Maintaining Professional Healthcare Standards

This essay discusses the management of needs of an individual presenting with Congestive Cardiac Failure and Venus Leg Ulcer, focusing on nursing theories and models, the selected model of nursing, and the nursing process. It also includes recommendations for future practice.

Maintaining Professional Healthcare Standards
Management of needs of an individual presenting
with Congestive Cardiac Failure and Venus Leg
Ulcer
SID: 1511896
Word Count: 4800

Table of Contents
Introduction..................................................................................
Patient's Information....................................................................
Venous Leg Ulcer........................................................................
Nursing Theories and Modules....................................................
Selected Model of Nursing........................................................10
The Nursing Process..................................................................13
Assessment.................................................................................15
Planning.....................................................................................19
Implementation..........................................................................21
Evaluation..................................................................................22
Recommendations for Future Practice.......................................23
Conclusion……………………………………………. 24
Reference……………………………………………....25

INTRODUCTION
This essay will be based on an assessment that helps in determining the nursing
needs of patient. The choice of patient was discussed with my mentor and he
thought it was appropriate to explore this aspect at this level. The rationale for
choosing to write about this patient was made during a community placement
where the responsibility of more than half nurse who is accountable for his
treatment. According to posnett el at (2009), CVLU affects 1- out of 2% of the
UK population with over half having an active ulcer. The annual costing of
National Health Service accounts for around 5.3 billion each years as per the
recent study conducted in 2013-2014 in the UK. The study also reveals that the
patients suffering from this dangerous diseases will be counted all above the age
of 18 years as there is record of patients having this disease below 18 years.
They also reported that majority of CVLU patients find incapacitating with
physical impact such as pain and reduced mobility along with psychological
impact of low-esteem, depression and social isolation. The study reveals that the
practiced nurses are involved in treating patients in order to avoid social
isolation. The practice of the hospital starts that 18.6 million practices nurses
and doctors are form part of this event, 1.09 million doctors and paramedical
staffs also visits communities and 3.4 million hospital also gathers and treats
outpatient visits through organising camps.
NHS Choices defines venous ulcers as wound which occur on skin of human
being due to improper functioning of venous valves. It generally occurs when a
hard-bony area covered by a thin layer of tissue comes in contact with a hard
surface such as bed, trolley, theatre table wheelchair. This essay will also
stresses on the nursing requirements of the patients in order to take care by
meeting their needs. Moreover, individualized, holistic and collaborative based
care has been demonstrated, as well nursing theories and its step are analyzed in
context of given scenario. In addition to this, Roper-Logan-Tierney activities of

living model and carper’s model has been explained throughout the essay.
Moreover, the patients past medical history (PMH) are also incorporate in the
report which further helps in as well as reason for planning, implementation and
evaluation of patient care with the use of appropriate model has also be
explained. It also involve data regarding pressure ulcers as its occurred annually
among 575600 peoples in the UK and on average cost per patient will be 4300-
6400 pounds and cost incurred by NHS in this kind of ulcer is 1.8-2.6 million
pound annually.
Patients Medical History
Robert is a 78year- old man who lives alone in a one-bedroom flat. He was
admitted in the community with venous leg ulcer as they feel more comfortable
with all the individuals suffering from the same disease and get motivated in
terms of taking treatment in order to get well. The basic problem of social
isolation will be reduced if Robert will meet and greet all the individuals
suffering from identical diseases then their mental distress level gets reduces
they will focus more on other activities. The loneliness of Robert will be
minimized by breaking the social isolated boundaries of their room. The consent
of Robert has taken in verbal form by talking face to face with the patient by
asking various questions related their problem and mental status by living in the
society. The information obtained regarding their prescribed medicines, allergy,
reactions, blood and sugar level will be very helpful in analyzing their nursing
needs. Robert has past medical record of congestive cardiac failure which also
helps in planning perfect prescription for providing perfect treatment to the
patients. According to Robert the main reason he was admitted to the
community is because he knocks his knee and they are unable to stand on their
feet and are para handicap which decreases their chances to live freely in the
overall society as they get incomplete without restyling on their wheel chairs.
Wheel chair will become their partners as the severe causes of this disease will

fold their legs inwardly which induces their pain but their mental level of stress
is so high which will compensated with their physical pain in comparison with
the mental stress. Robert had a patient who has controlled analgesia which is
also known as PCA, a urinary catheter, which allows them to monitor the pain
which is worked as pain relief machine. The programmable machine and
functioning has intended that will not deliver overdose of the medication. It
allows patient to take a complete set of vital signs to monitor their own
temperature, pulse, respiration, blood pressure and oxygen saturation level.

VENOUS LEG ULCER
The Venous ulcer is described by The Wound, Ostomy and Continence Nurse
Society (WOCN) as an open wound on the lower leg of venous origin or ankle
of person. The most common causes of VLS are chronic condition and venous
hypertension. The higher pressure of venous tends to become reason of vales in
the lower leg veins. However, vales perform the work to prevent backflow of
venous blood at the time of calf muscle congresses the veins to pump the blood
return to the heart (Viv as, Lev-Tov and Kirsner, 2016). Owing to this, in case
vales are incompetent then form of ulceration can be found in skin as venous
pooling and congestion leads to leak the blood into the tissue as edema.
NURSING THEORIES AND MODELES
There are different nursing theories and models which helps in rendering good
quality of services to its patients. However, nursing staffs in the community
adopts systematic and holistic assessment of patients whereby health can be
recovered in relatively less time span. At this stage, Fawcett's concept of four
metaparadigms can be applied which covers Nursing, environment and Health
as well as person (Lazarus and et. al., 2016). This concept shows that people

who are getting services from nursing staff can be individuals, families and
communities. It is well known fact that various dimension of nursing is
associated with open, interrelated and interactive way where nursing staff which
has require to put their efforts with informed choices. It proves to be effective in
rendering good quality of services to patients by following above mentioned
dimensions.
One of the dimension of the model is peoples which has explained from
the perspectives of the patients that they get feeling of home as their care has
been done by different peoples. An individual need intensive care from nursing
staff or therapists as well as doctors to fulfill their needs and objectives. Patients
are well treated ion home cares which helps all the patients to forget their pains
and enjoy with the nurses as they demand attention which is nor provided to them
in normal society and by their family members. They face issue related to
language and cultural diversity which affect them as people working in health
care have different cultural backgrounds.
At this juncture, human beings are considered as the most valued persons
in care home where care workers require to give respect to all the patients by
providing their services. In the given case where Robert will be informed
related to their treatment as his consent will matter for care homes. Taking
consent of Robert will mentally prepare them in order to feel good which in turn
helps doctors to treat them without any consequences.
On the other hand, environment is another factor of this model which
includes set of values, mores, expectations and customers as well as societal
beliefs which is directly related to both service users and providers. There are
different elements found under environmental considerations such as cultural,
historical, physical psycho social and development processes which tends to
provide peaceful environment to the patients. It tends to create good atmosphere
for services users and accordingly time and quality is managed and maintained
by care workers (Petherick, Pickett and Cullum, 2015).

Furthermore, health is another element of Meta paradigm as it is dynamic
process that stresses on two major points that is wellness and illness. It reflects
that level of health is sort of expression which is derived from mutual
interactive process between environment and humans. The health of human
being is directly related to feeling of caring by another person which in turn
motivate them to ensure their good health by focusing upon various healthy
standards. This also involves minimizing the stress level of a person by focusing
on their weaknesses in order to convert them into their strengths.
Moreover, nursing practice is another most important element of
Metaparadigm. This is science of holistic health care which is guided through
set of choice, responsibility, and human freedom. The nursing practices uses
various logical analysis, researcher and theory of development which in turn
provides complete package of good quality of services. Nursing staff uses
critical thinking and clinical judgment through which they can effectively treat
patients who are suffering from several kinds of disease. In this regard, caring
attitude is required for nursing staff through which they can understand the
exact need of users which in turn transform their actions in a correct way to
provide all the services in effective way. The nursing staff follow different
approaches for rendering services to users which consists of clinician, learner
and leaders. However, they take the responsibility to provide supportive,
technologist and therapeutic care as per the needs and expectations of the
patients.
Raffetto and et. al., (2015) asserted that it is very basic level in which
there are three main key components of nursing model exists. One among the
model includes different set of beliefs and values which facilitates in carrying
out various activities that are related to prescribing medication. However,
statement of the goals is framed under which the model will represent the
application of nursing practices which will helps in achieving the same.
Similarly, knowledge and skill are also acquired by nursing staff in accordance

with set objectives. A counter argument might be that nursing models focus
upon four central concepts which are already explained (Van Gent and et. al.,
2015). It has been found that nursing models include complex terms such as
care requisites, self-care deficit and health deviation affect learning to a great
extent. Furthermore, ineffective use English language is the commonly found
barriers while interacting with various set of customers.

SELECTED MODEL OF NURSING I think the theories is too long
make it simple.
The selected model for the study is of Roper-Logan-Tierney (RLT) model of
nursing which is based upon activities of living (AL). This model at first
developed in 1998 where basis was Nancy Roper 1976. This RLT model is
highly based upon activities of daily living under which is generally used in
UK. However, this model was updated in 2001 in accordance with societal
needs. The central focus of this model was on care of patients through which
nursing staff can easily implement the standards set by health care sector (Jozic
and et. al., 2015). It can be critically evaluated that care homes of UK uses such
kind of approaches just for checklist on admission. By using such kind of
approach, experts come to know that how life of a person has been changed due
to certain illness or admission to hospital. Though, it does not shed light on
increasing Independency or patients and quality of his life.
The activities of living covers in this model reflects that independence of patient
should be enhanced by putting efforts in the same direction (Vilela and et. al.,
2016). The basic purpose of implementation of this model is to judge how an
individual can improve own health and challenges. It also determines how care
patients can be ready to cope up with changes. This aids to provide learning
among patients and they follow the positive behavior for recovering their health
in relatively less time span. Furthermore, activities of living assesse exact
independence of individual and potential for independence on the range from
complete dependence to self-dependence to analyze the interview which form
the basis for increasing the self-dependence (Fox and et. al., 2015). At the same
time, activities required to compensate the dependence are also assessed for
enhancing the learning of sufferers towards health or maintaining the sound
health. Roper's model is considered most helpful as it shows that nurses should
adopt such kind of behavior in their care towards patients.

Different activities covered under activities of living are; maintaining a safe
environment, communication, breathing, elimination and washing & dressing.
Along with that, controlling temperature, mobilization and sleeping as well as
working & playing are also included which must be there at part of patients.
These activities of living cover all the important activities which are related to
human being or patients so they are referred at the time of admission of patient
on a ward or service (Lin and et. al., 2016). It is helpful in rendering effective
care to patients because changes are considered to analyze that whether person
is improving or not. At juncture, nursing staff can effective assess the how Judie
is recovering her health from the issue of Venous leg ulcer. However, it is very
important to use results of assessment only when it is done frequently for
extracting valid outcome in term of health improvement and health promotion.
For example, care home where Judie is treated can apply this model so that
scope of improvement can be recorded in a right manner. Though, it does not
work well with all care is provided by staff even when patient can take self-
care. It is because basic aim behind using this approach is to bring improvement
in the health of person where focus has been laid on independence rather on
dependence on staff members or care providers (Guest, Ayoub and Greaves,
2015).
Apart from this, Robert who is suffering from venous leg ulcer can focus upon
different factors influencing activities of living. It consists of biological,
psychological and social cultural as well as environmental which tend to affect
daily living activities of a patient like Robert. Along with that, politico-
economic factor is also included which has direct impact on health of patient
(Filkor and et. al., 2015). Accordingly, this model represents the life span
continuum where full dependency begins at birth and people become fully
independent during midlife and again phase of fully dependent come during old
age. This is the major reason where older people are vulnerable to risk because
they need to be cared by others. Here, the first factors effective living activities

as biological reflects that how nutritional activities of a person different
between one who is having issue of diabetes and the one who is not having the
same. On the other hand, psychological factor shed light on spiritual beliefs and
ability to understand by patients. For instance, if a person is educated enough
then he will be sufficient self-dependent in term of health promotion. In this
manner, overall thinking, believing, hoping and feeling are considered. It aids to
determine influence of psychological factor on dependence of patient as Judie
(Harding, 2016).
Furthermore, socio-cultural factor presents the expectations and values in
accordance with actual health. This is because all culture follows different set
procedures and accordingly they tend to behave in different manner. The eating
habits and caring attitude is perceived by individual based on culture. However,
expectations and assumptions of societies also matter under which care workers
will come to know that whether patient is self-dependent (Marshall and et.
al.,2015). On the other hand, environmental damages also have direct impact on
health of one person. Here, people do care of themselves in case they are
residing in an unfavorable environment. Moreover, last factor as politico-
economic also affect activities of living because of violent conflicts, easy to
access to benefits provided by government.

THE NURSING PROCESS
The nursing process is very important in health and social care as it support
users to access good quality of services. The basic aim of nursing is to focus
upon identification of the services which are required by users. It enables them
to treat patients to satisfy them as per their needs. Under this process staff at
first give importance to service users which proves to be effective meet their
expectations in an effectual manner. The nursing process has dynamic nature
under which all elements related to each other in the cyclical form (McCaughey,
Cullum and Dumville, 2015). As per the given scenario, Robert can effectively
get treatment with the help of nursing processes adopted by social health care
homes. It aids in ensuring that clinical decision making is used for resolving
issues which are being faced by patients. Though, quality remain the most
imperative aspect which in turn users can get drastic change in their health
condition. Furthermore, Robert is provided individualized service care under
which quality plays the important role. It reflects that nursing staff taking care
of quality standard and in the same services are provided by them to the patients
suffering from leg ulcers. This disease may get infected as proper hygienic
factors needs to be considered while handling sensitive patients like Robert. It
is well known fact that nursing staff are directly associated with patients so they
must be treated with respect. Therefore, Robert will undergo the nursing process
consists of four stages such as assessment, planning and implementation and
evaluation (APIE). It includes all the standards of NMC such as competency
standards for nursing staff and foundation of nursing curriculum. By using
nursing process, theories and beliefs are formed which can be used by health for
rendering good quality of services (Hampel-Kalthoff and et. al., 2015).
Nursing diagnosis has been recognized as additional element of process
which will be helpful for Robert to get effective treatment of venous leg ulcer.
This fifth stage is considered as the most important as it widens the scope of

nursing profession. Cummings and Bennett (2012) explained that nursing
diagnosis is not likes normal medical under which diseases is identified rather
its main aim is to recognize the actual and potential health issues which forms
disease.

ASSESSMENT
The first step of nursing process is assessment under which important
information related to Robert will be collected. As per the given case scenario,
the information gathered regarding the medical history of Robert will be
presented in front of nurse so they can understand the present state of health.
This assessment can be done in several manners such as emergency assessment,
initial and risk as well as problem focused. Along with that, comparative
assessment is also done under which reassessment is done just after the original
one so that data can be compared with the standard guidelines of the nursing
process. Furthermore, comparative analysis aid to prepare baseline so that
extracted information regarding current causes of leg ulcers which facilitates the
doctor to provide necessary treatment for patients (Williams, 2015). On the
other hand, risk is assessed in the integrated manner under which specific
potential problem faced by Robert is identified effectively. However, problem
focused approach is used to identify the symptoms of the diseases and their
impact on the health conditions of a person. On the contrary, this stage the
doctors will predict the determined time of treatment in which this disease so
that Robert can get rid of this problem.
The nursing diagnosis is also considered as effective approach under
which nurses uses critical thinking skills to review the collected data from the
assessment stage. However, nursing staff will also analyze the health condition
data of Robert for making appropriate care plan. At the same time, clinical
judgment skills are used to identify service users and their potential problems
Anderson (2011) declared that assessment phase of nursing procedure will also
include data base regarding accurate information account the physical, spiritual,
social impact of the diseases etc. However, Robert will be assured that all the
collected information will be confidential where access will be provided to team
which is providing services for Robert. As per the assessment of Robert, it has
been found that Vital Signs for respiration was 29bpm with the use of accessory

muscles to breath. Total NEWS score was 11 where Oral temperature was 37.6-
degree C and Manual BP of Robert having issue of Congestive Cardiac Failure
(CCF). Furthermore, fluid balance lasts for 24 hours negative 1,080mls but oral
fluids is not taken by patients. Apart from this, status of Chest X-ray was
Pulmonary Odema and current medication is having property of Oral
Furosemide loop diuretic. Therefore, overall assessment scenario of Robert
shows that assessment will be done which helps nursing staff in order to prepare
the effective plan. However, nursing diagnosis is showing that Hyperventilation,
Hypoxia and Immobile which depicts that situation of patient is damn critical.
Furthermore, A variety of pain rating scales such as the Numerical Rating
Scale and the Universal Pain Assessment Tool as well as the Visual Analogue
Scale can be used. In this regard, different signals associated with non-verbal
communication such as grimacing, gritting teeth and acute pain occur to patients
can be included.
Anderson (2012) asserted that nursing staff consider specific aspects such as
specification of patients' requirement. The assessment will also include other
tools such as the Applied Wound Management tool at the place of infection, and
healing which is plotted on continuum along with Time framework. This time
framework facilitates in taking care of patients effective in accordance with set
standards. However, different Color are applied for distinguishing between
Different types of tissue; granulating tissue appears red. Apart from this,
Infection or Inflammation’ prompts assessment aids to find information related
to infection such as swelling, pain, erythema and fever. As per the given
scenario, assessment of Robert shows that mouth and lips remain dry and skin is
also in the same condition as these are the outcomes of the diagnosis process.
Apart from this, pitting peripheral oedema feet and ankles. Therefore, care plan
will have made accordingly but patient will also be informed regarding the
potential treatment to increase level of satisfaction and heal the same person in

relatively less time span. The other major issue associated with Robert is related
that he is living along where proper care is not given to him.

PLANNING
The planning phase of nursing practices play important role which reflects that
long term goals or objectives are established. It serves as planned nursing
intervention where focus is laid on clear priorities and care plan. Harding (2016)
suggested that short term goals can also be established by nursing staff just for
the sake of motivation and self-esteem. It is very crucial to involve evidence
based approach, multidisciplinary team along with easy accessibility to other
members. This facilitates to cater requirement of patient like Robert who is
suffering from severe diseases which can be minimized by the doctors and
special care can be done by the nurses. According to the provided scenario,
nursing staff involved service users, family members for the purpose making
informed choices. However, care plan was communicated among them in detail
manner which in turn family members can also provide their suggestions
(Hampel-Kalthoff and et. al., 2015).Furthermore, collaboration with patent is
the most important phase at planning stage under which nursing staff to
convince the patient to follow the specific criteria of care and provide support.
Owing to this, reason for complying the set standard will also be communicated
that how health will be recovered which is possible by conducting checkups on
monthly basis or weekly basis by the experts called upon on social service
users. Moreover, occupation therapists were referred along with social services
because Robert is living alone. The care plan of Robert will involves family
members and services users to make informed choices. The care plan of patients
shows that pulse to be 51-90 bpm within duration of 2 hours’ ad respiration
require to be 12-20 per 60 seconds but without use of accessory muscle to
breath with 2 hours. In addition to this, dietitian and Nutritional support team
was referred for eating and drinking of patients.

IMPLEMENTATION
Implementation of care plan is the most important aspect as it supports patient
to recover his/her health. At this stage, nursing staff generally implement the
care plan in accordance with set criteria. The implementation of plan will be
done by monitoring the score on hourly basis to physician unit to reach the
desired scope of activities plan. A nurse is provided who teach the light exercise
related to deep breathing, lease of lung expansion and expectations of any
sputum. The pressure will be relieved with standing position on chair by
moving from chair to bed and vice versa (Petherick, Pickett and Cullum, 2015).
It facilitates to make patient feel happy and accordingly hypertension will be
released in relatively short time span. Light attire is preferred for Robert for
night as well as day with appropriate atmosphere of room as in leg ulcers the
itchy clothes may increases the pain of the patients. For this purpose, windows
are left open along with anti-pyrexia medication to provide peaceful sleep over
night to relieve their pain. Apart from this, plan is implemented for mouth dry in
term of use of 24% via nasal inhalers. Diet chart is prepared and accordingly
liquids is offered in the small interval which includes soups, milk based drinks
and smoothies.

EVALUATION
The evaluation of care plan is very important as it provides support to care
workers that support their existing conditions in order to improve. NEWS was
inspected in 1-hour basis and was found that score is less and equal or 4. Score
for water low was greater or less than 8 in the interval of 2 hours. Apart from
this, fluid balance was daily weight and BMI will be ascertained once in a week
as normal patients as it has role in this disease for checking hourly basis.
Further, peripheral oedema was assessed on the basis pitting assessment on
daily basis (Lazarus and et. al., 2016). The mandatory requirements were related
to dietary intake at mealtimes and 48 hours’ time interval was kept where score
must be greater or equal to 3. Apart from this, mobility is assessed on daily
basis and moving as well as handling activities are observed. 4 hourly signs of
infection is assessed. Moreover, urinary catheter will serve as the basis for
evaluation where pressure is relieved after each pressure which facilitate the
patient to check their relieved pain on specific time interval.

RECOMMENDATIONS FOR FUTURE PRACTICE
According to the assignment, it has been found that Roper-Logan-Tierney
should be implemented by nursing staff to ensure effective care of patient. This
can be used as checklist so that patients can be observed in an effectual manner.
However, framework for individualized assessment and holistic should be used
by taking base of RLT model. This facilitates to understand the current mental
state as well as health condition of patients. However, certain national
guidelines should be provided for Venous Leg ulcer so that nursing staff can
work accordingly (Viv as, Lev-Tov and Kirsner, 2016). On the other hand, care
workers should be provided time to time training so they will effectively take
part in improving the service quality. The actual ratings of urinary catheter in
form of using PCA ratings will be used to strengthen the treatments.

CONCLUSION
The report concludes that nursing practices should be implemented in care
home with extensive care. Nursing theories and concepts as well as beliefs must
be understood among all nursing staff which will have direct impact on service
users. It can also be said that nursing process is the standardized method for
rendering care. Furthermore, nursing diagnosis is applied for effective
assessment of patients so that appropriate care plan can be prepared by nursing
practices. Apart from this, Venous Leg Ulcer tends to affect quality of life of
one person whereby service providers focus upon certain aspects and
accordingly treatment is provided. In addition to this, Roper-Logan-Tierney
activities of living model is very helpful in extracting important information of
clients or service users. The good impacts of the carper’s model will also help
the doctors in assessing the good or bad results generated from this model
which has several elements such as environment, health and peoples as this play
a significant role in the life of all the individuals in providing their valuable
services to all the patients suffering from venous leg ulcers.

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