Nursing Care Plan: Incontinence Treatment for a Patient with Dementia

This nursing assignment focuses on developing a comprehensive care plan for a patient experiencing urine incontinence, complicated by comorbid conditions including Alzheimer's disease. The report outlines the application of the ASPIRE framework and the Roper Logan and Tierney (RLT) model to assess the patient's needs, develop systematic nursing diagnoses, and formulate SMART goals for treatment. The body of the report details a holistic care regimen, emphasizing the nurse's role in promoting good health behaviors and the use of electronic health information systems for efficient record-keeping. The assignment also highlights the use of the SBAR tool for effective communication, particularly with patients experiencing cognitive impairments, and the implementation of interventions such as pelvic floor muscle exercises (PFMEs) and bladder training. Ethical and legal considerations, such as patient confidentiality and informed consent, are also discussed. The evaluation phase involves continuous rechecking and analysis of the effectiveness of the implemented care plan, emphasizing the importance of patient participation and the integration of evidence-based practices to achieve the best possible outcomes.

Running head: NURSING
Nursing
Name of the student
University name
Author’s note

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Table of Contents
Introduction................................................................................................................... 2
Body:.............................................................................................................................2
Assessment.................................................................................................................. 2
Holistic care regimen........................................................................................................2
RLT model used for assessment of patient health...........................................................3
Systematic nursing diagnosis.......................................................................................4
Planning........................................................................................................................5
Planning of SMART goals................................................................................................5
Implementation............................................................................................................. 7
Recheck and evaluation................................................................................................8
Conclusion.................................................................................................................... 8
References................................................................................................................... 9

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Introduction
The current assignment focuses on the aspect of nursing for continuous care and
management of the daily life activities of individuals. The assignment aims at designing
a care plan for the urine incontinence treatment of a patient suffering from co-
morbid conditions. The patient here had been suffering from Alzheimer’s which though
has been in control. However, recently the patient had been suffering from a severe
urine infection and had been admitted to the hospital with complaints or urine
continence. Thus, the nurse working in the incontinence management team or the
multidisciplinary hospital team looking after the overall health of the patient needs to
work together in order to provide the patient with long term care goal. The current
assignment uses the ASPIRE framework along with the Roper Logan and Tienary
model (RLT) for the planning of the care. The ASPIRE model had been broken down
into a number of components for the evaluation of the health issues suffered by the
patient such as –Assessment, systematic nursing diagnosis, planning and
implementation.
Body:
Assessment
Holistic care regimen
The nurses catering to the diverse clinical needs of the patients admitted in the
hospitals play a crucial role in motivating good health behaviour and change within the
target patient group. As commented by Sirls et al. (2013, p.205), the role of the nurses
is to design effective and holistic treatment care plans for the care support users. This
could be ensured by the implementation of self-management programs within the
hospital setup. As commented by Visser et al. (2015, p.213), educating the patient
about their present health concerns ant and the effective self-managerial strategies can
help in providing more autonomy to the support service users. Additionally,
implementing linguistically and culturally sensitive practices within the hospital set up
can helps in reducing the communication gaps. The nurse could use electronic health

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information systems for maintaining the patient records. The reports and the data
generated can help in easy access to the vital information about the patient’s health
condition.
RLT model used for assessment of patient health
In this context, the nurse could use the Ropert Logan and Tienary model in
looking after the care needs of the patients admitted to the hospital. The model was
developed in the 1980’s and has been accepted as the standard model of care
assessment in UK based hospitals. The model stresses upon the societal needs of the
patients and the importance as well as the impact of the daily set of activities upon the
life of patients. The various components of the model help in evaluating the effect an
illness may have on the daily life activities of an individual. As mentioned by Nelsonand
Carey (2016, p.20), the RLT model inculcated as a necessary checklist within the
hospital assessment parameters helps in the evaluation of the physical and the mental
stability of an individual.
Figure1: RLT model

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(Source: Heidenreich et al. 2012, p.125)
Systematic nursing diagnosis
The nurses are liable to access the current health problems and situations of the
patients from a closed end. Therefore, reporting and collection of authentic data records
become a pre-requisite. As commented by Williams (2015, p.25), one of the sole
features of the data collection process is the identification of the problems encountered
by the Patient and maintain a clear record of all these data. However as mentioned by
Tastan et al. (2014, p.1161), a number of potential barriers and challenges are faced by
the nurse in looking after diverse care needs of the support users. In this context, one of
the problems encountered by the nurse in looking after the patient was a gap in
communication. The patient here was an 85-year-old woman suffering from dementia.
Therefore she would often miss communicating the important details to the nurse or
other health care professionals looking after her. The patient here named Julie had
been a long term survivor of dementia and had been living with her husband. However,
lately, she was admitted to the hospital with urine incontinence. Therefore, the patients
need to be put under proper hygiene and cleanliness maintenance along with
conducting a number of important tests of the patient such as ultrasonography and CT
scan of the kidneys and the bladder.
In this context, proper record keeping needs to be done such as the amount of
liquid intake by the patient along with the amount and the frequency of urination. As
mentioned by Liu et al.(2014, p.17), detailed record keeping might help in prioritising as
well as looking after the patient needs. The SBAR tool of communication was used by
the nurse to facilitate the exchange of information as well as promote easy and effective
communication between the nurse and the support service users. The SBAR model
could be used for effective data collection and recording of the health details of patients
with communication gaps. The lack of communication could be attributed to languages
barriers along with cognitive impairment and lack of decision-making skills in the
support service user(Faller et al. 2013, p.783). In this context, Julie was an 85-year-old
lady suffering from dementia. Therefore, the SBAR tool used by the nurse could help in
accessing and preserving the vital health details of the patient. The SBAR tool is based

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upon analysis of the situation, assessment of the background along with the
provision of suitable recommendation for addressing the problem situation of the
patient.
Planning
A number of care plans and strategies could be implemented by the practising
nurse for looking after the condition of urine incontinence of the patient. As mentioned
by Ghitza (2015, p.25), one of the effective practices which could be conducted over
here is maintaining a record book. Additionally, monitoring the intake of fluids along with
maintaining appropriate hydration regimen serves as well tested evidence based
measure in looking after the care needs of patients with urine incontinence.
In this context, some of the care goals could be implemented for looking after the
concerns of support users like Julie. The long terms care goals which could be
exercised over here includes implementation of Pelvic floor muscle exercises (PFMEs).
This would help the patient in retaining as well as controlling the frequent need to
urinate. The results after the implementation of the process could be evaluated with the
help of recording the voiding and the hydration details of the patient. Additionally,
provision of toilet assistance and bladder training could be useful interventions(Ghitza,
2014, p.15).
Planning of SMART goals
Objective
To implement pelvic floor muscle exercises as a part of the care planning
Specific  To identify the extent of the infection
 To evaluate the co-morbid conditions of the patient
Measurable  To use the SBAR tool to analyse the problem
situation of the patient
 To evaluate the patient response to recovery through

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Roper Logan Tienary (RLT) model
Achievable  Implementation of light exercises such as PFMEs for
the patients with urine incontinence
 To maintain a log book recording the daily health
performance of the patient
Realistic  Diagnosing the patient condition through internal
organ scanning
 Report to the multidisciplinary team regarding
further surgical measures
Time –bound  Implementing the PFMEs for a repetitive period of six
months
 Evaluation of the effect through regular follow-up
Table: SMART tool
(Source: Author)
Both the nurse and the patient play a pivotal role in the planning and
implementation of the SMART goals and objectives. The nurses can design the care
plan using the SBAR tool which would help them analyse the detailed problem situation
of the patient. As mentioned by Prodonovich et al. (2014, p.177), tailoring the care plan
as per the requirements of the patients helps in addressing the diverse and the complex
health requirements of the patients. The patients need to participate as well as show
sufficient zeal in the evidence based program. This could be ascertained by providing
the patients with transparent and communicative information.

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Implementation
The nurse needs to consider the patient preferences in planning and designing of
effective care interventions and policies. As mentioned by Katigbak et al. (2015, p.25),
the involvement of the patient in the designing of the treatment plan provides more
autonomy to the patients. Additionally, tools such as SBAR and RLT used by the nurse
could help in narrowing down to the problem statement faced by the patient. The RLT
assessment tool can be used by the nurse in accessing the daily activities of the patient
and the impact of the same on the life of the patient (Dundar et al.2014, p.314). The
RLT tool helps in analysing the basic set of activities undertaken by the patient daily and
the impact of the same on the health conditions of the patient. One of the prerequisites
of the RLT model is to maintain a safe and clean environment for the patient ( Parwaiz,
2016, p.189). The same could aid in the recovery and healing of the patient. Similarly,
some of the parameters such as the mobility, measuring the normal respiration rate of
the patient along with sleeping pattern can give an idea about the overall health
condition of the patient. Additionally, implementation of exercises such as the Pelvic
floor muscle exercises can help in controlling the urine incontinence rates in the patient.
In this context, the nurse looking after the UI patient could also use her contact
base resources where she is well connected with other health care professionals. As
commented by Joffe et al. (2013, p.500), sharing of information across relevant
expertise channels can help in the speedy attainment of the care and support services.
Therefore, the nurse needs to keep a tab of the reports collected from the patient and
discuss it over with the professional health experts or Urologists to design an effective
care plan for patients such as Julie. However, a number of ethical and legal issues
could be faced by the nurse in looking after the care needs of support users like Julie.
The ethical issues may be faced with respect to the resistance offered in the
implementation of effective exercises for relieving the aggrieved condition of the patient.
As mentioned by De Meester et al.(2013, p.1193), the resistance could be offered due
to lack of sufficient knowledge in the support users regarding the effectiveness of the
implemented strategies. Additionally, lack of cognitive judgment and undertaking in the
patient attributed to dementia could also be mentioned as a limiting factor over here.

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Additionally, failure in confidentiality of vital patient records as per the Data Protection
Act, 1998 can call for legal action.
Recheck and evaluation
The nurse needs to constantly recheck the measures to evaluate the effectivity of
the implemented goals. In the context of Julie, the nurse would conduct the RLT
evaluation daily and compare the data over a week to analyse the improvement in the
health of the patient. The evaluation becomes the last part of the ASPIRE framework
after assessment, systematic diagnosis, planning and implementation. It is the final
stage of the entire process where both the nurse and the patients could measure the
success of the implementation of a plan. As commented by Dundar et al (2014, p.15),
evaluation is the last and the most decisive stage of patient care.
Conclusion
The assignment focuses on the importance of the implementation of a suitable
framework for looking after admitted to the care concerns of the patient admitted to the
hospital. In this context, the patient had been admitted to the hospital with issues related
to urine incontinence. Additionally, the patient had been seen to possess co-morbid
conditions such as dementia. Therefore, the presence of dementia made the process of
assessment difficult for the nurse. In this respect, the RLT model had been used by the
nurse in order to measure the improvement in health. The implementation of the model
also helps the nurse in planning long term care goals. The assignment also focuses on
the importance of the SBAR tool for designing of effective communication strategies for
analysing the loopholes and the drawbacks suffered by the patient in the care and
treatment. In this respect, a SMART tool had been designed in order to implement
effective exercises and supportive framework for looking after the care needs as well as
providing more autonomy to the support users.

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