Analysis of Holistic Nursing Care for Mrs. Jones After a Stroke

This report provides a comprehensive analysis of the holistic nursing care provided to Mrs. Jones, an 81-year-old patient admitted to a medical ward following a stroke. The report maintains patient confidentiality through the use of a pseudonym and adheres to NMC guidelines. It examines Mrs. Jones' complex healthcare needs from biological, psychological, spiritual, and social perspectives, identifying the impact of the stroke on her well-being. The report scrutinizes the evidence behind the care delivered, exploring challenges nurses may encounter and strategies to overcome them, including communication techniques for patients with aphasia and the importance of family involvement. It highlights the significance of holistic care, including pain management, nutritional support, and psychological interventions. The report emphasizes the importance of patient empowerment, informed decision-making, and working collaboratively with other healthcare professionals, such as speech and language therapists, to optimize the patient's recovery and quality of life. The report concludes by underscoring the importance of ongoing psychological support and the need to address both the physical and emotional needs of the patient and her family.

Mrs. Jones complex healthcare needs after a stroke attack and nursing holistic care
This article will look at holistic nursing care needs for an identified patient who
admitted to a medical ward. In this project, confidentiality will be maintained throughout
with the use of pseudonym Mrs. Jones, this is to maintain the patient’s privacy, dignity, and
confidentiality in line with the NMC Code of conduct (Nursing and Midwifery Council
(NMC), 2015). NMC (2015) states clearly that nurses have a duty to protect their patients’
confidential information and use it for delivering care to them as well as the best interest to
them. This also has been highlighted by Price (2015) that information about patient’s health
status is shared quickly by the team and wider healthcare services, and it can be sensitive,
therefore nurses have obligation use it appropriately. Evidence from Cox (2015) suggests that
managing patients’ confidential health data inappropriately can result in negative reputation
in health care services. Therefore, healthcare professionals have a duty to protect their
patients’ information from being inappropriately intruded, mismanagement and misuse. This
paper will examine and critically analysis Mrs. Jones individual complex healthcare needs,
scrutinize and review some evidence behind the care delivered. Moreover, the aspects of how
the patient’s health breakdown affects her from biological, psychological, spiritual and social
perspective will be explored. Some challenges and barriers that nurses may encounter when
implementing care to the patient will be identified and explained how nursing staff can
overcome them to deliver holistic care to the patient, as well as how some guideline, health
policies, literature evidence encompass them. Finally, a conclusion will be presented.
Mrs. Jones aged 81 lives on her own in a shelter housing accommodation and her only
son lives twenty miles away however unable to see her regularly due to the nature of his
work, although they have a close relationship. She is a retired primary school teacher and
claims that she does not go to church. In her spare time, she enjoys reading and drawing and
they are the major hobbies. She is general unwell recently, has reduced appetite and weight
loss. She had a fall at home and admitted to a medical ward for investigation and possible
medical treatment. She did not have a fracture but have some bruise on her upper arms. Mrs.
Jones had a stroke whilst hospitalization, resulting in her left side paralysed and her speech
affected. She is right-handed and thus, still has the capacity to consent medical treatments.
She also possesses calibre to understand the medication. In addition to this, she does get the
medical discussions on her illness. However, it should be recognised that due to the illnesses
she is suffering from, it is hard for her to speak about her exact situation. Further, she can not
do her work appropriately on her own after getting paralysed. When approaching Mrs. Jones,
she appears tearing and she seems not engaging with healthcare staff when asking how she
feels. This is because of the reason of absence of connectivity between them which the nurses
should aim to develop. This may suggest that she exhibits social withdrawn. Also, as she has
to spend her days alone is making her emotional distress. It can be seen from the way of
avoiding going to churches. In addition to this, the weight loss and reduced appetite indicate
that she may have been suffering from Anorexia. This disease is further responsible for
creating emotional distress. Nurses have a duty of care to the highest standard, meet their

patients’ holistic needs (Allen, 2014), advocate and empower patients and help them
informed choices (NMC, 2015; Lansdell).
Stroke attack is a life-changing event and has an impact on survivors’ emotion as well
as their carers’ and families’(Stroke Association, 2013). The emotional impacts of stroke are
major , they can bring dramatic and unexpected changes to people's lives. As mentioned
above, she used to pass her time by drawing and painting, now that when she has stroke she
can not perform those activities effectively which make her feel good. However, it should be
noted that social effects resulting from stroke are greater than physical effect (Burton, 2000).
Stroke survivors often find that they have lost their identity unexpectedly and often feel
intense, frustrated, angry about their body image, losing the social role, being unable to carry
out some everyday activities(Hafsteinsdottir and Grypdonck, 1997; McCrum,1999 and
Burton, 2000). They would feel particularly distressing when they have lost their social role
for example not able to do some valued activities and do the things that they used to enjoy
doing and interested in. This could increase their sense of social isolation (Metchell and Keb,
2004). Anxiety and depression would grow over time (McCrum, 1999) and could last for a
long period of time (Young et al., 2003; Hare et al., 2006 and Broomfield et al., 2014). This
psychological problem has been evidenced to slow stroke functional recovery and
rehabilitation and reduce the quality of life (Nys et al. 2005 and West et al. 2010). Emotion
disorder can lead to changes in behaviours and these behaviours may indicate that the person
is not well.
Ayerbe et al. (2013) outlined that when patients are not willing to engage nursing
activities it can be a sign of depression post stroke; mood disorder have an impact on more
than 50% of stroke patients. Evidence suggests that depression and cognitive issues can
reduce their motivation of participation of rehabilitation, resulting in poor healthcare outcome
(Skidmore et al. 2010; Harrison et al. 2017). Moreover, as per the views of Salter et al. (2008)
and Satink et al. (2013) two qualitative research studies find that stroke survivors often feel a
sense of loss, socially isolated, uncertainty about their future, depending on others and
become a burden. People with depression and mood disorder can increase the risk of
developing cardiovascular disease and increase the risk of secondary stroke and mortality
(Katon, 2011). Depression has a significant impact on pain severity (Sahin-Qnat et al. 2016),
increase the risk of developing a pressure ulcer, and malnutrition (Perry and McLaren, 2004),
particularly in older patients. Clearly, Mrs. Jones may be experiencing these psychological
problems (Ostir et al., 2011). Indeed, psychological care should be a fundamental part of a
patient’s care plan. To provide holistic care, it involves healing the mind, body, and soul of a
person as a whole and the person’s emotional, spiritual, social and personal needs must be
addressed and met (Nina and Dariene, 2013). Nursing aspects include pain management,
pressure ulcer prevention, nutritional support, spiritual and social care should be included in
the nursing activities and meet the patient’s complex holistic needs and empower the patient
and help her informed choices and decision making (NMC, 2015; NICE, 2014; Lansdell,
2016). Also, as stated by Thomas et. al., (2015), the shortage of neurological cells after she
paralysed will change the body image and functions. This decrements will results to the

things which will take some time for her to be fluent with. For instance: Avoiding use of left
hand in any activity.
Evidence suggests that psychological support for Mrs. Jones is as essential as physical
rehabilitation (Welch, 2008; the Stroke Association, 2012). Moreover, the psychological care
is important for both the patent self and his or her family who will endeavour to manage the
impact of stroke on their lives during the hospital stay as well as in the longer term when
discharge from hospital (Gillham, 2011). It is, therefore, important for nurses to clarify with
the patient if it is appropriate to inform the family about the patient current health condition
and any changes. Mrs. Jones was explained and asked her if she would consent to inform her
son about her stroke and the current care (NMC, 2015). Mrs. Jones’ body language, facial
expression and holding the staff’s hand show that she agrees to the plan. She seems a bit
more cheerful after having spoken to her about informing her son her situation, although she
could not verbalize with her thoughts. Edvardsson (2010) argues that healthcare staff work
with patient’s family as a partnership and their involvement can be therapeutic as that can
help develop and maintain trust between the patient, family, and healthcare team.
Considering Mrs. Jones’ son is busy with his work, Mrs. Jones is kept informed that her son
would receive information from the healthcare team about her care and keeps her son update
any changes. Therefore, it would help her son to reduce the needs to contact the healthcare
team constantly for the information about the patient, treatment, and care (Edvardsson, 2010).
Mrs. Jones seems happy with the plan.
Holistic care for Mrs. Jones includes the aspects of respecting the patient has a vital
role in the care process, participating with nursing activities, encourage self-care and working
towards rehabilitation goal (Thompson et at. 2008). The patient’s engagement would give the
patient hope, increase one’s social interaction skills and confident, a sense of autonomy and
decision making. Healthcare Staff regularly attends to Mrs. Jones to provide nursing
intervention, checking if the patient is comfortable or may have other needs (Harris, et al,
2017). Skidmore et al. (2010) highlight that if a stroke patient can express how they feel, their
emotion, sadness, depress, anger to someone, it is an important part of the recovery process.
However, Mrs. Jones is unable to express her feeling verbally to the care staff. Code et. al.
(1999) outline that people with aphasia experiences unexpected inability to take part in a
complete range of activities and social leisure and depression is often displayed because of
negative emotional reactions. There are different strategies that nurses can use to the patients
who are language deficit (Cott, 2004). They can make use of pictures to graphically represent
the message. Further, they can make communication with the help of different interaction
sources such as written, symbols, etc. In order to simplify the way in which the patient can
reveal the feelings, nurses are required to attain their trust. This can be gained only after
ensuring an effective communication. They can also take a written questionnaire comprising
of indirect questions that can help in analysing the feelings of the patient. In turn, this kind of
nursing intervention would improve psychological problems she may have, as taking part in
the nursing activities can be recognised as a part of receiving 45 minutes of relevant therapy
for a minimum of 5 days a week recommended by NICE (2013). The nursing activities
include washing and dressing, self-feeding when eating and drinking using the unaffected
hand, continent care, and hygiene needs. Mrs. Jones is explained in detail about these

activities, a potential benefit she could gain from and encouraged to participate. At the same
time, it would be beneficial to Mrs. Jones to optimise her potential in terms of speech
function gain. Therefore she is referred to the speech and language therapist (SALT) team
(Kneebone, et al. 2010). Working in conjunction with SALT, it would help nurses carry out
some structured speech therapy guided by them when intervening Mrs. Jones regularly. With
the help of these therapies nurses can understand the issues of Mrs Jones and thus, an
effective plan can be developed for the intervention (Townend, et al. 2007).
On the other hand, Cott, (2004) explained that both psychological as well as
emotional pain of the patient should be addressed to render proper care. There exist some
psychological factors that helps in pain management (Alexander, et al. 2016 and Edvardsson,
2010). For instance: If a person is mentally stronger than he or she will have an ability to
cope up with the emotional and physical issues. If the patient will be motivated to relive soon
then the actions of him/her will also be in same direction (Tripp et al. 2006 and Hall et al.
2011). This, in turn, will help in fast relieving from the pain. In order to promote this, nurses
can In addition to this, nursing staff and healthcare practitioners are required to support those
activities which promote health. In addition to this, effective tactics of interacting with the
patients will help in influencing their behaviour towards the health and associated factors
(Naess et al., 2012; Klit, 2011). Further, as per the views of Brown, (1990) ; Fishbain, et al.
(1997) and Madhukar and Trivedi, (2004), psychological well being helps a person to deal
with the anxiety, depression and other mental illnesses that impacts on a person's
determination to cope up with the physical pain. These issues reduces the motivation level of
patients which is highly required to manage the emotional and thus physical pain. This
suggests that managing psychological well-being have benefit to reduce physical pain rather
than completely rely on a medical model, for example, using analgesic to relieve pain.
Spiritual care is also including the process of assessing, planning, implementing and
evaluation of care (Baldacchino, 2015). Mrs. Jones has been asked if she visited church
before admitted to the hospital and she confirmed that she is not a church person. It is not
practical to refer her to a chaplain in the hospital. However, it is recommended that nurses
can help meet patient’s spiritual need by taking an active role (Atart and Baldacchino, 2014).
Weitzel et al. (2011) argue that nurses present themselves to the patient is a unique way of
helping her or his spiritual needs particularly in her or his critical stage of illness (Department
of Health (DH), 2010). As the character is least interested in visiting churches thus, nurses are
advised to engage her in those activities which makes her happy. For instance: Mrs. Jones
likes reading, drawing, etc. (Iseminger et al. 2009; NMC, 2015) In this way, nurses are
suggested to bring some constructive written pieces for her to go through. In addition to this,
they can also bring some soothing pictures to draw. These things were help in accomplishing
the spiritual needs of Mrs. Jones which will help her in fast recovery (Downey and
Lloyd,2008).
It is evidenced that nurses are good at helping their patients with physical illness,
however, their attendance to patients’ psychological and spiritual needs has been questioned
by some researchers (Yang and Yeh, 2012). Further study research outlines that the nurses
recognise that they have inadequate skills and knowledge to deliver spiritual care to their

patients and need additional training to become competent in spiritual care (Ross et al. 2014),
although they consider that it is an important part of their nursing role (Baldacchino, 2015).
However, this could be argued. Delivering spiritual care does not mean that nurses must be
an expert in understanding each individual’s rituals and regions and facilitating participation
in patient’s religious rituals. Nursing care involves recognizing, respecting and meeting
patient’s needs, communicating and listening to them, being there with them, providing care
and supporting the recovery, showing empathy and helping them find new self and life
purpose when they are ill. These nursing activities have been well recognised as part of
spiritual care (Ross, 1997) and should be included in the patient’s individual care plan.
As the left side of the body is get paralysed and fortunately, Mrs. Jones is right-
handed person that is she can manage her work at her own. Also, she is able to use the
affected side and by using it she can engage herself in the productive activities that can help
her in felling emotionally, psychological strong (NMC, 2015). It is noticed that Mrs. Jones
used to enjoy reading and drawing and these activities were part of her hobbies. When asking
Mrs. Jones if she would like to do drawing whilst in the hospital she seems happy with the
arrangement (Yousefi and Abedi, 2011). Painting and drawing can be a way of expressing
oneself, in which ones’ emotions can be released and no longer hide inside. There is evidence
that suggests that stroke patients who have language deficit can self-help through drawing
and painting and it helps the person to articulate their feeling of anger, loneliness, increase
the desire of social contact, gaining social skills and reduce boredom (Carmi and Mashiah,
1996). She is right-handed and the stroke has not affected her dominant side. This suggests
that Mrs. Jones would still be able to carry out some drawing activities that she had been
doing at home, provided if she has good sitting balance. Reading and drawing require good
sitting balance. To support her sitting balance, it is beneficial that she has physiotherapy input
to help her regain balancing and Occupational therapy input to regain skills to perform these
tasks. Nurses would be working in conjunction with them to provide extended therapy
particularly during the out of business hours and the weekend (Lindley, 2011). This could
help Mrs. Jones maximise opportunities to take part in such activities. Reading and drawing
should be recognised as part of therapy and should be included in her care plan. There are
different activities that nurses can conduct such as drawing competition for the patients
suffering from prolonged diseases. It will not only help Mrs. Jones but also, all the patients
that have lost social activities can get benefits of it (NICE, 2008). Further, it will create an
effective healthy environment in the healthcare home that is effective for patients. On the
other hand, (Yousefi and Abedi, 2011) explained that involving family members in the
medical discussions of the patients is essential Thus, healthcare practitioners are required to
pay attention on this. They should involve her son the discussion. Also, as Mrs. Jones only
has her son thus, it can be understand that they will surely be sharing a strong bond which
will assist in making communication process with the patient easier.
In context to the physical pain that is being felt by Mrs. Jones, the paralysed portion
of the body is troubling her a lot in performing daily life activities. In addition to this, the
pain in the portion is creating muscle stiffness and shoulder problems and this can distress the
patient. (Langhorne et al. 2000 and Mclean, 2004). There are different tactics that the patient
can make use of to get relived from these issues. It is suggested to nurses to state about the

right positions in which To help Mrs. Jones manage her pain and reduce the stiffness a
regular repositioning intervention and some daily activities are recommended, for example, to
encourage the patient to use the unaffected hand to wash self as much as possible with
assistance from healthcare staff. Evidence finds there is a positive outcome in terms of
lessening psychological as well as physical pain by encouraging the patient to take part in
some nursing care activities and learn self-management (Walsh, 2001). At the same time
when doing these tasks, the staff has opportunities to engage with the patient, recognise
patient has empowered their care and the patient often feel included, valued and respected as
an individual (Richard and Tabatha, 2010). Whilst asking Mrs. Jones if she could roll onto
one side, she is asked if she is in any pain or any other sources of discomfort on movement.
She is asked to raise her hand if she had. Encourage the patient to use body language to
communicate with healthcare staff can benefit patient’s psycho well-being and learn to regain
thinking and reasoning skills.
Nurses are aware of that when stroke patients with communication difficulties are not
able to self-report their pain to their healthcare provider. Unable to express their pain to
caregivers can lead to their pain not being adequately assessed and recorded, resulting in
them receiving inadequate analgesia or untreated. However, Mrs. Jones can use her
unaffected hand to point to a number on pain assessment scale which could help nurses to
identify per pain therefore to find therapy to help with her pain relief, particularly providing
repositioning, relaxation therapy for instance music as an effective pain management rather
than predominantly rely on analgesic. Staffs also make eye contact with Mrs. Jones when
communicating and showing her a numeric scale of pain assessment (British Pain Society and
British Geriatrics Society, 2007). Mrs. Jones is asked to point to a number to indicate her
pain. Madenski (2014) asserts that patients experience undertreated and unmanaged pain
could have an impact on patient’s recovery and prolong hospital stay. Therefore, to recognise
and assess patient’s pain appropriately is a crucial component in effective pain management.
To reassure that Mrs. Jones articulate her pain intensity and manage it effectively, another
method is also used to ask Mrs. Jones about her pain experience: none, mild, moderate or
severe (British Pain Society and British Geriatrics Society, 2007). This also benefits Mrs.
Jones’ thinking and reasoning skills as this scale help Mrs. Jones to understand her pain
experience and translate it into words meaningfully.
Using some equipment such as cushion, pillows to support the affected limbs and
support her body posture, it could help relieve pain and make the patient feel more
comfortable. It would help sitting balance as well as reduce the risk of developing pressure
score. This caring relationship can develop when nurses interact with the patient and it could
promote healing (Watson, 2005). Verbal and non-verbal communication is important during
the nursing intervention and has found therapeutic in a way patient often feel being an equal
partner of their healthcare clinician and it helps patient’s recovery (McCabe and Timmins,
2013 and Wright, 2012). The patient’s engagement may help them counteracting boredom,
build and gain socializing skills and increase confident therefore positive rehabilitation
outcome. All people have a spiritual dimension in their life whether they profess a religion or
not and spirituality emphases on what gives meaning to the person’s life. Brain impairment
does not end a person’s spiritual life (Kirby et al. 2004). Few sources suggest that spirituality

is an important resource in maintaining psychological well-being in older adults and full-
filling their spiritual needs has been highlighted as a sign for the individuals in term of life
satisfaction, suggesting spirituality has a positive effect with psychological functioning in
them (Kirby et al. 2004; Cowlishaw et al. 2013). To assist Mrs. Jones to understand her
disease and the disease process and help her develop disease -management and self-
management skills. She is provided with information about the importance of nutrition intake
which helps body function and recovery. Good nutrition support can reduce the risk of
developing a pressure ulcer. Legs exercise, participating activities of daily living including
washing and dressing, toileting, transferring, balance maintaining can be recognised as part of
her daily activities. There are some therapeutic strategies tailored for Mrs. Jones, which could
potentially help her find new life purpose, accept new self.
A Recent study by Liu et al. (2016) finds that inpatient wearing own clothes is
therapeutic and help recovery as their own clothes give them a sense of unique identity,
comfortability, good appearance and psychological satisfaction. To ensure Mrs Jones’ dignity
and respect are maintained and she is treated as an individual (NMC, 2015), she is explained
about the benefit that she could have by wearing own clothes for example overall sense of
well-being, self-esteem (Wilson, 2006) and there is no problem to assist her dressing and
undressing. Moreover, dressing and undressing can be good activities for Mrs. Jones to
practice using the unaffected arm and help stimulate the weak limb, and promote thinking
and coordinating skills. Clearly, this can be considered as part of occupational therapy.
Dressing and undressing involve full body movement, the movement self can help pressure
relief and to reduce the risk of developing a pressure ulcer. Clearly, nursing interaction
including washing and dressing, maintaining personal hygiene, assisting to eating and
drinking, encouraging patients to use and exercise the affected limbs, helping patients regain
balance, can create a therapeutic patient-nurse relationship and could potentially meet
patients’ social, psychological and spiritual needs (Narayanasamy and Owens, 2001 and
Yousefi, and Abedi, 2011). There are various benefits that Mrs. Jones is allowed to take with
the help of suggested intervention. Firstly, the communication method suggested will assist
her in revealing her exact situation to the health practitioner. In addition to this, involvement
of patient and family members will assist in developing a strong communication bond that
will further help nursing staff to achieve the trust and loyalty of them.
In summary, this article has looked at the various requirements in effective healthcare.
The above report is based on a case to understand the deep in-sights of all the necessities.
There are certain code and ethical standards which are needed to be abide whilst performing
medication. In the present report, a case of stroke has been analysed focusing on the impacts
of the issue, healthcare needs, intervention methods, etc. From the present report, it can be
concluded that person-centred care plays a crucial role in the complex healthcare situations.
Thus, administrative bodies should pay attention on the particular needs and demands of
patients. Despite of the physical pain, people also does suffer with the emotional and
psychological factors. Hence, it is the foremost duty of healthcare practitioners to develop
effective tactics that can assist in healing the pain. In addition to this, nursing staff should

implement all the laws and regulations associated with the healthcare services in the hospital.
This report further focus on the parameters that healthcare practitioners should consider
before developing a plan for the suffered person.