University Nursing Case Study: Patient Care and Fall Prevention

This nursing case study examines the care of a 75-year-old patient, Mr. Taylor, who experienced multiple falls leading to injuries, including a fractured hand and subsequent diagnosis of anemia. The case explores the application of evidence-based approaches, patient-centered care, and the use of multidisciplinary teams, including the involvement of a GP and a physiotherapist. The patient's medical history includes hypertension, diabetes, and allergic arthritis, all managed with medications. The study reflects on the GP's initial approach to the falls, highlighting the need for early evidence-based assessments. The Gibbs reflective framework is applied to evaluate the care process, emphasizing the importance of patient education, particularly in fall prevention and the management of multiple health conditions. The analysis concludes with an action plan focusing on improving therapeutic skills, incorporating evidence-based practices, and enhancing patient-centered care to optimize patient outcomes and quality of life. The case highlights the importance of a comprehensive approach to patient care, including the use of the Nightingale philosophy, patient involvement in care decisions, and the need for continuous improvement in healthcare practices.

Running head: NURSING CASE STUDY 1
Nursing Case Study
Student’s Name
University

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Nursing Case Study
Nursing care is established on improving patient outcomes through the application of
evidence-based approaches and patient-centered care to achieve the required clinical outcomes.
Nurses are supposed to reflect on their practice using different established models to understand
the areas that need to be addressed. Nurses rely on nursing philosophies to guide their clinical
processes and achieve the best clinical outcomes. The Gibb’s reflective framework is a student
learning tool that can be used to reflect on different clinical situations to improve learning (Wain,
2017). Reflection is a way to appraise the clinical intervention and develop an action plan for
future practice through building on the issues raised in the reflection.
The case study presents a patient situation that highlights how different approaches to
healthcare were used to achieve the intended healthcare outcomes. Taylor is presented with
multiple falls that have led to different levels of injury to the body like fracturing the right hand.
Evidence-based approaches require that healthcare professionals have to use available evidence
from the life history of the patient and the manifestation of clinical signs to determine the cause
of the medical challenge. An x-ray was done and to assess the nature of the injury during the fall
since he was complaining of pain in the right arm. As the x-ray results were being waited the
pain was managed with codeine to relieve the pain. In this case, the GP applied the Florence
nightingale philosophy of caring has been applied in the case to maximize the mental and
physical wellbeing of the patient (Koy, 2015). The x-ray results showed that he has a 30cm tear
which extended to the shoulder and had to be sewn up and could not be repaired due to the age of
the patient. To manage the fracture the patient was referred to a physiotherapist who assisted him
on how to manage his life with one arm. In this case, patient-centered approaches are evident

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since the physiotherapist has to work with the patient to develop a care plan that reflects the
needs of the patient.
The second fall happened after four weeks and is what led to an anemia test since the
patient complained of a ratified breathing due to the failure of the body to get enough oxygen.
The cause of the falls was diagnosed as anemia which causes the limited supply of oxygen in the
body. The patient was put on iron tablets to manage the effects of anemia and further tests were
supposed to be carried to determine the primary cause of anemia. This was through colonoscopy
and an endoscopy which were negative in identifying the cause of anemia (Khanbhai, Shah,
Cantanhede, Ilyas, & Richards, 2014). This led to the need for a gastroenterologist test to be
done which entailed swallowing a body cam that will take photos of his body system every two
seconds. The patient is also suffering from hypertension, diabetes and allergic arthritis which are
being managed by regular medications. The patient also recently underwent inferior turbinate to
reduce the breathing problem. The following medications are being used by the patient to
manage the different conditions: cetirizine, amlodipine, Indocin, metformin, and Flomax.
The feeling that I have about this case study relates to the nature of care received by the
patient. In the first fall, the GP did not apply evidence-based approaches to assess the cause of
the fall, since he failed to assess the underlying cause of the fall. I feel that by only focusing on
the fracture, the GP did not adequately use evidence-based approaches. It is only after the second
fall when the GP ordered an anemia test best on the clinical manifestation of the causes of the
fall. The role of multidisciplinary teams was effectively applied since the GP developed a care
process by linking the patient to a physiotherapist and using a patient-centered approach to
address the needs that Taylor presents.

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I have noted that the Nightingale philosophy has been used to provide a safe environment
to improve the wellbeing of the patient. The GP used this approach by putting the patient on pain
medications to improve the quality of life as the patient underwent different tests to assess the
nature of the problem (Mackintosh-Franklin, 2016). High-quality care was based on values,
beliefs, and ethics to enhance patient experience and have an impact on the patient’s health.
According to the National Safety and Quality Health Service Standards (2019) partnering with
the patient in providing care increases the direct impact of the health outcomes. This is seen in
how the patient was involved in assessing the cause of anemia especially in the use of the body
cam which requires that the patient manages the assessment on his own. This process requires
that the patient is involved in decision making when choosing the best approach for managing
the condition. In the care process, the decision of using the body cam was arrived at through
consultation with the patient since this requires the ability of the patient to manage the condition.
The use of therapeutic skills in nursing care is seen in the way the multidisciplinary teams
dealt with the Taylor incidence. The GP and the physiotherapist used therapeutic skills to meet
patient needs through the nursing care process of enhancing and preserving human dignity to
enhance the quality of life (Conroy, Feo, Boucaut, Alderman, & Kitson, 2017). In addition to
that professionalism is defined by how healthcare teams deal with the issues of the patient
through the use of 5 C’s of compassion, competence, commitment, competence, conscience, and
confidence. Keohane, et al. (2018) suggests that patient-centered care builds on the care process
on individual needs to create interpersonal relationships established in the care process. The
therapeutic skills are used to enhance patient experience and achieve the intended care outcomes.
Despite that, the aspects of care received by the patient were inadequate since they lacked
adequate patient education to address the issue of anemia. Patient-education is used to enhance

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the quality of life by assisting the patient in how to manage the existing condition (Duffett,
2017). The fact that the patient was anemic means that the GP should have referred him to a
nutritionist or dietician to assist him in identifying iron-rich foods that can be used to manage the
condition. Patient education has not been effectively used in this case since Taylor needed to be
educated on how to detect fall episodes early so that he can prevent the magnitude of the falls. If
patient education was used, it could have enhanced the life of the patient by assisting him to
learn fall prevention measures and how to manage the multiple health conditions that he has.
From the case study, I can conclude that the healthcare process needs to address the needs
of the patient to improve the quality of life and clinical outcomes. This entails working for
multidisciplinary teams and use if evidence-based approaches to determine the patient-centered
requirements that the patient needs. This entails developing a care plan that focusses on the needs
of the patient. Delaney (2018) states that the care process needs to be designed based on the
existing needs of the patient through use of evidence-based methods. However, limited patient
education can limit the quality of life that the patient achieves in care settings. When seeking
medications, patients assume that the GP will adequately assess the healthcare problems being
faced and develop a care plan that focusses on their needs. Thus the therapeutic care received by
Taylor missed the aspect of education in his care process which could have increased clinical
outcomes.
The action plan that I have developed from this case is the need to address the varying
needs of the patient using evidence-based approaches. Thus I have to put measures in place to
assess the patient situation and develop a care process that reflects the clinical needs of the
patient. Evidence-based approaches form the basis of clinical care since they allow the
professional to develop the clinical process that addresses the needs of the patient. Secondly,

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patient education needs to be used as part of a patient-centered approach that focusses on
identifying the specific needs of the patient and developing a learning process to assist the
patient to manage the health condition. In this case, I believe I have to work on my therapeutic
skills, evidence-based abilities, and patient-centered knowledge to define the best way to deal
with the issues being faced by the patient.
Therefore, Gibb’s reflective framework can be used to asses nursing processes to
determine the best approach for dealing with the health challenges of the patient. As seen in the
case of Taylor, there is a need to apply evidence-based approaches and patient-centered care to
improve the quality of life of the patient.

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References
Conroy, T., Feo, R., Boucaut, R., Alderman, J., & Kitson, A. (2017). Role of effective nurse-
patient relationships in enhancing patient safety. Nursing Standard, 31(49).
Delaney, L. J. (2018). Patient-centred care as an approach to improving health care in Australia.
Collegian, 25(1), 119–123.
Duffett, L. (2017). Patient engagement: what partnering with patient in research is all about.
Thrombosis research, 150, 113-120.
Keohane, C., Dwyer, K., Boulanger, J., Zigmont, K., Babayan, A., Cushing, E., & Walsh, B.
(2018). Partnering With a Medical Malpractice Insurer to Improve Patient Safety and
Decrease Risk. The Journal of perinatal & neonatal nursing, 32(1), 66-71.
Khanbhai, M., Shah, M., Cantanhede, G., Ilyas, S., & Richards, T. (2014). The Problem of
Anaemia in Patients with Colorectal Cancer. International Scholarly Research Notices,
10(5), 1-5.
Koy, V. (2015). Nursing care quality: a concept analysis. International journal of medical
sciences, 3(8), 1832-1838.
Mackintosh-Franklin, C. (2016). Nursing philosophy: A review of current pre-registration
curricula in the UK . Nurse Education Today, 37, 71-74.
NationalSafetyandQualityHealthServiceStandards. (2019). National Safety and Quality Health
Service Standards. (2019). The NSQHS Standards | Australia Commission on Safety and
Quality in Healthcare. Retrieved September 25, 2019, from National Safety and Quality
Health Service Standards: https://www.safetyandquality.gov.au/standards/nsqhs-
standards
Wain, A. (2017). Learning through reflection. British Journal of Midwifery, 25(10), 662-666.

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