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Person Centred Approaches 2 Supporting People with Complex NeedsAssignment- Assessment for and with People who have Complex NeedsYou must follow PCA2 summative guidance for completing the workbook.Section 1:Consent and confidentiality: (max 200 words)A nursing assessment took place at the Lodge after a manager and a keyworker raisedsome concerns about one of the patients who is unable to eat and drink properly. In thisassignment, a pseudonym will be given to hide the true identity of service user. The chosenpseudonym is Muno where she is a 26 years old woman, diagnosed with a condition calledcerebral palsy. According to Schmolke and Amering, (2017) [p.97.] it is identified that cerebralpalsy is alifelong condition that affects the movement and co-ordination of body and is causedby a problem with brain that occurs either before, during or soon after the birth. The symptoms ofcerebral palsy may include difficulty in swallowing, constipation, muscle spasms and many more(Butcher and Wagner, 2018).As per the scenario, a discussion took place in between health care professionals, patientsand her sister (Heller and Fisher, 2015). In the given video, consent has been received frompatient as well as her accompanying family members with the best of their interest. Also, thenurse is responsible to undertakeall roles and responsibilities that are needed to be performed toprovideeffectivecare to disabled people.Section 2:Assessment-> plan -> intervention -> evaluationAssessment based on Roper, Logan & Tierney’s Activities of Living Model (1980). (max1000 words)Activities of Living1
Identify and prioritise 4 activities of living in relation to the individual’s health need. The wordlimit for this section means that you do not need to discuss all the activities of living.Delete the activity headings that you have chosen not to discussIn this assignment, Roper, Logan & Tierney’s Activities of Living Model (1980) will be used to makean assessment on Muno. The four activities of living which are going to be used are communication,eating and drinking, sleeping and mobility.CommunicationCommunication is vital and through it, people share their thoughts and feelings in differentpersonal, formal and social situation(Holland et al 2008). Due to Muno`s complex needs, she isunable to communicate in words which means she is able to communicate nonverbally. According toRoyal College of Nursing, (2015) “non-verbal communicationwhich is usually done using bodylanguagethatsays a lot aboutgetting engaged with aninterestofcommunicating”.(Schmolke,Amering and Svettini, 2016. (pp. 97-111). During the assessment, manager and keyworker pointedout that Muno uses pictures, objects references and facial expressions as her means ofcommunication.According to NHS, (2015) people with complex needs require support in their everyday lives.People with complex needs require support of activities in their daily living; they might find itchallenging, exchanging and passing on information using pictures and body language to support theircommunication (MacArthur and Fletcher, 2015). However, there are many communication aids whichhelp but they do not express the individual`s emotions Kennedy and Brewer (2014). Communicationis difficult when individual has difficulty in expressing their choices and struggles to understand theinformation Regnard et al. (2003).Eating and DrinkingIn the nursing assessment, it was highlighted that the main cause of concern was that Muno isnot eating well; she is only eating small amount of food, coughing, not having appetite and as a result,she is losing weight. It is essential to maintain the body by eating a balanced diet. Brooker and Waugh(2013) highlighted that each person is recommended to have 1500mls of fluids per day, whereas,Muno is not drinking much which contributes to her constipation as it was mentioned in the meetingthat Muno is taking movicol.In the nursing assessment, it was mentioned by the key worker that Muno was given with2
medication in her food. However, the nurse highlighted that this is a bad practice as Muno should begiven with some of the medications; at least 30 minutes before (Heller and Hsieh, 2014). Carolinehighlighted that some of the medicines which delay swallowing process or increase salivation mightimpact on swallowing function. Theadom, Parmar and BIONIC Research Group, (2015) [pp.674-681]stated that it is important to have medication review among people with learning disabilitiesand theside effects might impact on their drinking, eating and nutritional habits that are needed to beconsidered carefully at the time of prescribing medication. It was together stated by the nurse in thegiven video that the patient Muno is fed by the staff who supports her to eat because she is morecomfortable in sitting onto a bean bag and faces difficultly in sitting to a moulded chair for eating.Risk of poor posture during mealtimePoor risk posture can become a risk for an individual while eating. This may can choke thefood and create serious issues for an individual. It can create swelling difficulties and choking are thekey areas of concern.SleepingIt was highlighted that Muno does not sleep much during the night; she tends to sleep moreduring the day.Roper et al stated that sleep allows the body to relax from all stresses of everydayactivitiesand also leads to the growth and repair of cells, during the sleepRoper et al. (1999, 2000)highlight that sleeping is vital for everyone and therefore,it is an important Activity of Living.Thekeyworkers suggested that Muno might not be sleeping well because of the muscle spasm. Therecould be some related issues that might be affecting Muno’s sleeping pattern such as feeling tired andnot eating well at meal times and also,it might be affecting her sleep pattern where she is also notcomfortable in her chair(Spear-Swerling, 2018).The nurse should consider helping Muno with theissue.It can be suggested that it could be another reason for Munofor not being able to sleep at nightwhere her bedding and pillows must be checked properly.The room temperature is very importantand it is ideal to haveitaround 20 Celsius degrees. If the room is too warm or too cold, adjustmentscan be considered.Also, a monitoring chart is required to record the temperature in her room.It willgive an evidence through monitoring chart in order to give a balanced assessment and referrals in thefuture (Grimshaw, McGowan and McNichol, 2017) [pp.1169-1180] It was also mentioned that Munois happy when left to rest lying down.MobilisingIt was pointed that Muno uses moulded wheelchairand they also use a hoist to transfer her3
they with other aids to help Muno with her needs(Schmolke, Amering and Svettini, 2016) (pp. 97-111)stresses that problems with mobility are highly associated with people having physicaldisabilities who have complex needs with an important need therapeutic positioning.Muno is relyingon others for the comfort and to ensure that the correct measures are taken to improveand maintainher posture.It was mentioned that Muno feels comfortable when lying in bed during the day. Therefore,Muno will now missing out the activities she enjoyed by lying in bed during the day. It wasmentioned that when eating her food, she sits on the bean bag, whereby her posture is complicated,and she will end up choking. Mencap (2016) pointed out that posture is about using right equipmentand positioning techniques. It was said that Muno does not like to be hoisted and she is not happysitting on her wheelchair (Mencap, 2016).Negative effect of poor postureThere are various risks associated with the poor posturesuch as it can impede the ability of thelungs to expand(Hartling, Milne and Newton, 2014). It has also become a risk factor for manyinjuries and create swelling difficulty.Section 3:Assessment–Diagnosis-plan -> intervention -> evaluationKey Health Need / Nursing Diagnosis: (100 words)One health need with rationaleRegular exercise is one of the health needs which is identified. It is because; Muno is notperforming any daily activitiesand she use to sleep in day time which lead to increase her healthissues.AetiologyThe causes of her disease are too much consumption of caffeine and avoiding daytimenaps.Muno has spastic cerebral palsy which affects all her four limbs. She is unable to standand she has a moulded wheelchair.CharacteristicsAccording to Pawlyn and Carnaby, (2009) sleeping problems are also generally more inpeople with learning disabilities. Not sleeping at night can negatively affect Muno in performing4
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