Managing People with Stroke - Essay Example

MANAGING PEOPLE WITH STROKE by The of the The of the School The and where it is located The Date Managing People with Stroke The need to develop the treatment and management of long-term health conditions such as cardio vascular disorder, diabetes, dementia, cancer, and stroke is the most important challenge facing the NHS. Studies have suggested that in order to improve the care for people with long-term conditions, the initial medical practice should shift away from a reactive, disease-focused, and fragmented model of care towards a more proactive, holistic, and preventive model. People with long-term conditions are encouraged to play a central role in managing their own health. This article stands testament to that philosophy and is set to comprehend such a case in the process. The Roper Logan Tierney Model has been used to comprehend this understanding further by attending to patients with long term conditions such as stroke. The rate at which long term health conditions have affected the UK has notably decreased over the past decades. Cases such as Hypertension, CHD, and Diabetes (Type 1&2) have been on a steady decrease. However, studies have shown that this is not the case in reference to the number of stroke cases. Despite stroke mortality figures in the UK falling progressively since the late 1960s it has not been at the same rate as other long-term conditions such as cardiovascular disorder (Torbey & Selim, 2013, p. 12). This can be attributed to a number of reasons the most notable one being the lack of information about the condition, which is evident when collecting epidemiological data on stroke cases. It has been realized that in 2012, about 55% of the total number of Transient Ischaemic Attack (TIA) cases have eventually been diagnosed with stroke in the UK. Furthermore, about 83% of the number of individuals who were admitted to hospital following stroke spent their time on a stroke unit (Barnett, 1998, p. 7). Despite documented improvements in mortality and morbidity, individuals with stroke need access to effective rehabilitation services with a more holistic nursing model from the one that exists. Studies have shown that stroke rehabilitation is a multidimensional process, which is intended to assist restoration of or adaptation to the loss of physiological or psychological function when reversal of the underlying pathological process is incomplete (Alway & Cole, 2009, p. 56). Rehabilitation aims to enhance functional activities and participation in society and thus improve quality of life. In this article, a wider perspective of this phenomenon is explained using a case study on a stroke patient (Bornstein, 2009, p. 67). Stroke A stroke is the abrupt onset of paralysis, aphasia, numbness, weakness, slurred speech, difficulties with vision, and other signs caused by sudden interruption of blood flow to a specific area of the brain. The ischemic area involved determines the type of focal deficit that is seen in the patient. Studies have shown that stroke is a chief health problem in the UK. Each year, roughly 115,000 people in England, another 12,000 people in Wales, and finally 5,000 people in Northern Ireland have a first or recurrent stroke. Currently, more than 1,000,000 individuals in England are living with the effects of stroke (Fisher, 2009, p. 78). Most of them survive the first stroke but frequently have a weighty morbidity. Stroke mortality rates in the UK have been falling steadily since the late 1960s due to the development of stroke units. This was achieved after the publication of the Stroke Unit Trialists Collaboration meta-analysis of stroke unit care, and the further reorganisation of services following the advent of thrombolysis, which has resulted in further significant improvements in mortality and morbidity from stroke as documented in the National sentinel stroke audit. However, the burden of stroke may increase in the future because of the ageing population. An individual’s life style increases the risk of stroke such as high blood pressure and poor dietary tendencies are evident across the country and demographics (Wykle & Gueldner, 2011, p. 7). It is evident through medical practices on long-term health conditions that people with stroke need access to effective rehabilitation services. Stroke rehabilitation is a multifaceted process, which is intended to assist in restoration or help to live with the loss of physiological or psychological function when the setback of the underlying pathological process is incomplete. Rehabilitation targets are aimed at improving functional activities and involvement in society and the quality of life (Torbey & Selim, 2013, p. 43). Main aspects of rehabilitation care under the Roper Logan Tierney Model consist of multidisciplinary assessment, identification of functional problems and their measurement, treatment planning through objective setting, delivery of involvements, which may either effect, change or support the individual in managing persisting change and evaluation of effectiveness. Pathophysiology of Ischaemic Stroke The common understanding of ischaemic stroke is lack of adequate blood flow to perfuse cerebral tissue, which is caused by a narrowed or clogged arteries leading to the brain. Ischaemic strokes can be segmented into thrombotic and embolic attacks. Narrowing is commonly the outcome of atherosclerosis caused by the occurrence of fatty layers lining the blood vessels. As the layers grow in size, the blood vessel consequently becomes narrowed and the blood flow to the area beyond is lessened. Damaged areas on the blood vessel can cause blood clot, which lumps the blood vessel thus causing a thrombotic stroke. On the other hand, an embolic stroke is caused when blood clots or debris from elsewhere in the body, typically the heart valves, travel through the circulatory system and block narrower blood vessels (Randall & Ford, 2011, p. 89). Pathophysiology of Haemorrhagic Stroke Haemorrhagic strokes are caused due to the tearing or busting of blood vessels, which consequently leads to compression of brain tissues caused by an expanding haematoma. Additionally, the pressure may cause loss of blood supply to the damaged tissue with resultant infarction (Aiyagari & Gorelick, 2011, p. 45). The blood discharged by brain haemorrhaging tends to have direct poisonous effects on brain tissue and vasculature Epidemiological Data From data collected from the health department and healthcare papers concerning strock cases in the UK, it is clear that the number of patients who were admitted to hospital following a stroke attack has increased over the years. During the 2010-11 and 2011-12 period, a 12.8% increase was realized (Wityk & Llinas, 2007, p. 89). The subsequent period of 2011-12 and 2012-13 had an 11% increase as well. The percentage of patients who spent at least 90% of their time on a stroke unit was also steadily increasing from an initial 75.2% to 81% and 83% during three years (Alexander, Brooker & Nicol, 2012, p. 67). This increase in this number has prompted the national health council to place more medical strategies to control this condition. As earlier placed each year, approximately 110,000 people in England, 11,000 people in Wales and 4,000 people in Northern Ireland have a first or recurrent stroke and more than 900,000 people in England are living with the effects of stroke (Meerabeau & Wright, 2011, p. 78). The Roper-Logan-Tierney Model (Nursing model of choice) The Roper-Logan-Tierney (RTL) Ideal for Nursing is a philosophy being advocated for by the department of health in UK to offer nursing care founded on activities of daily living, which are frequently shortened as ADLs or ALs. RTL is extensively used in the United Kingdom, particularly in the public sector health delivery sector. The model is denoted from its creators: Nancy Roper, Winifred W. Logan, and Alison J. Tierney. The philosophy endeavours to describe what living with a long term heath condition means. It classifies the findings into happenings of living through a holistic patient assessment, followed by an intervention that supports objectivity in practices that may be problematic for the patient to address unaccompanied. The aim of the valuation and interventions stage is to endorse maximum independence and involvement for the patient through their treatment and rehabilitation stages. The physical events of living itemized in the RLT Model of Nursing are: Maintaining a Safe Environment: This is based on the patient’s changes in terms of surroundings for instance, the use of wheelchairs meaning the environment should have ramps to assist in motion. Communication: most stroke cases have a chance of changing an individual’s speech, most of the patients become slurry in their speech, the model takes the patient through therapy that helps in communicating. Breathing: Strokes cause paralysis that might affect vital organs such as the lungs and the model medically checks if there is a problem in breathing. Eating and drinking: The model watches what the patient takes in order to help in the recovery process. Elimination: Due to reduced mobility and failure in major organs such as the kidney the maodel takes into account the comfortably and privacy of passing any form of bodily waste> Washing and Dressing: most stroke patients loss a percentage of their physical ability hence such activities as washing and dressing become hard to perform, the model takes this to account and helps them get through the challenge. Controlling Temperature: Most stroke patients have problems in keeping cool since they may be in a single position for long periods of time, the model takes this into account and this makes them more comfortable. Mobilization: Movement in stroke patients is always limited to reduce different kinds of strain, due to this the model helps in taking a patient from place to place or a position to another. Working and Playing: Due to reduced physical ability, the model helps patients cope with the loss of professional and social ability. Sleeping: With reduced mobility the model takes into account that a patient might need ample rest and hence when sleeping the nurses help turn the patient. The model also takes care of the patients psychological needs by allowing them time and advice on their condition and at most times loss in physical ability that may lead to frustration and depression to follow. It has been well documented that a lot of stroke survivors have had a tough time to accept the fact that part of their mobility is gone. Things they once did at ease may not be done anymore. The treatment takes patients through therapy courses to allow them better understand what is going on from that point forward. The Roper-Logan-Tierney Model through its founders is the most holistic and interactive medical practices for patients living with long-term conditions. Providing them with physical, physiological, spiritual, and social solutions to their specific needs. However, the physical, psychological, spiritual, and social activities of daily living ought not to be employed as a checklist system. In its place, Roper states they ought to be regarded "As a perceptive methodology to the valuation and maintenance of the patient, not on document as a list of boxes, nonetheless in the nurses tactic to and organization of their care”. The patient should be evaluated on admission to the hospital, and their dependence and independence ought to be studied through the care plan and assessment. By observing at variations in the dependence-independence range, the nurse can know whether the patient is recovering well or not, and make alterations to the care offered based on the signs presented. Case Study The purpose of this case study is to authenticate the Roper- Logan- Tierney Model of health care management that a nurse can offer a patient who had stroke for the first time or a recurring case. It also provides a need-orientated attitude to care using a nursing model alongside a nursing process in order to create a framework. The model shows how the LMT was used in assessing, evaluating patient’s care, planning, and implementing on a patient’s condition. The principal factors of this care study are on risk factor management and acute treatment, which is recognized as the patient’s focal difficult. The patient’s name has been altered to uphold privacy. In this study, health and social care rules influencing the patient care were taken into consideration as well. Patient Profile Patient Q was alighting from a van when he abruptly felt his left leg weakening. He then fell to the ground, and his colleagues got him a chair to rest. They later brought him a cup of tea then again he could not visibly locate the cup handle. Somehow, he knew he had stroke and asked his workmates to take him to hospital (Geyer, 2007, p. 71). By the time he got to hospital, Mr. Q did not have any feeling in his left side. At this point, he could barely get out of the car. After some analysis doctors confirmed that Mr. Q had stroke (Bederson, 1997, p. 45). At that moment of the attack patient Q was 55 years old, living an active life though he had high blood pressure. He was also diabetic, which is a risk feature for stroke. Though, he had never indulged in cigarette smoking. He was by this time following the vigorous diet endorsed for stroke fighters (Bornstein, 2009, p. 22). Pathophysiology The prime pathophysiology of stoke is in principal a heart or blood vessel disease. The subordinate effects in the brain are the consequence of one or more of these original diseases or risk factors. The main pathologies include hypertension, atherosclerosis that may cause coronary artery disease, dyslipidemia, heart disease, and hyperlipidemia (Caplan, 2009, p. 57). The two types of stroke that result from this disease state are ischemic and haemorrhagic strokes (Barrett & Meschia, 2013, p. 27). Assessment Assessment is a fundamental nursing skill required to gather all the information required about the patient in order to meet all of their needs. ‘De Chesnay, through his article suggests that ‘assessment is extremely important because it provides the scientific basis for a complete nursing care plan’ (2004, p. 15). The first assessment done by nurses is to gather information concerning the patients’ requirements. Nonetheless, this is only the start of assessing the holistic desires of the patient, which comprises of social, physical, physiological, religious, cost-effective and environmental wants to be taken into deliberation in order to deliver suitable individualized care. The Roper- Logan-Tierney Model of Nursing is centered on activities of living with long term conditions and was used in planning the care of Mr. Q. LMT. In addition, it is a widely used model in practice areas in the UK (González, 2011, p. 32). A selection of two of the twelve activities of daily living or care plan have been selected to show how well rounded the nursing model works in Mr. Q’s cases. The two activities are breathing, and working and playing. Breathing As the patient arrived in hospital, he hardly had any feeling in the left side. This would cause risks in vital organ failure such as the lungs. However, a mean of his respiratory performance was done as he was going through treatment and recovery. Patient Q has a mean respiratory rate of 15 breaths per minute and oxygen saturation of 98% on air (Duckett & De La Torre, 2001, p. 78). He also has no notable shortness of breath, no signs of respiratory distress, and no complaints of pain during breathing. Working and Playing Before the attack, patient Q was a person working in an office. He was also a family man with children as well as grandchildren living an active life. During his treatment and recuperation period, his speech and 85% use of his hands was regained through therapy. This helped him physiologically though he cannot work anymore. He spends time with his family without much effort of the lost body functions such as walking and playing (Davis, Fisher, & Warach, 2003, p. 21). Identification of Patient’s Problem This is the second stage of the nursing model, while in the Stroke Unit, Mr. Q was assessed using the LMT Model based on his daily activities. From those activities, all problems identified were related to his blood pressure at the time of the incidence. During the assessment, patient Q explained that when he had the stroke, he had no idea he had high blood pressure. The initial results suggested that he has to stay in the hospital further until his hypertension condition was put in check, his speech was regained, part of his body mobility was reclaimed, and his condition manageable by a primary care unit (Roper, Logan, & Tierney, 2000, p. 17). Goals After nursing interventions, Mr. Q was able to verbalize feelings regarding his condition and understand the course of treatment that had been done to him. In 27 weeks, the Mr. Q was able to regain 85% of hand mobility and fully regained his speech as well as communication patterns. Finally, Mr. Q’s information were collected and placed in a folder and kept in a safe place so that only associates of the Multi-faceted team accountable for his care and only they will be able to access it. It is the charge of healthcare specialists to protect their patient’s confidential information and share it solitary to appropriate personalities. Mr. Q’s private information was held in accord with Data Protection Act of 1998 (Brooker & Waugh, 201, p. 13). Overall Evaluation and Critique of Framework The nursing procedure is a dated method of scheming and providing nursing care amenities, which are gathering information and evaluating the patient, scheduling care, and signifying objectives for nursing care amenities, applying interventions, and assessing results. This valuation, which is regarded as the first stage of the nursing procedure and should be done frequently. This being the case, the use of RLT Model is centered on doings of living with long-term conditions favoured for Mr. Q’s case (Mohr, 2011, p. 12). The model evaluates the patient’s requirements wholly and can define the impact of stroke on his itemized twelve activities of living as documented by the model. Using RLT model, an impression of Mr. Q’s health status was plotted and from it, prioritizing of his requirements is much easier (Corkin, Clarke, & Liggett, 2012, p. 6). This model allowed healthcare specialists to produce a care idea, which is exclusive or aligned to his wants. As the writer of this care study, I established this framework to be an perfect model in evaluating patient and beneficial for healthcare specialists, as they do not miss any feature of care. Viewing at the disadvantage of the model, it is a very long procedure of valuation and it takes time for a healthcare staff to finish all the twelve actives (Mccance & Huether, 2014, p. 31). Conclusions and Implications for Future Practice Health and social care strategies are indeed very significant and have a unlimited impact to the healthcare scheme. It aids as the basis for the beliefs in making their own strategies since it guides healthcare specialists to their repetition. Typically, nurses practice in agreement with the NMC Code, Values of conduct, presentation and morals for nurses and midwives as well as other regulations and strategies. The British government and dissimilar departments or activities such as the Department of Health (DH), National Institute of Clinical Excellence (NICE), and World Health Organization (WHO) provide these decrees (Lippincott Williams & Wilkins, & Ovid Technologies, 2005, p. 65). After using the RTL, the care of Mr. Q went easily during his visit in the hospital. His post- stroke problems have been achieved without any major matters. Since the very start of the procedure, nurses and other memberships of the MDT comforted him that personal details and all evidence regarding his care would be preserved as private and that this could only be shared to suitable people only on his endorsement (Williams, Perry, & Watkins, 2010, p. 54). The MDT associates based their interferences on the procedure and strategies of the faiths, which was centered on National strategies. Mr. Q’s problems were achieved by the interventions delivered in the hospital and was now cleared to his home. Long-term goals were also taken into account and a proper transfer to the regional nurse was done afore he went home. References Aiyagari, V., & Gorelick, P. B. (2011). Hypertension and stroke: pathophysiology and management. New York, Humana Press/Springer. Alexander, M. F., Brooker, C., & Nicol, M. (2012). Alexanders nursing practice. Alway, D., & Cole, J. W. (2009). Stroke essentials for primary care: a practical guide. New York, Humana Press. 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