Integrating the Sciences and Practice of Nursing - Essay Example

INTEGRATING THE SCIENCES AND PRACTICE OF NURSING Location Integrating the sciences and Practice of nursing The key purpose of this assignment is to discuss the care of a patient that I cared for on placement. The nursing models in use are Roper, Logan and Tierney. Therefore, the essay begins by introducing the patient and discussing their symptoms in detail. Accordingly, the paper discusses the care, which nurses provide through all the stages of the nursing process. Finally, it discusses personal strength and weaknesses in relation to patient care (Roper et al. 2000). Following the Nursing and Midwifery (NMC) code of professional conduct (2008), it is a critical to change patient’s name. Therefore, the name is Jack and for confidentiality reasons, the placement setting will be anonymous. The patient gave consent after clear explanation regarding the information that is necessary for academic assignment purpose. The information in the report came from the patient, patient’s medical and nursing notes. Jack is a sixty-nine-year-old gentleman who has Chronic Obstructive Pulmonary Disease (COPD) diagnosis for nine years. Since then, Jack’s health has deteriorated, and he has lost much weight. Jack stopped smoking in 2007 two years after he was diagnosed with COPD. Jack is a widower who lives alone at home and has two cares four times a day. Apparently, the wife died of breast cancer five years ago, and they have a daughter who lives 140 miles away and sees the father once in a month. The nurses admitted Jack to the admissions ward with shortness of breath. However, they later diagnosed the patient with COPD exacerbation caused by the chest infection. An exacerbation is the worsening of symptoms from their usual stable state (NICE, 2010). The typical symptoms associated with COPD exacerbation are degenerating breathlessness, cough with increased sputum production and change in sputum color (NICE, 2010). COPD is characterized with the obstruction of the airway, which the medical stuff cannot fully reverse and progresses over time (NICE, 2010). The progressive narrowing of peripheral, airways are making it difficult and eventually impossible to breath cause the airway obstruction. World Health organization (WHO) (2010) states that the primary cause of COPD is smoking. However, occupational dusts and chemicals, exposure to indoor air pollution in those, who use biomass and coal for cooking, and frequent lower respiratory infections during childhood can cause it, as well. The nursing process is a four-stage process consisting of assessment, planning, implementation and evaluation. It is an organized planning method, which offers private nursing care that concentrates on identifying the patient’s health needs and establishing plans to meet the imminent requirements (Hamilton and Price 2013). The primary goal of the nursing process is to aid the nurse in the assessment of the patient’s needs. Similarly, it enables them to create some objectives to promote and restore patient’s health or to maintain the patient present state of health (Seaback 2012). The nursing exercise is a cyclical and ongoing process, whereby they can end the care any time. Therefore, they could have achieved the objective, or they can modify the care plan if they have not met their objectives. As the first stage of the nursing process, assessment involves collecting information about the patient’s level of health from which they may formulate a care plan (Seaback 2012). Moreover, the assessment should be holistic and focus on healing the whole person. In other words, it recognizes that the patients are not just their illnesses. A holistic nursing allows the nurse to look at all different aspects of a patient. Siviter (2004) states that holism allows the nurses to treat a patient as an individual with unique needs. Accordingly, the NMC code of professional conduct (2008) reinforces the idea, which says that nurses should respect patients as individuals. For a comprehensive holistic assessment, the nurse collects physiological, psychological, social, cultural and spiritual data about a client. It is within a theory that the assessment of Jack took place. For the nursing process to be successful, a nursing model was in the application. The standard of nursing care the ward used is the Roper, Logan and Tierney (2000). The model consists of 12 activities of daily living (ADLs), which are maintaining a safe environment, communication, breathing, eating and drinking. Also, they include elimination, controlling body temperature, personal cleansing and dressing, mobilizing, working and playing, expressing sexuality, sleeping and dying (Roper, Logan and Tierney 2000). After Jack’s admission in the ward, nurses carried out an assessment basing on ADLs to ensure they achieve a holistic care. Therefore, I introduced myself to Jack with the aim of building good rapport in order to feel comfortable with each other per (Seaback 2012). Accordingly, I explained the purpose of the assessment in order to gain Jack’s consent. I used various assessment skills such as observations: measurement and communication during the assessment process. Additionally, according to Seaback (2012), effective communication is a vital skill critical when assessing patients. I identified problems akin to breathing, eating and drinking and maintaining a safe environment. However, for the purpose of the assignment, the paper will only discuss breathing. On examination, Jack looked distressed, but was alert and was breathless on rest and exertion. I recorded the patient’s baseline observations per White, Duncan and Baumle (2010). However, Jack’s body temperature was 37 degrees Celsius, pulse: 83 beats per minute, blood pressure: 110/69 millimeters of mercury. The assessment of the rate of respiration, depth and character were critical to obtaining a picture of the respiratory state as it can indicate whether the patient is deteriorating or improving. Jack’s respiratory rate was 28 per minute. This was above the normal range as normal respiratory rate in adults is 12-20 breaths per minute. Similarly, the breathing was shallow; the patient was wheezy and used accessory muscles to breathe (Rootmensen et al. 2008). The performance of the Arterial blood gases (ABGs) was necessary to examine the degree of the exacerbation and to monitor the degree of hypoxaemia, hypercubic and the saturated haemoglobin percentage in the blood. The measurement of Oxygen saturations was through pulse oximetry, and it was 87% on air. This was below the required range for COPD patients, which is 88-92% (British Thoracic society 2008). Jack’s peak expiratory flow rate (PEFR) was assessable only through using a pyrometer to measure the function of the lungs and monitor the progress (Brooker and Waugh 2007). Moreover, it was necessary to assess the patient’s cough as well to check the ability to cough out excess phlegm (White, Duncan and Baumle 2010). Therefore, they recorded the color, amount and the smell of sputum. Then a sputum sample was evident, and a chest infection was present (Francis 2006). There was pain, and Jack complained of sharp pain in the chest and throat when breathing that he gave a score of three. According to the pain assessment score on the observation chart, a score of three meant Jack was experiencing severe pain. Infection causes inflammation in the trachea, which might have been the cause of Jack’s pain. Jack’s Early Warning Score was four and put patients at risk (PAR), and the nurses were to record Jack’s observations every hour. Consequently, nurses identified problems relating to breathing, which included: high respiratory rate, changes in depth and rhythm, coughing, wheezing, excess production of sputum, respiratory pain. All these problems meant that Jack was at risk of obstructed air passageways due to increased mucus secretions and eventually respiratory arrest (Francis 2006). Following assessment, a care plan was devised and implemented to meet the needs identified. Based on Jack’s problems, the goal of care was to improve his breathing. The aim was for Jack to be able to breathe comfortable, maintain SpO2 above 90% (NICE 2004), reduce anxiety and restore normal breathing and ensure effective coughing. Jack’s PAR score was four indicating a need for frequent observations. Therefore, a plan for Jack was to record all the vital signs every hour, and then reduce to four hourly when stable. Jack was involved in the planning of his care, and they agreed the goals with him giving him choice and autonomy. In order to reach the goals they outlined, Jack had to carefully have an excellent position in bed, sitting upright supported with pillows, to have all the medications and oxygen therapy as the physician prescribed. Similarly, needed encouragement to take fluids and be referred to the respiratory nurse. In order to implement the necessary care, the nurses documented a care plan so that it is available to all members, and this applies to every aspect of nursing care (White et al. 2010). It is at this stage that the nurses delivered the patient’s care. Jack maintained an upright position while in bed supported by pillows. Sitting upright helps the lungs to expand allowing more absorption of oxygen (Brooker & Waugh 2007). The nurses gave Jack 28% oxygen through a venturi mask to deliver accurate concentrations of oxygen per NICE guidelines (2004) and recommendations. According to British Thoracic Society (2008), either 24% or 28% of oxygen should be deliverable as a high percentage of oxygen can suppress the respiratory drive and damage the lungs further. After 60 minutes of receiving oxygen, the nurse’s re-examined Jack’s arterial blood gases for any increase of carbon dioxide concentration or a fall in the pH (Marieb 2006). Jack received a prednisolone (steroid), Atrovent, tiotropium, clarithromycin, co-amoxiclav and amoxicillin. The nurses administered Bronchodilators through nebulisers. Jack had poor inhalation technique, and he benefited from nebulisers, as this was the most effective way to deliver bronchodilators. Rootmensen et al. (2008) states that patients with COPD exacerbations often require nebulisers due to breathlessness, shaky hands, anxiety and lack of focus. Jack received frequent oral and nasal care, as well due to breathing dry gas, which irritates mucus membranes (Frances 2006). Similarly, fluid intake is significant in helping thin secretions for easy expectoration and eventually clearing the infections (Marieb & Hoehn 2006). If Jack’s SpO2 and breathing worsened, the medical team had to be contacted, and Jack would be assessed within 30 minutes. The respiratory nurse visited Jack to teach the patient about a proper inhaler technique. However, throughout Jack’s care, there are legal and ethical issues that arose. An example of these is the ethical issue of informed consent. Informed consent is an agreement given by the patient to receive treatment. Valid consent bases on the ability of the patient to make informed health care decisions. Such patient should have a full understanding of the pros and cons of the proposed medication plan and an alternative treatment available (White et al. 2010). The patient voluntary must give consent without being pressurized by healthcare professionals, family or friends. There are patients who cannot give consent. For example, people with cognitive impairment and unconscious patients are not capable of giving consent. In such cases, the healthcare professionals can act on the patients’ best interest (Bosek & Savage 2007). In the course of emergencies, consent can be waived and must be obtained when emergency is over for any care that follows (White et al. 2010). The Nursing and Midwifery council (NMC) (2008, p3) code states that, one must ensure that they obtain a patient’s consent before the commencement of any care or treatment. However, Jack did not receive sufficient information about the medications, which the medical staffs were offering. Nevertheless, Jack received information on what the treatment was for, but they never informed Jack concerning the risks and alternatives. Similarly, the medical team did give Jack a choice of bronchodilators. The patient could have used hand-held inhalers instead of nebulisers. Even though Jack had consented to the treatment, the consent was invalid, as he did not have full information about the risks of medication. Now after the implementation of the care, I am going to enter the evaluation, which is the fourth stage of the nursing process. It is at this stage where the patient undergoes review to ensure that the care provided worked (Seaback 2008). Within 12 hours of delivering the nursing interventions, Jack’s breathing pattern had developed, and no signs of distress were observable. The patient was able to clear his respiratory tract by expectorating phlegm more effectively. Vital signs improved and were back to normal with respirations 18 per minute and SpO2 were 93%. Upon a reassessment, Jack’s PAR score was ‘0’ indicating a little risk of his condition deteriorating. The hourly observations then changed to four hours. Getting a job, which required doing a comprehensive assessment of the patient, made me conduct a literature search on holistic breathing assessment. Before this, I did not understand the involvement of a holistic breathing assessment. For me, counting the respirations as part of vital signs was just enough. Writing this assignment has equipped me with the knowledge of what a comprehensive breathing assessment entails. I have also learnt that breathing assessment is an essential skill for professionals working with COPD patients, as it is an indicator of whether a patient’s condition is deteriorating or improving. Throughout the patient’s care, I had a lack of confidence in my abilities. Active collaboration between healthcare professionals and Jack made it possible to meet goals and have positive outcomes. The knowledge has enlightened me the importance of inter-professional working and involving patients in their care. The communication skills gained in the process of gathering data in the course of the assessment will be valuable to me throughout my training and career. In conclusion, the nursing process has helped me in the process of identifying and understanding Jack’s individual needs and establishing a person-centered care. The identification of Jack’s problems has been through assessment, and a plan of care implemented has been discussed. The care given has been evaluated, and Jack breathing has improved. References Bosek, M. S. D., & Savage, T. A 2007, the ethical component of nursing education:  Integrating ethics into clinical experience.  Philadelphia:  LWW.  (published March 2006) Brooker C. Waugh A 2007, Foundations of Nursing Practice. Mosby Duncan, Baumle and White 2010, Study Guide for Duncan/Baumle/Whites Foundations of Nursing, Cengage Learning; 3 edition (April 12, 2010) Francis K 2006, Nursing uniforms: professional symbol or outdated relic? Nursing Management; 37: 10, 55-58. Marieb E, Hoehn K 2006, Human Anatomy and Physiology. New York, NY: Benjamin Cummings. NICE 2010 accessed November, 2014-11-18 at nice.org.uk. Nursing and Midwifery Council 2008, The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. London: NMC. Rootmensen G, Nvan Keimpema, A.R, Looysen E.E, van der Schaaf L, de Haan R.J., Jansen H.M 2008, The effects of additional care by a pulmonary nurse for asthma and COPD patients at a respiratory outpatient clinic: results from a double blind, randomized clinical trial Patient Educ Couns, 70 (2) ., pp. 179–186 Roper N, Logan W, Tierney A 2000, The Roper-Logan-Tierney Model of Nursing: Based on Activities of Living. Churchill Livingstone. Seaback W 2012, Nursing Process: Concepts and Applications. Delmar Cengage Learning Read More