NRSG366: ISBAR Components in Community Nursing Practice Analysis

This report examines the application of the ISBAR (Introduction, Situation, Background, Assessment, Recommendation) framework within the context of community nursing practice, focusing on two case scenarios. The analysis emphasizes the Situation and Assessment components of ISBAR, incorporating the clinical reasoning cycle to evaluate patient conditions and guide nursing interventions. The report details the assessment of Mrs. Zoya Solarian, a patient with Type II diabetes and hypertension, and Mr. Anh Duong, a patient with renal failure, highlighting the community nurse's roles in patient education, intervention, and empowerment. It also discusses the importance of cultural diversity and effective communication in patient interactions. The report includes recommendations for managing the patients' conditions and emphasizes the importance of understanding medication pharmacology and potential risks. The document aims to provide a comprehensive understanding of community nursing practice, patient assessment, and the application of ISBAR framework for effective healthcare delivery.

Running head: ISBAR COMPONENTS IN COMMUNITY NURSING PRACTICE 1
The Use of ISBAR Components in the Analysis of Patient Condition in Community Nursing
Student’s Name
Institutional Affiliations
Date

ISBAR COMPONENTS IN COMMUNITY NURSING PRACTICE 2
The Use of ISBAR Components in the Analysis of Patient Condition in Community Nursing
Case Scenario 1
Assessment
The assessment process is important in the promotion of patient safety and recovery
from the condition. The assessment of the conditions affecting Mrs. Zoya Solarian needs to
be assessed using the clinical reasoning cycle to improve the understanding of the medical
conditions observed in the case scenario. For effective assessment of the conditions affecting
Mrs. Zoya Solarian, it is important to apply critical thinking to improve patient safety during
diagnosis and therapeutic procedures. Clinical reasoning cycle pertains various activities
intended to improve patient assessment and provision of quality nursing services (Machan,
Hrynchak & Irving, 2012). Critical thinking is also important in the determination of the
effective diagnostic and therapeutic modalities for the management of Mrs. Zoya Solarian
conditions.
The ulcer on the left leg is due to severity of the type II diabetes mellitus. People with
this type of people normally have a chronic ulcer on their legs or feet. The weekly dressing of
the ulcer is meant to promote the healing of the wound. The type II diabetes reduces the
ability of the cells to proliferate and recuperate, therefore, affecting the wound healing
mechanism (Machan, Hrynchak & Irving, 2012). The assessment of the risks related to the
ulcer on her foot is an important aspect in this case scenario. One of the risk factor is living
on the third floor. If she has to work through the stairs, the wound may not heal faster
because of the pressure exerted during the extensive exercise. Another risk factor is
associated with the cataracts on her eye. Cataracts affect her vision, therefore, it may cause
serious accidents like falling down from the building. It is important to advise her to move to
ground floor to avoid such risks. It was important for me to visit this patient to assess the

ISBAR COMPONENTS IN COMMUNITY NURSING PRACTICE 3
conditions that affect old people in the community. Before I visited her, I practiced on
effective communication skills to improve my interaction with the patient. Cultural diversity
is another consideration to be assessed before visiting the patient in her house.
Recommendations
ISBAR components are important in the analysis of the efficacy of healthcare services
offered to patients (De Meester, Verspuy, Monsieurs & Van Bogaert, 2013). Effective
assessment of the conditions affecting Mrs. Zoya Solarian is important for making
appropriate recommendations that can help in the treatment and management of the medical
condition. The appropriate recommendation for the treatment of hypertension is the use of
Angiotensin-converting enzyme inhibitors and calcium channel blockers (Freitag & Carroll,
2011). These two medication are important in regulating the levels of calcium in the blood
because calcium increases heart contraction. In this case, the ACE inhibitors and may be used
with a potent diuretic agent like furosemide to increase the rate of blood flow and reduce
resistance on the walls of the vessels. Another recommendation for the high blood pressure is
the use of non-pharmacological approaches. In this case, the patient is advised to make
lifestyle changes. Physical exercise ensures that the body weight of the patient is normal
because overweight leads to obesity, therefore, causing hypertension. Physical exercise is
also recommended for the management of Type II diabetes before the condition worsens
because obesity leads to both hypertension and Diabetes mellitus.
Nutritional planning is also an important recommendation for this case because
cataracts on the right eye resulted from accumulation of galactose in the retina, therefore,
taking food with limited amounts of galactose/lactose reduces the severity of type II diabetes.
The management of this type of diabetes leads to the treatment of cataracts (ACCORD Study
Group 2010). The only recommendation for managing the ulcer on the left leg to adhere with

ISBAR COMPONENTS IN COMMUNITY NURSING PRACTICE 4
the prescribed medication because type II diabetes mellitus lead to development of a chronic
diabetic foot ulcers. Maggot debridement therapy may also be used in the treatment of the
ulcer on the leg (Diabetes Association, 2015). May have been contributed by the worsening
of the conditions and failure of the current medications.
Roles of a Community Nurse
The roles of the community nurse are to promote the recovery of the patients in which
he/she is attending (Allen et al., 2011). As a Registered nurse, I am supposed to attend to
patients in their localities to improve patient satisfaction. The practices undertaken by a
community nurse should ensure that the needs of the patients are taken into consideration.
The first role of the community nurse is to provide education to the patient o the appropriate
nutrition to help reduce type II diabetes, hyperlipidaemia, and hypertension as observed in
Mrs. Zoya Solarian. Another role to be played by the community nurse is to provide
appropriate nursing interventions that can be used to treat the conditions affecting Mrs. Zoya
Solarian affectively. Empowerment of the patient is another role to be played by the
community nurse. Empowerment of the patients involves the provision of mutual support in
critical practices like decision-making processes. Lastly, the community nurse is accountable
in assessing the efficacy of the medications by the patient in the treatment of current
conditions.
Case Scenario 2
Situation/ Current Issue
Mr. Anh Duong is a retired science teacher. He is now a 74 years old man living with
his family. He presents with various medical conditions. The situation to be analysed in this
case scenario is the current issue presented by Mr. Anh Duong, that is, reddened area around

ISBAR COMPONENTS IN COMMUNITY NURSING PRACTICE 5
the site of catheter insertion. Catheter is one of the invasive medical devices inserted into the
bodies of patients with different complication (Sobngwi et al., 2012). In this case scenario,
the catheter inserted to Mr. Anh Duong was to manage his condition of renal failure.
However, the reddening on the site of catheter insertion is a sign of infection. The catheter
may have introduced or attracted bacterial agents. The microbes on the site of insertion cause
acute inflammation that is characterized by reddening. The reddening is also caused by sepsis
since the cells around the site undergo inflammation, therefore, leading to cell necrosis.
Appropriate antibiotics should be provided to Mr. Anh Duong to prevent severe sepsis and
reddening in the site of insertion because the catheter may attract bacterial agents.
It is important to visit this patient in his homestead to improve health recovery and
assess the efficacy of the medication used in the treatment of the conditions. Another reason
for visiting the patient is to analyse the relation between the identified conditions with the age
of an individual. As a community nurse, I should interact freely with patients to improve my
professional competence and self-confidence. Lastly, I visited him to familiarize with the
issues facing old people in the society and improve patient outcomes in healthcare provision.
Assessment
It is important to assess the conditions and medications used in the treatment of these
medical condition to ensure effective patient care and recovery (James et al., 2014). The
assessment of the condition and promotion of patient recovery should involves a good
understanding of the pharmacology of the drugs, that is, the mechanism of action and their
adverse effects. The risk that may affects be affecting the current issue observed in the patient
may have resulted from the adverse effects of the medication. The assessment of the risks
requires good understanding of the current issue in relation to the pharmacology of the drugs
(Mohamed, 2014). The adverse effects of calcitriol are also important in the evaluation of the

ISBAR COMPONENTS IN COMMUNITY NURSING PRACTICE 6
correct dose for administration. The medication is taken orally and metabolized in the liver
before being excreted in the kidney through urine. Calcitriol may lead to the imbalance of the
electrolyte levels in the blood, therefore, causing serious adverse effects to the patient
(Kesten, 2011).
The assessment of the reddening on the site of catheter insertion is important in
determining an appropriate nursing intervention for treating and managing the condition. The
insertion of catheter helps in management of peritoneal dialysis (Wanner et al., 2016). The
catheter may introduce microbes to site of insertion, therefore causing inflammation which is
typified by reddening. The reddening on the site of catheter insertion should be analysed to
identify the possible cause of the condition (Sobngwi et al., 2012). It is important to assess
the current issue of the reddening on the area of catheter insertion because it affects the health
status of the patient. The risks associated with the catheter is the introduction of bacterial
agents into the site of insertion, therefore, causing inflammation. The risk occurs when the
catheter is not sterile. Unsterile medical invasive devices are dangerous because they can
cause serious infections to patients. As a community nurse, I am supposed to assess some of
the risk that may arise from the active participation of Mr. Anh Duong in community and
religious activities.
The planning for a visit involves the identification of the cultural diversity that may
exist between the community nurse and Mr. Anh Duong. Good communication skills should
also practice ensuring effective interaction with the patient (Philibin et al., 2010). I will also
arrange for a pre-visit to interact with the people and familiarize with their values. This is
important in creating a rapport. I will consider the epidemiological factors and prevalence of
the diseases that might be affecting the people in that locality. During the interaction, I will
also familiarize with the nature of the patient and his communication skills. Consider using a

ISBAR COMPONENTS IN COMMUNITY NURSING PRACTICE 7
formal language because the patient is a retired science teacher.
Roles of the Community Nurse
The main role of the community nurse in this case scenario is to compare the
efficacies of the various medications used by Mr. Anh Duong because most of them treat
similar conditions. Another role is to provide education that can help to manage the reddened
area around the site where the catheter was inserted during the control of peritoneal dialysis.
The community nurse should also advice the family member on the appropriate strategies and
nursing interventions to be used in promoting the recovery of Mr. Anh Duong from the
conditions affecting him. The community nurse is also accountable for protecting the rights
of the patient, for example, Mr. Anh Duong should be allowed his right to engage in religious
and other social activities because it promotes his recovery and positive living in the
community.

ISBAR COMPONENTS IN COMMUNITY NURSING PRACTICE 8
References
For Case Scenario 1
ACCORD Study Group. (2010). Effects of intensive blood-pressure control in type 2 diabetes
mellitus. New England Journal of Medicine, 362(17), 1575-1585.
Allen, J. K., Dennison-Himmelfarb, C. R., Szanton, S. L., Bone, L., Hill, M. N., Levine, D.
M., ... & Curtis, C. (2011). Community Outreach and Cardiovascular Health
(COACH) Trial: a randomized, controlled trial of nurse practitioner/community health
worker cardiovascular disease risk reduction in urban community health
centers. Circulation: Cardiovascular Quality and Outcomes, 4(6), 595-602.
American Diabetes Association. (2015). Standards of medical care in diabetes—2015
abridged for primary care providers. Clinical diabetes: a publication of the American
Diabetes Association, 33(2), 97.
De Meester, K., Verspuy, M., Monsieurs, K. G., & Van Bogaert, P. (2013). SBAR improves
nurse–physician communication and reduces unexpected death: A pre and post
intervention study. Resuscitation, 84(9), 1192-1196.
Machan, C. M., Hrynchak, P. K., & Irving, E. L. (2012). Age-related cataract is associated
with type 2 diabetes and statin use. Optometry and vision science, 89(8), 1165-1171.
Freitag, M., & Carroll, V. S. (2011). Handoff communication: using failure modes and effects
analysis to improve the transition in the care process. Quality Management in
Healthcare, 20(2), 103-109.
For Case Scenario 2

ISBAR COMPONENTS IN COMMUNITY NURSING PRACTICE 9
James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler,
J., & Smith, S. C. (2014). 2014 evidence-based guideline for the management of high
blood pressure in adults: a report from the panel members appointed to the Eighth
Joint National Committee (JNC 8). Jama, 311(5), 507-520.
Kesten, K. S. (2011). Role-play using SBAR technique to improve observed communication
skills in senior nursing students. Journal of Nursing Education, 50(2), 79-87.
Mohamed, S. (2014). Functional foods against metabolic syndrome (obesity, diabetes,
hypertension, and dyslipidemia) and cardiovascular disease. Trends in Food Science
& Technology, 35(2), 114-128.
Philibin, C. A. N., Griffiths, C., Byrne, G., Horan, P., Brady, A. M., & Begley, C. (2010).
The role of the public health nurse in a changing society. Journal of Advanced
Nursing, 66(4), 743-752.
Sobngwi, E., Ndour-Mbaye, M., Boateng, K. A., Ramaiya, K. L., Njenga, E. W., Diop, S.
N., ... & Ohwovoriole, A. E. (2012). Type 2 diabetes control and complications in
specialized diabetes care centers of six sub-Saharan African countries: the Diabcare
Africa study. Diabetes research and clinical practice, 95(1), 30-36.
Wanner, C., Inzucchi, S. E., Lachin, J. M., Fitchett, D., von Eynatten, M., Mattheus, M., &
Zinman, B. (2016). Empagliflozin and progression of kidney disease in type 2
diabetes. New England Journal of Medicine, 375(4), 323-334.