Holistic Account of Care for a Patient or Client with Complex Needs - Essay Example

Holistic account of care for an elderly patient with chronic obstructive pulmonary disease (COPD) and sacral pressure ulcer Holistic account of care for an elderly patient with chronic obstructive pulmonary disease and sacral pressure ulcer NMC has set up relevant code of ethics that every nursing and midwifery professional should adhere to and work towards the codes acts as the base for proper nursing and an imperative tool towards safeguarding of the public’s health and wellbeing. In this essay, I will review on the care plans for patients with complex needs in terms of a long term COPD condition and acute sacral pressure ulcer. That notwithstanding the code must be adhered to in full. Among the key ethics the nurse should adhere to in order to treat the above conditions there is-: Need to treat people as individuals, this will entail-: I. The nurse must respect the dignity of a patient and also remember that the patient is an individual. II. A nurse should not, despite the situation act in a discriminatory manner towards those whose care they must look into. III. There should be kindness and consideration in the treatment of people IV. A nurse should be the advocate of the patients, assisting them to have access to information, right health care, support and relevant social care (NMC, 2010). Need to have respect of people’s confidentiality, which involves-: I. Respect to the right of confidentiality II. A nurse should disclose information if there is eminent harm. This should test the conscious of the law in the country of practice. III. Make the patient understand why information need to be passed along to all those people providing health care (NMC, 2010) Need to have collaboration between the patient and the nurse providing care, which involves-: I. A practitioner should listen to the concerns, needs and respond accordingly. II. Assist the patient to care for themselves so as to recover on their health. III. There is need to appreciate and recognize the effort the person has taken in order to improve on their own health. IV. Make an effort or arrangement in order to meet the patient’s communication needs. V. Make the sharing of information with the patient be something the patient can understand (NMC, 2010) A nurse should seek consent from the person who they are caring at, in the following areas-: I. Consent to start any treatment or form of care. II. Come to terms with people’s refusal or acceptance of care or treatment. III. Have understanding of the right for a person to contribute in opinion about their care. IV. In case of an emergency you must act in the person’s preferred and best interest. V. Ensure safeguarding of people with, low mental capacity to make the right decisions (NMC, 2010) Finally there is need to adhere to professional boundaries, in the following areas-: I. Any attempt to influence a nurse to provide preferential treatment through favors or gifts, the nurse must refuse. II. Any person in your care should not offer a loan and you accept. III. There should be clear sexual boundaries between you and the patient. This rule extends to families of the patients too (NMC, 2010) In this essay, the nurse is going to offer care to a person who has complex needs, the person has a long term COPD and an acute condition of sacral pressure ulcer. The nurse will come up with a care plan to offer to the person in question, while taking note and being sensitive on the above mentioned code of ethics on the patient. Nursing is profession that offers care to patient after the doctor has done his part of the main treatment (Gulanick, 1997). To start with let me define what COPD is. In full the name means – chronic obstructive pulmonary disease. This is a generic name adapted for various lung conditions pertaining to lung diseases such as emphysema and chronic bronchitis or obstructive. People who have this condition find it challenging to experience normal breathing. The difficulty in breathing arises from the narrowing of airways creating a situation known as obstruction of airflow (Hanania, 2011). COPD has the following symptoms-: I. Unrelenting coughing coupled with phlegm II. Regular infections of the chest III. Chronic breathlessness. The main cause of COPD originates from smoking; its manifestation rises with the period of smoking. The relationship between smoking and lungs is that, the smoke causes irritations and inflammation of the lungs which leads to scarring. As the years go by, the inflammation of the lungs persists and this makes permanent changes to the organs. The walls of the lungs normally thicken making the walls to produce a lot of mucus. The air sacs within the lungs get damaged and soon enough, due to emphysema the lungs elasticity gets lost (Lynes, 2007). Apart from the air sacs getting damaged, the airways get narrowed down and scarred, which automatically leads to breathlessness symptoms, phlegm or cough. Such symptoms qualify to COPD. Others causes of COPD include, genetic disorders, dust and fumes though in rare proportions. This disease normally affects people with a bit of advanced age, the majority of diagnosis occurs in people who are in their fifties, though it is normally manifested at the age of 35. According to gender statistics, in the UK the disease affects men more then it affects women (Hanania, 2011) A smokers cough as they call it, is the first real sign of the respiratory disease. Once damage to the lungs has already occurred, there cannot be a reversal to the situation but the acceleration can be reduced down through quitting of smoking and using certain medications relevant to treating of the lungs. But some people, though a very tiny minority can opt for surgery. COPD has the ability to completely change a person’s lifestyle; hence in order to cope with symptoms of COPD there is need to assist the patient. They need to learn new breathing techniques, take relevant medication, maintain activeness as much as possible and obviously choose to stay healthy (Lynes, 2007). Based on the above explanation of COPD, we can see that, a patient suffering from advanced COPD is a person who is older and falls under the complex needs category. The person despite having a significant age in most cases, the respiratory disease renders weak them in certain areas. As such, the particular patient will have to be accorded professional help form a nursing professional in order to make the symptoms of the disease bearable and also to reduce the spread of the disease. People with COPD in the UK, have access to financial support, end of life care, and they are normally given advice on relationships. COPD is a life threatening condition, the situation of hunger of air brings in a feeling of an eminent demise to the person suffering the condition. As such, the patient tolerance in activities greatly diminishes leading to social loss and functioning of roles. Since people are social beings, this class of patients will normally have a feeling of isolation and depression. That notwithstanding management of the disease requires the patient to have complex modifications of lifestyle regime (Kara, 2007). Reports from existing patients are that, they face life restrictions, and ultimately they give up their normal way of life. It is in evitable not to face exacerbation which can lead to frustrations bringing with it compromised QOL. The disease has a word wide representation of 5% in terms of deaths according to 2011 data. Death associated from the disease arises due to reduced capacity of the lungs which makes multiple organs in the body to fail. By 2030, the condition is projected to be the 3rd killer in the world. The condition makes the patient to keep visiting the hospital; hence hospital readmission associated with the disease is quiet high. High frequency of readmission is due to the inherent nature of the disease, it has characteristics of frequent and repetitive clinical episodes of exacerbation. The condition has an inherent course of deterioration in most cases (Barriett, 2009) Management and maintenance of the disease is dependent on the compliance level of the patient. The regime of treatment is complex in nature and also requires the patient to take up lifestyle changes. As such the disease has an impact psychologically to the patient abilities in functioning and self-care motivation. As such, this vulnerable group experiences difficulties in relationships when they face independence loss, self-esteem issues and confidence complications. This makes the mechanism of social support difficult in managing this disease (Lynes, 2007). With such a view on COPD, and the impact of devastation it can have on the patient, there is always a need to identify an effective model of care which can optimize the outcome of health in the management of this chronic disease. The specimen patient In this essay, is experiencing long term condition of COPD and also an acute sacral pressure ulcer, as a nurse I am required to come up with a plan on how to care for the specimen patient, and the steps I would follow to improve the health condition of this patient. The definition of sacral pressure ulcer is a situation where there is localized injury to the tissue underlying the skin. The ulcer presents itself as a blistered, broken, necrotic or red skin all the conditions manifesting themselves in persistency. This condition is caused by shear, pressure or both together. The following conditions do aggravate the risk of getting the ulcer, and they include, COPD, Parkinson’s disease, tract infections, malignancy, failure of the heart, mellitus diabetes and thrombosis of the deep veins. The ulcers can develop in any part of the body but when it comes to adults, the disease manifests itself over the prominences of bones. The patients who have the disease are normally recommended to have initial assessment and ongoing assessment. This assessment involves-: a. Health status- to check on illness, neurology, mobility, systematic infection, posture. (In summary the ulcers and the physical conditions of the body need to be assessed together) b. Prior damage caused by pressure. c. Social and psychological factors. d. Assessment of the ulcer (Macklebust, 2012). These assessments are particularly important in order to determine the spread of the ulcer in order to determine the management of the ulcer. It is recommended that patients with advanced pressure ulcers be directed to a specialist service. The healing period is a long procedure, but provided a patient has good pressure redistribution, perfect nutrition and nice management of the wound, the patient will normally heal. In the case of our specimen patient the condition is acute, meaning it has fallen grade 3 or 4 which automatically qualifies to a specialists care. Among the things that a nurse should do towards making the management and healing process of the ulcer involves-: a) Positioning and mobility- this involves changing of position so that to relieve pressure, with a goal of avoiding positioning patients on the ulcers or prominence of the bones. Even better patients with reduced mobility need to have passive movements. b) Pressure relief- This is done through equipment of pressure relieving. The access to this equipment’s should be over a period of 24 hours on any single day to these ulcer patients. c) Topical agents and dressings- the perfect dressing needs to be easy to apply and also it needs to be easy to remove. Before doing a change of dressing, there needs to be a removal of excess exudate or slough (F Rankin, 2004). Hence as such we find that a patient with acute sacral pressure ulcer is a patient whose mobility is highly affected and hence the patient joins the category of a highly vulnerable person. Hence this is a person who requires care and attention to detail in order to overcome the effects of this disease. The person giving the care should be a qualified practitioner and in the context of this essay that practitioner is a qualified nurse. The redness of the skin associated with sacral occurs due to flow of blood to dermal tissue, which makes the skin on that part to break down, leading to formation of open sores (Hoeman, 2008) The location of a sacrum is at the base of a spinal code and too much pressure in this area makes the sacral to appear and they are a resemblance of blisters. Others causes of sacral ulcer involve malnutrition or even dehydration. Other causes include vascular disease, urinary incontinence, and a prolonged stay in bed that is devoid of movement. Among the elderly and this is the class of the person to whom care is to be provided in this essay, most of the ulcers develop due to the quality of care that is offered in the care homes (Miller, 2009). Preventive measures in the nursing homes are gravely disregarded making the old people in these homes to develop acute sacral ulcer, even simple bed sores if unchecked and untreated can lead to development of ulcers. Let me now introduce my patient well, he is elderly, the fact that he is elderly automatically promotes him to a complex needs category, he has a long term condition of COPD and he is suffering an acute sacral pressure ulcer. All this conditions have been extensively introduced above making him into the category of complex, needs and complex care plan that needs to be put in place. The goal is to make the provision of the health care to be comfortable as possible, and to try and heal the acute sacral ulcer while keeping in mind that this particular patient is old and hence the healing process will take longer. The other target in the plan is to reduce the effects of COPD and reduce the spread of the respiratory disease. The patient will be accorded the code of ethics earlier explained in this essay and they will be given care according to the best health care practice. In the provision of this care, I will use RLT model in the provision of this care plan. The model developed in 1970’s it identified activities involved in the daily living of a person (Holland, 2009). These activities when put into context of providing health care to a patient will involve the details that I will illustrate below. The specimen patient taking note of his complex conditions, his care plan will involve the following aspects of RLT-: a) Maintaining a safe environment- since the patient is old, I will assess the hearing and vision ability in this category. On ulcer I will review his mobility and immobility combined with tissues assessment. Also in this category I will collect physiological data and assess the number of falls the patient has. And hence use data to improve his surroundings b) Communication- in any patient, the communicating language must be established, hence it will be imperative to know if the patient can speak and hear or there is need to use communication aid. In this category his mental capacity is critical to determine if he can make his own decisions. Then establish a communication channel. c) Breathing- in relation to COPD, there is need to establish a smoking history, then observe the level of pain in breathing and look at the rate and efficiency of his breathing. Then assist the patient to develop new breathing regime. d) Eating and drinking – pressure ulcer can be aggravated by lack of proper diet and drinking hence there is need to observe the patterns of eating and drinking. Any prevailing allergies and the diet required to heal the two or improve the worse effects of both diseases. Hence the standard is to check if hydration or nutrition is right. e) Elimination- this category of living in this care, involves doing away with bad habits, not bad parse but act as the reason behind COPD. In the case of COPD, there is need to work on eliminating smoking and in the case of ulcer there is need to increase mobility frequency. f) Personal cleansing and dressing- an ulcer patient will require dressing of the wounds like explained earlier, hence they need to be assisted and in a way that is not an insult to their own dignity. All the hygienic transformation must be taken care of, around the patient. g) Control of body temperature- the temperature of the patient needs to be taken regularly so as to guarantee that patients do not experience fever. It is imperative that if the patient is able, they should be shown how to maintain their temperature. h) Mobilizing- if the patient is unable to move, alternative should be sort out, hence handling and moving assessment should be carried out. Staying in one place for a long time can make the patient develop ulcers. Both diseases plus the combination of elderliness require some activity. i) Working and playing- to develop a professional relationship with a patient, as a nurse I need to understand their hobby, sports they love and prior employment, socialization is imperative to the patient in order to avoid loneliness associated with this condition. j) Expressing sexuality- it is part of the model, hence if my patient would be willing to speak up, there is need to understand if the patient has a problem in expressing their sexuality. Either way, since it is on a profession level, there is need to redeem the psychological confidence of the patient. k) Sleeping- in the cases of a patient who cannot be in a position to sleep due to the condition, there is need to establish the ability of specimen patient to sleep. Hence activities that promote sleep should be established, while coming up with a right pattern of sleep. l) Dying- there is need to talk with the patient on matters related to death. Hence there is need to talk about the religious and cultural beliefs of patients and also prepare friends and family on any eventuality is the condition of the patient is dare and critical (Kara, 2007) The above health care plan, involves both the assessment and the action plan itself. The goal in the above stated plan is to establish a healing process while taking care of the critical living essentials befitting a human being. The criteria used in narrowing down to the above plan involve being specific, measurable, achievable, realistic and timely initialized as SMART (Davis, 2011). Once the above plan commences as a nurse I will have to keep monitoring to ensure that the goals set above are being achieved. And also I will invite an independent party to assess the quality standard of the care provided. Finally all records can be scrutinized legally since they are legal documents. Hence as part of the professions requirement I will need to have records of the care plan, and the patient. Record keeping is imperative since it ensures that in a team based care everybody who comes in understands the extent and progress of care. The records should follow the basis of SOAPIE. This stands for-: 1) Subjective data- information that to what the patient has said. 2) Objective data- measurable factual information involving signs and tests. 3) Assessment data- conclusions drawn by the nurse. 4) Plan- strategy to tackle the patient’s needs. 5) Intervention- action plan the nurse has taken to address the needs. 6) Evaluation- the nurse’s analysis on the care so far (Wilkinson, 2001) Appendix NMC- nursing & midwifery council COPD- chronic obstructive pulmonary disease QOL- quality of life RLT Model- Roper, Logan, Tierney SMART- specific, measurable, achievable, realistic, timely References Barrett D, Wilson B, Woollands A (2009) Care Planning: a guide for nurses, Dorchester, Pearson Education White, L. (2001). Foundations of nursing: Caring for the whole person. Albany, N.Y: Delmar/Thomson Learning. Carr S (2002) Tackling NHS Jargon: Getting the message across, Oxford, Radcliffe Medical Press Hanania, N. A., & Sharafkhaneh, A. (2011). COPD: A guide to diagnosis and clinical management. New York: Humana Press. Miller, C. A. (2009). Nursing for wellness in older adults. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Davis N, Clark A, OBrien M, Plaice C, Sumpton K, Waugh S (2011) Learning Skills for Nurses, exeter, Learning Matters FRankin, J., Regan, S., & Turning Point (Organization). (2004). Meeting complex needs: The future of social care. London: IPPR. ield L, Smith B (2008) Nursing Care: An essential guide, Dorset, Pearson Education Holland K, Jenkins J, Solomon J, Whittam S (Eds) (2008) Applying the Roper Logan Tierney Model in Practice, 2nd Edition, London, Churchill Livingstone Maklebust, J. A., & Sieggreen, M. (2000). Pressure ulcers: Guidelines for prevention and management. Springhouse, Pa: Springhouse Corp. 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