge readiness can improve patient satisfaction. Some studies have seen a shorter hospital stay and a shorter hospital readmission, but there has been no indication that healthcare expenses have been lowered (Anderson et al., 2016).

The literature review reveals that a hospital offends patients with insufficient preparation, bad training, insufficient knowledge, lack of cooperation among health care team members, and inappropriate contact between the hospital and the community. Skilled hospitallers have long-standing attempts to address the continued care needs of hospital-dischived patients both in order to ensure that the patient performs at the highest pace and to facilitate the smooth transition from hospital to home or other chronic health facility. Discharge preparation has been developed, often considered an essential way of improving the standard of treatment and solving problems after discharge.

5.2 Role of the Registered Nurse and Team Work:

A research project has been undertaken to objectively investigate and assess the factors that hindered or facilitated decision-making for discharge preparation processes for people moving home from an acute hospital in London in an interdisciplinary / multidisciplinary setting. It was achieved by evaluations, casual interviews and focus groups in the two wards and the recovery committee assisted by the discharge. Data have been analysed and a conceptual structure developed that illustrates the core factors: leadership, team work and collaboration, the actions, emotions and resources involved, including environmental and human capital (Cashing et al,. 2017).

A further review of the data showed the value for decisions on discharge preparation to be taken by a management that was a nerve centre for the pivoting of the details, orchestration and representation of the team, and ensure successful performance. All the relevant considerations were team activity, focused on collaboration, embracing obligations, tasks and boundaries. However, these issues are scarcely explored and little services have to be developed, and the study demonstrates that strong teamwork and leadership are important to the progress of successful discharge preparation (Wilson et al., 2020).

The healthcare staff currently responsible for managing the discharge planning process gave several perspectives on the new discharge planning process. Many participants found the new discharge initiative to be a preliminary solution. No formal and guidelines-based discharge preparation procedure was decided to be essential for promoting needless hospital readmission discharge scheduling processes. As a policy guidance for medical practitioners to follow, a structured release preparation procedure is being developed in the UK, the US and Australia (DeLaune et al,. 2019).

6 Conclusion on Mr. Ian Dury Case Study

A cohesive team of people has long found the quality of healthcare to be successful. Patients develop more eyes and ears, insights into multiple information sources and a greater range of abilities. Most have thus been used as a benchmark for high quality care by team care. Despite its appeal, team care remains a source of uncertainty and cynicism, especially in the primary care community. This study shows that modifiable risk factors such as hypertension affect CAD patients more and more. The study provides appreciated insight, however, that nurses have provided positive evidence-based care strategies for hospitalized CAD patients, which substantially improved the risk factors for coronary artery disease of the patients.

In order to define activities which can reduce hospitalization complications for heart failure, the cardiologist has an important role. We observed in various contexts that heart failure hospitalization is a critical public health issue. The multidisciplinary approach to the application of scientifically proven good practises will reduce the risk of hospitalization. These procedures should be applied in hospitals, which have shown to minimised hospital admissions.

Education and support programmes to help patients improve risky behaviour or become better self-manager are expanding, improving outcomes for a variety of chronic diseases. There are also increasing evidence. Instead of merely acquiring knowledge, successful therapies aim to improve expertise and actively strive to increase patients' trust and faith in treating their illness instead of promoting dependency. Many physicians do not have the ability or time to consult on behaviour modification or to support themselves.

7 Sources for Mr. Ian Dury Case Study

Anderson, C., Moxham, L., & Broadbent, M. (2016). Providing support to nursing students in the clinical environment: a nursing standard requirement. Contemporary Nurse52(5), 636-642.

Cashing, A., Heartfield, M., Bryce, J., Devey, L., Buckley, T., Cox, D., ... & Fisher, M. (2017). Standards for practice for registered nurses in Australia. Collegian24(3), 255-266.

DeLaune, S. C., McTier, L., Tollefson, J., Lawrence, J., & Ladner, P. K. (2019). Fundamentals of Nursing: Australia & NZ Edition 2e. Cengage AU.

Halcomb, E., Stephens, M., Bryce, J., Foley, E., & Ashley, C. (2016). Nursing competency standards in primary health care: an integrative review. Journal of clinical nursing25(9-10), 1193-1205.

Ossenberg, C., Mitchell, M., & Henderson, A. (2019). Adoption of new practice standards in nursing: Revalidation of a tool to measure performance using the Australian registered nurse standards for practice. Collegian.

Parry, Y., & Grant, J. (2016). Nursing in Australia. Understanding the Australian Health Care System, 245-255.

Wilson, N., Lewis, P., Hunt, L., & Whitehead, L. (2020). Nursing in Australia: Nurse Education, Divisions, and Professional Standards.

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