Discuss anout the Cycles of Reflection and Challenge.
The assignment is based upon designing of an effective nursing care plan for an aged person going though crisis situation. The goal is to promote evidence based nursing care approaches for the patient. Some of these nursing care approaches have been tested in an actual clinical scenario and have been seen to offer positive results. Here, the clinical reasoning cycle or millers functional consequences theory have been used to analyse the present condition of the patient. The priority designing helps in narrowing down to the primary focus of care, which helps in improving the quality of care. Additionally, adopting of the millers functional consequences theory can help in considering the situation of the patient such as old age the conditions associated with old age which further help in providing an effective and balanced care.
In the current scenario, the case study of Amalie Jones had been taken into consideration. She is an 89 years old woman and has been affected with a number of clinical and co-morbid conditions such as hypothyroidism, macular degeneration and rheumatoid arthritis. Recently, the macular degeneration and rheumatoid arthritis has been taking over her social life as she has not been able to keep up with her community. The macular degeneration has limited activities such as driving to the community centres to catch up with her friends as well as the rheumatoid arthritis has restricted her daily movements.
Based upon the present health condition of the patient the nursing professional deployed in the care of Amalie Jones needs to design a comprehensive care plan. The patient here had a number of co-morbid health conditions such as poor eye sight, hypothyroidism and acute joint pain. Amalie was survived her husband Henry and children from her previous marriage. Therefore, owing to her physical health she had a number of restrictions in her life some of which prevented her from living her life fully. Additionally, she considered herself to be a burden on her family and hence secluded herself. The patient had macular degeneration which meant that her condition would only deteriorate with age (Vries et al., 2016). Additionally, the rheumatoid arthritis allowed her little physical movement. This restricted her from efficiently carrying out some of her daily activities for living such as she could not manage cooking for herself and keeping the house clean. On further assessment, it was found that the patient was losing weight owing to hypothyroidism. Reports and evidences have further linked the presence of hypothyroidism with rheumatoid arthritis.
The clinical condition of the patient could be further accessed for the collection of cues. The patient had swollen and stiff joints which restricted her movements around the house as well as restricted her activities of daily living (ADL). The patient here also suffered from occasional dizziness vision impairment. The deficit in vision could be attributed to the effect of old age which leads to deposition of fat tissues in the retina. Since it was a progressive disorder the chances of recovery in the patient was low.Additionally, the rheumatoid arthritis further restricted the movement of the patient. the patient was prescribed a number of medications such as effective doses of paracetamol were provide to the patient in quarterly to hourly cycle in order to regulate the pain the patient. The patient had been put on 400 mg ibuprofen three times daily. The patient was also provided 200 mg o of hydrocholorquinine to regulate the condition of rheumatoid arthritis in the patient. However, as argued by McCorkell, Harkin, McCrory, Lafferty & Coates (2017) overdependence upon pain killer could probably result in worrisome conditions such as intestinal retraction.Though, the patient gave an affirmative reply regarding intake of medications. However, in the absence of a family or someone to take care of the patient it was quite possible that the patient actually missed the effective doses of medication.
The patient complained of acute pain owing to rheumatoid arthritis which made daily living difficult for her. The patient also suffered from hypothyroidism which made the condition worse for her. As mentioned by Dewar & Kennedy (2016), the presence of hypothyroidism could be linked to the development of arthritis in the patient. Low levels of thyroxin have been seen to trigger the condition of osteoporosis affecting bone density and influx of calcium potassium in the bones (Brooke & Manneh, 2018). However as argued by Nicolini, Vandenberghe & Gastmans (2017), the rheumatoid arthritis is often triggered owing to the development of an autoimmune disorder. Under an autoimmune disorder the body produces considers some of its own organs, tissues and products as threats and produces antibodies against them.
Therefore, based upon the patient conditions and history a number of effective care concerns could be designed for the patient which include restoring the mobility in the patient, effective pain and medication management. The patient had reported that she found conducting some of her basic day to day house hold activities difficult as she had difficulty in moving her limbs. She had restricted movement around the joints which means that any movement around it would cause excessive pain in the patient. The stiffness and the limited movements also meant that the patient had a higher risk of falling, which further affected the confidence patterns in the patient (Hutchinson, Hurley, Kozlowski & Whitehair, 2018). Hence the patient felt more so dependent upon the care provider. Therefore, the patient had to be provided with a positive an affirmative care plan which would restore agility in the patient. Some of these could he provided by designing an implementing an effective care regimen for the patient where the stress will be on light physical exercises. The light stretching could help in restoring the mobility patterns in the patient (Kim, Min, Kim & Shin, 2018).
Additionally, the patient had been suffering from acute pain, which made life difficult for her. Therefore, there was a need to effectively manage the sensation of pain in the patient, which could be done by cognitive behavioural monitoring, which helped in ensuring that perception of the patient regarding pain is altered. As mentioned by Rossiter & Day (2016), the attitude of the patient regarding the pain can help in controlling the amount of pain experienced. It had been seen that through behavioural therapy and counselling sessions the patient could be seen to take the entire experience of pain as a normal apart and process of life.
The patient had been suffering from a number of clinical conditions. Therefore, the patient had to be hugely dependent upon medications. In this respect, the patient lacked effective support and care services, which would help her take her medicines on time as the patient was an 89 year old lady making a living on her own. Therefore, provision of effective training and development of effective cause could be beneficial to help the patient with her daily care plan.
The miller’s functional consequences theory could be applied over here in order to evaluate the condition of the patient and design an appropriate care plan fitting her age. As commented by Jones, Hamilton & Murry (2015), the functional perspectives theory focuses upon adoption of holistic perspective of mind, spirit and body interrelatedness. As per the functional consequences rthoery the nurses should consider age related changes and risk factors while designing of a care plan for the older adults. In this respect, the age related changes noted within the patient were macular degeneration and progressive rheumatoid arthritis. Hence, one of the top priorities which could be undertaken over here is ensuring that the patient has sufficient freedom and autonomy over her own movements. In this respect, as the patient was an 89 year old woman she could be supported with the help of a walking aid.
The nursing priority could be decided based upon the assessment of the clinical condition of the patient. Based upon the number of co-morbid health conditions of the patient some of the top priorities were decided as restoring the mobility patterns in the patient. The goal could be further framed based upon the SMART framework where SMART refers to –specific, measurable, attainable, Realistic and time bound.
Some of the ways by which the condition of the patient can be improved with the help of nursing and care implementation have been explained in the following lines. The patient is unable to walk thus this can be solved by providing her with a walking aid so can move around freely (Kaylor & Strickland, 2015). The Braden scale can be used to measure the amount of pain that the patient is going through (Lamothe, Rondeau, Malboeuf-Hurtubise, Duval & Sultan, 2016). In case the patient experiences stronger amount of symptoms then she can be recommended to a physiotherapist to treat her joint stiffness and for the management of her pain. The patients require a care provider who can help her throughout the day and ha care giver should manager her activities of daily living which is also known as ADL (Jones, Hamilton & Murry, 2015). As Amalie has recently started having muscular degeneration and she also lives all by herself with no one to look after her she should have a “fall risk management”.
The assessment of the results of the condition of the patient will help to realize the importance of the care provider or nursing. The analysis of the results can predict the possibility of recovery of the patient. After the care was provided to Amalie there was some improvement noticed in her health and as a result, it was found that she experienced less pain. She was also able to do her daily chores all by herself. Amalie slowly became self-sufficient and she also had the hope of recovering completely, as she got well, she also wanted to meet her family.
The experience, which I had from providing nursing care to Amalie, helped me in understanding the fact that under such conditions connecting with the patient on a personal level helps a lot to understand the difficulty the patient is facing. I had to listen carefully to what she had to say about her experiences regarding the conditions or the problems that she was facing. She suffered from a number of medical conditions she suffered from rheumatoid arthritis at the same time she had hypothyroidism and degeneration of the muscles. All these conditions made it impossible for her to conduct her daily activities and she required additional help from someone. Being sympathetic and knowing her personally made it easier for me to help her to provide her the required cared that she needed. Moreover, the nursing experience with Amalie made me confident about taking medical and clinical decisions.
Conclusion
In this assignment, the kind of care to be provided to a patient with serious medical conditions has been discussed. The patient was becoming isolated from the world and her relatives, as she was unable to move or function properly. She had rheumatoid arthritis and muscle degeneration, which caused a lot of pain in her physical movements. Along with these two medical conditions she also had stiffness in joints and that also restricted her movement. The wishes and personal opinions of the patient should be given priority during the entire process of providing care. The members of the family of the patient should also be involved in the process of recovery of the patient. The application of processes which has been already proven to effective should help in deciding the care planning of the patient in a more effective manner.
References
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Dalton, L., Gee, T., & Levett-Jones, T. (2015). Using clinical reasoning and simulation-based education to’flip’the Enrolled Nurse curriculum. Australian Journal of Advanced Nursing, The, 33(2), 29. Retrieved from: https://search.informit.com.au/documentSummary;dn=018184224173600;res=IELHEA
Dewar, B., & Kennedy, C. (2016). Strategies for Enhancing “Person Knowledge” in an Older People Care Setting. Western journal of nursing research, 38(11), 1469-1488. Retrieved from: https://journals.sagepub.com/doi/abs/10.1177/0193945916641939
Hutchinson, M., Hurley, J., Kozlowski, D., & Whitehair, L. (2018). The use of emotional intelligence capabilities in clinical reasoning and decision?making: A qualitative, exploratory study. Journal of clinical nursing, 27(3-4). Retrieved from: https://doi.org/10.1111/jocn.14106
Jones, T. L., Hamilton, P., & Murry, N. (2015). Unfinished nursing care, missed care, and implicitly rationed care: State of the science review. International journal of nursing studies, 52(6), 1121-1137. DOI: https://doi.org/10.1016/j.ijnurstu.2015.02.012
Kaylor, S. K., & Strickland, H. P. (2015). Unfolding case studies as a formative teaching methodology for novice nursing students. Journal of Nursing Education, 55-67. Retrieved from: https://doi.org/10.3928/01484834-20150120-06
Kim, Y. H., Min, J., Kim, S. H., & Shin, S. (2018). Effects of a work-based critical reflection program for novice nurses. BMC medical education, 18(1), 30. Retrieved from: https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-018-1135-0
Lamothe, M., Rondeau, É., Malboeuf-Hurtubise, C., Duval, M., & Sultan, S. (2016). Outcomes of MBSR or MBSR-based interventions in health care providers: A systematic review with a focus on empathy and emotional competencies. Complementary therapies in medicine, 24, 19-28. Retrieved from: https://doi.org/10.1016/j.ctim.2015.11.001
McCorkell, G., Harkin, D., McCrory, V., Lafferty, M., & Coates, V. (2017). Care of patients with dementia in an acute trauma and orthopaedics unit. Nursing Standard (2014+), 31(36), 44. Retrieved from: https://search.proquest.com/openview/ea5d71986d79a62d7a5ad72bf259a178/1?pq-origsite=gscholar&cbl=2042228
Nicolini, M., Vandenberghe, J., & Gastmans, C. (2017). Substance use disorder and compulsory commitment to care: a care?ethical decision?making framework. Scandinavian journal of caring sciences. Retrieved from: https://doi.org/10.1111/scs.12548
Rossiter, R., & Day, J. (2016). Cycles of reflection and challenge: Using sequential blended learning strategies to enhance student understanding of, and transition to, the Nurse Practitioner role in Australia. Collegian, 23(2), 159-166. DOI: Retrieved from: https://doi.org/10.1016/j.colegn.2015.04.001
Vries, N. M., Staal, J. B., Wees, P. J., Adang, E. M., Akkermans, R., Rikkert, O., … & Nijhuis?van der Sanden, M. W. (2016). Patient?centred physical therapy is (cost?) effective in increasing physical activity and reducing frailty in older adults with mobility problems: a randomized controlled trial with 6 months follow?up. Journal of cachexia, sarcopenia and muscle, 7(4), 422-435. Retrieved from: https://doi.org/10.1002/jcsm.12091
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