Maintaining Professional Healthcare Standards: Nursing Care Report

This report provides a detailed analysis of the nursing care provided to a 78-year-old male patient, Robert, who is experiencing both a venous leg ulcer and congestive cardiac failure. The report begins with an introduction to the case, including background information on venous leg ulcers and their impact on patients. It outlines the patient's medical history, emphasizing the importance of understanding his past conditions in developing an effective care plan. The report then delves into relevant nursing theories and models, specifically highlighting the Roper-Logan-Tierney model of nursing and its application to the patient's care. The nursing process, including assessment, planning, implementation, and evaluation, is thoroughly discussed, demonstrating how the patient's needs are addressed through a holistic and individualized approach. The report concludes with recommendations for future practice, emphasizing the importance of continuous improvement in patient care and adherence to professional healthcare standards.

Maintaining Professional Healthcare Standards
Management of needs of an individual presenting
with Congestive Cardiac Failure and Venus Leg
Ulcer
SID: 1511896
Word Count: 4800

Table of Contents
Introduction..................................................................................
Patient's Information....................................................................
Venous Leg Ulcer........................................................................
Nursing Theories and Modules....................................................
Selected Model of Nursing........................................................10
The Nursing Process..................................................................13
Assessment.................................................................................15
Planning.....................................................................................19
Implementation..........................................................................21
Evaluation..................................................................................22
Recommendations for Future Practice.......................................23
Conclusion……………………………………………. 24
Reference……………………………………………....25

INTRODUCTION
This essay will be based on an assessment that helps in determining the nursing
needs of patient. The choice of patient was discussed with my mentor and he
thought it was appropriate to explore this aspect at this level. The rationale for
choosing to write about this patient was made during a community placement
where the responsibility of more than half nurse who is accountable for his
treatment. According to posnett el at (2009), CVLU affects 1- out of 2% of the
UK population with over half having an active ulcer. The annual costing of
National Health Service accounts for around 5.3 billion each years as per the
recent study conducted in 2013-2014 in the UK. The study also reveals that the
patients suffering from this dangerous diseases will be counted all above the age
of 18 years as there is record of patients having this disease below 18 years.
They also reported that majority of CVLU patients find incapacitating with
physical impact such as pain and reduced mobility along with psychological
impact of low-esteem, depression and social isolation. The study reveals that the
practiced nurses are involved in treating patients in order to avoid social
isolation. The practice of the hospital starts that 18.6 million practices nurses
and doctors are form part of this event, 1.09 million doctors and paramedical
staffs also visits communities and 3.4 million hospital also gathers and treats
outpatient visits through organising camps.
NHS Choices defines venous ulcers as wound which occur on skin of human
being due to improper functioning of venous valves. It generally occurs when a
hard-bony area covered by a thin layer of tissue comes in contact with a hard
surface such as bed, trolley, theatre table wheelchair. This essay will also
stresses on the nursing requirements of the patients in order to take care by
meeting their needs. Moreover, individualized, holistic and collaborative based
care has been demonstrated, as well nursing theories and its step are analyzed in
context of given scenario. In addition to this, Roper-Logan-Tierney activities of

living model and carper’s model has been explained throughout the essay.
Moreover, the patients past medical history (PMH) are also incorporate in the
report which further helps in as well as reason for planning, implementation and
evaluation of patient care with the use of appropriate model has also be
explained. It also involve data regarding pressure ulcers as its occurred annually
among 575600 peoples in the UK and on average cost per patient will be 4300-
6400 pounds and cost incurred by NHS in this kind of ulcer is 1.8-2.6 million
pound annually.
Patients Medical History
Robert is a 78year- old man who lives alone in a one-bedroom flat. He was
admitted in the community with venous leg ulcer as they feel more comfortable
with all the individuals suffering from the same disease and get motivated in
terms of taking treatment in order to get well. The basic problem of social
isolation will be reduced if Robert will meet and greet all the individuals
suffering from identical diseases then their mental distress level gets reduces
they will focus more on other activities. The loneliness of Robert will be
minimized by breaking the social isolated boundaries of their room. The consent
of Robert has taken in verbal form by talking face to face with the patient by
asking various questions related their problem and mental status by living in the
society. The information obtained regarding their prescribed medicines, allergy,
reactions, blood and sugar level will be very helpful in analyzing their nursing
needs. Robert has past medical record of congestive cardiac failure which also
helps in planning perfect prescription for providing perfect treatment to the
patients. According to Robert the main reason he was admitted to the
community is because he knocks his knee and they are unable to stand on their
feet and are para handicap which decreases their chances to live freely in the
overall society as they get incomplete without restyling on their wheel chairs.
Wheel chair will become their partners as the severe causes of this disease will

fold their legs inwardly which induces their pain but their mental level of stress
is so high which will compensated with their physical pain in comparison with
the mental stress. Robert had a patient who has controlled analgesia which is
also known as PCA, a urinary catheter, which allows them to monitor the pain
which is worked as pain relief machine. The programmable machine and
functioning has intended that will not deliver overdose of the medication. It
allows patient to take a complete set of vital signs to monitor their own
temperature, pulse, respiration, blood pressure and oxygen saturation level.

VENOUS LEG ULCER
The Venous ulcer is described by The Wound, Ostomy and Continence Nurse
Society (WOCN) as an open wound on the lower leg of venous origin or ankle
of person. The most common causes of VLS are chronic condition and venous
hypertension. The higher pressure of venous tends to become reason of vales in
the lower leg veins. However, vales perform the work to prevent backflow of
venous blood at the time of calf muscle congresses the veins to pump the blood
return to the heart (Viv as, Lev-Tov and Kirsner, 2016). Owing to this, in case
vales are incompetent then form of ulceration can be found in skin as venous
pooling and congestion leads to leak the blood into the tissue as edema.
NURSING THEORIES AND MODELES
There are different nursing theories and models which helps in rendering good
quality of services to its patients. However, nursing staffs in the community
adopts systematic and holistic assessment of patients whereby health can be
recovered in relatively less time span. At this stage, Fawcett's concept of four
metaparadigms can be applied which covers Nursing, environment and Health
as well as person (Lazarus and et. al., 2016). This concept shows that people

who are getting services from nursing staff can be individuals, families and
communities. It is well known fact that various dimension of nursing is
associated with open, interrelated and interactive way where nursing staff which
has require to put their efforts with informed choices. It proves to be effective in
rendering good quality of services to patients by following above mentioned
dimensions.
One of the dimension of the model is peoples which has explained from
the perspectives of the patients that they get feeling of home as their care has
been done by different peoples. An individual need intensive care from nursing
staff or therapists as well as doctors to fulfill their needs and objectives. Patients
are well treated ion home cares which helps all the patients to forget their pains
and enjoy with the nurses as they demand attention which is nor provided to them
in normal society and by their family members. They face issue related to
language and cultural diversity which affect them as people working in health
care have different cultural backgrounds.
At this juncture, human beings are considered as the most valued persons
in care home where care workers require to give respect to all the patients by
providing their services. In the given case where Robert will be informed
related to their treatment as his consent will matter for care homes. Taking
consent of Robert will mentally prepare them in order to feel good which in turn
helps doctors to treat them without any consequences.
On the other hand, environment is another factor of this model which
includes set of values, mores, expectations and customers as well as societal
beliefs which is directly related to both service users and providers. There are
different elements found under environmental considerations such as cultural,
historical, physical psycho social and development processes which tends to
provide peaceful environment to the patients. It tends to create good atmosphere
for services users and accordingly time and quality is managed and maintained
by care workers (Petherick, Pickett and Cullum, 2015).

Furthermore, health is another element of Meta paradigm as it is dynamic
process that stresses on two major points that is wellness and illness. It reflects
that level of health is sort of expression which is derived from mutual
interactive process between environment and humans. The health of human
being is directly related to feeling of caring by another person which in turn
motivate them to ensure their good health by focusing upon various healthy
standards. This also involves minimizing the stress level of a person by focusing
on their weaknesses in order to convert them into their strengths.
Moreover, nursing practice is another most important element of
Metaparadigm. This is science of holistic health care which is guided through
set of choice, responsibility, and human freedom. The nursing practices uses
various logical analysis, researcher and theory of development which in turn
provides complete package of good quality of services. Nursing staff uses
critical thinking and clinical judgment through which they can effectively treat
patients who are suffering from several kinds of disease. In this regard, caring
attitude is required for nursing staff through which they can understand the
exact need of users which in turn transform their actions in a correct way to
provide all the services in effective way. The nursing staff follow different
approaches for rendering services to users which consists of clinician, learner
and leaders. However, they take the responsibility to provide supportive,
technologist and therapeutic care as per the needs and expectations of the
patients.
Raffetto and et. al., (2015) asserted that it is very basic level in which
there are three main key components of nursing model exists. One among the
model includes different set of beliefs and values which facilitates in carrying
out various activities that are related to prescribing medication. However,
statement of the goals is framed under which the model will represent the
application of nursing practices which will helps in achieving the same.
Similarly, knowledge and skill are also acquired by nursing staff in accordance

with set objectives. A counter argument might be that nursing models focus
upon four central concepts which are already explained (Van Gent and et. al.,
2015). It has been found that nursing models include complex terms such as
care requisites, self-care deficit and health deviation affect learning to a great
extent. Furthermore, ineffective use English language is the commonly found
barriers while interacting with various set of customers.

SELECTED MODEL OF NURSING I think the theories is too long
make it simple.
The selected model for the study is of Roper-Logan-Tierney (RLT) model of
nursing which is based upon activities of living (AL). This model at first
developed in 1998 where basis was Nancy Roper 1976. This RLT model is
highly based upon activities of daily living under which is generally used in
UK. However, this model was updated in 2001 in accordance with societal
needs. The central focus of this model was on care of patients through which
nursing staff can easily implement the standards set by health care sector (Jozic
and et. al., 2015). It can be critically evaluated that care homes of UK uses such
kind of approaches just for checklist on admission. By using such kind of
approach, experts come to know that how life of a person has been changed due
to certain illness or admission to hospital. Though, it does not shed light on
increasing Independency or patients and quality of his life.
The activities of living covers in this model reflects that independence of patient
should be enhanced by putting efforts in the same direction (Vilela and et. al.,
2016). The basic purpose of implementation of this model is to judge how an
individual can improve own health and challenges. It also determines how care
patients can be ready to cope up with changes. This aids to provide learning
among patients and they follow the positive behavior for recovering their health
in relatively less time span. Furthermore, activities of living assesse exact
independence of individual and potential for independence on the range from
complete dependence to self-dependence to analyze the interview which form
the basis for increasing the self-dependence (Fox and et. al., 2015). At the same
time, activities required to compensate the dependence are also assessed for
enhancing the learning of sufferers towards health or maintaining the sound
health. Roper's model is considered most helpful as it shows that nurses should
adopt such kind of behavior in their care towards patients.

Different activities covered under activities of living are; maintaining a safe
environment, communication, breathing, elimination and washing & dressing.
Along with that, controlling temperature, mobilization and sleeping as well as
working & playing are also included which must be there at part of patients.
These activities of living cover all the important activities which are related to
human being or patients so they are referred at the time of admission of patient
on a ward or service (Lin and et. al., 2016). It is helpful in rendering effective
care to patients because changes are considered to analyze that whether person
is improving or not. At juncture, nursing staff can effective assess the how Judie
is recovering her health from the issue of Venous leg ulcer. However, it is very
important to use results of assessment only when it is done frequently for
extracting valid outcome in term of health improvement and health promotion.
For example, care home where Judie is treated can apply this model so that
scope of improvement can be recorded in a right manner. Though, it does not
work well with all care is provided by staff even when patient can take self-
care. It is because basic aim behind using this approach is to bring improvement
in the health of person where focus has been laid on independence rather on
dependence on staff members or care providers (Guest, Ayoub and Greaves,
2015).
Apart from this, Robert who is suffering from venous leg ulcer can focus upon
different factors influencing activities of living. It consists of biological,
psychological and social cultural as well as environmental which tend to affect
daily living activities of a patient like Robert. Along with that, politico-
economic factor is also included which has direct impact on health of patient
(Filkor and et. al., 2015). Accordingly, this model represents the life span
continuum where full dependency begins at birth and people become fully
independent during midlife and again phase of fully dependent come during old
age. This is the major reason where older people are vulnerable to risk because
they need to be cared by others. Here, the first factors effective living activities

as biological reflects that how nutritional activities of a person different
between one who is having issue of diabetes and the one who is not having the
same. On the other hand, psychological factor shed light on spiritual beliefs and
ability to understand by patients. For instance, if a person is educated enough
then he will be sufficient self-dependent in term of health promotion. In this
manner, overall thinking, believing, hoping and feeling are considered. It aids to
determine influence of psychological factor on dependence of patient as Judie
(Harding, 2016).
Furthermore, socio-cultural factor presents the expectations and values in
accordance with actual health. This is because all culture follows different set
procedures and accordingly they tend to behave in different manner. The eating
habits and caring attitude is perceived by individual based on culture. However,
expectations and assumptions of societies also matter under which care workers
will come to know that whether patient is self-dependent (Marshall and et.
al.,2015). On the other hand, environmental damages also have direct impact on
health of one person. Here, people do care of themselves in case they are
residing in an unfavorable environment. Moreover, last factor as politico-
economic also affect activities of living because of violent conflicts, easy to
access to benefits provided by government.