The Science of Nursing Decision-Making: A COPD Case Study Analysis

This case study examines the nursing decision-making process in the care of Mr. Murphy, a 63-year-old patient with a long-standing history of COPD, complicated by an upper respiratory infection. The assignment utilizes the Engel (1977) Biopsychosocial Model to holistically assess Mr. Murphy's biological, psychological, and social needs. The analysis includes a review of his current care plan, which involves home oxygen and medication, and provides recommendations for improvements, such as encouraging smoking cessation, regular exercise, proper medication adherence, and addressing psychosocial needs like anxiety and social isolation. The study highlights the importance of person-centered care, risk assessment, and holistic approaches to enhance the patient's quality of life and health outcomes. The case study emphasizes the need for evidence-based interventions and palliative care, especially in advanced COPD cases, and stresses the significance of maintaining the patient's dignity and providing a supportive environment.

The Science of Nursing
Decision Making

Contents
INTRODUCTION...........................................................................................................................1
MAIN BODY..................................................................................................................................1
the Engel (1977) Biopsychosocial Model....................................................................................1
Identify a patient’s need (health problem) and assess it holistically from the biological,
psychological and social aspects.................................................................................................1
identify the recommendations that would be appropriate to introduce to the patient’s care plan
.....................................................................................................................................................3
CONCLUSION................................................................................................................................4
REFERENCES................................................................................................................................5

INTRODUCTION
Nursing decision making includes the conclusion about health status of patient and also they
are being involved in determination of needs so that health related wants and demands of patients
are being fulfilled. Present report will lay emphasis on patient Mr. Murphy. Mr Murphy is seen
by the intermediate care team at home complaining of worsening breathing difficulties over the
last few days. Patient has a history of COPD and is suffering from upper respiratory infection
from past two weeks. He has not consulted any health care professional so far. Patient is married
and he has 2 children. The report plan is about care plan which has been identified and given to
Mr. Murphy. Present report will lay focus on a patient’s need (health problem) and the report
will assess it holistically from the biological, psychological and social aspect.
MAIN BODY
the Engel (1977) Biopsychosocial Model
The Biopsychosocial model assists in understanding a person medical condition. This
model explains that there are various physical, social and biological factors that can affect an
individual health condition. All these factors needs to be taken into consideration when taking
care of patient. By analysing these factors health care professionals can have analysed the issues
which has been faced by service user. They can make use of adequate interventions by making
use of this biopsychosocial model. There are various emotional, behavioural and social factors
which can affect the health and well-being of an individual. This model must be used for
assessing the condition of patient. It will assist health care professional in enhancing health
outcome of patient.
Identify a patient’s need (health problem) and assess it holistically from the biological,
psychological and social aspects.
Mr. Murphy has a long-standing history of emphysema which is popularly known as COPD.
Patient has been involved in smoking cigars sometimes, even after suffering from the respiratory
disease. Mr. murphy weighs 76 kg. Patients mother was suffering from COPD which means he
has family history of COPD. Service user was consuming Glycopyronium/indacaterol inhaler, 1
puff daily. For this health care professionals needs to be involved in analysing patients’ needs so
that health and well-being of patient can be improved (Melin‐Johansson, Palmqvist and
Rönnberg, 2017). Proper and adequate care needs to be given to Mr. Murphy so that their health
outcome can be enhanced. The initial observation of patient was RR 36. It means that this
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respiratory rate is abnormal and really high. This clearly means that Mr. Murphy is suffering
from any type of respiratory disease. The heart rate of patient has been measured at 100, and the
blood pressure rate is measured at 100/64 mmHG. The heart rate is quiet normal and the blood
pressure rate is also normal. Patient has Cardiac rhythm: sinus tachycardia, Alert but anxious,
Pupils equal and reacting to light, Temp 37.5 C. There are various screening and test done for
patient. Patient has been transferred to acute trust and he has been admitted to respiratory ward.
By identifying the needs of patients there are various biological, psychological, and social needs
which must be identified by the health care professional. He had sputum sent for microscopy and
culture, blood taken for full blood count, urea and electrolytes. Patient now has on a venti-mask
2L (24%). This mask is used for Mr. Murphy so that there is no shortness of breath.
Biological needs: The biological needs of COPD patients is that they must be involved in
giving up the smoking as this can be the most important thing which can be done for Mr.
Murphy who are been suffering from COPD. Patient also must be involved in doing the regular
exercise so that health outcome of them can be improved. Mr. Murphy must be motivated to take
the medications properly and also on time (Nibbelink and Brewer, 2018). By this there well-
being and quality of life can be improved. Mr. Murphy also needs to be involved in taking their
medication right and correctly. All these needs of patient must be analysed by health care
professionals and their nurses so that better and adequate care can be given to Mr. Murphy. It has
also been evaluated that nurses also needs to motivate patient to avoid having alcohol and he
should also be engaged in consuming proper diet so that no such disease can be faced by them in
future.
Psychosocial needs: It has been analysed that psychosocial effect of living with such a
devastating disease can be really severe. In this patient can face several issues such as they can
be bounded with feeling of isolation and loneliness. In this Mr. Murphy can also face depression
and anxiety as he will be admitted in hospital and where patient can face social anxiety. This can
lower down health outcome of patient and also his self-esteem can be lowered. The psychosocial
needs which has to be analysed and evaluated by nurses is that they must be provided with
family support (Thabet and et.al., 2017). All the decisions which is been taken by health care
professionals must be taken by considering patient, they must discuss everything with patient so
that no issues are being faced by Mr. Murphy in future. In the psychosocial intervention health
care professional must needs to be involved in taking care of their personal and emotional well-
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being. Caring activities must be based on the alleviations of symptoms. This can assist them in
motivating patient to self-manage themselves. This will assist in enhancing the health outcome of
patient. It has also been analysed that appropriate care regarding the maintenance of psychosocial
needs to be done. In this there needs and quality of life maintenance must be done. especially in
advanced COPD with oxygen/ventilator aid, appears unrecognized, there should be proper
analysis by health care professionals in relation to it. If there is any kind of urgent need than
evidence based psychosocial intervention must be taken, so that health outcome of patient can be
enhanced (Standing, 2020). The psychosocial intervention should assess Mr. Murphy in
enhancing the functioning which is physically as well as psychologically. This must be the first
priority of health care professionals for the patients who are been suffering from COPD. Home
medical care support can be provided to patient as he was not visiting the hospital because of
which the disease started spreading. Health care professionals must make sure that holistic care
is been provided to patient so that they can be able to enhance Mr. Murphy health outcome
emotionally, spiritually and physically. This will assist them in enhancing well-being of patient.
Palliative care can also be given to patient. In this better and adequate interdisciplinary treatment
can also be provided. If there is lack of palliative care for COPD patients than their health
outcome can be lower down. For severe COPD patient advance care planning must be done.
Health care professionals must motivate patients to keep positive attitude so that wellbeing can
be improved.
Social aspects: In this Mr. Murphy’s must be provided with better and peaceful
environment. Nurses needs to make sure that the respect and dignity of patient is been
maintained by them. This will assist them in enhancing well-being of patient who is suffering
from severe COPD (Marques, 2019). It has also been evaluated that nurses must make sure that
adequate communication is been used by them so that they can identify social needs of patients.
This will assist them in enhancing health outcome of Mr. Murphy. No stress should be given to
patient in order to enhance their health and wellbeing.
identify the recommendations that would be appropriate to introduce to the patient’s care plan
It is being recommended to health care professionals that they must be involved in making
use of person centred care. This will assist them in easily identifying the needs and demands of
Mr. Murphy. Also they must be involved in assessing risk which can be faced by patient while
being admitted to acute care ward. Care at home can also be given to patient as he denies to visits
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hospital. It is also recommended to health care professionals that they must be engaged in
making use of holistic care approach so that quality of life can be enhanced (Oliver and et.al.,
2018).
CONCLUSION
From the above study it has been summarised that Mr. Murphy has been admitted Patient also
must be involved in doing the regular exercise so that health outcome of them can be improved.
Mr. Murphy must be motivated to take the medications properly and also on time. It has been
evaluated from the case study that patient mother was suffering from COPD. Mr. Murphy has
denied to get the care previously. His respiratory rate was really high. He was engaged in
smoking even after discovering such issues. It has also been analysed that holistic care has been
given to patient so that their well-being and quality of life can be enhanced. It has also been
analysed that health care professionals have also used evidence based interventions.
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REFERENCES
Books and Journals
Nibbelink, C.W. and Brewer, B.B., 2018. Decision‐making in nursing practice: An integrative
literature review. Journal of clinical nursing, 27(5-6), pp.917-928.
Thabet, M. and et.al., 2017. The effect of problem-based learning on nursing students’ decision
making skills and styles. Journal of Nursing Education and Practice, 7(6), pp.108-116.
Melin‐Johansson, C., Palmqvist, R. and Rönnberg, L., 2017. Clinical intuition in the nursing
process and decision‐making—A mixed‐studies review. Journal of clinical
nursing, 26(23-24), pp.3936-3949.
Marques, M.D.F.M., 2019. Decision making from the perspective of nursing students. Revista
brasileira de enfermagem, 72(4), pp.1102-1108.
Standing, M., 2020. Clinical Judgement and Decision Making in Nursing. Learning Matters.
Oliver, D.P. and et.al., 2018. Shared decision making in home hospice nursing visits: A
qualitative study. Journal of pain and symptom management, 55(3), pp.922-929.
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