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.
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Maintaining Professional Healthcare Standards Management of needs of an individual presenting with Congestive Cardiac Failure and Venus Leg Ulcer SID: 1511896 Word Count: 4800
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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 assessmentthat 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 definesvenous 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 tissuecomesin 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 throughoutthe 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
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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 totheheart (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 modelswhich 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 factthat variousdimension of nursing is associated with open, interrelated and interactive way where nursing staffwhich hasrequire to put their efforts with informed choices. It proves to be effective in rendering good quality of services to patientsby 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 demandattentionwhich 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 whereRobertwill 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).
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Furthermore, health is another element of Meta paradigmas 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 tofeeling 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 thinkingandclinical 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 thatit 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.
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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 differentfactorsinfluencingactivitiesofliving.Itconsistsofbiological, psychological and social cultural as well as environmental which tend to affect daily living activities of a patient likeRobert.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
asbiologicalreflectsthathownutritionalactivitiesofapersondifferent 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 inensuring thatclinical decision makingis usedfor 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,Robertis 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
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nursingprofession.Cummingsand Bennett (2012)explained thatnursing diagnosis is not likes normal medical under whichdiseases is identified rather its main aim is to recognize the actual and potential health issues which forms disease.
ASSESSMENT Thefirststepofnursingprocessisassessmentunderwhichimportant 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 lastsfor24 hours negative 1,080mls but oral fluids is not taken by patients. Apart from this, status of Chest X-ray was PulmonaryOdemaandcurrentmedicationishavingpropertyofOral Furosemide loop diuretic. Therefore, overall assessment scenario of Robert shows that assessment will be donewhich helpsnursing staffin orderto 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 healingwhichis plotted on continuum along with Time framework. This time frameworkfacilitates in taking care of patientseffective 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 ofRobertshows 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
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relatively less time span.The other major issue associated withRobertis 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 nursingstaff to convince thepatient 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 ofRobert willinvolves 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 ofroom as in leg ulcers the itchy clothes may increases the pain of the patients.For this purpose, windows are left open along withanti-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.
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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 andBMI 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 stateaswellashealthconditionofpatients.However,certainnational 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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