Table of Contents INTRODUCTION...........................................................................................................................1 PROBLEM SOLVING APPROACH AND ITS SIGNIFICANCE................................................1 APIE Approach............................................................................................................................1 BEHAVIOUR RELATED TO CASE STUDY OF JOE.................................................................4 GLASSES....................................................................................................................................4 PORRIDGE.................................................................................................................................6 REFLECTION.................................................................................................................................7 Gibbs reflective model.................................................................................................................7 CONCLUSION................................................................................................................................9 REFERENCES..............................................................................................................................10
INTRODUCTION The bio psychosocial approach is defined as the way to analyse and use biological, social as well as psychological perspective for the treatment and diagnosis of any disease. The approach is widely used by the health care professionals to improve the quality of health care services (Mitchell and et.al., 2016). It has been observed that evaluation of only clinical or physical perspective may not deliver effective health outcomes. Thus, for developing better understanding of the patient needs and health care service providers also assess the social and psychological elements. The problem solving approach used by the nurses can also influence the quality of health outcomes. In order to provide the holistic care to the patients it is required that nurses must pay proper attention to the problem solving approach so that the care needs can be identified and suitable interventions can be used. The report will discuss the APIE approached used by the professionals and how it enhances the quality of services. It will also describe the behavioural issues associated with a given case study. PROBLEM SOLVING APPROACH AND ITS SIGNIFICANCE For the health care professionals the problem solving approaches assist in improving the physical, mental as well as emotional health of the patients. Being a health professional is very criticaljobandrequiresattentionandefficiencyinsolvingproblems.Forthenursing professional the decision making is based upon the knowledge, problem solving skills and experiences (Bagley, 2015). In order to solve any clinical problem nurses are required to analyse several aspects. For instance the causes, possible risks, expected outcomes and possible solutions which can solve the problem. The clinical errors or the problems can be very risky for the lives of patient. Thus, for avoiding such risk specific problem solving methods are used by the service providers. APIE Approach The most common approach used by the health professionals to solve the problems which occurs during their practices. APIE refers to the following stages which are involved in determining the solution of a particular problem. By following this model it is easy to get solution of problems. Moreover, each stage is having a specific purpose that solves problem. ï‚·Assessment ï‚·Planning 1
ï‚·Implementation ï‚·Evaluation The use of this well defined structure for problem solving assist nurses in choosing appropriate intervention or the nursing practices. The nurses are required to first analyse the condition and problems of patient then on the basis of these observations nurses choose suitable treatment model and its impact on patient care, their health outcome and the care delivery model. The various stages of APIE model can be used in the following way to enhance the professional efficiency: Assessment: At first it is necessary for the nurses to understand the actual problem which needs to be solved. Without proper assessment nurses will not be able to identify the accurate problem area which needs improvement (Overton,Lerner and Molenaar,2015). For assessing the patients nurses aims to seek answers to the questions such as what are the possible causes of the problem, when and how it is affecting individual and what the behavioural and psychosocial changes which are observed. During the practice and training period nurses are provided with the sufficient knowledge to diagnose the various clinical issues. On the basis of this clinical knowledge and observations health professionals also predict that what changes or the advancement problem may take in turn. It is also possible that a single individual may suffer from multiple health issues. Time is very critical and sensitive attribute in the health care services. Thus, in the assessment stage nurses are also required to prioritise the several aspects of the problem so that complexities can be reduced and effective solutions can be provided. Planning: Another problem solving step used by the nurses after assessment is the planning approach. When health professionals have identified the root causes and impact of the problem then they develop and interventions and suitable plans to resolve the problem. For instance like if health professionals does not get any in-depth analysis of the problem then they decide to investigate further through clinical tests or diagnosis procedures and on the basis of the conclusions drawn nursing interventions or treatment strategies of the patient are determined. The health professionals also prepare plans that if the treatment resources are available within health care organisation or not (Simonton,2015). For example if any problem can be 2
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solved by changing the diet plan then service providers analyses that is there any possibility to do this or if there is dietician available who can assist in implementing this plan. Along with the knowledge the experience and reflective practices also plays key role in developing plans. The previous incidents can help nurses to use their valuable experience so that the risk and adverse impacts can be identified or eliminated. The planning and implementation phase of the problem solving is also governed by the nursing and midwifery regulations. These regulations describe the practices and required standards which must be followed by the service providers. Thus nurses must be very careful in the planning stage so that the accuracy and efficiency can be assured. Implementation: Implementation can be considered as the major step in solving a particular problem. The outcomes of the problem solution are obtained through this stage. The treatment strategies planned by the nurses are implemented or applied so that condition of the patient can be improved and problem can be solved. It is also possible that during implementation phase nurses may experience several challenges. For instance the nurses in the transition period may not be able to provide suitable care to the patients due to lack of experience. Thus, implementation may not be executed as per the planning. Hence, it is very essential that experienced health professionals must guide and monitor the novice nurses so that they can perform their task without any error. Theproblemcannotbesolvedwithoutincorporatingtheplannedstrategiesinto outcomes. In order to achieve the desired results it is necessary that the nurses and other health professional analyse the attributes which can affect the successful implementation of the problem solution (Hari,Samsand Nummenmaa,2016). This can be understood by an example like if the health of a patient can be improved by the holistic care and person needs attention and care from multidisciplinary team then for successful implementation various professionals need to work in team with nurses. It will overcome the possible risks or the implementation barriers. Evaluation: Once the necessary solution strategies are used by the health professional for solving the problem it is required to evaluate the outcomes. The evaluation will help to assess that if problem is actually being solved or has worsened. For instance in many clinical situations the surgeries are performed as the remedy to treat particular disease. However, as a side effect it can bring 3
significant changes or decline in physical strengths or behavioural patterns. Thus nurses must evaluate these shortcomings so that they can be resolved and problem can be solved from the root. In health care services the negligence to evaluation practices can be harmful for the health of the patients. Due to this reason evaluation has been one of the elements of APIE approach so that a clinical complication which results due to problem solving process does not become complex and life threatening. The use of this clinical and problem solving technique lowers the risk vulnerabilities in the treatment and diagnosis of the health care issues. Besides this, it supports in evaluating solutions and then selecting the best one to solve problem. Through this, problem is broken down and simplified. Then, a proper plan is developed which on how problem will be solved and at last plan is implemented and evaluated. BEHAVIOUR RELATED TO CASE STUDY OF JOE There is several behaviour issues related to Joe. From case study it is analysed that nurses are giving care services to him in ineffective manner. Due to this there are different factors that is affecting Joe behaviour. Each factor is affecting in different way on Joe. This is changing his behaviour towards nurse. So, it is impacting mental condition of Joe. Therefore, in order to identify behaviour there is a concept used known as glasses and porridge. It is mentioned below :- GLASSES Psychological –It is a model that consists of 8 stages of psychological development. It defines that how personality development outcome is affected due to psychological crises(Erik Eriskson stage of psychosocial development. 2018). Here, crises nature includes need of individual that conflict with needs of society (Shibutani,2017). The stages related to case study are as follows :- Trust vs mistrust-When there is consistent care provided it leads to building trust with patient. But its failing in this task may result in anxiety, insecurities, etc. Autonomy vs shame –here, in an individual is encouraged their confidence level increases. They become capable to survive and fight against challenges. Whereas if they are restricted to do things and highly depend on other then it may be difficult for them to survive. 4
Generatively vs stagnation-In this stage people experience those nurture things that helps in their survival. It brings in positive change in their behaviour. On other hand in case of failure, an individual may feel disconnected with society. Ego integrity vs despair-this stage occurs after 65. The individual may feel that he or she did not attain goals and objectives and is dissatisfied with life. This results in despair which leads to depression. Thus, late life is characterised by integrity and despair. In Joe case it is observed that Joe due to unethical behaviour of nurse he may not be able to nurture those things which help in survival (Ananth,2017). Due to this there might be no positive change in his behaviour rather he may feel disconnected with society and make him upset. Alongside it, there are many other things such as if Joe might not have accomplished his life goals so he will be highly dissatisfied with it. This will lead to despair in Joe. So, getting in depression might affect Joe health more adversely. He may lose hope in life and might not be willing to recover. As Joe was already depressed the rude behaviour of nurse towards him made it more difficult to recover. It completely changed his behaviour towards life. He thought that there is no hope left in getting effective treatment. His ego was hurt. Sociological –There are several sociological factors that affect health and behaviour of an individual such as ethics, values, etc. these factors impact differently on person. Due to this change in behaviour can be easily identified. In this the behaviour can be observed through oppressive practice. There is great impact on individual mental and physical health. Usually, in oppressive practice nurses behave in very unethical manner. They do not give importance in providing care services. Besides this, no specific process is followed in and high quality care services are provided. Joe was also a victim where nurse followed oppressive practice. It highly impacted him in negative way. Biological –Biological factors are related to an individual personal traits, disease, nutrition, metabolism, etc. it plays important role health of a person (Scambler,2016). Any change in these factors affect health of a person. It is related to studying human behaviour through mobility. Similarly, Joe was affected as well. Due to improper behaviour his metabolism was highly affected. The nurse did not allow Joe to move freely and to do things on his own. Thus, there was no change in behaviour of Joe. 5
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PORRIDGE Psychological-In this classical conditioning can be applied where learning is given through association (Classical conditioning2018). There are three stages in this where in each one stimuli and responses changes. The stages are as follows :- Before conditioning-In this the stimulus and response produced are both unconditionally. So, there is no new behaviour learned. Also, neutral stimulus is not having any effect on person. In Joe case there is During-Here, stimulus that produces no response is associated with unconditional stimulus and at some point it becomes conditioned stimulus. The nurse provided care to Joe After –It is a stage where conditioned stimulus associates with unconditioned one to create a new conditioned response. It can be evaluated from case that Joe condition was critical due to which his stimulus was responding quickly (Dooley,2019). There was no association between stimulus and response. So, Joe behaviour was not associated with stimulus rather it was depend on condition. When nurse did not have him glasses, Joe did not produce a response. Also, in spite of continuous expectations made by Joe he was not getting proper treatment. Before clinical conditioning it is observed that Joe response was not so effective. It is due to unconditional condition. The nurse gives them care services that vary day by day. In stage 2 Joe stimulus produces response with condition stimulus. Sociological –The sociological behaviour of Joe can be identified by ageism. It can be observed in video that Joe is an old person. Also, nurses are not treating him respectfully. They are not providing proper and effective care services. Nurses are treating Joe very badly. They are considering Joe as normal person. Moreover, the care provided by them is not holistic. Their attitude is also not with respect to senior citizen. The language used is very harsh. They gave him medicines early as compared to time. Nurses did not follow their responsibilities properly. It clearly shows discrimination against seniors by nurses in providing care services. Biological-The special senses can be used to define Joe behaviour. They are senses where specialised organs are devoted to them. For example, eye, nose, tongue, etc. They all are connected to nervous system which helps in visualising information. From case it is evaluated that nurse treated Joe very badly (Carrierand Walby,2015). They woke him up in early morning due to which his eyes were affected. Also, they did not give glasses to him when 6
required. Furthermore, food provided to Joe was not healthy enough. This affected taste buds of tongue. Apart from it, eyesight of Joe was impacted as he was not able to properly see and identify things. So, this shows how holistic care was ignored in nursing practice. REFLECTION In the video which describes that nurses are not give proper efforts on the patient that they not paying attention to the patient properly and also they not care. As a nurse I respect people and patients I cannot hurts their dignity. For reflection Gibbs model is been used. It contain 4 stages which helps in writing reflection that is as follows :- Gibbs reflective model Description In the video, I am watching that nurses are not give proper attention to theJoewhich describe that nurses are only concentrate on the gossips they only interact with each other and not listen the Joe, Joe wants the glasses but nurses ignored. Nurses are not much interactive with the patients there have lack of communication. So it shows that nurses hurt the dignity of the Joe and they not give the respect to the patients. Joe is very old and they not proper breathing but nursesare not properly care and not provide the best food to the Joe. they wake up early to the Joe and also not give good attention as that they cannot wish good morning properly, its creates the negative environment for the Joe. Basically I show that nurses are not done their work properly as they not behave professional they only interested in their gossips. As a nurse, I am working in the health care institution I can give my hundred percent to provide the best facility to the patients. As I can more concentrate on their health also I provide the positive environment to the patients. I can work as a professional. Moreover, I worked by following a routine plan that enabled me in getting insight about what I have to do next. Feelings I am feeling not good because nurses are not behaved well with the Joe, they are not giving the proper attention. So I am not feeling good because the attitude regarding the work it’s not proper and this is not the way of treating the patients, Nurses are not respect the Joe so I am felt that respect is necessary when you treat the people during the critical time so this is the way oftreatsthepeople.Ipersonallyfeelthatmedicalprofessionisnobleone.Themajor implications that a medical professional can bring is well being of people and in accordance to 7
their social surroundings. Another impact is that as a nurse, I interact with families and lean about the patients' lifestyle which helps me to gain knowledge. This later help me to give them appropriate treatment plans and medication as well. Therefore, it is also important for me to have clarity and reliability to make my patients feel at home. I also believe that all human beings must be blessed with good health in terms of eating nutritive food and leading as healthy life and thus as medical practitioner, I give them information and detail to use it wisely for better living standards. I might felt that there is need to change the process through which care is provided. Evaluation I can feel that the situation which arises in the case study is not good because nurses are not respect the Joe. As a senior person Joe want respect but in the audio that behaviour of the nurse are not proper, as they not give the attention to the Joe. So this case study creates the negative impact on the Behaviour of nurses. As a nurse I give the best facility to the patients as I am provided the positive environment to the Joe. I can perform my all duties regarding the different services I am providing healthcare services, monitoring patient progress, and educating patients and their families about their health condition or disease. So I can evaluate these strategies to improve the environment of the hospital. I came to a conclusion that evaluating strategies will be beneficial in finding out how overall procedure was followed. Besides this, it will be useful for me to compare it with set standards. I will be able to develop plans accordingly in the future. Furthermore, it will be easy for me to make changes in strategies and plans. Analysis I learn from this case study that is, being a professional person you have a responsibility to manage all the things as a professional person. I learned that when you take the responsibility of work so you are completed all the work according to your job responsibility. So I can understand that as a professional person you are responsible of your work so I am learned that I am doing the proper work and also I can manage all the work according to the priority of work. I also learn that I am providing the best facility to the patients. Furthermore, I came to a conclusion that there is need to develop a procedure through which responsibility can be followed. For this I can take help of other nurses as well. By this it will be easy for me to treat patients and provide them care. However, in order to manage work I did not follow schedule. Due to this I did not complete activities in time. Conclusion 8
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In this case study I can learn that I can manage the dignity of the patients I also respect the patients during the critical situation of the patient. I am also connected with the patients and make the better relationship. So patients also like this facility and they also improve their health. I am provided the special treatments to the patients to improve the health. I also understand the feelings of the patients. So basically I can provide the best facility to the patients as health care professional. I must ensure that patient communicate with me frequently so that I can identify their needs. It will help me in delivery care in proper time. I need to respect the dignity of patient so that they feel comfortable. Action plan In this situation I promise that I can manage all the work I provide the best service to the patients to improve their health. I can perform my all duties regarding the different services I am providing healthcare services, monitoring patient progress, and educating patients and their families about their health condition or disease. Also, I can give the proper education to the patients for particular diseases. I am provided the best environment to the patients. I also treat people as a good manner so as nurse I communicate with the patients also understand the people that what they want and what are the needs, they are comfort or not when they are not comfort I provide the best resources to the patients to feels comfortable. I will review my progress by taking feedback from colleagues and patient. It will enable me in measuring my progress with set goals. By this I can make changes in my action plan and accordingly progress in future. This will provide ease in my career growth and nursing practice. However, continue evaluation will benefit me in learning different nursing practices and implementing in professional career. CONCLUSION Hereby, it is concluded nurses faces many problems in providing care to patients. The problems are occurred during carrying out practices. In order to identify problems and solve them there is a problem solving approach known as APIE. It contains 4 stages where solutions are defined and solved. There are some psychological, sociological and biological factors that affect a person. Its affect can be either positive or negative depending on person behaviour. In psychological Ericken model is used along with classical conditioning. Through Gibbs model nurse can analyse their performance and develop action plan to implement changes. 9
REFERENCES Books and journals Ananth, M., 2017.In defense of an evolutionary concept of health: nature, norms, and human biology. Routledge. Bagley, C., 2015.The social psychology of the child with epilepsy. Psychology Press. Carrier, N. and Walby, K., 2015. For sociological reason: crime, criminalization, and the povertyofbiosocialcriminology.JournalofTheoretical&Philosophical Criminology,7(1), p.73. Dooley,B.D.,2019.Undisciplined:TracingCriminology'sGrowingDivergenceFrom Sociology.Sociological Inquiry,89(1), pp.94-122. Hari, R., Sams, M. and Nummenmaa, L., 2016. Attending to and neglecting people: Bridging neuroscience, psychology and sociology. Mitchell, K. and et.al., 2016. The new Medical College Admission Test: Implications for teaching psychology.American Psychologist,71(2), p.125. Overton, W.F., Lerner, R.M. and Molenaar, P., 2015.Handbook of Child Psychology and Developmental Science; Volume 1: Theory and Method. John Wiley & Sons. Scambler, G. ed., 2016.New directions in the sociology of chronic and disabling conditions: assaults on the lifeworld. Springer. Shibutani, T., 2017.Society and Personality: Interactionist Approach to Social Psychology. Routledge. Simonton, D.K., s2015. Psychology as a science within Comte's hypothesized hierarchy: Empiricalinvestigationsandconceptualimplications.ReviewofGeneral Psychology,19(3), pp.334-344. Online ErikErisksonstageofpsychosocialdevelopment.2018.[online]Availablethrough:< https://www.simplypsychology.org/Erik-Erikson.html> Classicalconditioning.2018.[online]Availablethrough: https://www.simplypsychology.org/classical-conditioning.html 10