Enhancing Miller's Consequences Theory for Parkinson Disease Patient Ratin

This report aims to provide a treatment plan for Ratin, an individual with Parkinson's disease, focusing on patient-centered care. The plan is based on a clinical reasoning cycle that involves identifying the current situation and problems, collecting information about the patient, and analyzing the data to establish priorities. Three main categories were identified as key areas for enhancing Miller's consequences theories: (1) medication management, (2) symptom management, and (3) healthcare financial support. The plan also emphasizes the importance of using electronic health records, telephones, and other communication tools to help Ratin take his medications properly. Furthermore, it highlights the need for continuous evaluation and statistical analysis to assess the performance of nurses in providing patient-centered care.

NRSG259: Promoting Health in Extended Care
Care Planning: Individual Discussion
Monica Casio
S00206115

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Table of Contents
Introduction......................................................................................................................................2
1. Considering the patient history....................................................................................................2
3. Processing of information............................................................................................................4
4. Identification of problem/issues..................................................................................................5
5. Establishing goals........................................................................................................................5
6. Taking action...............................................................................................................................6
7. Evaluation of the outcomes.........................................................................................................7
8. Reflection.....................................................................................................................................7
Conclusion.......................................................................................................................................8
References......................................................................................................................................10

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Introduction
The current assignment focuses upon the aspect of nursing care practices and its
importance in the regulation and management of chronic illnesses. The nursing practices are
based upon a number of set principles or guidelines which places patient care experience at the
centre of the health care delivery. The current study uses the Miller’s functional consequences
theory to understand the effect of various social, economical, biological and physical
determinants on the health of a person. The study over here uses the Levett Jone’s clinical
reasoning cycle to identify access, implement and evaluate the care processes. The topic also
emphasizes upon construction of suitable goals and actions which could be taken in order to
provide optimum care services to the patient.
The assignment helps in the identification of different steps or measures which could be
taken in order to provide support to the patient here who had been suffering from Parkinson’s.
Additionally, the man was also lacking sufficient financial resources which also affected his care
retrieval processes. The assignment describes the clinical reasoning cycle in detail which consist
of a total of 8 steps and has been discussed elaborately under each sub-head of the assignment.
1. Considering the patient history
This is the first step of the clinical reasoning cycle where the health care professional
collects pivotal information about the patient health. These forms the backbone of the care
delivery processes based on which further therapeutic and clinical interventions can be
implemented. The care personnel here can use through questioning and interviewing methods to
collect sufficient and relevant health information about the patient. Here, the patient name Mr.

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Ratin Bhai was an 87 year old Indian who had migrated from his native land with his wife and
extended family. He was recently diagnosed with Parkinson’s and hypothyroidism both of which
have affected the daily life processes of the man. Ratin had been living in a two –storeyed house
alone and has been managing his cooking and daily activities all alone.
However, as per miller’s theory the reduced mobility and tremors experienced in both
the hands can expose him to increased risk of accidents from fall. In this context, the locomotor
abilities of the man are severely impaired causing safe movement through the stairs of a two
storeyed house difficult for him. Though, the hypothyroidism has been under control his
Parkinson’s has been getting worse. Additionally, dwelling alone he doesn’t have anyone to
support him with his daily course of activities. It has also been mentioned that the man has little
or no source of income. The care professional has also recorded the present medication pattern
and doses of the patient. The man has been taking 100μg of thyroxin daily along with
carbidopa/Levodopa 25/100 q8h, entacapone 20 mg q8h.
2. Collection of cues or information
The recent condition of the patient had been getting worse attributed to his Parkinson’s.
The man had been experiencing slights tremor in both of his hand which has been getting worse.
As commented by Odin et al. (2015), impaired locomotor abilities can affect the daily life
processes of an individual. In this context, the patient had been living alone and had been
suffering from advanced stages of Parkinson’s. Moreover, he had been experiencing increased
tremors in both his hands due to Parkinson’s. This could make him more prone to injury from
falling down as a result of poorly coordinated movements.

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Additionally, the man had been dwelling alone which could subject him to increased risk
of depression. Moreover, the lack of support care along with affected cognition can affect his
medication patterns. It has been mentioned by the man that he does not wish to bother his family
living next door. Therefore, as per Miller’s Functional consequences theory such isolated
environment can result in the onset of depression within the individual.
3. Processing of information
The man had been suffering from hypothyroidism along with Parkinson’s which had
affected his daily set of activities. Reports and evidences have suggested that the presence of
hypothyroidism is almost 10% higher in people with idiopathic Parkinson’s disease. However as
argued by Hutchinson & Wick (2016), there has been little or less clinical correlation between
the two. As mentioned by Chenet al. (2016), less thyroxin within the blood have also been
known to cause tremors in the patient. However, with medication the condition of
hypothyroidism has been controlled in the patient. The condition of Parkinson’s had been found
to be getting worse in the patient causing increased tremors of arms and legs. As commented by
Magennis et al.(2016), Parkinson’s is a progressive neurodegeneration disease affecting the
cerebral cortex of the brain and has severe consequences on motor abilities of a person. In this
context, the progressive neurodegeneration disease also affects the degree of mental awareness
and cognition of the person. Therefore, the reduced decision making skills can affect the
medicine schedule of the person. The increase in the tremors could also make the person unable
to travel the clinics situated distantly or access regular medical services. Therefore, preparation
of rosters for time and schedule of medicine uptake along with constant supervision can aid the
process.

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4. Identification of problem/issues
From a detailed analysis of the case scenario of the patient three most significant issues
or problems encountered by the patient can be highlighted over here which needs proper care and
intervention. The patient had been living alone therefore his worsening Parkinson’s calls for
support care. Additionally, the patient also suffers from hypothyroidism which has been found to
be present as a co-morbid condition in Parkinson’s. Therefore, his current situation calls for
sufficient clinical intervention and medication management. Additionally, the man reportedly
does not have enough financial resources to avail proper care treatment. This calls for the
sufficient support from health care professionals and community care concerns.For the current
assignment, proper medication management for Parkinson’s has been undertaken as one of the
prime nursing concerns.
5. Establishing goals
The medication management is taken as the top priority for establishing the goals in the
treatment plan of Parkinson disease in order to follow the Miller’s consequences theories. As
stated already in the scenario, that Ratin has problems regarding the medications. He has been
prescribed with medicines like Thyroxine, carbidopa, and Entacapone Considering the
symptoms of Parkinson disease, thyroxine is given to the patient to manage the thyroid hormone
which would be necessary for motor movements (Odin et al, 2015). Carbipoa is given to lessen
nausea. Entacapone would manage the involuntary functions. Based on these the intervention
goals would be set up following the SMART rules:
Specific The nurses would have to evaluate the safety and on time prescribed drugs

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Measurable There will be a treatment team that would make assessment of the ward
nurses and how they are managing the medications of Ratin
Attainable The entire evaluation strategy would be feasible until one month
Results oriented This identifies that the output would reach the realistic level in which all the
nurses involved would be asked questions about the medication
management
Timely The interim steps like reports would be generated after the survey by the
end of the month
6. Taking action
The above quasi experimental strategy used by the nurses can help them to take interventions
and fulfill all the rationales in medication management for Parkinson disease. The interventions
are to be taken that will help Ratin to take medicines on time. He faces problem in medication
intake because he has both financial problems and he lives alone. The nurses can prepare for him
rooster that would help him take the medicines daily as prescribed by his physicians. The
telephonic calls by nurses can remind him of the medicines that are to be taken with the
oncoming of different symptoms and can also change the doses according to the problems he
faces (Rascol, 2015). In this way, nurses can describe the medication administration, monitor
their dosage systems, multi dosage system analysis and dose administration aids. The nurses can
also use the telecommunication systems like electronic health records for describing the patient
with medication protocols and the medicine reconciliation. The rationale for this intervention is

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that it would help nurses to give the list of the drug name, dosage, frequency, discrepancies,
omissions (Katus & Shtilbans, 2014).
7. Evaluation of the outcomes
The evaluation of the entire process would be extended from the goals that were set in the
analysis of the medication management. This is done by collecting the objective data that would
give the measurable data on the situations observed. It is the quasi experimental study that would
be developed in order to understand the new concerns and the interventions taken for the
medicine management of Ratin. The primary data is collected by the questionnaires made on the
nurses that are involved in handling the treatment of Ratin (Connolly & Lang, 2014). This would
be specifically tailored to identify and evaluate the current conditions and quality in the
medicinal management for the patient. This would be a research based study and would
practically identify if the interventions are been performed well. The process would be more
effective is done on the analysis of qualitative data (Morton et al, 2017). This data gives the
measurement not in terms of the numbers of nurses involved in the medication plan but with the
natural description of the recurrent situation. The inferential statistics can be used to identify the
situation in the medicinal management.
8. Reflection
Thus, from this entire report, I as a nurse have identified three main categories for
enhancing the Miller’s consequences theories that would provide the wellness of old people like
Ratin. I have also understood that clinical reasoning cycle would be useful in a collection of the
cues and information. The process information can also be made that can predict the outcome
(Urden et al, 2015). Finally, I can easily identify the problems and issues. When the problems are

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known then the goals can be established that is based on the main priority of medication
management of Ratin. The interventions were also taken accordingly following the rationales.
The recent use of electronic health records, telephone, rooster can be used by the nurses to help
him take medicines properly. Thus I now have more knowledge in understanding the impact of
Parkinson disease and the interventions that can be taken for the management. Next time I would
take more steps in more improvement of the treatments that are to be provided to Ratin.
Conclusion
The following treatment plan for the management of Parkinson disease would help the
nurses to take useful strategies to provide patient centered care. This is based on studying the
current situation and the problems of Ratin and then applying the clinical reasoning model for
getting the priorities on which the nurses must observe to provide high-quality treatment to the
patient. This would be based on collecting all the information of the patient and then make a
critical analysis of the information to identify the top 3 requirements which are the medication
management, management of patient symptoms of Parkinson and providing health care financial
support for him. The take home message from this report is that the patient centered care would
be well provided for fixing a particular goal and then taking the interventions and rationales
based on the situation. There would be complete evaluation and statistical analysis that would
reflect the performance of the nurses in medicinal management. Thus the report in future would
give the preferences, needs, and values for the patient and guide the clinical decisions based on
it.

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References
Castrioto, A., Lhommée, E., Moro, E., & Krack, P. (2014). Mood and behavioural effects of
subthalamic stimulation in Parkinson's disease. The Lancet Neurology, 13(3), 287-305.
Chen, S., Chan, P., Sun, S., Chen, H., Zhang, B., Le, W., ... & Cheng, Y. (2016). The
recommendations of Chinese Parkinson’s disease and movement disorder society
consensus on therapeutic management of Parkinson’s disease. Translational
neurodegeneration, 5(1), 12.
Connolly, B. S., & Lang, A. E. (2014). Pharmacological treatment of Parkinson disease: a
review. Jama, 311(16), 1670-1683.
Ferreira, J. J., Katzenschlager, R., Bloem, B. R., Bonuccelli, U., Burn, D., Deuschl, G., ... &
Kostic, V. (2013). Summary of the recommendations of the EFNS/MDS‐ES review on
therapeutic management of Parkinson's disease. European journal of neurology, 20(1), 5-
15.
Hutchinson, K., & Wick, J. Y. (2016). Deep brain stimulation and medication management in
parkinson's disease. The Consultant Pharmacist®, 31(2), 73-84.
Julius, A., & Longfellow, K. (2016). Movement Disorders. Medical Clinics, 100(4), 733-761.
Katus, L., & Shtilbans, A. (2014). Perioperative management of patients with Parkinson's
disease. The American journal of medicine, 127(4), 275-280.
Magennis, B., Lynch, T., & Corry, M. (2014). Current trends in the medical management of
Parkinson's disease: implications for nursing practice. British Journal of Neuroscience
Nursing, 10(2).

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Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017). Critical care nursing: a
holistic approach. Lippincott Williams & Wilkins.
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Rascol, O. (2015). Collective physician perspectives on non-oral medication approaches
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