Patient care is referred to the tasks of preventing, treating and managing of the disorders or illness and preserving mental and physical wellbeing of the patient through providing health services by the professionals. Nursing intervention can be considered as a task more than just delivering care. It is required to consider the presenting illness of the patients along with his illness history so that an integrated care plan can be developed. The patient care program is also required to be shared and involvement of the family and community is highly crucial to help the patient live a quality life. Moreover, proper communication and collaboration of the healthcare professionals is also required to deliver quality care.
The current study will discuss about the case of Mr T and plan a nursing intervention based on clinical judgment and knowledge so that the patient outcomes can be improved. In doing so, evidence based, up-to-date. The patient name is not used here in order to maintain confidentiality. The study will thorough discuss the health issue the patient is suffering from, its impact upon his mental, physical and social health and will plan an intervention about how the condition of the patient can be addressed. The intervention will integrate individual patient, his family members and community.
Mr T aged 65 is currently diagnosed with Category 4 pressure ulcer to his left buttock of 6cm X 4cm measurement. As mentioned by Rivers et al. (2018), pressure ulcers are likely to lower the quality of life by affecting individual’s physical, psychological and social health. As per the International Classification of Disease, pressure ulcer is a condition (decubitus pressogenes) of bedsore where, localized tissue can be damaged due to friction or pressure of skin or underlying tissue. Pressure ulcer is responsible for disrupting the physical comfort of the patient along with his positioning. As a result patient’s like Mr T might be forced to sit or lay on only one side that is physically distressing. Additionally, it has also been identified that the patient has a history of stroke after which the mobility of the patient has reduced. Therefore, it can be stated that the current patient is suffering from physical distress that might affect the overall wellbeing of the patient and impact upon social and mental health (Wang, Chow & Chan, 2017). The everyday activities and performance of the patient is difficult and infections are taking time to heal.
As the patient face difficulties in even performing the daily activities, it is likely to impact the mental health of the patient through affecting his self image. Patient may withdraw from others and undergo mental distress. Patient may not find pleasure in the activities once were pleasurable. This affects the overall psychological health of the patient. As the patient no longer finds pleasure on pleasurable activities such as socializing, gardening and others, it might impact negatively on the social wellbeing of the patient (Treadaway et al., 2019). The lack of physical mobility also contributes to non-engagement of the patient with social groups leads to isolation.
Nursing models are the structures or frameworks that are developed based on theories and concepts that provide evidences of effective implementation of the care plan. As mentioned by Bertoldi & Roat (2019), nursing models also provide the nurses with opportunity for achieving uniformity and seamless care. Roper Logan Tierney Model is one such model that outlines 12 nursing activities in total through which the patient can be offered, environmentally safe care, effective communication, care for breathing effectiveness, regular eating and drinking activities, self care such as dressing and bathing, controlling the body temperature, helping the patient mobilize, playing, working, sleeping and others so that overall welling of the patient can be achieved. Another model of nursing that can be mentioned here is Total Patient Care Model (Mudallal et al., 2017). This model suggests addressing each of the patient needs offering the patient a total care of his requirements until the shift of the nurse ends. Using this model of care, nurses can effectively meet the individual needs even at the end of the medical needs of the patient. Therefore, it can be stated that both of the models are helpful in providing care to the patient considering the overall needs of the patient and they are put first at the top intervention plan.
The nursing assessment is conducted fist for Mr T so that the care requirements can be effectively designed as per the health needs of the patient. As mentioned by Galvão et al. (2017), stage 4 pressure ulcer can be characterized by extensive destruction of the tissue. Additionally, tissue necrosis and damage to muscle, bone structure can take place. The patient may also develop tunneling or undermining. The first assessment task for the nurse for Mr T has been assessed for some specific risk factors. As influenced by Moyaert et al. (2017), the client’s general skin condition has been assessed. The client’s nutritional status has also been assessed along with his weight, serum and albumin levels and so on. In addition to this, the past medical history of the patient has also been identified. It has been identified that the patient had a stroke in the same year earlier with an effect upon his mobility and increased weakness is resulted. The inability breath and swallow properly has led the patient lower intake of food and his BMI is now 18.
A skin admission has been conducted after the patient has been referred and assessment of daily increasing number of risk factors has been conducted. There is no history of radiation therapy identified from the given information as assessed. The fecal and urinary continence have also been examined by the nurse and no abnormalities have been found. The mobility range of the patient has also been investigated where a significant loss of physical mobility has been identified. In doing so, the shift weight at the time of shifting, turning over the bed, moving from bed to chair are taken under consideration. All of these activities have been observed to be impaired in the current case. As suggested by Brill et al. (2018), it is also an important factor to assess the amount of pressure exerted laterally and friction of the skin of Mr T. It is due to the significance of patient’s skin comfort which is highly required to be optimized. As the patient has refused to use the pressure relieving cushion and hospital bed, it is required to assess the cushion, chair or other equipments patient is using.
The level of pain patient is experiencing is also assessed by the nurse while changing the dressing and other procedures. The condition of the wound has also been assessed by the nurse where it is checked if there is any necrotic tissue, assessment of oxygenation, tissue viability are also conducted through examining the colour of the wound. The level of infection has been assessed through examining the odor of the wound. As the patient is aged over 60, the viability of bones, joints and muscle has also been assessed by the nurse (Keene et al., 2016). The size and expansion of the ulcer has also been tested.
While planning intervention for the patient, important factors such as previous history of stroke will be considered. Additionally, the nutrition of the patient will also be prioritized, mobility of the patient has been considered, and enhancement of social interaction and others have been considered for the intervention planning of the current patient. These can be considered as the objectives of the care plan developed for Mr T.
The care plan has been developed based on the needs of the patient. It has been identified that the patient had an issue with mobility due to the occurrence of stroke previously. Based on this, it can be stated that the patient needed a care plan that helps the patient to become mobile (Minteer et al., 2020). It has also been identified that the patient has a requirement for dietary change as the BMI score is very poor along with increased malnutrition. Therefore, through consulting with dietitian and other professionals, proper nutritional intervention has been taken under consideration. As suggested by Nishioka et al. (2017), patients with the history of stroke may demonstrate decline in nutrition as the difficulties in swallowing may lead difficulties in eating.
The patient is also not familiar and not accustomed with pureed food. Therefore, while developing diet plan the nurse have informed the dietitian to incorporate necessary changes into the diet plan. In addition to this, it can be observed that the patient has dysphagia. Therefore, allowing the patient to make swallowing easier, the nurse planned for appropriate positioning of the patient so that the food can pass on to stomach successfully. It is also planned to maintain the hydration of the patient as swallowing water was also difficult for the patient. A regular inspection of the condition has been conducted along with monitoring the signs and symptoms of malnutrition or dehydration. As literature suggests, patient with pressure ulcer may lose a big amount of protein even after taking adequate amount through food due to which the patient may require 4000 kcal per day (Basiri et al., 2020). Therefore, the albumin level is regularly checked and if abnormalities detected the patient is referred to the respective physician of the current patient.
The care plan also included adequate level of mobility of the patient so that the sore does not deepen or spread. The patient and his family members have been empowered for understanding the requirements for the patient’s daily care. The nurse has also educated the patient and his primary carer or his wife that why the hospital provided bed, pressure relieving cushion and other pressure relieving equipments are useful for enhancing the health condition of the patient. Physiotherapy has been planned for the patient for increasing mobility (de Vries et al., 2016). In order to relieve the patient from psychological stress, the nurse performed the role of an interactive listener so that the patient does not feel isolated. After slight improvement of mobility through physiotherapy, the patient has been encouraged to involve in social gathering. The community members have been informed about the condition and requirements of the patient and educated how they can help the patient to engage with the social groups.
The community members have also been informed about the adverse effects of trauma due to social isolation and discrimination. Therefore, as suggested by Boivin et al. (2028), community members have been involved in integrating care plan for the current patient. The nurse s also supported the patient and his family members to overcome the distress due to the illness of the patient.
Respect, compassion and dignity are the core principles of patient centered care. As per the Australian Commission on Safety and Quality in Healthcare (2020), the needs and preferences of the patient are required to be respected. For instance, the current patient was mentally distressed and was waiting for children to come and see him, the patient taken an active step to communicate the same with the children of the patient so that it can be made possible. The patient has been encouraged to engage with the family members and residents in a constructive manner. The patient does not like pureed food and is unable to swallow properly. In this context, the nurse has respected the choice of the patient and asked for preferences and planned the intervention accordingly. The aged care standards in Australia include maintaining dignity of risk so that the further injury can be prevented. Apart from that, the respect to the patient’s choice and dignity has been protected by considering assessing daily requirements.
The cultural values of the client have also been respected and inclusive approach has been taken towards the care plan of the consumer as well. For instance, the community members have been involved in the care plan shared the information regarding how the patient can be engaged into the social events. The client’s preference upon the environmental noise control has also been considered by the nurse. Along with this, due to the changed cognition and impaired perception of the patient, a situation of mental distress has taken place. The nurse was in constant efforts for enhancing the mood of the patient by making him more engaged with his pleasurable activities such as gardening after through assessment of the physical health condition.
Nurse has demonstrated adequate empathy as this may significantly contribute to the patient well-being. As observed by Lindsay et al. (2017), the empathic stance of the nurse is highly effective in reducing the mental stress associated with pain symptoms in the case of pressure ulcer patients. Additionally, it can be stated that the patient has demonstrated a significant change in his mobility and interaction pattern with the family and community members. It has also been observed that the patient is able to identify the usefulness of the pressure relieving equipments though the patient was not forced to use these equipments without his consent. While assisting the patient in his daily self care, the patient was always asked before any activities done by the nurse (Oxelmark et al., 2018). Though the patient was not ready to take nursing care at home, after several attempts for educating the patient for need of his care, the patient agreed to follow the care instructions.
Adequate response from the patient could be observed; for instance, the patient actively asked for help when he needed and did not show unnecessary dependence on the nurse. This can be a strong evidence of accustomedness of the patient with the care plan.
Evaluation is the final step towards completing the nursing care plan successfully. As mentioned by Oxelmark et al. (2018), after completion of the nursing plan implementation, it is important to identify if the nursing plan was successful in improving the condition of the patient. It has been identified that nurses face challenges in providing timely, cost effective, competent and complex care to the patient. In the current context, the evaluation process has included the determination of effectiveness of care, making necessary changes in the plan and ensuring favorable outcomes for the patients. With the nursing diagnosis impaired skin integrity relating to the physical mobility, the outcomes expected for the current patient was recovery from the pressure sore.
Considering the wound healing examination after the end of intervention, it has been observed that red and healthy tissues were observed. Evaluative data has directly been collected from the patient where the patient has been asked to share his personal experience during the care plan implementation. Clients feeling have been effectively discussed and if any negative psychological impact identified, necessary modifications have been incorporated. One of the main objectives of the current nursing plan was to make the patient able to intake nutritious food without disrespecting his choices (Jonsson et al., 2020). At the end of the nursing intervention, it has been identified that the client is able to swallow solid nutritional food with less difficulty. However, improvement in breathing capacity and positioning of the client is required to be changed more frequently as the client is able to move one place to other unlike the previous scenario.
Reports on metabolism and albumin level have also been assessed to identify the physical impact of the nursing intervention upon the patient. It has been identified that the patient has the BMI level of 18.5. As mentioned by Kang, Kim & Kim (2016), the serum albumin level gradually decreases with age. However, the patient has been assessed for albumin level and results suggest 3.9 g/dL albumin level. Therefore, a significant impact upon nutrition and metabolism has been observed. The assessments considered earlier have been performed repeatedly to identify if the patient is showing significant progress towards recovery. In addition to this, Mr T has joined a weekly community gathering where he shares information to the community members about gardening and related other activities. As discussed with the client, it has been identified that this community gathering has helped the client to enjoy gardening which he abandoned for immobility after the occurrence of stroke.
The evaluation process also involved the family members where the patient’s wife has been asked if any change is observed by her. It has been reported by Mr T’s wife that the level of dependence of the patient upon family members have reduced.
In conclusion, it can be stated that a nursing intervention plan has been developed by the patient presenting illness of stage 4 pressure ulcer. This condition has taken place after the occurrence of stroke in the same year. The right side of the patient has become weak and immobile. Though pressure relieving equipments have been provided by the hospital, Mr T refused to use them. There was also a difficulty in swallowing of food which led the patient demonstrate gradual decline in the health and wellbeing. The nursing care plan has considered a primary assessment of the mental, physical and social condition of the client along with health history. The family members such as the patient’s wife, children and the community members have been involved in the care plan. The objective was to help the patient improve in psychological, physical and social sphere of life.
Restoration of the patient’s mobility and nutrition has been prioritized in the care plan for the current patient. The patient has been care for following the Roper Logan Tierney Model and Total Patient Care Model. The patient’s allover needs and requirements have been prioritized. The nurse also maintained respect and dignity for the patient by respecting his choices such as choices regarding food intake and asked for consent before involving any care activity. The patient has also been treated compassionately as the current health condition highly affected the patient mentally reducing the pleasure on the activities enjoyed earlier such as gardening. In addition to this, the intervention plan has also been evaluated. In order to evaluate the care plan, previously set objectives have been compared with the patient outcome. The BMI of the patient is optimized, the healthy and red tissue can be visible at the wounded place and the patient has engaged with the community on a weekly basis fulfilling his social needs.
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