Nursing Decision Making

This article discusses the importance of nursing decision making in patient care, focusing on a case study of a patient with hypertension. It explores the biopsychosocial model of health and its application in analyzing the patient's physical, psychological, and sociological impacts. The current care plan is critically analyzed, and recommendations for improvement are provided. Legislative requirements and policies related to the care plan are also discussed.

NURSING DECISION
MAKING

Table of Contents
INTRODUCTION...........................................................................................................................3
MAIN BODY..................................................................................................................................3
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................1
APPENDIX......................................................................................................................................3
Current Care Plan........................................................................................................................3

INTRODUCTION
The patient Mr. Khan is 60 years old and suffers mainly from hypertension and chest pain.
The patient has a complex past medical history where the major diseases revolve around
depression, tension and even acute coronary syndrome (Boffa and et.al., 2019). The current case
report will evaluate hypertensions as a disease which Mr. Khan is suffering and the different
symptoms; Biopsychosocial Model will be used to analyse physical, psychological and
sociological impacts, and the care plan that has been developed for the patient will be critically
analysed. This will help in the identification of the faults or drawbacks in the overall care plan
that has been developed for the patient and then based on the critical analysis, a better care plan
will be recommended (Kitt and et.al., 2019). The better practices that should be introduced in the
care plan will be identified and this will be supported by adequate evidences so that their
reliability can be justified.
MAIN BODY
Biopsychosocial Model of Health illustrates the fact that there are three different aspects that
are associated with the mental health mainly biological of physical, social and psychological
(McManus and et.al., 2016). This model predominantly helps in the assessment of the mental
condition of the patient and the variety of aspects that are associated with it.
The current case of Mr. Khan can be illustrated as the one where the major issues or
disease that is being faced by the patient is the hypertension (Gazzard and et.al., 2018). The
major symptoms of hypertension include shortness of breath, dizziness, chest pain, blood in
urine, headaches etc. mainly and all these collectively indicate that a patient is having higher
blood pressure or hypertension. These are usually caused when the mental strain for the patient is
very high and they are stressing over something critical (Forster and et.al.,2015). For Mr. Khan
as well, an analysis can be made regarding the disease of hypertension that he is facing.
The different aspects that are associated with the physical, psychological and sociological
aspects of the patient Mr. Khan can be analysed in following manner:
Physical Impacts: The physical aspects help in analysing that there are different factors such as
physical disabilities, physical health, genetic vulnerabilities, the overall temperament, drug usage
and consumptions etc. which affect the overall physical disposition of a person (Barrera and
et.al., 2016). In the current case of Mr. Khan as well, it can be seen that he has a past medical
history of suffering from anxiety, acute coronary syndrome, depression etc. and all of these arise

when the person is stressed about something. The disease of Hyperlipidaemia is the biggest
indicator however which indicates that the overall physical health of Mr. Khan is not proper and
does not indicate a healthy mind set and physique that a person should have (Waterall and et.al.,
2015). The impact of the adverse physical aspects is also affecting the overall physical health of
the patient that might be termed as a contributing cause in the overall development of
hypertension.
Social Impacts: The social impacts mainly illustrate the overall family and friends surrounding
and belongingness that a person develops around them. The support of the peers and the
classmates, the different circumstances in which a person develops themselves, the schooling etc.
can collectively lead to a significant impact on the development of the social circumstances
(Petersen and Benzeval, 2016). In case of Mr. Khan as well, it can be analysed that he is mainly
a lonely man who has been divorced by his wife, his children live away from him and from what
it seems, he is not particularly familiar or friendly with his relatives as well. The social isolation
where a person does not engage in communication and relationship formation, restricts the
overall growth and fostering of the individual (Capewell, McCartney and Holland, 2015). This
can be a major cause of depression and further hypertension amongst Mr. Khan thus depicting
the reason behind the present situation of Mr. Khan.
Psychological Impacts: These includes the ones where the factors like self- esteem, social
connections, traumatic experiences etc. impact the overall emotional or psychological stability in
the patient and the stability indicates the healthier lifestyle that a patient might develop (Kittel,
2019). Mr. Khan, since he was an isolated person, he could not communicate and exchange
emotions with other and this can be a major contributory factor in the development of
hypertension (Mollan and et.al., 2019). When he finds that he has no one to really support him or
listen him out, then it automatically shuts down a person and the bottled up emotions can be a
deadly aspect for the patients who have a chronic past medical history (Scholes, Conolly and
Mindell, 2020). Therefore, the psychological impact also indicates that he does not appears to be
a happy and joyful person who is satisfied of the life that they are living and this can cause the
different social factors to affect negatively.
The current care plan that has been developed for Mr. Khan is overall a comprehensive plan
for the treatment of the hypertension on the first basis (Nolan and et.al., 2018). It is enough for
the treatment and cure of the symptoms that arise towards hypertension such as chest pain,

headaches etc. However, the current plan does not effectively take into consideration the past
medical history of the patient and the diseases that he suffered i.e. the depression and anxiety, his
habit to live alone and independently (Hernández and et.al., 2016). There are no factors that
motivate him to communicate with other people and learn to share emotions by discussing the
problems and opportunities that arise accordingly. The current care plan also inclines more
towards the medical cure of the diseases using medical procedures rather than adopting the
holistic approach (Harrison, 2017). The increased anxiety levels, depressed state of mind etc., all
fall under the purview of psychological aspects of hypertension where they need to be cured by
developing appropriate interventions and care plan strategies. These also help in the curing of the
different aspects that are associated with the overall addressing of the hypertension as a cause
(Crilly, 2020). The current plan however is not comprehensive and lacks in these aspects
cohesively.
The recommendation that can be made in order to incorporate changes in the current plan
include the aspects that are related to the overall curing of the different psychological aspects as
well. The improved care plan that can be developed will include the additional aspects that are to
be taken under purview where increased communication and increased social interaction will be
the key interventions (Lay-Flurrie and et.al., 2020). The new plan that is developed will increase
the external communication of Mr. Khan where he will be able to interact with other individuals
of his own age and hence the problem of anxiety and depression can be cured accordingly. For
this, the patient can be shifted in a care home so that he meets with different people.
Additionally, the new care plan can also include the medical details that are necessary to address
the problems that are being faced by the patient Mr. Khan (Trayner and Taylor, 2017). The
current care plan therefore that can be implemented will help in the addressing of the problem
that are related to the different problems that Mr. Khan is facing collectively.
There are a variety of legislative requirements and policies that come under the overall
governance of the different aspects that are associated with the care plan that has been developed
for the patient Mr. Khan. The compliance to these acts is necessary and these target the different
areas such as Mental Health Acts, 2007 helps in evaluating the different aspects related to the
care plan and strategies developed for mental treatment and care, the Care Act, 2014 evaluates
and ensures that the care strategies that have been developed are justifiable for the patient and
ensures his safety (Leader and et.al., 2019). The Data Protection Act, 2018 will guarantee that all

the personal details and data of the patient is protected at all times by the relevant personnel and
lastly in UK, the development and implementation of the NICE guidelines, CQC, etc. has made
it necessary and legal to comply with all of them (Vrijens and et.al., 2017). These collectively
ensure that the overall care plan, interventions and strategies that have been developed for the
patient guarantee the full safety and best treatment measures for the patient. Therefore, the care
plan that has been recommended for Mr. Khan is comprehensive enough which will help in the
addressing of the different factors accordingly.
CONCLUSION
The overall research that has been conducted in the case study helps in concluding that the
importance of addressing of the different psychological and social factors contributes towards
development of better factors. The case study analysis concluded that the current care plan that
has been developed for Mr. Khan does not address the psychological and social factors that were
identified under the Biopsychosocial Model. The different aspects that are related to the overall
development of a comprehensive care plan will help in the fulfilment of the different needs of
Mr. Khan. Lastly, a discussion on the different legislative requirements regarding the care plan
and interventions developed in UK were evaluated and the impact they have on the overall
operation of the plan were developed.

REFERENCES
Books and journals
Boffa, R. J and et.al., 2019. Hypertension in adults: summary of updated NICE
guidance. Bmj, 367, p.l5310.
Kitt, J and et.al., 2019. New approaches in hypertension management: a review of current and
developing technologies and their potential impact on hypertension care. Current
hypertension reports. 21(6). p.44.
McManus, R.J and et.al., 2016. Self-monitoring in hypertension: a web-based survey of primary
care physicians. Journal of human hypertension, 28(2), pp.123-127.
Forster, A. S and et.al.,2015. Estimating the yield of NHS Health Checks in England: a
population-based cohort study. Journal of Public Health. 37(2). pp.234-240.
Barrera, L and et.al., 2016. Impact of ethnic-specific guidelines for anti-hypertensive prescribing
in primary care in England: a longitudinal study. BMC health services
research. 14(1). p.87.
Waterall, J and et.al., 2015. Invited debate: NHS Health Check: an innovative component of
local adult health improvement and well-being programmes in England. Journal of
Public Health. 37(2). pp.177-184.
Petersen, J. and Benzeval, M., 2016. Untreated hypertension in the UK household population—
Who are missed by the general health checks?. Preventive medicine reports. 4.
pp.81-86.
Capewell, S., McCartney, M. and Holland, W., 2015. Invited debate: NHS Health Checks—a
naked emperor?. Journal of Public Health, 37(2), pp.187-192.
Kittel, M., 2019. NICE guidance on hypertension in adults: take blood pressure tablets at night,
measure blood pressure at home. Bmj, 367.
Scholes, S., Conolly, A. and Mindell, J.S., 2020. Income-based inequalities in hypertension and
in undiagnosed hypertension: analysis of health survey for England data. Journal
of Hypertension. 38(5). pp.912-924.
Nolan, K and et.al., 2018. NICE public health guidance update.
Harrison, C. E., 2017. Using telehealth in the management of hypertension. Nursing
Standard. 31(48).
Crilly, P., 2020. Managing hypertension: the role of diet and exercise. The Pharmaceutical
Journal. 304(7934).
Lay-Flurrie, S. L and et.al., 2020. Impact of changes to national hypertension guidelines on
hypertension management and outcomes in the United
Kingdom. Hypertension, 75(2), pp.356-364.
Trayner, I. and Taylor, L., 2017. NHS Western Isles-Involving Our Patients: Faster Access to
Treatment for Hypertension in Primary Care. International Journal of Integrated
Care. 17(5).
Leader, R and et.al., 2019. Hypertension− an update for the dental (sedation) team. Dental
Update. 46(6). pp.508-513.
Vrijens, B and et.al., 2017. Current situation of medication adherence in hypertension. Frontiers
in pharmacology, 8, p.100.
Hernández, R and et.al., 2016. Monitoring ocular hypertension, how much and how often? A
cost-effectiveness perspective. British journal of ophthalmology, 100(9), pp.1263-
1268.
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Gazzard, G and et.al., 2018. Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial. A
multicentre, randomised controlled trial: design and methodology. British Journal
of Ophthalmology, 102(5), pp.593-598.
Mollan, S. P. And et.al., 2019. The expanding burden of idiopathic intracranial
hypertension. Eye. 33(3). pp.478-485.
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APPENDIX
Current Care Plan
Complaints/
Symptoms
The complaints are mainly for the chest pain experienced
frequently. The symptoms include increased anxiety, dizziness and
chest pain.
Past medical history Patient has been known to suffer from hyperlipidaemia, acute
coronary syndrome, anxiety and depression.
Medication Aspirin, ARBs, CCBs
Interventions The patient is recommended rest and regular blood tests in order to
maintain the blood pressure levels.
Care Plan The patient follows a daily routine where the required medicinal
doses are given to them within the required time intervals.
3