NT2 Holistic Care

This essay is a case study on holistic care of the patient. It discusses the importance of holistic nursing care and the use of holistic care in the case study of Bella Geller. The essay also explores the Roper-Logan-Tierney Model of assessment and the nursing interventions involved in holistic care.

Running Head: NT2 Holistic Care 0
NT2 Holistic Care
Essay
Student name:
1/4/2019

NH2 Holistic Care 1
Introduction:
This essay is a case study on holistic care of the patient. It is important to take care of the
person and not take them as a patient or diagnosis. Holistic nursing care includes curing the
body, soul and mind of the patients. Holistic care is a physiological, psychological and social
process to take care of the patient.
In this essay, we will discuss the case study of Bella Geller and the use of holistic care
method of treatment helped her heal. The type of patient assessment will be discussed in the
essay further including the nursing interventions. The case study include, the past medical
history of the patient, physiological conditions, psychotically conditions, social history and
other pertinent information. In this essay, the holistic care and assessment is discussed in
detail including the model of patient’s assessment. In the model, a table will be provided to
demonstrate the patient’s needs assessment, baseline, on admission or on assessment and the
associated nursing interventions is included. Nursing intervention will be described with the
role of promoting autonomy, self-care and independence to a patient. The essay also consists
of the definition of autonomy, meaning of autonomy to a patient and by being a nurse
allowing a patient to be autonomous. This also includes the nurse ensuring about the patient’s
self-care and independence when it is maximised and its limitation.
Confidential clause:
This essay is a case study on holistic care of the patient. The real identity is not revealed in
this essay, as the patient’s and doctor has formed trust in between them and the real names is
not revealed for the safety purposes. The names used are changed in the essay, so that the
privacy of the patient is not threatened in any way possible or by any means (De Bord et al.,
2014).

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Case study:
Bella Geller is a 58 year-old British woman who is living with her only daughter and son-in-
law. Her past medical history says that she has hypertension, diabetes, heart diseases and
osteoarthritis. Hypertension is a state of excessive psychological stress, which causes
abnormal high pressure. Diabetes is a disease where the body’s ability to produce or respond
to the insulin hormone is stopped which causes abnormal metabolism of carbohydrates and
elevate the level of glucose in blood. Coronary heart disease is caused when the blood vessel
of the heart is functioning in an abnormal way, which can further lead to heart attack.
Osteoarthritis is degeneration of joint cartilage and the core bone causing pain and stiffness.
The report says that she has pain on the joints especially on the knees and spinal column. She
also, complains about weakness and tiredness that she feels all day, she fear that she might
fall anytime due to weakness in her body.
Physiological condition is also defined as the external condition or the physical state or
internal milieu that may occur in the nature of the organism or cell system (Merriam-
Webster, 2019). This basically, deals with the roles and actions of the organisms or living
things and its physical and chemical phenomena in the nature. Bella’s physiological condition
report states that she has extreme pain on the joints especially on the knees and backbone.
Her external look is weak, due to osteoarthritis is cannot walk properly or stand for a long
duration. She mostly sits or lay down straight on the bed.
Psychological condition is defined as mental conditions of a person who is going through
emotional or behavioural problems on extreme level (Brogaard, 2015). Bella is mentally
weak, she has fatigue issues and she is afraid she may fall anytime. In addition, this is caused
due to vast range of other physical, mental and emotional symptoms.

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Holistic nursing care is defined as a nursing care practice that heals the complete individual.
A holistic nurse is a qualified nurse who takes approach on the traditional nursing method
that is mind, body, spirit, emotion, and environment (Wang, 2017). This also mean that the
organization take care of the complete patient, which is considered as the physical, emotional,
social, economic, and spiritual needs of the individual. Holistic nurse care includes taking
care of the patient by responding to her/his problems and the consequence of the problems on
the capability to encounter self-care needs according to the situation (University, 2017).
Holistic care is important to any patient because nurses enrich the lives of the patient. Nurses
need to promote the psychological and emotional health. Holistic care increases self-
awareness and self-confidence to the patient. It expresses gratitude towards the patient’s
priorities and conserves the patient’s dignity (Selimen & Andsoy, 2011). In addition, holistic
nursing can be practiced in any place of care and in with any surrounding and things. Holistic
nurse care is always focused towards the patient, which is a positive attitude towards the
patient as the nurses diagnose a patient by healing their mind, body, and soul. In some care
settings, the nurses do not look out for the patient’s required medication and the basic needs
of a patient. Holistic care also focuses on the emotional state of the patient and treats them
with positive environment, which is important for any patient as they go through physical as
well as mental pain due to their diseases. Mental health is also as important as physical
health. Holistic care is practical and sustainable approach to the patients of any age.
Holistic assessment includes physiological, psychological, sociological development of the
patient through spiritual and cultural meaning by enlightening patients about self-care and
helping them to perform their daily routine independently. The nurses can use holistic
methodology to collect data regarding the patient’s family subtleties, morals, opinions and
other aspects that would be needed to heal the patient. This treatment is more effective and
has positive results for the patients. This care is also sustainable and can be practiced

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anywhere. It is beneficial to every age group of patients. Holistic care assessment forms a
better bond between the nurse and patient. Holism help the patient to be stable mentally and
physically, a patient puts faith on the nurses taking care of them (Papathanasiou, 2013). As
this relationship grows between a patient and a nurse, the patient may recover easily from
their physiological and psychological problems. Patients with depression due to their disease
can easily be healed with friendly environment around them (Taleghani et al., 2015).
Patient centred care does not only mean providing everything a patient needs, it means it
considers patient’s required assessments, family conditions, social environments and regimes
and then take care of everything a patient need to heal or develop appropriate solution to the
problem (Morgan & Yoder, 2011). The patient centred care basically, focuses on an
individual and their families as well. This type of care commits to meet and exceed the needs
of the patients. Patient centred care commit on demonstrating respect, dignity and
compassion through everything they do for the patient (Pelzang, 2013). Whereas on the other
hand, holistic care believes in the physical, mental, and spiritual needs of every patient. They
commit on healing the patient and their take care of the patient needs only.
Illness and psychological behavioural problems usually do not harm physically and hence it
is hard to response to complex interaction with a single patient (Neil et al., 2016). Holistic
care works as healing the patient’s physically as well as mentally and sometimes it is hard to
focus on every detail of the problem. It is hard to break down and point to one reason of the
illness or ailment when there are so many interacting people at a same time. Moreover,
holistic care cannot diagnose the diseases entirely.
The Roper-Logan-Tierney Model is the type of assessment used for this case study. This is
used because this model type believes in evaluating the meaning of the patient’s life that has
been changed due to disease, wound, or admittance to a hospital rather than just developing a

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plan to increase independency and quality of life (Alligood, 2018). Nurses usually uses, this
model to evaluate the patient’s virtual individuality and possibility for achieving the
independence of activities the patients are going through in daily life. This model follows the
holism form of assessment and care planning (Williams, 2015). This model is widely used in
United Kingdom. It applies the valuation, verdict, arrangement, intermediation and
assessment as this is usually used as a guide for the nurses of a holistic patient to assess them
based on care planning. This model also includes some factors that are based on the concept
of nursing and makes it a holistic model. The reasons that this model depend on are
biological, psychological, socio-cultural, environmental, and politico-economic.
As the factors incorporate, the holistic assessment such as the biological factor centres on the
impacts of the complete fitness that is present damage on body and disease. The
psychological factor centres on the effect of emotional state or the spiritual state of mind and
ability to understand it (Pike, 2013). The socio-cultural factor includes expectations and
values that are based on the culture and beliefs of the individual, as well as by pertaining
independence in daily life activities. The environmental theory focuses on the environment of
the activities taking place in daily life. The politico-economic factor is the impact that is
based on government, policies and programs, war, availability to benefits, political reforms,
interest rates, and availability of public and private funding. Hence, holistic care assessment
is a factor of Roper-Logan-Tierney Model (T. Welle et al., 2013).
The nursing process in the Roper-Logan-Tierney Model includes assessing the patient’s
virtual independence and potential for independence for daily life activities (McCrae, 2011).
The patient’s freedom is looked at on the range from complete dependency to complete
freedom. This assists the nurse to control the involvements that will lead to improved
independency as well as dependency provision.

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Assessment type baseline On admission/or on assessment Nursing
intervention/sNeeds assessment of
patient
Initial assessment
 The needs are
obtaining
patient’s
medical
history or
checking
him/her
physical needs
(Tammy &
Wendy , 2018).
The health status of
Bella is that she has
osteoarthritis and she
has physical pain on
her knees and
backbone. She walks
slowly, and cannot
move too much. She
does not stand for a
long time. She needs
support to walk and
sit.
Bella is on admission assessment due to
severe pain in her hips and knees.
Name: Bella Geller
Medical record number: 38722
Age: 58
Date: 30 December, 2018
Time: 1.45 pm
Past medical history: left knee operated
once, has osteoarthritis on the joints that
is knees and backbone, heart diseases,
hypertension and fatigue problems,
further including diabetics.
Assess pain: pain on the knees and
backbone. Due to her heart problems, her
chest also pains sometimes.
Allergies: none
Medication: Cymbalta 120 mg, Inspra
50 mg, and Precose 25 mg
Activities: daily routine exercise that
includes walking for thirty minutes and
neuromuscular exercises
Psychological: Bella has fatigue and
Nurses need to know
the symptoms and
recognize the risk
factors. The basic
symptoms are aging,
family history of
osteoarthritis, injuries,
obesity, and repetitive
overuse of a joint.
Nurses help them with
exercise and physical
therapy such as low
impact aerobics,
swimming, strength
training, and
neuromuscular
education
(AmericanNurseToda
y, 2015).

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hypertension.
Nutritional: appetite is good.
Weight: 52 kg
Height: 173 cm
Vital signs:
Temperature: 37 degree Celsius
Heart rate: 60-100 bpm
Respiratory rate: 12-20 breaths per
minute
Blood pressure: 122/87
Pain level on admission: knees and
backbone pain increased.
Oxygen saturation: 80 mm Hg
Focused assessment
 This is the
stage, where
the pain or the
physical
injuries are
exposed and
treated
(McGuffin,
The health
conditions of Bella
states that she has
pain on her left knee
more than the right
and in the hip area of
her body. Focused
assessment needs
take place and this
Bella is on Roper-Logan-Tierney
assessment due to her stable health
conditions. Her knee and backbone pain
is decreased.
Name: Bella Geller
Medical record number: 38722
Age: 58
Date: 2 January, 2019
Time: 10 am
Bella has
osteoarthritis due to
her family history of
osteoarthritis. She is
also aged. Hence, the
nurse exercises her
through physical
therapy by low impact
aerobics, basic

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2019). includes X-rays and
other tests as well.
Nurses run the test
by including X-rays
of her knee and
collarbone to treat
her.
Past medical history: left knee operated
once, has osteoarthritis on the joints that
is knees and backbone, heart diseases,
hypertension and fatigue problems,
further including diabetics.
Assess pain: less pain on the right knee,
left knee and backbone still hurts
sometimes.
Allergies: none
Medication: Cymbalta 120 mg, Inspra
50 mg, and Precose 25 mg
Activities: daily routine exercise that
includes walking for thirty minutes,
physiotherapy sessions, and
neuromuscular exercises
Psychological: Bella has fatigue and
hypertension.
Nutritional: appetite is good.
Weight: 52.5 kg
Height: 173 cm
Vital signs:
Temperature: 37 degree Celsius
Heart rate: 60-100 bpm
Respiratory rate: 12-20 breaths per
minute
physiotherapy
exercises and
neuromuscular
education (C. Mentes
& Egan, 2010).

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Blood pressure: 122/87
Pain level on admission: knees and
backbone pain increased.
Oxygen saturation: 80 mm Hg
Time lapsed
assessment
 During this
assessment,
the present
status of the
patient is
compared with
the past
baseline during
and prior
treatment
(McGuffin,
2019).
The medical
condition of Bella is
positive. Her body
has shown
improvements. She
can walk easily
without support. She
is still facing
problem with her
diabetic problem and
some heart issues.
Bella is on admission assessment due to
increase in chest pain.
Name: Bella Geller
Medical record number: 38722
Age: 58
Date:5 January, 2019
Time: 4 pm
Past medical history: left knee operated
once, has osteoarthritis on the joints that
is knees and backbone, heart diseases,
hypertension and fatigue problems,
further including diabetics.
Assess pain: pain on the chest
sometimes.
Allergies: none
Medication: Cymbalta 120 mg, Inspra
50 mg, and Precose 25 mg
Activities: daily routine exercise that
includes walking for thirty minutes,
physiotherapy sessions, aquatic exercise
for ten minutes and neuromuscular
Bella has diabetes and
she has to make effort
in controlling blood
glucose levels to
ensure good blood
flow. If the blood flow
is good then the heart
issues will be solved.
Nurses are educating
about self-
management and care.
They have also
implemented the
neuromuscular
exercise and aquatic
training once in a
week (Shimizu et al.,
2011).

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exercises
Psychological: Bella has fatigue and
hypertension.
Nutritional: appetite is good.
Weight: 53 kg
Height: 173 cm
Vital signs:
Temperature: 37 degree Celsius
Heart rate: 40 bpm
Respiratory rate: 12-22 breaths per
minute
Blood pressure: 128/89
Pain level on admission: chest pain
Oxygen saturation: 78 mm Hg
In United Kingdom, the model is dominant in the clinical practice, as it is not only used as
checklist it is being used for other clinical practice as well. This model is frequently used to
evaluate the journey of the patient’s life changing due to sickness, damage, or admittance in
the hospital rather than planning a method for increasing independency and worth of
existence. The limitation of the Roper-Logan-Tierney model is that this model gives
importance to the physical needs and does not focuses too much on the spiritual needs or
psychological needs (tibule, 2013). The limitation of the model in nursing intervention is that
the pain can be reduced physically or the anxiety can be reduced by spiritual needs but the
patient needs to have good bond and faith on the staff. This model cannot heal a patient

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completely through its spiritual methods, as it is traditional method of nursing (Noble &
Elsherif, 2013).
Nursing interventions can be defined as any treatment, which is based on clinical practice and
knowledge performed by the nurse to aid a patient. The nurse has to practice the usage of
his/her understanding, abilities, and experience to choose which interventions will aid the
patient in that particular situation (Wagner et al., 2018). Here, in the case study, the relevant
nursing intervention is insulin administration and anxiety/distress therapy through the
medium of spirituality culture and person centred care. These two nursing intervention is
chosen because Bella has anxiety issues and she have diabetic problem. The nursing
intervention will take place for insulin administration by injecting insulin syringe into the fat
layer of the patient. As Bella has common anxiety disorder, the intervention will take place
by using cognitive-behavioural therapy on her and educating about healthier and effective
method to focus on better things.
The nurse should promote patient’s autonomy, self-care and independence. According to Roy
(1976), her adaption model of nursing described the balanced between dependence and
independence stress by assessment of behaviour and diagnose the disease (İşeri et al., 2014).
Orem (1980) focused on the self-care on the other hand placing importance on autonomy and
the promotion of patient’s ability to meet their own needs and the patients need not to be
dependent on anyone. The ability to be dependency may also affect the amount of autonomy
a person is given to be independent (Braden & Sidan, 2011). Promoting patient’s autonomy,
self-care, and independence in health care is defined as improving stage of health of the
patient. Patients are expected to take care of their own health and the take their own
responsibility in their own hand.

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Autonomy means allowing the patients who have managerial capacity for the rights to take
their own responsibility and decision regarding their care or clinical recommendations (Skår,
2010). Physicians have to value patient’s autonomy by providing them the knowledge
required to know the advantages and disadvantages or possibilities and profits of a planned
intervention as well as practical replacements so that the patient can take their own self-
determining choices.
A patient’s freedom is the main importance everywhere. The bioethics restricts the role of
others who might affect the patient to take their own wishes or beneficial interest first (Mi
Sook et al., 2013). Like in this case, Bella always tries to include her daughter’s and son-in-
law’s decision or wishes first rather than thinking about herself. Bella has anxiety issues due
to this. She is not able to heal easily and she is emotionally and mentally disturbed.
We as nurses know that a patient is allowed being autonomous when the patient takes his/her
own decision without including his/her family’s idea first or keeping them away from their
own decisions. The patient is allowed to take choices about their therapeutic maintenance
without the help of their health caretaker trying to effect the decisions. Being a nurse, we
know that patient autonomy permit the health caretakers to coach the patient about their
autonomy but it does not allow the health caretakers to make the patient’s choices behalf of
them. Such as in this case study, Bella usually tries to include her daughter’s decision and
does not think of her own. She lets her daughter and son-in-law dominate her health life
decision. Because of this, she is always dependent upon her daughter and son-in-law. Health
care providers are educating her for self-care and independency.
We ensure the patients self-care and independence is maximised by measuring the approach
towards self-care of a patient. These are based on behaviour of health care staff should
develop skills in supporting self-care and non-judgemental practice of the patient. A staff

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should use good communication and relationship skills that educate and encourage
identifying the strengths and abilities in a patient (Vitale, 2009). The staff should access to
suitable coaching and self-care skills improvement in the patients. The staff, should advice
the patient on participation of decision-making processes and supports the networks.
NHS campaigns such as PJ paralysis and Frailty pathways are free medical care campaigns
held in United Kingdom (England, 2018). This campaign was created to build strong
relationships between healthcare assistant, therapy and nursing staff. Nursing and therapy
have good communication support towards the patient and their families for better outcomes
(Skrypak, 2018). NHS aims to take care of the patient by maintaining high quality clinical
care for the patient. In addition, they recruit highly skilled and engaged staffs that embrace
and deliver the aims.
Conclusion:
From this essay, we conclude that Bella is getting better due to holistic care and she is
improving her health day by day. In this essay, we have discussed about holistic care nursing
and the basic structure of the patient’s physiological condition, psychological condition,
social history or past medical history and other pertinent information that is required for the
case study. A confidential clause is added in the essay that states, the real name and the
location is changed in this case study due to maintaining the privacy of the patient.
Holistic care is defined, and discussed about the importance of holistic care to the patient and
nurse. Comparison and contrast is discussed between patient centred care and holistic care.
The challenges to holistic assessment in clinical practice are discussed further in the essay.
Model of assessment is introduced in the essay. The chosen model is Roper-Logan-Tierney
(ADLs) and we have described the model in detail in the essay. This model is a holistic
nursing assessment. The nursing process is included in description of this model. A table is

NH2 Holistic Care 14
provided, which demonstrates patient’s needs assessment including baseline, on admission or
on assessment and the associated nursing interventions. In addition, we have analysed the
limitations of this model in the essay. The nursing interventions is described and the role of
nurses in promoting patient’s autonomy, self-care and independence. Further, autonomy is
defined and discussed the meaning of autonomy to a patient. In the end, the NHS campaigns
such as PJ paralysis and Frailty pathways are described and the roles and aims are discussed
in the essay.
The two things that is, learned from this essay are that the holistic care is affordable process
of treatment and it is the traditional method of treatment in United Kingdom. Nursing is a
difficult task to perform, as a patient needs a lot of attention to be healed. Forming a good
bond with between a patient and the staff is not easy; it takes time to a patient to believe that
nurse or physician can heal them.
The two ideas to take forward from this essay is that the NHS campaign in every country
should take place as it is the affordable method of treatment and this is the traditional method
of healing the patients. The other idea is the Roper-Logan-Tierney model of nursing as the
autonomy, self-care and independence are necessary for a patient to heal easily and
independently.
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