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Table of Contents
Fundamentals of Care:
Fundamentals of Care - Relational
Fundamentals of Care - Physical
Psychosocial fundamentals of care.
The current assignment will focus on strategies to be applied to develop therapeutic relationship by nurses with the patients. It also includes planning of supports needed for comforting and enhancing communication of the patient in the given case study- the case study of Mr. John Brown.
Importance of nurse-patient relationship
Developing effective and trustworthy relationship with the patients is of utmost important. It can be considered as rapport establishment that helps the nurses to understand feelings of the patients and the communication process is accelerated as well. As nurse-patient relationship improves the process of connecting with the patients the patient care outcome enhances.
Strategies to develop therapeutic relationship
The most important and widely used strategies used for developing therapeutic relationship with the clients are showing empathy, allowing open communication, maintaining confidentiality and keeping congruence between said and performed tasks.
It is ability that nurses are required to be incorporate into their role through which the situation of the patients can be understood better along with their feelings and perspectives. It helps in deeper understanding of the patient’s suffering based on which more personalized care can be provided by the nurses to the clients as well. As mentioned by Berman et al., (2014), the actions of the nurses will be embedded with understanding of the patient’s individual needs through effective communication and collaboration with the patients. In this strategy nurses give emphasis on the feeling components and actual needs of the patients that lead to better patient outcomes.
Allowing open communication
It has been identified by Martini, Nath & Bartholomew (2018), that better patient outcome can be elicited with the help of effective communication. The basis of nurse-patient therapeutic relationship is, understanding the preferences of the patients and their situation. If there is a lack of communication between the nurses and the patients, it is likely that error may occur in the process of providing care services to the patients. For instance, after conducting medical assessments during the course of admission of the patients might encourage changes in the patient care planning or treatment processes.
Patients rely on the nurses that the shared information with them will be kept confidential and would not be used unless it is purported for the better patient outcome. Therefore, it becomes a responsibility for the nurses to increase their capacity to make the information confidential. Breaching the privacy of information shared may lead to greater patient dissatisfaction (Pawłowski et al., 2017).
Keeping congruence between said and performed tasks
Nurses are responsible for keeping their words to the patients as promised. It is required to be remembered that the basis of relationship between nurses and patients is trust (LeMone et al., 2017). If the nurses fail to perform tasks as promised to the patients or letting them know if they are unable to perform that particular task, nurse-patient relationship my get affected.
Pathophysiological and anatomical understanding
It is evident that the pathophysiology of Bronchial Asthma diffuses airway inflammation that may ultimately result in narrowing of the airways which is reversible. As per the views of LeMone et al., (2017), at the activated mast cells releases different chemicals namely the mediators. These chemicals result in the inflammatory responses. Because of this perpetuation blood flow increases and vasoconstriction may take place along with leakage of fluid from vasculature which attracts the white cells in that particular area leading to bronchoconstriction. Allergens results in acute bronchoconstriction with the help of mediators released from the mast cells. This type of Asthma may become persistent with time. As a result the inflammation may increase may lead to limiting airflows.
The current context of the study would provide understanding on the role of the nurses in providing care to Mr. John Brown supported with the above stated pathophysiology of the client medical condition.
Different therapeutic support can be provided to the patients having this type of Asthma where a nurse plays the role of comforter to the patient in focus. The primary responsibility of the nurses include assessing the history of the patient, assessing Mr. John’s respiratory status, assessing the medications and designing pharmacotherapy and fluid therapy.
The muscles around the airways get tighten at the time of attack. The airway linings also swell as a result of this. The amount of secretion of the mucus increases which might led to blockage of the lungs and air tubes. As a result of this air can be trapped, this causes breathing difficulties. The airways becomes inflamed and narrower which can be called asthma trigger.
Comforting the patient
Nurses are responsible for comforting the patient of Bronchial Asthma in the best possible way so that the patient can relax and be in a comfortable position. Collaboration between the nurse and John is required to be established as effective therapeutic relationship will lead to better understanding of the current needs of the patient so that he can be comforted. As per the views of Daly, Speedy & Jackson (2017), lack of awareness regarding the treatment course may lead the patient to feel uncertain about the progress. Nurses are responsible for conveying accurate information regarding the diagnosis, prognosis and treatment of the issues Mr. John is facing.
It is also required to be noted that the therapeutic process is required to be accepted and appreciated by the client to get the best out of it. If Mr. John is not accepting any particular type of therapy, it might not comfort his pain. In this case two types of therapies can be applied for comforting John; Pharmacotherapy that is monitoring the prescribed medication for the current patient and fluid therapy such as administering fluids if the patient is detected to be dehydrated (Berman et al., 2014). In doing so the nurse appointed for assisting Mr. John is required to ensure adherence of the patient in those therapies, preventive measures and appointment follow up is required. It can be stated that the patient may feel nervous if the application process and action plan is not clear to him. Therefore, it is required for the nurse to ensure that the patient is comfortable with the prescribed therapy.
The responsibilities of the nurse in the context of the treatment of the current patient are to make the environment of the patient comfortable so that the recovery process becomes effective. The environmental control is required for managing the triggers. This may include keeping the house clean and avoiding pets so that allergens do not affect the health of the current patient (Metwally et al., 2019). The bedding of the patient is required to be kept clean and the mattresses and pillows and required to be covered with dust proof equipments. The humidity of the room the patient is staying that is required to be kept in low humidity.
Nurses are also required to monitor the function of the lungs of the patient. In order to comfort the patient the nurse is required to use a peak flow meter in order to gauge the function of the lung. Additionally, the breath sounds are required to be listened to and pulse oxymetry is required to be conducted. The current patient can be comforted through ensuring proper oxygen supply to the lungs (Mudd & Silbert-Flagg, 2016). Therefore, in order to comfort John, the nurse is required to evaluate the respiratory depth and rates and sound of breathing. The body position of the client is required to be changed for enhancing the sense of comfort within the client.
It has been identified earlier that how the communication between the patient and the nurses is highly required to achieve the desired patient outcomes (Reid-Searl, Dwyer & Moxham, 2013). One of the major needs of the asthma patients is that psychosocial needs such as communication is difficult to be met as it is required to be conscious for avoiding any triggering situation. However, in order to accelerate the rate of recovery, the client is required social support and connection which can be achieved through effective communication. Mr. John can be encouraged to communicate with his family members, healthcare providers as well as to the acquaintance.
Therefore, some strategies may be applied by the nurse for improving the health outcomes of the patient through enhancing communicability. The nurses are required to put the patient first. This can be achieved through giving priority to the the patient is sharing. Better connection can be established with the client through active listening to the patients concerns. Active listening includes paying attention on the patients concerns and rephrasing or echoing back what the patient is talking about. This also provides the patient non-verbal cues that may enhance or suppress the patient communicability. Maintaining eye contact at the time of communicating with the client is another important practice to be followed by the nurses. As mentioned earlier, effective communication increases satisfaction level of the patient that improves patient outcome.
Open communication can be considered as one of the most essential skills that nurses are required to possess while working in their role because it is a way through which the patients share their feelings, thoughts, grievances or others tht highly modifies the way an individual patient is handled (Tollefson, 2018). Spending reasonable time communicating with the client is highly required for establishing trustworthy and effective relationship. Patients are required to be encouraged for initiating communication with the family members, friends and others with adequate measures for avoiding the risk associated with any trigger.
This is needed to be conducted by the nurses through providing health education to the patient. It may not be possible for the nurse to comfort the patient 24/7. Therefore, through health education, nurses may prepare the family members of John about different aspects associated with Asthma, purposes due to which John is required to be take medications, possible triggers which are required to be avoided effectively and educating about the appropriate inhalation technique.
A nursing care plan surrounding comforting and meeting communication needs of a client namely Mr. John Brown is performed in the current study. Strategies of nursing practices have been incorporated in the current study to conduct the care plan.
Mr. John Brown’s age is 68 and he lives independently with his family and recently retired from the police force. He has been admitted to the hospital for intolerance to activity as a result of decreased oxygenation. He is also experiencing most productive cough. He has been diagnosed with bronchial asthma and has diabetes. He is required to be provided care.
Nursing is a collection of autonomous and collaborative care for patients of all the ages with different health issues. Nursing helps in promoting health of the patients and increasing wellbeing. Further the nursing care aims at preventing illness to occur further. Patients are required to be understood and proper health services are required to be provided where nurses play an important role in supporting the patients that are disabled, aged or dying.
It has been identified that the patient is required to be provided with physical comfort such as pain reduction therapies and others. In doing so, it has been incorporated in the planning that the physical environment of the patient would be maintained and cleaned along with taking avoidance measurement for the triggers (Levett-Jones et al., 2018). Along with this, psychosocial needs for communication has been planned to be enhanced with the help of implementing communication strategies.
It can be recommended to the patient to take adequate measure before entering into social gathering so that the triggers can be avoided. It can also be suggested to the client to engage in communication with family members and the other associates so that his communicability improves.
It can be concluded from the current study that Mr. John Brown has the bronchial asthma and require hospital care service for recovery of the current condition. It has been identified in the current study that nurses are required to apply four main strategies so that patient-nurse relationship can be developed effectively. It is required to be focused on so that the patient can meet his physiological and psychological needs. Empathy, confidentiality, open-communication and congruence in behaviour are required to be performed so that relationship between the nurse and the patient is enhanced. The current study has emphasised upon the pain management and comfort and related responsibilities of the nurse with it and the requirements for meeting the psychosocial needs of the patient.
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Metwally, S. M. I., El-Dakhakhny, A. M., Amer, O. T., & Bassam, S. E. A. (2019). Effect of an Educational Training Program on Quality of Nursing Care Provided to Children having Asthma. Zagazig Nursing Journal, 15(1), 43-46.
Mudd, S. S., & Silbert-Flagg, J. (2016). Implementing the flipped classroom to enhance nurse practitioner clinical decision-making in the care of the pediatric asthma patient. Nursing Education Perspectives, 37(6), 352-353.
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