Article on Holistic Nursing Care

Added on - 06 Jun 2020

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Mrs. Jones complex healthcare needs after a stroke attack and nursing holistic careThis article will look at holistic nursing care needs for an identified patient whoadmitted to a medical ward. In this project, confidentiality will be maintained throughoutwith the use of pseudonym Mrs. Jones, this is to maintain the patient’s privacy, dignity, andconfidentiality in line with the NMC Code of conduct (Nursing and Midwifery Council(NMC), 2015). NMC (2015) states clearly that nurses have a duty to protect their patients’confidential information and use it for delivering care to them as well as the best interest tothem. This also has been highlighted by Price (2015) that information about patient’s healthstatus is shared quickly by the team and wider healthcare services, and it can be sensitive,therefore nurses have obligation use it appropriately. Evidence from Cox (2015) suggests thatmanaging patients’ confidential health data inappropriately can result in negative reputationin health care services. Therefore, healthcare professionals have a duty to protect theirpatients’ information from beinginappropriately intruded, mismanagement and misuse. Thispaper will examine and critically analysis Mrs. Jones individual complex healthcare needs,scrutinize and review some evidence behind the care delivered. Moreover, the aspects of howthe patient’s health breakdown affects her from biological, psychological, spiritual and socialperspective will be explored. Some challenges and barriers that nurses may encounter whenimplementing care to the patient will be identified and explained how nursing staff canovercome them to deliver holistic care to the patient, as well as how some guideline, healthpolicies, literature evidence encompass them. Finally, a conclusion will be presented.Mrs. Jones aged 81 lives on her own in a shelter housing accommodation and her onlyson lives twenty miles away however unable to see her regularly due to the nature of hiswork, although they have a close relationship. She is a retired primary school teacher andclaims that she does not go to church. In her spare time, she enjoys reading and drawing andthey are the major hobbies. She is general unwell recently, has reduced appetite and weightloss. She had a fall at home and admitted to a medical ward for investigation and possiblemedical treatment. She did not have a fracture but have some bruise on her upper arms. Mrs.Jones had a stroke whilst hospitalization, resulting in her left side paralysed and her speechaffected.She is right-handed and thus, still has the capacity to consent medical treatments.She also possesses calibre to understand the medication. In addition to this, she does get themedical discussions on her illness. However, it should be recognised that due to the illnessesshe is suffering from, it is hard for her to speak about her exact situation. Further, she can notdo her work appropriately on her own after getting paralysed. When approaching Mrs. Jones,she appears tearing and she seems not engaging with healthcare staff when asking how shefeels.This is because of the reason of absence of connectivity between them which the nursesshould aim to develop.This may suggest that she exhibits social withdrawn. Also, as she hasto spend her days alone is making her emotional distress. It can be seen from the way ofavoiding going to churches. In addition to this, the weight loss and reduced appetite indicatethat she may have been suffering from Anorexia. This disease is further responsible forcreating emotional distress.Nurses have a duty of care to the highest standard, meet their
patients’ holistic needs (Allen, 2014), advocate and empower patients and help theminformed choices (NMC, 2015; Lansdell).Stroke attack is a life-changing event and has an impact on survivors’ emotion as wellas their carers’ and families’(Stroke Association, 2013).The emotional impacts of stroke aremajor , they can bring dramatic and unexpected changes to people's lives. As mentionedabove, she used to pass her time by drawing and painting, now that when she has stroke shecan not perform those activities effectively which make her feel good. However, it should benotedthat social effects resulting from stroke are greater than physical effect (Burton, 2000).Stroke survivors often find that they have lost their identity unexpectedly and often feelintense, frustrated, angry about their body image, losing the social role, being unable to carryout some everyday activities(Hafsteinsdottir and Grypdonck, 1997; McCrum,1999 andBurton, 2000). They would feel particularly distressing when they have lost their social rolefor example not able to do some valued activities and do the things that they used to enjoydoing and interested in. This could increase their sense of social isolation (Metchell and Keb,2004). Anxiety and depression would grow over time (McCrum, 1999) and could last for along period of time (Young et al., 2003; Hare et al., 2006 and Broomfield et al., 2014). Thispsychological problem has been evidenced to slow stroke functional recovery andrehabilitation and reduce the quality of life (Nys et al. 2005 and West et al. 2010). Emotiondisorder can lead to changes in behaviours and these behaviours may indicate that the personis not well.Ayerbe et al. (2013) outlined that when patients are not willing to engage nursingactivities it can be a sign of depression post stroke; mood disorder have an impact on morethan 50% of stroke patients. Evidence suggests that depression and cognitive issues canreduce their motivation of participation of rehabilitation, resulting in poor healthcare outcome(Skidmore et al. 2010; Harrison et al. 2017).Moreover, as per the views of Salter et al. (2008)and Satink et al. (2013) two qualitative research studies find that stroke survivors often feel asense of loss, socially isolated, uncertainty about their future, depending on others andbecome a burden. People with depression and mood disorder can increase the risk ofdeveloping cardiovascular disease and increase the risk of secondary stroke and mortality(Katon, 2011). Depression has a significant impact on pain severity (Sahin-Qnat et al. 2016),increase the risk of developing a pressure ulcer, and malnutrition (Perry and McLaren, 2004),particularly in older patients.Clearly, Mrs. Jones may be experiencing these psychologicalproblems (Ostir et al., 2011). Indeed, psychological care should be a fundamental part of apatient’s care plan. To provide holistic care, it involves healing the mind, body, and soul of aperson as a whole and the person’s emotional, spiritual, social and personal needs must beaddressed and met (Nina and Dariene, 2013). Nursing aspects include pain management,pressure ulcer prevention, nutritional support, spiritual and social care should be included inthe nursing activities and meet the patient’s complex holistic needs and empower the patientand help her informed choices and decision making (NMC, 2015; NICE, 2014; Lansdell,2016).Also, as stated by Thomas et. al., (2015), the shortage of neurological cells after sheparalysed will change the body image and functions. This decrements will results to the
things which will take some time for her to be fluent with. For instance: Avoiding use of lefthand in any activity.Evidence suggests that psychological support for Mrs. Jones is as essential as physicalrehabilitation (Welch, 2008; the Stroke Association, 2012). Moreover, the psychological careis important for both the patent self and his or her family who will endeavour to manage theimpact of stroke on their lives during the hospital stay as well as in the longer term whendischarge from hospital (Gillham, 2011). It is, therefore, important for nurses to clarify withthe patient if it is appropriate to inform the family about the patient current health conditionand any changes. Mrs. Jones was explained and asked her if she would consent to inform herson about her stroke and the current care (NMC, 2015). Mrs. Jones’ body language, facialexpression and holding the staff’s hand show that she agrees to the plan. She seems a bitmore cheerful after having spoken to her about informing her son her situation, although shecould not verbalize with her thoughts. Edvardsson (2010) argues that healthcare staff workwith patient’s family as a partnership and their involvement can be therapeutic as that canhelp develop and maintain trust between the patient, family, and healthcare team.Considering Mrs. Jones’ son is busy with his work, Mrs. Jones is kept informed that her sonwould receive information from the healthcare team about her care and keeps her son updateany changes. Therefore, it would help her son to reduce the needs to contact the healthcareteam constantly for the information about the patient, treatment, and care (Edvardsson, 2010).Mrs. Jones seems happy with the plan.Holistic care for Mrs. Jones includes the aspects of respecting the patient has a vitalrole in the care process, participating with nursing activities, encourage self-care and workingtowards rehabilitation goal (Thompson et at. 2008). The patient’s engagement would give thepatient hope, increase one’s social interaction skills and confident, a sense of autonomy anddecision making. Healthcare Staff regularly attends to Mrs. Jones to provide nursingintervention, checking if the patient is comfortable or may have other needs (Harris, et al,2017). Skidmore et al. (2010) highlight that if a stroke patient can express how they feel, theiremotion, sadness, depress, anger to someone, it is an important part of the recovery process.However, Mrs. Jones is unable to express her feeling verbally to the care staff. Code et. al.(1999) outline that people with aphasia experiences unexpected inability to take part in acomplete range of activities and social leisure and depression is often displayed because ofnegative emotional reactions.There are different strategies that nurses can use to the patientswho are language deficit (Cott, 2004). They can make use of pictures to graphically representthe message. Further, they can make communication with the help of different interactionsources such as written, symbols, etc. In order to simplify the way in which the patient canreveal the feelings, nurses are required to attain their trust. This can be gained only afterensuring an effective communication. They can also take a written questionnaire comprisingof indirect questions that can help in analysing the feelings of the patient.In turn, this kind ofnursing intervention would improve psychological problems she may have, as taking part inthe nursing activities can be recognised as a part of receiving 45 minutes of relevant therapyfor a minimum of 5 days a week recommended by NICE (2013). The nursing activitiesinclude washing and dressing, self-feeding when eating and drinking using the unaffectedhand, continent care, and hygiene needs. Mrs. Jones is explained in detail about these
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