Strength Based Nursing Care Plan for Emma Gee: A Case Study

This essay discusses the strength based nursing approach for Emma Gee, an occupational therapist who had been admitted to the hospital following an episode of stroke. It includes a strength based care plan, rehabilitation admission, and discharge planning. The essay also highlights the importance of patient empowerment, partnership and collaboration, therapeutic relationship, and cultural competence in nursing care.

Running head: CNA343
Emma Gee case study
Name of the Student
Name of the University
Author Note

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Introduction- Strength based nursing (SBN) refers to an approach that focuses on care
of people, which encompasses eight core principles that guide the nursing profession, thus
promoting self-efficacy, hope, and empowerment of the patients (Gottlieb 2014). Across
different levels of care that range from primary care services for healthy patients, to critical and
acute care services for patients who are unconscious, the domain of SBN primarily focuses on
reaffirming the goals of a nurse for promoting the health and wellbeing of the patients,
facilitating easy recovery and healing process, and alleviating all kinds of suffering.
This is principally achieved by development of an environment that strengthens the
capacities of the patient for health and the associated mechanism self healing and recovery.
According to DeNisco and Barker (2013) SBN is found to compliment medical care and also
assists or supports by providing a language that facilitates easy communication, regarding the
contribution of nurses to the health and healing of the patient, thereby empowering them to gain
increased control over their quality of life (Moyle, Parker and Bramble 2014). The essay will
focus on the case study of Emma Gee, an occupational therapist who had been admitted to the
hospital following an episode of stroke. This will be followed by formulation of a strength based
care plan during her transition journey.
Strength based nursing care plan- Despite increasing attention that that is being paid to
wellness prevention and patient centred care, the medical model that places an emphasis on the
deficits of the patients, rather than their strengths, often remains the most commonly used
practice model in clinical services (Tourangeau et al. 2016). Most nursing professionals have
been trained to place a due focus on the problems that are faced by the patients, which in turn is
facilitated by conducting an analysis of the concerns and thoughts of the patient. In the words of
Ibrahim, Michail and Callaghan (2014) formulation of strength based nursing care plan will

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help in bringing a balance to the deficit based care plans and it will focus on gaining a deeper
understanding of the problems within the holistic and broader context that will uncover the outer
and inner strengths of the client Emma Gee.
Following Emma’s admission to the hospital where she is being delivered adequate care
services in the Intensive Care Unit (ICU) and is gradually regaining consciousness, it is utmost
necessary for the nursing professionals to provide her assistance in feeding activities. Stroke
most often affects the way by which food moves around in the mouth and the swallowing
capabilities of a person, thereby leading to a condition called dysphagia. This condition most
often creates problems with drinking and eating and the food or drink might get inserted in a
wrong way or inside the lungs (Rofes, Vilardell and Clavé 2013). Conduction of a swallowing
assessment is essential to evaluate the oesophagus and its associated functions. The Fiberoptic
Endoscopic Evaluation of Swallowing (FEES) might also be used to determine the functionality
and anatomy of the swallowing apparatus and its associated reflexes. Dysphagia results in
aspiration and some of the most common signs and symptoms include shortness of breath and
wet sounding voice. Hence, assistance is also required from a speech pathologist for managing
dysphagia (Wan et al. 2014). A dietician will help in ensuring that Emma is being provided
adequate nutrition and is taking proper nutritional supplements (Crary et al. 2013). Collaboration
with a speech pathologist will also help in checking the muscles that are used for swallowing
food. Videofluroscopy or modified barium swallow can also be used for the same purpose. This
should be followed by supervision and/or assistance from speech pathologist such as, drinking
thickened drinks, or eating smooth foods that are considered safe, besides suggesting movements
that would make swallowing easier and safer (Edmiaston et al. 2014). Therefore, effective
collaboration is required from the nurse in charge, the speech pathologist and dietician who will

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take all possible efforts to make Emma show compliance to a well formulated diet chart that will
enhance her health status and help her tolerate certain drinks and food. Conduction of frequent
pain assessments, making a regular note of her vital signs, managing integrity of the skin, and
assessing the psychological functioning of the patient are also imperative in this case study. The
patient should also be frequently repositioned, with the aim of promoting her optimal recovery,
which will be achieved by modulating the muscle tone and preventing complications such as,
respiratory problem, pain, contracture, and pressure sores.
The case study also hints at communication deficits in Emma that resulted in a failure of
her family members and the nursing staff in interpreting what she intended to say. Although a
white board has been brought by her sister, effective collaboration between the therapists and her
family members will help in gaining a deeper understanding of the different strategies and
communication techniques that should be employed in this scenario. Flynn et al. (2013) stated
that several stroke patients report difficulties in their communication that commonly includes a
history of dysarthria, apraxia, cognitive difficulties, and dysphonia. The speech pathologist will
assess Emma’s reading, talking, listening, understanding, and writing and will work together
with the family members for developing a rehabilitation program. Some of the commonly used
resources that might prove beneficial in this context are presence of white boards,
communication signals and pictures. Talking in a quiet place where there is no distraction,
speaking in simple short sentences, obtaining feedbacks to make sure that the instructions have
been correctly interpreted or understood, and using different gestures might prove helpful
(O'Halloran, Worrall and Hickson 2015).
Emma’s family that comprises of her father, mother, and sister has been found to be
extremely supportive in her recuperation journey. Hence, a family centred partnership

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approach should be taken in order to facilitate health care decision making process. Some of the
basic principles that must be followed while are namely (1) information sharing in an objective,
open and unbiased manner; (2) fostering a collaboration and partnership that will help in taking
medically appropriate decisions best fits her strength values needs and ability; (3) negotiating the
desired outcomes of the medical care plan; and (4) respecting and honouring the linguistic and
cultural traditions diversity and their preferences of her family members (Coyne 2015). Some of
the essential components of a therapeutic relationship that must be followed in this context
include genuineness, empathy, and respect (Coyne, Hallström and Söderbäck 2016). The nursing
professionals should have the ability to identify with, and understand the situation of the client
for motives and feelings, thus establishing a personal connection. Features of genuineness must
include being honest, open and sincere towards the patient, besides showing an absence of
defensiveness, and traits of active listening skills (Kaakinen et al. 2018). Establishing respect by
including the strengths and weaknesses of the client will also help Emma and her family
members to feel at ease, and will increase the opportunity for awareness and valuable enquiry
related to her health.
The Australian family Strengths Nursing Assessment (AFS) will also be followed
where the eight qualities related to family strength will help in fostering conversation with the
family, and taking into account their preferences and opinions, related to clinical decision
making. This family based strength assessment model will build on different positive attributes
that are essential for family functioning such as, affection and appreciation, positive
communication, commitment, spiritual well being, coping with crisis and together time.
Rehabilitation admission- Rehabilitation services are specialised healthcare facilities
that assist an individual regain mental, physical, and cognitive abilities, which get impaired or

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lost due to some injury, disease, or treatment (O'Sullivan, Schmitz and Fulk 2013). This
admission to a stroke rehabilitation centre will play a crucial role in assisting Emma in her
journey of recovery. According to Laver et al. (2015) the primary goal of stroke rehabilitation is
to provide assistance to be affected individuals in relearning the skills that have been lost when
stroke affected a portion of their brain. Common physical activity that Emma must be assisted to
perform is mobility training and use of mobility aids such as, wheelchairs, walkers and ankle
brace (Winstein et al. 2016). Performing motor skill exercises will also help in improving the
strength of muscles and its coordination, besides strengthening swallowing capabilities. Emma
must also be convinced to undergo different occupational and speech therapies that will help
her deal and cope up with lost cognitive abilities namely, processing memory, social skills, and
problem solving (Mendis 2013). Speech therapy will also help in regaining the lost abilities of
listening, writing, speaking, and comprehension. Efforts must be taken during the rehabilitation
program to maintain her dignity and privacy, while setting up a proper regimen for toileting and
grooming activities.
Discharge planning- The primary objective of discharge planning is to improve service
coordination, following discharge of a patient from hospital by taking into consideration the
needs of the client in the largest community (Poston, Dumas and Edlund 2014). The strength
based approach should be completely utilised in order to enforce a discharge plan that promotes
her health and wellbeing, while allowing her to live a meaningful and purposeful life after stroke.
The strength based approach will place be grounded on the inherent strength of Emma, her
family and communities, by deploying personal strength that will facilitate empowerment and
recovery (Shepperd et al. 2013). Solution Focused Therapy (SFT) will form an essential aspect
of discharge planning, which will elaborate on what she wants to achieve, rather than the

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problems that are making her seek help (Bond et al. 2013). Encouraging Emma and her family
to focus on determining their path to reach intended goals will accelerate the recovery process.
Educating her family members on stroke and increasing their awareness on its management will
also be crucial. Organising conferences, consultations and family meetings will help in focusing
more on the role and responsibility of the family and its dynamics in Emma’s recovery journey.
Safe accommodation forms an imperative part of discharge planning. Adequate
recommendations must be given for making adjustments in her home such as, mobility
equipment installation, and presence of mobility aids (New et al. 2013). Consultations with
occupational therapists and home visit programs will also be an important component of
discharge planning. Emma must also be recommended the referral of counsellors to discuss her
concerns regarding sexual problems (if any). Referring her to different employment
opportunities will help in eliminating feelings of hopelessness, and depression due to lack of
employment.
Discussion- An analysis of Emma’s case suggested that there were some problems related
to communication gaps, inclusion of family and absence of patient centred care. Providing
care services that are respectful of and responsive to her preferences, values, and needs would
have helped in ensuring that her values guided all the major clinical decisions that were taken.
The case study also elaborated on lack of encouragement from the nursing staff and forceful
feeding. Absence of any emotional connection and therapeutic relationship with the healthcare
professionals also made Emma isolated and depressed. Hence, involving the patient in decision
making process and treating her with respect, dignity, while showing sensitivity towards her
autonomy and cultural values, was needed. Anxiety and fear associated with illness are often as
debilitating as the physical impact. Involving the friends and family of the patient in decision

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making process and supporting the family members of caregiver, besides recognising their
strengths and needs was also essential in this regard.
Role of SBN- Carman et al. (2013) opined that patient engagement has been recognised
as a crucial strategy for achieving triple aim related to healthcare namely, improving patient
experience, reducing costs, and advancing the population health. SBN focuses on active
collaboration between patients and providers to manage design and accomplish possible health
outcomes that will help in successfully achieving patient engagement in healthcare practices. The
process of patient empowerment also assists people to gain control over their life, besides
elevating their capacity to immediately act on different problems that they define as crucial.
Some of the major aspects of patient empowerment include self-awareness, self-efficacy,
coping skills, confidence, and health literacy. This will help the patient gain a sound
understanding of the presenting complaints, access to healthcare services, and proposed
treatment plans (Schulz and Nakamoto 2013). The SBN will also help nurses to deliver services
that are culturally competent, by recognising the patient differences in beliefs, practices,
demographics, norms, and desire related to clinical care, and taking the perspectives into account
while proposing a care plan (Betancourt et al. 2016). Australia is a melting pot of different
cultures and ethnicities, including the indigenous population. Conducting a cultural assessment
will also be an essential step in the process of patient centred care that will help the nurses to
formulate an appropriate treatment plant for each client, based on the information provided
regarding the beliefs, values, and opinions of the client.
Conclusion- To conclude it can be stated that, the strength based approach of nursing care
as discussed in the essay that might help Emma in her recovery journey, after being affected by
stroke. Some of the most essential attributes that should be taken into account are empowerment

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of the patient and family, partnership and collaboration, establishment of therapeutic
relationship, and application of strength based nursing to provide better quality of care services.
True patient engagement not only relies on patient education of communication, but focuses on
the skills, knowledge, willingness, and ability of patients to manage their own health. Hence,
SBN will make the nursing professionals increase their cultural competence based on three facets
of attitude, skills, and knowledge. While caring for patients and their family members it is
imperative for a nursing professional to focus on the outer and inner strength, besides taking into
account the preferences and demands of the patients and families that will best assist them in
dealing with their problems and minimising all deficits. Completely informing Emma about her
prognosis and condition, besides providing emotional and physical comfort, would have also
created a significant positive impact on her experience of hospitalization. Employing active
listening skills to identify the concerns and problems of the patient, and adopting a non
judgemental and unbiased approach will also make Emma feel valued and respected.

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