Acute Care Nursing

Fundamentals of Care

Fundamentals of Care - Relational:

In nursing, building up a relationship is taken as a basic required element while taking care of the patients. The development of therapeutic relationships can help in encouraging the patients in the duration of their treatments or therapies or live their life in a better way. It is important as the patients who are suffering from health issues are provided with a safe and open environment so that they can share their thoughts, ideas can question without being judged. The establishment of a therapeutic nurse-patient relationship is significant because of its key role in the recovery rates of the patients. For building up such a relationship, the key is – trust (Shen et al., 2019). According to Thibeault (2016), the nurse-patient relationship is important because it enables the patients to shift from their stressed and confused state that they are facing due to their sufferings, to a better, improved and healthier state of life. This approach is used by the nurses to unfold the feeling of their patients.

  • There are many strategies to establish a therapeutic connection with patients. The following section is discussing the four major strategies:

Therapeutic listening: According to Kornhaber et al. (2016), listening helps a lot in healing that further creates the conditions for the patient to heal and recovery at a faster rate. In this way, it is believed that the nurses are respecting their patients by listening to their feeling and thoughts and making them feel responsible for their health recoveries and other health-related decisions.

Response to patients’ unmet needs: According to Kornhaber et al. (2016), a clear and positive response towards the patients’ emotions, either positive or negative, encouraging either verbal or non-verbal communications with the patients can help in building up a powerful therapeutic relationship with the patient. Moreover, meeting the exact needs of the patients can also establish a good relationship.

Non-judgment of patients: According to van Belle et al. (2020), in therapeutic relationships, there should be no use of judgmental statements being said for the patients. The nurses should keep their feelings in check to prevent the judgment of patients on grounds of religions or caste.

Patient-centered care: According to Kornhaber et al. (2016), patient-centered care is very important. This develops trust, compassion, empathy, and genuineness, these help in establishing a strong therapeutic relationship. This is very useful for patients who recovered from poor mental health.

Fundamentals of Care - Physical:

A therapeutic relationship is an essential tool for nurses. It is believed that the nurse-patient relationship improves the quality of the patients’ well-being as well as helps in maintaining the level of good health (Mirhaghi et al., 2017). As Mr. John Brown is diagnosed with asthma so the role of the nurse is to manage the oxygen supplies for the patient, safety standards in his room to prevent infections, risk assessments including the monitoring of the lung functions and after obtaining the history of any allergic reactions to medications, manage the use of medications like anti-inflammatory and bronchodilators for the patient. According to Scullion (2018), the nurses should possess the inhaler knowledge because inhalers are very important for asthma patients as they are used to deliver the drugs directly to the lungs of the patients without any serious side effects. Most of the common drugs used in treatments are delivered in the same way. The nurse has to regularly monitor the patient’s inhaler technique because a wrong habit or poor handling technique can result in health issues like an increase in complications, at later stages.

Sometimes, few patients do not inhale forcibly or deeply that finally results in insufficient drug delivery inside the body, reduced positive results, and an ultimate increase in complications.

Since Mr. John Brown has a blood pressure of 145/90mmHg that is slightly high because for old people the normal blood pressure should be less than 140/90mmHg. It should be ensured that it does not increase above the defined values and should also be regularly checked for proper risk assessments. For quality health care patient safety is very important (Lawati et al., 2018).

The body temperature of the patient was found to be 37.5°C instead; it should be lower than 36.2°C for an older adult. As the patient had a moist productive cough so it is a prime role of the nurse not to use the drugs for which the patient is allergic, supply the patient with plenty of fluids, steamy shower, and let him rest as much as he can. The vital signs should be checked regularly for proper risk assessments. As the bowel was also not open for three days so the role of the nurse here is to provide the patients with lubiprostone or other drugs and supply fiber-rich food to the patient to reduce the chances of infections and complications. According to Haghighatdoost et al. (2018), high water intake has a positive impact on health as it decreases depression and anxiety. Moreover, the patient should take 8 glasses of fluids (like water, soups, juices) per day and limit the intake of caffeine drinks to a maximum of two per day. To keep his diabetes in control the administration of metformin should be continued. As Mr. John Brown had a hip replacement three days ago so the body posture should be proper and bending over or putting stress on the back portion of the hip should be avoided, all this should be monitored with every visit of the nurse. According to Begic et al. (2017), cough is a symptom of disease as well as a defense reaction. Depending upon the duration, cough can be of many categories like chronic or acute, discreet or strong, persistent or recurrent, this all because of the changes in the temperature differences or changes in the positions of the body. Depending upon serum production, there are two types, one is productive and the other is non-productive. A productive cough produces serum, whereas non-productive cough does not produce serum. Cough is one of the most common health issues for which the patients seek doctors' health. As the patient, in this case, Mr. John Brown is having a moist productive cough, it can be treated with the use of secretolytic agents, water steam inhalation, expectorants, chest physiotherapy, exercises or help of breathing devices can also play an important role, all these measures can play a keep role in controlling the chances of infection development as well as complications. According to Begic et al. (2017), in acute bronchitis productive cough produces serum that can be detected by conducting an X-ray diagnostic of the respiratory system.

Some other risk assessments include regular monitoring of breath sounds, respiratory status, oxygen saturation levels, and assessment of other vital signs routinely. To minimize the complications asthma triggers should be kept under control like the exposure of the patient to tobacco, smoke, dust particles, pollen, prevention of viral infections, and allergy towards the use of antibiotics (Quirt et al., 2018). Further, as Mr. John Brown has a cat also so if the family visits with the cat to meet the patient it should be strictly mentioned not to allow the cat in his room or near him for the patient’s safety of health.

Psychosocial fundamentals of care:

The psychosocial fundamentals of care include privacy, dignity, respect, communication emotional wellbeing, and a few more. A nurse plays a major role in providing this aspect of care to the patient. According to van Belle et al. (2020), effective patient-centered care is important in nursing and found that nurses give importance to patient’s privacy like covering the patient with blankets or towels while giving the patient bath or cleaning and helping the patient to get dressed up. Most nurses provide privacy to the patient whenever he/she is in a room with multiple beds by providing closed curtains if the patient wants to change his/her clothing or dressings. Similarly, in this case, as the patient is an old man, he should be provided with his private space as well whenever he wishes for the same. If he wants to clean his private parts on his own, then he should be allowed thereby respecting his decision. Moreover, if he wants private time with his family members when he is visited by them, then the nurse should give him the requested private space with his family so that he can have personal discussions with his family. If he wants to go outside his room then it is the responsibility of the nurse to cover his body. If he doesn’t want to discuss his test results in front of his visitors, then this decision should also be respected and accepted.

According to Shen et al. (2019), a patient has trust in the nurses believing that they will not disclose his private discussions and privacy and trust are the two important factors for the nurse-patient relationship. This also affects the mental health of the patient. In this case, Mr. John Brown’s private discussions with his family or any other health officer should not be disclosed to others. It is a moral responsibility of his nurse to keep any information about the patient to be kept private without getting involved in it. Moreover, privacy is every patient’s right (Abedi et al., 2017). This further ensures a safe environment for the patient. This right gives power to the patient to decide who, how, when and to what extend others can access his health information. It is the role of the nurse to ensure that the patient’s right to privacy is not violated because the patient’s reports contain private information like his address, information on personal relationships, and other confidential information.

All the records and information regarding the patient’s treatment are to be kept confidential by the staff. As the patient trusts the health care staff while providing his private information to them, hence it becomes their duty to respect the patient’s trust. There is no need to keep the record of what the patient is talking about on his phone calls to his family members, friends, or relatives.

ISBAR Handover

ISBAR stands for introduction, situation, background, assessment, recommendation. It is a tool that helps to organize the information into the different important categories elements while transferring it from one person to another. A standardized transfer of patient information regarding his current tests, medical history, or recommendations in form of ISBAR from one doctor to another increases the quality and safety of health care (Ramasubbu et al., 2017). 

  • Introduction:

The patient's name is Mr. John Brown. He is a male. His age is 68 years old. His date of birth is 01/01/1952. The patient unit record number is 012345.

  • Situation:

His vital signs are temperature 37.5°C, pulse 96beats per minute, respiratory rate of the patient is 22 cycles per minute, blood pressure is 145/90mmHg, peripheral capillary oxygen saturation level is 96%. The patient is administered oxygen as 4L oxygen via nasal specs. The patient has had not his bowel opened for three days after the surgery. He has been diagnosed with bronchial asthma and has been ordered to administer or take 2.5mg of salbutamol with 2 - 4hourly as per requirement.

  • Background:

He was admitted yesterday with intolerance to activity due to decreased oxygenation and was experiencing a moist productive cough. He has a case history of asthma, hypertension, type II diabetes mellitus (T2DM), and had a right hip replacement three years ago.

His medications include metformin 500mgs twice daily.

  • Assessment:

All vital signs have been checked, all are normal except for his blood pressure that is slightly increased with slightly high body temperature. His diabetes and hypertension are under control. An X-ray was conducted and results showed an increase in the working fitness of his respiratory system. He has asthma and moist cough problems and he is improving.

  • Recommendation:

Regular checkup of vital signs recommended with continued administration of 2.5mg of salbutamol and metformin 500mgs as prescribed. Referral to a nutritionist and dietitian will be given to learn of a diet full of fibers, take at least eight glasses of water every day, reduce the caffeine intake as much as possible, and perform exercises for fit health or counseling sessions with a physiotherapist. A night of sound sleep and proper rest is also recommended. It is recommended to perform an X-ray again after a few days to check the progress report of the patient’s respiratory system.

References for Mr. John Brown Case Study

Abedi, G., Shojaee, J., Moosazadeh, M., Rostami, F., Nadi, A., Abedini, E., Palenik, C. J., &Askarian, M. (2017). Awareness and observance of patient rights from the perspective of Iranian patients: A systematic review and meta-analysis. Iranian Journal Of Medical Sciences42(3), 227–234. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5429490/

Begic, E., Begic, Z., Dobraca, A., &Hasanbegovic, E. (2017). Productive Cough in children and adolescents - View from primary health care system. Medical Archives (Sarajevo, Bosnia and Herzegovina)71(1), 66–68. DOI: 10.5455/medarh.2017.71.66-68

Haghighatdoost, F., Feizi, A., Esmaillzadeh, A., Rashidi-Pourfard, N., Keshteli, A. H., Roohafza, H., &Adibi, P. (2018). Drinking plain water is associated with decreased risk of depression and anxiety in adults: Results from a large cross-sectional study. World Journal Of Psychiatry8(3), 88–96. DOI: 10.5498/wjp.v8.i3.88

Kornhaber, R., Walsh, K., Duff, J., &Walker, K. (2016).Enhancing adult therapeutic interpersonal relationships in the acute health care setting: An integrative review. Journal of Multidisciplinary Healthcare, 9, 537-546. DOI: 10.2147/JMDH.S116957

Lawati, M., Dennis, S., Short, S. D., &Abdulhadi, N. N. (2018). Patient safety and safety culture in primary health care: A systematic review. BMC Family Practice19(1). DOI: 10.1186/s12875-018-0793-7

Mirhaghi, A., Sharafi, S., Bazzi, A., &Hasanzadeh, F. (2017). Therapeutic relationship: Is it still heart of nursing?.Nursing Reports, 7(1). DOI: 10.4081/nursrep.2017.6129

Molina-Mula, J., Gallo-Estrada, J., &Perelló-Campaner, C. (2017).Impact of interprofessional relationships from nurses' perspective on the decision-making capacity of patients in a clinical setting. International Journal Of Environmental Research And Public Health15(1). DOI: 10.3390/ijerph15010049

Quirt, J., Hildebrand, K. J., Mazza, J., Noya, F., & Kim, H. (2018).Asthma. Allergy, Asthma, And Clinical Immunology, 14.

DOI: 10.1186/s13223-018-0279-0

Ramasubbu, B., Stewart, E., & Spiritoso, R. (2017). Introduction of the identification, situation, background, assessment, recommendations tool to improve the quality of information transfer during medical handover in intensive care. Journal of the Intensive Care Society18(1), 17–23. DOI: 10.1177/1751143716660982

Scullion, J. (2018.The nurse practitioners' perspective on inhaler education in asthma and chronic obstructive pulmonary disease.Canadian Respiratory Journal. DOI:10.1155/2018/2525319

Shen, N., Sequeira, L., Silver, M. P., Carter-Langford, A., Strauss, J., &Wiljer, D. (2019). Patient privacy perspectives on health information exchange in a mental health context: Qualitative study. JMIR Mental Health6(11). DOI: 10.2196/13306

Thibeault, C. (2016). An interpretation of nurse-patient relationships in inpatient psychiatry: Understanding the mindful approach. Global Qualitative Nursing Research3. DOI: 10.1177/2333393616630465

van Belle, E., Giesen, J., Conroy, T., van Mierlo, M., Vermeulen, H., Huisman-de Waal, G., &Heinen, M. (2020). Exploring person-centred fundamental nursing care in hospital wards: A multi-site ethnography. Journal of Clinical Nursing29(11-12), 1933–1944. DOI: 10.1111/jocn.15024

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