Nursing Process and Care Planning

The provided assignment is on the topic of Nursing Process and Care Planning. It discusses the importance of assessing subjective and objective data to make informed care plans for patients with specific conditions, such as asthma. The document references various books and journals, including 'Medical-Surgical Nursing-E-Book' by Ignatavicius and Workman, and 'The Royal Marsden Manual of Clinical Nursing Procedures'. It highlights the need for healthcare organizations to improve health behavior and treatment adherence. The assignment is relevant to nursing students and professionals who want to understand the principles of care planning and implementation.

FOUNDATIONS FOR
ADULT NURSING FIELD
OF PRACTICE

Table of Contents
INTRODUCTION...........................................................................................................................1
PART 1- Communication................................................................................................................1
Issues of communication.............................................................................................................1
Theories of communication for improving related issues...........................................................2
PART 2- Nursing problems.............................................................................................................4
CONCLUSION................................................................................................................................8
REFERENCES..............................................................................................................................10

INTRODUCTION
Adult nursing refers to specific nursing fields in which they deal with adult patients and
their family members. It consist to assess the sick people and assess their actual needs in order to
make an appropriate plan to deliver effective care for their well-being. However, nursing staff
should work with adults of all ages who has several short an long term physical health problems
including injuries, heart disease, pneumonia, arthritis, cancer and diabetes. Moreover, the adult
nurse is required work in hospital wards, outpatient units or specialist departments, patient's
home, a clinic, GP surgery, walk in centres or nursing homes, prison service, police, voluntary or
private sector (Ignatavicius and Workman, 2015). This essay is based on White Lodge Care
Home which provide care services to needy people in order to make them healthy. It consist case
of Julie facing breathing problems and further assessed that she is suffering asthma. The present
report will focus on methods of communication use by nurse while dealing with specific patient
named Julie having breathing problems and barriers faced by her to communicate with carer. It
will also include problems faced by nurse at the time of providing care to given patients for her
well being.
PART 1- Communication
Issues of communication
According to selected case scenario, Julie is 28 years old adult who has suffering from
breathing difficulties admitted in medical ward of White Lodge Care Home. She has a habit if
intake cigarette on daily basis and feel allergic reactions due to excess toxic pollution in
environment. An adult nurse is in charge of that patient in respect of assessing patient's actual
requirements in terms of preparing more effective as well as efficient care plan (Mowrer and et.
al., 2015). However, nursing assistant is required to provide correct medications and treatment to
Julie in order to reduce her difficulty of breathing for improving comfort level of patient.
However, there are several issues of communication faced at work place while providing medical
facilities and care to Julie.
Anxiety – The anxiety is responsible for creating problem in conducting an effective
communication which is not favourable to assess actual problem of patient and create difficulty
for making an accurate nursing plan of action for providing correct treatment. If patient become
highly anxious then they avoid to to interact with anyone which is major problem for nursing
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staff to evaluate right cause of breathing difficulty to render appropriate medication to make
them healthy. In context of Julie, she become anxious due to which is an issue for nurse to assess
actual symptoms of breathing problem.
Confusion – The confusing situation creates problem for both patient and nursing staff
because in this condition, an individual is not capable to communicate actual feeling of particular
health issue. However, it will generate problem for nurse to analyse overall signs or symptoms
and that impacts negatively on care plan (Tabloski, 2014). In addition to this, Julie get confused
about her signs due to breathing difficulty and not able to communicate correct information
which is confusing to make decision about particular relevant disease she is suffering from.
Theories of communication for improving related issues
Communication can be described as a process of sharing information, ideas and thoughts
with the help of an appropriate method. It consist several methods such as verbal, non- verbal or
interpersonal, written, formal & informal and visual communication. However, it is necessary to
select one more effective and suitable method of communication for sending specific type of
information in particular situation. In addition to this, medical professionals prefer to written
communication method when they deal with patients by making notes of their symptoms to
provide report of the same to superior in order to make correct decision of treatment. Moreover,
active listening and make patient comfortable with carer is favourable to evaluate actual causes
of specific health issue to render correct medication for their well being.
At the other hand, it has been analysed that electronic health records system is required to
applied in White Lodge Care Home which is appropriate to improve accuracy of information and
reduce issue of errors in clinical settings. The electronic health records are helpful to maintain
overall information related to sick people and administrative activities which is useful for future
aspects in respect of conducting desired actions for achieving better outcomes (Klok, Kaptein
and Brand, 2015). However, it is necessary to generate skill of active listening in terms of
understanding actual situation of patient to analyse their health problem which facilitate to
establish an appropriate nursing care plan for providing treatment properly for their well being.
Additionally, the carer patient relation should be maintained effectively with Julie which helps
her to share every feeling experienced by her to gain information about her allergic compounds
to avoid them while providing medications. In context of White Lodge Care Home, ward team
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prefer to verbal communication along with written notes to avoid missing information about
patient so that effective treatment can be provided to Julie for overcoming breathing difficulties.
Theories of communication
Peplau's interpersonal relations theory - Focus of this theory is on relationship of nurse-
client and therapeutic process which takes place. Communication which takes place in this
involves complex factors like environment and in addition practices, attitude and beliefs in
dominant culture (Tratto and et. al., 2014). This theory defines four stages of relationship which
achieve common goal: Orientation phase: The nurse engages patient in treatment, and patient can ask questions
and receive informations and explanations. This stage develops trust and impression
about health care system and nurse in patients. Identification phase: In this stage patients takes benefit from all services offered and to
address treatment goals exploiting nurse patient relationship.
 Resolution phase: Due to effective communication, patient's needs are met and patient
can move towards independence. Patient and nurse relationship ends and they no longer
need help.
The Peplau's interpersonal relations theory is also suitable and can be applied for carrying
out effective communication with patient as it impacts positively on treatment process in order to
gain better outcomes through making patient well being. It is necessary to establish efficient
conversation with patient as it facilitate to conduct treatment process in effective way which
results into better outcomes.
Dyadic interpersonal communication model – This model describes dynamic interactive
process which takes place in between two individuals. Based on recipient and sender- decoder
and encoder- and outside influences like attitude, content, perception and physical and emotional
elements (Dougherty and Lister, 2015). It points to many factors which can alter message's
delivery or messages. As sender provides a message, recipient must process the given
information. The dynamic interpersonal communication models has been used in clinical settings
of White Lodge Care Home which is helpful to understand actual symptoms of Julie regarding
asthma to treat the same in accurate manner. Better relationship with patients is helpful to reduce
fear of patient about treatment process and make comfortable by improving their will power
which impact positively on patient outcomes.
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PART 2- Nursing problems
Nursing staff is working in hospitals in different shift and deal with different types of
patients with their dissimilar health issues then it is really a critical job to attend every patient in
daily routine. It include their flexible working shift in different specific medical wards including
general units, ICU and surgical unit. However, sometimes work load increased and work force
reduced which impacts on their regular work routine negatively and create problems for them.
Excess work pressure reduce their piece of mind and resting time which effects their
performance while dealing with adult patients (Nouri and Rudd, 2015). Moreover, extended
working hours effects performance which may results into drugs errors and other related
mistakes that are not appropriate. In addition to this, it is necessary for hospital management and
inspecting agencies to assess problem faced by adult nursing in order to reduce them by making
effective schedule of working in terms of improving patient outcomes respectively.
Roper-Logan-Tierney model for nursing
According to the Roper-Logan-Tierney model for nursing can be considered as a theory
of nursing care based on daily living activities having a purpose of using for proper patient care.
It consist several activities such as maintaining a safe environment, breathing, communication,
eating & drinking, elimination, washing & dressing, controlling temperature, mobilisation,
working & playing, expressing sexuality, sleeping and death & dying. However, overall of these
activities get influenced by certain factors including biological, psychological, sociocultural,
environmental and politico economic (Siantz and Aranda, 2014). In context of Julie, she has two
main problems like breathing and trouble in sleeping which are known as symptoms of asthma.
The given patient has majorly face an issue of breathing which create difficulty for her which is
required to be assess and provide care for overcoming with the same.
Problem stated – Considering work place of White Lodge Care Home and dealing with
Julie make nurse analyse about her problem of difficulty on breathing which is a major issue
according to her views. After conducting overall assessment, it has been analysed that she faces
breathing issue along with lack of sleeping because of shortness of breathe. However, other
related issue of asthma are also evaluated like tightness or pain in chest restlessness due to
insufficient sleep which is not favourable for better health. Moreover, due to facing difficulty in
breathing, Julie is not able stay calm and relaxed, hence her conditions become worse.
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Etiology related factors – The etiology can be described as investigation of cause of
disease of particular situation which is responsible for occurring specific problem. Meanwhile,
etiology of asthma consist that swelling & mucus aggregated from a n irritant or “trigger” cause
difficulty in breathing, wheezing lung sound and hypoxia. Moreover trigger involves pollen,
dust, smoke and infection due to different reasons. Asthma can take place in an individual which
may considered different types of causes in which some of them are given below.
Smoking increases the risk of developing asthma – This refers that smoking habit is
responsible creating infection in respiratory tract which is develop problem of asthma. It can
include active and passive smoking but both harm people by causing asthmatic disease through
infecting lungs (MELLINS and et. al., 2015). However, smoke is harmful for lungs and damage
alveoli which create problem in proper respiration and other relevant functions that is not
appropriate for remaining healthy. Additionally, smoking during pregnancy or around child can
increase risk of asthma or breathing problems in a child. Smoking also play a role in adult onset
asthma.
Being born early - A prematurely (before 37 weeks) born baby has more risk to get
asthma specially if they required ventilator to breathe after birth. And under weight or low birth
weight can be a risk factor to get asthma.
Bronchiolitis - It is caused by a virus and commonly affects babies as well as young
children who are less than two years old. This affects lungs and airways and leads to swelling.
Which make it hard to breathe and child gets cough and wheeze.
Exposure to triggers at work - occupational asthma is caused by particular things found
in workplace like dust from wood or floor and chemicals. If a person did not has asthma and gets
later after join to the work than that person is suffering from occupational asthma. It's common
cause of adult onset asthma.
Female hormones - Even some female hormones also can trigger late onset asthma and
several women can develop asthma after menopause or during menopause (Wang and et. al.,
2014).
Environmental factors - Contact with certain irritants, allergens or exposure to some
vital infections such as infant or in early of childhood when immune system not fully mature can
develop asthma. Exposure to particular chemicals in workplace may risk to develop asthma.
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Genetics - It play major role in causing asthma. If person's parents either mother or father
has asthma then that person is likely to have asthma.
Children with allergies - If a child has allergies, said to be 'atopic'. Being allergic to
things is usually something which runs in families. One allergy can lead to other allergies. For
example, child with eczema, and family with allergy has more risk to get asthma (Findley, 2015).
In context of Julie admitted in White Lodge Care Home, she has habit of smoking which
is responsible for condition of asthma due to which breathing difficulty occurs. In addition to
this, Julie also faced problem while exposed to highly toxic pollution of environment which can
be considered as one of the major cause of developing asthma.
Signs and symptoms
Asthma is a chronic disease of airways which transport air to and from lungs. In this
condition bronchial tubes become inflamed or swollen. Initially, an individual starts with
wheezing and coughing a bit. Suddenly, chest feels tight and during asthmatic attack, muscles in
airway tighten and lining gets swollen.
 Coughing a lot during night time.
 Person has trouble in sleeping.
 Difficulty in breathing after exercise and loosing breath.
 Peak expiratory flow numbers become lower.
 Chest tightness or pain.
 A whistling and wheezing sound at the time of exhaling.
 Coughing or wheezing attacks that are worsened by a respiratory virus such as cold or
flu.
 During attack, the symptoms include fast, shallow and short breaths. And a whistling
sound produces during breathe. A long term cough which won't go away. A kind of
squeezed feeling in chest (Bender, 2014).
Goal of nursing plan set for Julie
The goal of nursing plan include to reduce work of breathing and proper oxygenation to
tissues in the human body.
Methods used for subjective and objective
Methods used for collecting subjective and objective data about patients which facilitate
to prepare an accurate nursing plan of action in order to make her disease free. Initially,
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subjective data about patients was collected by proper observations and verbal communication to
determine symptoms like patient cannot breathe, feel chest pressure & pain, chest tightness and
cough. Moreover, objective information can be gathered by stethoscope to examine breathing
sound, spirometry, lung test and exhaled nitric acid test. It is helpful to analyse about pursed lip
breathing, low pulse oximetry, blue lips or fingers, Tachypnea, wheezing and tripod position.
Nursing care plan
 Firstly, it include to examine pulse oximetry and apply oxygen if O2 saturation is less
than 90% start at 2 litres nasal cannula (2L NC) which helps to maintain concentration of
oxygen in body.
 Secondly, it is necessary to educate patient about triggers or make sure that room of
patient does not have any kind of triggers which reduce risks of occurring asthmatic
attacks.
 Thirdly, it consist Auscultate lung sounds which helps to determine actual problem in
lungs to treat the same immediately.
 However, it is essential to maintain position of patient in as upright condition which is
helps to open lung bases and airway (Taylor‐Fishwick, Okafor and Fletcher, 2015).
 Moreover, it is important to have the patient perform a peak flow meter which helps
know exhaled volume of air.
 In addition to this, it is must to provide breathing treatments and medication therapy to
overcome with problem of asthma. Initially, Beta- agonist can be used like albuterol work
as bronchodilators and Anticholinergics such as Ipratropium work to relax
bronchospasm. Meanwhile, Corticosteriods including Fluticasone work as an anti-
inflammatory which make patient feel relieved.
 Furthermore, it in case, patient working very hard to breathe for a long period of and it
get worsen then it is essential to remain prepared with an airway cart and therapist must
aware about an individual to conduct treatment accurately.
Key policies to treat asthma
There are several policies which are appropriate patient having problem of asthma in
which more suitable can be applied in order to make them disease free respectively. In context of
White Lodge Care Home, there are different policies for treating asthma is available clinical
settings which are explained further –
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 Effective strategy for control and prevention of asthma includes that the primary
prevention to reduce the risk of asthma is frequent lower respiratory infections during
childhood, tobacco smoke and air pollution. Improving approach to cost effective
involvement such as upgrading standards, medicines and availability of care of health
care systems at different levels.
 Controller medications are most important because these medication prevent asthma
attacks. By using these medications airways are fewer inflamed and less react to triggers.
 Quick relief medication also known as rescue medications because it relax muscles
around airway.
 Anti- inflammatory asthma inhalers help to reduce mucus and swelling in airways and
prevent asthma attacks. Such as steroids (Alvesco, Flovent, Qvar, Aerospan and
Asmanex) and mast cell stabilizers like cromolyn sodium.
 Nebulizer are portable and can change medication from liquid to mist so it can be easily
inhaled into lungs. It is also called breathing treatment.
 Bronchial thermoplasty, treatment for severe asthma. It helps to open airways. In lungs
smooth muscles can be shrink by using gentle heat which was tighten during asthma
attack.
 Steroids may help to reduce symptoms of asthma attack but it takes several hours to act
ex: Budesonide, Mometasone.
CONCLUSION
Through considering working experiences at given organisation, it is very effective to
learn different aspects of nursing which provide support to make bright career on adult nursing
successfully. However, there are various communication methods have been learned in which
verbal and written method seems to be appropriate because written information maintain
accuracy of information whereas verbal make easy yo understand feelings of patients. In addition
to this, working experience develop several practical skills and abilities which are favourable in
future to achieve growth in career. Moreover, effective communication is very important to
understand actual cause of problem faced by patient and convey accurate information to ward
team for providing correct treatment to achieve positive outcomes by making an individual well
being. At the other hand, nursing care plan include to assess subjective and objective data about
sick person which facilitate to make goal of desired outcomes which is required to be complete
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by following care planing for making them disease free. Furthermore, nursing process include to
assess problem of patient by diagnosing actual causes in accurate manner. Work experience
helps to gain an idea of assess and then making appropriate care plan for applying the same for
making patient disease free respectively.
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REFERENCES
Books and journals
Ignatavicius, D. D. and Workman, M. L., 2015. Medical-Surgical Nursing-E-Book: Patient-
Centered Collaborative Care, Single Volume. Elsevier health sciences.
Mowrer, J. L. and et. al., 2015. Patients' and providers' perceptions of asthma and asthma care: a
qualitative study. Journal of Asthma. 52(9). pp.949-956.
Tabloski, P. A., 2014. Gerontological nursing. New York, NY, USA: Pearson.
Klok, T., Kaptein, A. A. and Brand, P. L., 2015. Non‐adherence in children with asthma
reviewed: The need for improvement of asthma care and medical education. Pediatric
Allergy and Immunology. 26(3). pp.197-205.
De Tratto, K. and et. al., 2014. Nurses’ knowledge of inhaler technique in the inpatient hospital
setting. Clinical Nurse Specialist. 28(3). pp.156-160.
Dougherty, L. and Lister, S. eds., 2015. The Royal Marsden manual of clinical nursing
procedures. John Wiley & Sons.
Nouri, S. S. and Rudd, R. E., 2015. Health literacy in the “oral exchange”: An important element
of patient–provider communication. Patient education and counseling. 98(5). pp.565-
571.
Siantz, E. and Aranda, M. P., 2014. Chronic disease self-management interventions for adults
with serious mental illness: a systematic review of the literature. General hospital
psychiatry. 36(3). pp.233-244.
MELLINS, R. B. and et. al., 2015. Developing and communicating a long-term treatment plan
for asthma. American family physician. 91.
Wang, K. Y. and et. al., 2014. Examining the causal model linking health literacy to health
outcomes of asthma patients. Journal of clinical nursing. 23(13-14). pp.2031-2042.
Findley, A., 2015. Low health literacy and older adults: meanings, problems, and
recommendations for social work. Social work in health care. 54(1). pp.65-81.
Bender, B. G., 2014. Can health care organizations improve health behavior and treatment
adherence?. Population health management. 17(2). pp.71-78.
Taylor‐Fishwick, J. C., Okafor, M. and Fletcher, M., 2015. Effectiveness of asthma principles
and practice course in increasing nurse practitioner knowledge and confidence in the use
of asthma clinical guidelines. Journal of the American Association of Nurse
Practitioners. 27(4). pp.197-204.
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