Problem-Solving Approach to Patient Care - Essay Example

?PROBLEM SOLVING APPROACH TO PATIENT CARE Nursing Introduction In this assignment, the care of a patient on my first placement will be discussed. For confidentiality purposes as stipulated in the nurse’s code of conduct, the patient will be named as Mr. Jones. Mr. Jones is a 72 year old Jewish man admitted to the ward with diarrhea and vomiting and suffers from Parkinsonism and arthritis, and has recently been diagnosed of having T cell lymphoma. The Roper-Logan-Tierney model will be used in the management of Mr. Jones since it is holistic and is concerned with how disease progress alters the activities of daily living of the patient. Upon applying the RLT model on Mr. Jones, three problems have been identified: eating/ drinking, mobilization, and death and dying. The nursing model will be implemented for the preparation of the nursing care plan since it is not only a holistic mode, it is also flexible, accessible, and hence can be modeled to suit the specific needs of the client. Respect of Mr. Jones and his preference in care and partnership with other health practitioners will be inculcated in this assignment. At the end of the assignment, care accorded to Mr. Jones with the help of the RTP model will be evaluated and a reflection of my nursing management delineated (Agleton & Chalmers, 2000, p. 10). Nursing models overview Nursing models serve as the foundation of nursing activities since they outline the professional interaction that takes place between a nurse and the patient. Prior to the use of nursing models, nursing was anchored on the medical model. According to this model, the patient gets ill as a result of pathology, once the pathology is detected; treatment modalities are channeled towards eliminating the pathology. It was a mechanized form of managing the patient since it did not take into consideration the other aspects of a patient that may be causing the illness; it did not provide holistic care to the patient. Nursing models are not delicate opinions of nurses, but they are the values, knowledge and ideas that nurses inculcate while taking care of the patients. They are developed following years of practice hence enhancing the validity and reliability of nursing models. They act as a guide in the management of patient, and above all, nursing models are patient centered. This is since they inculcate the nature of the individual, the causes of his problems; the diagnosis arrived at as a result of assessment, the interventions, and assessment of interventions. It is important to determine the nursing model that will be used in the management of a patient so as to have a guideline that aids in optimal care of the patient (Aggleton & Chalmers, 2000, p. 10). The Roper-Logan-Tierney (RLT) model The nursing model chosen to manage Mr. Jones is the Roper- Logan- Tierney model. This is a nursing model that has also been described as the human needs model or the activities of daily living model. This model was chosen in the management of Mr. Jones since it is a holistic model. This is since it focuses on the 12 activities of living and assessment how the illness has affected these activities hence identifying the cause. Priorities are then arrived out aimed at eliminating the cause and hence restoring the health of the patient. The activities are outlined as maintaining a safe environment, communication, eating/drinking, elimination, controlling temperature of the body, play and work, mobilization, personal hygiene, sexuality, sleeping, and death and dying of the patient (Roper, Logan, & Tierney, 2000, p. 20). The model is effective in the management of Mr. Jones since it stipulates the factors that may alter the activities of daily living. It inculcates the environmental, psychological, biological, politico economical, sociological, and educational influences on health of an individual. This cuts across Mr. Jones and how various aspect of his life influences his wellness and illness continuum. Consequently, the Roper- Logan- Tierney model is accessible and flexible in its application when managing a patient hence making it more viable for the management of Mr. Jones. Having identified the patient and the model of nursing to use, the management of Mr. Jones using the nursing process will be discussed. This will be closely interlinked with role of partnership, dignity, and respect as pertains to the care of Mr. Jones (Roper, Logan, & Tierney, 2000, p. 20). Developing a nursing care plan from the nursing process Nursing process is a cyclic systematic conceptual tool employed in the care of the patient and is used to design the nursing care plan of a patient. It is a 24 hour based initiative that needs to be reviewed according to the progress of the patient and interventions designed to address the forthcoming needs of the patient. The nursing process has four main steps: Assessment, Planning, Implementation, and Intervention. The nursing care plan is developed consistently with the nursing process and it is aimed at addressing the problems encountered during the assessment of the patient (Barrett, Wilson, & Woodlands, 2009, p. 13). Assessment This is the first step involved in the care of the patient. As the name suggests, it entails assessing the patient so as to learn more about the patient. It is a stage that is referred to as a data gathering stage and this information is very critical in the care of the patient since it greatly influences that subsequent care of the patient. Having identified the RTP model as our tool in the management of Mr. Jones, this will be used in the assessment of Mr. Jones. Assessment information is derived from the history of the patient, laboratory investigations, and the physical assessment conducted on the patient. Consequently, the data gathered is either classified as subjective (from the subject; Mr. Jones) or objective data (from investigations conducted). This serves as the starting point in the management of Mr. Jones (Barrett, Wilson, & Woodlands, 2009, p. 13). From the history elicited from Mr. Jones, he has been admitted in the ward since he presented with diarrhea and vomiting. However, Mr. Jones is being treated for Parkinson’s’ disease, and arthritis and T- cell lymphoma. It is also during the history taking that information concerning his two episodes of falls within the past 6 months is discovered. While applying the RTP model at the assessment stage, it is important to note the activities of daily living that have been affected. The drinking and eating pattern has been affected due to his current reason for hospitalization which is diarrhea and vomiting. Consequently, Mr. Jones mobilization has also been affected as a result of the reported falls. Subsequently, his current Parkinson’s disease is characterized by unstable gait that may be predisposing him to the falls. In addition, he suffers from arthritis which affects the knee joint capsule hence possible falls. His elimination and personal hygiene is also affected as a result of diarrhea and vomiting episodes. Moreover, as a result of his old age and multiple medical conditions it is of relevance that Mr. Jones is prepared to nurse to health or for a peaceful death (Barrett, Wilson, & Woodlands, 2009, p. 13). During the assessment stage, it is important to adhere to the rule of conduct that is expected to be elicited as a nurse performs her nursing duties. To begin with, it is important to uphold the dignity of Mr. Jones and treating him with respect. This is accorded by referring to him with his name, openly communicating with him about his condition and respecting his opinion. This is since the integration of Mr. Jones into the planning phase is essential for his recovery to be successful. Consequently, partnership is essential in the management of Mr. Jones since nursing is a collaborative profession and one nurse cannot competently manage Mr. Jones. This calls for enhancing teamwork in the management of Mr. Jones by involving other health care workers in his management like the physician, physiotherapist, nutritionist, and the counselor. This will also aid in holistic intervention of Mr. Jones condition. Having gathered data during the assessment phase, the nursing process now proceeds to the second phase of developing the care plan which is the planning phase (Barrett, Wilson, & Woodlands, 2009, p. 13). Planning This is the second stage of the nursing process and consequently in the nursing care plan. During this stage, the nurse focuses on giving meaning to the data gathered during the assessment phase of the nursing process. Planning entails deciding in advance, what will be done, by whom, when, and how the activities to be performed will be done. Planning aids in the prioritization of the needs discovered in the patient since it guides the implementation phase of the management of Mr. Jones. Bearing in mind the data gathered from Mr. Jones, three priority problems have been identified and the care of Mr. Jones will be closely linked in addressing these problems. The problems to be planned for will be discussed in order of their priority as pertains to the care of Mr. Jones and also with reference to the RTP model (Barrett, Wilson, & Woodlands, 2009, p. 37). Planning also entails the making of SMART objectives: Specific, Measurable, Attainable, Realistic, and Time bound. This means that the initiatives arrived at for managing Mr. Jones should fulfill the SMART criterion which achieved through the generation of nursing diagnosis during the planning phase (Barrett, Wilson, & Woodlands, 2009, p. 37). Drinking/ Eating: Nursing Diagnosis: Altered nutrition less than body requirements related to diarrhea and loss of weight as evidenced by frequency in passing stool, and vomiting. This is a health pattern in the management of an individual and is essential in influencing the health and the recovery of the patient. This serves as the priority diagnosis for Mr. Jones and hence influences the planning of his care while in the ward. This is a apriority diagnosis since the nutrition of Mr. Jones is essential in ensuring the he is not predisposed to acquiring opportunistic infections. The expected outcome of this nursing diagnosis is that Mr. Jones will have a balanced nutrition by the 7 days that he will be in the hospital. This will be evaluated by assessing the frequency in the passage of stool has reduced and also if the frequency in vomiting has ceased (Barrett, Wilson, & Woodlands, 2009, p. 37). Mobilization: Nursing Diagnosis: Altered physical mobility related to progressive degeneration of the knee joint by arthritis and effects of Parkinsonism as evidenced by reported two falls in the past 6 months. This serves as the second diagnosis that needs to be planned in order to effectively manage Mr. Jones. Mobilization is essential is assessing the health status of an individual since it reduces the chances that the individual will be at risk of falls and hence predisposition to injury. As pertains to mobilization, it is paramount to ensure that Mr. Jones stability is enhanced by the use of physiotherapy, health education and the use of physiotherapist to assist hi. The planning phase also needs to inculcate the evaluation of Mr. Jones since the expected outcome is that he will be less predisposed to falls as evidenced by proper mobilization (Barrett, Wilson, & Woodlands, 2009, p. 37). Death and dying: Nursing Diagnosis: Mr. Jones is at risk of death related to the multiple diseases, compromised immunity level and advanced age as evidenced by the advancement of symptoms of various diseases affecting him and presence of palliative care During the assessment phase, information was elicited that Mr. Jones has people who come to care for him twice a week in his home. This entails that Mr. Jones is already under the home based care that is used in the management of patients under palliative care. This means that it is essential that Mr. Jones sociologic, psychological and spiritual health be emphasized during his stay in the hospital. This is since the RTP model inculcates the preparation of a patient for peaceful death as an important element in the care of patients undergoing palliative care. During the planning phase of Mr. Jones, it is important to ensure that patient confidentiality is exercised where information is only relayed to health care practitioner. During the planning of care, it is of essence to inculcate Mr. Jones in the care since this shows that he is respected and involved in his care (Barrett, Wilson, & Woodlands, 2009, p. 37). Intervention/ Implementation This is the action phase of the nursing process and the nursing care plan. Having planned for Mr. Jones’ care, the next stage is to implement the planned activities. Implementation will be based on each nursing problem identified in the planning phase and that has been used to generate the nursing diagnosis. Moreover, the implementation is collaborative and entails the involvement of other health care professionals in the intervention of Mr. Jones health. Implementation phase is successful in patient care if there is partnership exhibited (Barrett, Wilson, & Woodlands, 2009, p. 136). Drinking/ Eating Mr. Jones has been admitted in the ward with history of diarrhea. This means that his nutrition is compromised and hence efforts should be made to restore his nutritional balanced. Mr. Jones is dehydrated due to loss of fluid through vomiting and diarrhea hence the first initiative is to restore fluids to Mr. Jones. This will be achieved by infusion with intravenous Normal Saline to restore the fluid balance alternated with Dextrose for energy. Concurrently, Mr. Jones needs to be started of fluid diet that is highly nutritious and rich in fiber to control the diarrhea. Consequently, the diet needs to be rich in protein for replenishment of gastrointestinal tissues and also vitamins to build up the immunity level of Mr. Jones. Moreover, Mr. Jones can be put on anti diarrhea medications and also on anti-emetic drugs for the vomiting. Since Mr. Jones has diarrhea and vomiting, this means that his personal hygiene is also compromised. This will be established by assisting Mr. Jones in elimination patterns and also during the vomiting episodes. Consequently, Mr. Jones will also require that his linen is change frequently especially if it gets soiled to prevent cross infection (Barrett, Wilson, & Woodlands, 2009, p. 136). Mobilization To begin with, Mr. Jones has two medical conditions that are altering his mobilization hence predisposing him to risk of falls and injury. An intervention measure is to ensure that Mr. Jones adheres to the treatment regimes prescribed for him. This can be achieved by carrying out investigations so as to assess the effectiveness of current drugs and the disease progression so as to take the appropriate action. Moreover, mobilization of Mr. Jones can be enhanced by the use of a physiotherapist who will aid is assisting Mr. Jones to perform passive exercise and consequently strengthening his skeletal system. Additionally, where the mobility is adversely affected, Mr. Jones needs to be rehabilitated. This entails educating Mr. Jones on the use of assistive devices like the use of a cane as he walks or to support himself with the wall as he walks to prevent falls. The family also needs to be used to ensure that Mr. Jones is not left unattended or in areas where he is predisposed to falls and subsequent injury (Barrett, Wilson, & Woodlands, 2009, p. 136). Death/ Dying This is an intervention that requires collaborative management by all stakeholders including Mr. Jones. This is since it involves the interplay of diverse efforts by various people. The family needs to be counseled on the possibility of disease advancement as pertains to the health of Mr. Jones. Consequently, Mr. Jones needs to be counseled as pertains to his health, how he can prevent adverse effects and also to boost his esteem as pertains to his current state of health. The use of home based care is advised since Mr. Jones will have an opportunity of spending his last days with people who care about him. This not only prepares that family for a peaceful death, but Mr. Jones will also feel cared for and appreciated by the family. Spiritual intervention is also necessary for Mr. Jones and his assertion, and decision should be respected by all individuals. The use of analgesics and reliving Mr. Jones the alleviating pain symptom is also a strategy that has been documented in preparing a patient for a peaceful death (Barrett, Wilson, & Woodlands, 2009, p. 136). Evaluation This is the final stage of the nursing process and care plan. It is at this level that the outcomes of the interventions are assessed and compared with the expected outcomes outlined at the planning of every nursing diagnosis. Results obtained from the planning phase aid in the formulation of the subsequent care of the patient hence the nursing process is defined as being cyclic. Evaluation serves as the feedback to the nursing process hence providing with additional assessment data (Barrett, Wilson, & Woodlands, 2009, p. 150). Eating/ Drinking This is evaluated with reference to the SMART nursing diagnosis generated as pertains to the eating and drinking problem of activity of daily living identified in the planning phase. Evaluation is done by the use of questions: Has Mr. Jones stopped vomiting and has the diarrhea also ended? Has Mr. Jones attained his expected weight for age and is his BMI body mass index adequate? Has he established normal nutritional balance? Is Mr. Jones able to consume foods without the assistance of other people and feed competently? The answers to these questions will aid in the planning of eating and drinking for the next 24 hours and an illustration of the effectiveness of the assessment, planning, and implementation phase (Barrett, Wilson, & Woodlands, 2009, p. 150). Mobilization This will be evaluated by enquiring if the drugs of arthritis and Parkinsonism are more effective and efficient and lead to reduced falls compared to before. Does Mr. Jones experience reduced cloudiness and is he less predisposed to falls? Is Mr. Jones is able to perform passive exercise with the aid of a physiotherapist and are the exercises assisting him in reducing his fall? Has Mr. Jones adapted to the use of assistive devices like the use of rails and clutches while walking? Does Mr. Jones family take the responsibility of ensuring that Mr. Jones is not predisposed to falls by not being left alone? Has the stable mobilization of Mr. Jones been achieved by the therapy offered to him during his stay in the hospital (Barrett, Wilson, & Woodlands, 2009, p. 150). Death and Dying The perception of Mr. Jones as pertains to the course of his disease is a viable tool in assessing the effectiveness of this nursing intervention. How the family of Mr. Jones accepts his condition and responds to the management is also essential in assessing the effectives of this initiative. Death and dying is an outcome that cannot be assessed once it occurs but the process can effectively be assessed. This will be achieved through examination of Mr. Jones and his family’s take on his current disease condition (Barrett, Wilson, & Woodlands, 2009, p. 150). Data collected during the evaluation phase as earlier foretold is essential in planning the subsequent care of Mr. Jones for the next 24 hours. Moreover, the data collected during the evaluation phase serves as the base of reflection for the nurse since in assessing if the nurse was successful in the care of the patient. Reflection is a very important aspect in the care of a patient and should be an activity performed by every nurse (Barrett, Wilson, & Woodlands, 2009, p. 150). Conclusion My reflection of care accorded to Mr. Jones is that it met the objectives that had been set for the care. I appreciate the effectiveness of the RTP model since it focuses on the holistic care of the patient and I am glad that I incorporated it in the management of Mr. Jones. I am satisfied with the restored nutritional status of Mr. Jones since the vomiting and diarrhea ended. However, due to the advancement in the arthritic and Parkinsonism disease, the stability of Mr. Jones could not be restored. This meant that Mr. Jones had to be rehabilitated to the use of assistive walking devices and also to rely on the help of his family. As pertains to the death and dying, I am happy with the progress of Mr. Jones and his family in accepting his disease condition and being positive about it. The only thing I wish I had done differently is that I wish I had met Mr. Jones earlier than in the ward; this is since maybe the advanced alteration in his mobility would be corrected early. Other than that, I am comfortable with the care I accorded to Mr. Jones and his family during his care in hospital. As pertains to my interaction with the other heath care professional, I accord the recovery of Mr. Jones to teamwork among the health care professionals. Alone as a nurse, I would not have made it in restoring the health of Mr. Jones. Consequently, I appreciate the importance of ensuring patient confidentiality and respecting the needs and privacy of the patient. This is since it aids in inculcating the patient into his care hence enhancing his recovery. Preparing a nursing care plan for a patient is an example of primary nursing modality that every nursing student should strive to practice. It not only helps the patient, it also enhances the nursing skills of a student nurse. Reflection is also important since it provides avenues for further reading, research and hence personal growth and the growth of the nursing profession. References Aggleton, P and Chalmers, H 2000, Nursing Models and Nursing Practice. 2nd Edition. Basingstoke. Palgrave. Barrett, D; Wilson, B & Woodlands, A 2009, Care Planning - a guide for nurses, Harlow, Pearson Education Limited. Roper, N; Logan, W, & Tierney, A 2000, The Roper- Logan- Tierney model of nursing: based on activities of living, Elsevier Health Science Publisher. Read More