Healthcare Management for Stroke Patient with Mobility Issues

This paper discusses the healthcare management for a stroke patient with mobility issues and loneliness. It suggests the use of APIE framework, ethical considerations, and empowerment model for managing the patient's issues and enhancing her quality of life.

Running head: HEALTHCARE MANAGEMENT
Healthcare management
Name of the Student:
Name of the University:
Author note:

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Introduction:
The case study represents the mobility difficulty of a 72 years widower due to the stroke
and she had a feeling of isolation. She had difficulty in bathing due to her mobility issues. She
found it difficult to manage the daily activities. However, she was able to cook, maintain the
decorum of house and able to enjoy going to the club for meeting her friends but shopping was
difficult for her because she was not able to drive. Moreover, her family lived far away from her;
therefore no family members were there to take care of her. Her neighbors help her in gardening.
The caregiver who assesses her by asking her about her needs reported that she experiences
loneliness along her mobility issues. They also reported that she requires someone to help her in
maintaining a house and arranging delivery of her. The major problem she experiences is
mobility issue and subsequent loneliness which had an effect on her quality of life. Stroke is a
brain attack where brain cells deprived of oxygen and begin to die (Yelnik et al. 2017). Some
people recover from the stroke after few months but some experiences severe mobility issue that
interrupted the daily activity. Therefore, require the assistance of nurses to manage the daily
activities and overcome issues of loneliness (Yelnik et al. 2017). According to practical guide to
care planning in health and social care ,nurses play an important role in managing the daily
activities of the patient by a addressing the area of concern of every patient (Pollock et al. 2014).
Philosophical approaches with the support of principle, knowledge, theories along with models
will help to overcome the issues with the help of healthcare professionals (Yelnik et al. 2017).
Therefore, this paper will illustrate structure, system and model for assessing the needs of Mrs.
X, current skills for assessment and the advice as a manager for managing the issues of Mrs. X.

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Question 1:
As observed in the case study, Mrs X was experiencing mobility issue due to stroke and
subsequently faces difficulty in managing daily activities. For assessing the area of concern of
the patient, the national occupational standards for social work refers to some of the framework
and care plan to manage the issues (English, Hillier and Lynch 2017). Philosophy of the care can
be applied which identify the purpose and theoretical framework that underpin the particular
practice to manage the issues of the patient. As a health professional, for assessing the issues of
the patient, certain codes of ethics such as obtaining the information without offending the
person or questioning the cultural belief of the individual need to consider so that the patient.
Nursing and Midwifery Council outlined an ethical consideration that requires for assessing the
patient (Bradbury‐Jones and Broadhurstm 2015). Making the care of the people as the first
concern and treating them as individuals by respecting their dignity is the first ethical
consideration. Second ethical consideration is for health professionals, working with others and
promoting health well being of the patient and their family members, caregiver and wide
community (Haddad et al. 2015). Providing the high standard of practice all the time and be open
and honest, acting with integrity and uphold the reputation of the profession are other ethical
considerations need to take in the account during assessing the area of concern of patient
(Vryonides et al. 2015). For providing a care to the patient, there are certain documents designed
for the health professionals as a part of the care planning process which enhances the assessment
of the health professionals (Bradbury‐Jones and Broadhurst 2015). First documentation is
required for the initial assessment with general information of the patient such as name, marital

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status of the patient, any known allergies, contact of the independent (Haddad et al. 2015).
Personal assessment documentation is needed for assessing the biological risk factors such as
sleeping, eating schedules, dressing and movement of the patient along with the exercise and
activities of the patient (nstefjord et al. 2014). The personal assessment also includes the
psychological area of concerns such as the thought process of the patient, mood and emotions of
the patient, beliefs about others need to consider along with the social life of the patient (Farag et
al. 2016).. General risk assessment documentation helps to identify other risk factors for
managing the health issues of the patient (Haddad et al. 2015). During the assessment, the
personal decision of the patient plays important role in making the successful intervention plans
(Bradbury‐Jones and Broadhurst, 2015).
From above case study analysis, lifestyle factors increase the risk of stroke which
includes the high blood pressure, diabetes, high blood pressure, and drinking habits or high-fat
diet need to monitor for reducing the occurrence of stroke (Benner 2015). Biomedical models
can be used for assessing the risk where the model helps to recognize the signs and helps to treat
the signs and symptoms of the disease involving complex physical need (Lloydn 2010).The
recording sheet can be maintained for the noting down signs and symptoms of the patient for
further assessment. The banner mobility assessment tool can be used for assessing the degree of
the mobility of Mrs X and it was seen that the patient scored well although she is not entirely
stable but have mobility issue in bathing and treatment requirements for developing gait and
stabilize her movement (Kontunen et al. 2018). Holistic assessment is available for assessing the
situation of the patient in the deeper level and address the need of her (Nanninga et al. 2018).
Since she lived in isolation and experienced loneliness that affected her daily activity and grossly

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decreases her quality of life (Deschênes and Goudreau 2017). Orem system of nursing can
applied in this case. Orem system of nursing theory is the theory for self-care deficit. In this case,
the patient was not able to take care of herself and need assistance. Therefore, this model would
help nurses to provide information so that she can mange her issues. Aspire model can be applied
for the patient. Assessment, Systematic nursing diagnosis, Planning, Implementation, Recheck
and Evaluation, these five steps will help nurses to address the issue of the patient and enhance
quality of life. An empowerment model of health and social care planning is available which
seeks to help the person to control over their health and social needs by taking the holistic
approaches for providing the support to the person which require collaboration between the
patient and health professionals(Jensen et al. 2015).. Applying the empowerment model,
assessment of her thought process and reason behind her isolation and loneliness can be done
(Nursalam et al. 2018). Since her family lived far away from her, she is feeling low and isolates
herself due to her mobility issue (Miller 2018). The empowerment model suggested that losing
the individuality can lead to the loss of empowerment and controls over health which is crucial
for enabling the recovery of individuals (Deravin et al. 2017). Loss of mobility is the main
reason that had not only affected her daily activities but had also made her isolated and depressed
(Jensen et al. 2015). Accordingly, effective care interventions are given which will help her to
develop better quality lives (Cairns et al. 2015).
Question 2:
When I reflected concerning the case of Mrs X, I observed that she needs extensive
assistance in mobility for her household chores which will not only ease her living, but will also

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decrease her symptoms of isolation. Upon going through the case study of Mrs X, I feel that
upon being entrusted with the task of being her respective nurse manager, I will be required to
employ a holistic approach for the successful provision of adequate care principles for the
patient, along with efficient conductance of her assessment procedures. As opined by the World
Health Organization (1998), there is a need for the consideration of the individualistic interests
of the concerned patient, concerning the prevalence of emerging trends considering inequalities
pertaining to health on a global scale (Batterham et al. 2016). Since the required nursing skill
sets should encompass a holistic approach for the purpose of caring for Mrs X, which includes
the conductance of a biopsychosocial model is of utmost importance for the purpose of caring
and assessing the concerned patient (Cairns et al. 2015). Hence, for the purpose of the
conductance of the same, as a nurse manager for Mrs X, I am required to consider her
psychological, her social, her biological as well as her spiritual characteristics, for the purpose of
sufficient execution of my skill sets required for her assessment of care.
One of the key skills which I am required to possess and execute as a nurse manager for
Mrs X is the initiation of personal and patient empowerment skills. For the purpose of initiating
empowerment in healthcare, there is a need assess the psychological health of the patient and
then encourage and inspire the patient adequately, in order for the patient to regain sufficient
betterment, control and confidence in life (Brett et al. 2014). In order to exhibit a care process
for Mrs X through empowerment and positivity, I believe my psychological and interpersonal
skills would be most essential for implementation, which will require of adequately assessing the
individual needs of the concerned patient. This would require my skill and ability to modify my
current beliefs and ideas as per the needs of Mrs X, with respect to how she views the world in
accordance to her present health conditions and experiences. There is also a need for me to

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consider social factors, as it is evident that Mrs X engages in active social relationships with her
friends and families. Hence, the care assessment will require my skill sets to give importance to
her social relationships and familial connections (Jensen et al. 2015). Most importantly, for the
purpose of empowerment, my skills should also be executed in accordance with the physical
needs of the concerned patient, Mrs X. it is evident from the case scenario, that Mrs X suffers
significant disturbances in her movement along with her toiletry habits, for which I will be
required to implement adequate management and required care processes.
Due to my duty as a nurse manager for the purpose of care provision of Mrs. X, I am also
required to engage in active nursing delegation and leadership skills, considering the various
physiological requirements of Mrs X. Appropriate delegation, is one of the key skills required by
nurses in appointed in leading roles, for the optimum management of the care treatment of
critical individuals (Johnson et al. 2015). As evident from the aforementioned case study, Mrs X
is overcome with several difficulties regarding the conductance of appropriate household
activities. Hence, I would appoint a domestic help for the purpose of conducting all of Mrs X’s is
household chores, along with the necessary activities which are required for the sustenance of
herself and the household, which includes shopping and collection of the required groceries. I
will make sure that the help designated by me, would be adequately educated and compatible
with the usage of technology, for the purpose of conducting online shopping practices for Mrs X.
As evident from the aforementioned case study, it is to be noted that Mrs X undergoes
considerable difficulties in her performance of activities pertaining to movement and self-care.
For the fulfillment of this need, I will appoint an in-house nurse. An in-house nurse is a nursing
professional who upholds the qualification of a licensed practical or registered nurse and engages
in active specialization in the provision of household aid to patients who are unable to conduct a

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movement to external nursing care homes for the purpose of treatment (Lloyd 2010.)The
employment of in-house nurses is of particular importance for the purpose of providing care for
senior individuals due to their decreased physiological functioning (Farag et al. 2016). Hence,
the in-house nurse appointed by me as a nursing manager for the purpose of caring for Mrs X
would engage in active assistance in helping her perform her movement across the household,
along with sufficient aid during conductance of her bathing and toiletry activities (Balslev et al.
2015). Hence, it is worthwhile to mention, that apart from usage of the empowerment as part of
implementing the care process of Mrs X, I will also require the implementation of sufficient
delegation and leadership skills for successful fulfillment of my duties as a nurse manager.
Hence, upon reflecting the skills sets which I may require, I can evaluate that despite the
difficult case of Mrs. X which I was entrusted with, I felt it was a enlightening experience since
it showcased my delegations and leadership skills. However, I feel that I could have managed
this situation better had I been aware of the importance of leadership and patient empowerment
in nursing. If I am ever faced with a similar case, I will actively engage in usage of holistic skills,
effective leadership skills and interpersonal skills to aid the management of the patient.
Question 3:
From the above analysis of the case study, it is observed that the patient, Mrs. X has a
mobility issue due to the stroke and she experiences loneliness due to her isolation. Nurses play a
crucial role in managing her mobility issue and emotional distress. The APIE framework has
been designed based on the evidence-based practices and considering the biopsychosocial
models or empowerment model for managing the issue of the patient (Jensen et al. 2015). It
suggested that the plans are designed according to the assessment of the patient and

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implementation would be done by seeking the consent of the patient and evaluated with the
assistance of the multidisciplinary team and patient (Griffiths 2015). From the assessment, it is
found that she has difficulty in showering since she cannot manage to bath safely and she does
not have the fitted shower (Balslev et al. 2015). Therefore, she has improper hygiene for living
the normal life. From the assessment of her mobility by using banner mobility tool, it is observed
that she has mobility issues but she able to cook properly and able to meet her friend every week
(Davidson et al. 2016). Therefore, the care plan needs to design by considering factors of
hygiene issue and mobility issue in this case. In the care plan, A home carer that is recruited for
helping her in managing the household will reduce her concern by helping her in cooking, doing
other work of household sufficiently (Shariff 2015). A social worker is required who will help
her in the delivery of food and it will ease the difficulty of the patient by enhancing the quality of
life (Norman et al. 2015). The arrangement has been made for the assisting her from in and out
of the bath (Griffiths 2015). This arrangement will help to that will prevent the sudden fall of the
patient and resolve her hygiene issue.
The main goal of the treatment would be the maximization of quality life of the patient by
managing the mobility issue of the patient, reducing the emotional distress, therefore, ensuring
the quality of life (Rahn et al. 2018). As a nurse manager, it should be advised to caregivers to
provide the exercise program for flexibility and restoring the mobility of her. It would provide
strength and balance as well coordination of body (Jensen et al. 2015). One of the main
interventions would be referring physiotherapist for restoring muscle functions and providing
different medication for reducing the problem (Farag et al. 2016). This would help to ease the
mobility issue. Certain food for increasing muscle flexibility should be incorporated in the diet

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for the managing the mobility issue of Mrs X. The home caregiver should be suggested to
provide help to the patient by use of different aids such as crutches or providing wheelchair or
other things that will manage the issue when needed (Landsperger et al. 2016). Since she is
facing the problem of bathing, the fitted shower should be installed for marinating proper
hygiene (Balslev et al. 2015). It should be recommended to nursing professionals to take care of
footwear’s like providing non-skid slippers. Moreover, fall risk management should be done by
professionals for reducing the risk of fall (Batterham et al. 2016). This would include removal of
the bed rails, proper bathroom bars, proper lightening of the house not wearing too much of
many clothes (Brett et al. 2014). This would help in the development of mobility of the patient
and prevent sudden fall. Since the loss of mobility was the main reason that had not only affected
his daily activities but had also made her isolated and lonely (Landsperger et al. 2016)..
Accordingly, effective interventions would help her to live a better life without any emotional
distress. Therefore, It should be suggested to health professionals to provide the opportunity so
that she can involve her in social activities which would reduce the loneliness (Deschênes and
Goudreau 2017). It should be recommended to the caregivers to engage her in conversation,
provide empathy, compassion and address her area of concern in order to reduce her loneliness
(Farag et al. 2016). Moreover, interventions such as motivational therapy, speech therapy,
involving her in events where she will be the centre of making any decision should be given
(Balslev et al. 2015). It will help her in managing her feeling of loneliness, install hope and boost
self-esteem within (Deschênes and Goudreau 2017). Sharing personal experiences with her can
help her to overcome loneliness. Besides, contacting her family members and arranging meetings
with family members would help her in overcoming her loneliness and consequently the quality
of life.

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Conclusion:
Thus, it can be concluded that Mrs X is experiencing mobility issue due to stroke and
subsequently faces difficulty in managing daily activities. For assessing the area of concern of
the patient, the national occupational standards for social work refers to some of the framework
and care plan to manage the issues. She has difficulty in bathing due to her mobility issues. She
fines it difficult to manage the daily activities. Nurses play an important role in managing the
daily activities of the patient by an addressing the area of concern of every patient and providing
patient-centric care to every patient. As a health professional, for assessing the issues of the
patient, certain ethical consideration need to take in to account such as obtaining the information
without offending the person or questioning the cultural beliefs, making patient first priorities by
respecting them. Assessment should be done by using the documentation for personal and
professionals which will help to evaluate the outcome and designing the effective interventions
for reducing the mobility issue. As a nurse manager, required nursing skill sets should
encompass a holistic approach for the purpose of caring of the patient which includes the
conductance of a biopsychosocial model is of utmost importance for the purpose of caring and
assessing the concerned patient. The appropriate delegation is one of the key skills required by
nurses in appointed in leading roles, for the optimum management of the care treatment of
critical individuals. In this case, the main goal of treating the patient would be the maximization
of quality life of the patient by managing the mobility issue of the patient, reducing the
emotional distress, therefore, ensuring the quality of life. Risk management along with
management of loneliness would be the successful intervention for reducing the mobility and
increasing quality of life.

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