Saturday, February 23, 2019
Meeting Essential Care Needs Essay
Mrs Gale is a 70 year old leave behind and retired unqualified arrive ater. The patient lives alone and relies on her son to provide introductory c atomic number 18, music and meals. Mrs Gale has a history of clog fluctuation owing to lifestyle nevertheless is trustworthyly at risk of malnutrition taboo-of-pocket to Parkinsons unsoundness. Mrs Gale shows signs of early(a) delirium and suffers from scurvy mobility and pain ca apply by arthritis. Mrs Gale to a fault has mild notion triggered by loss and has become brotherlyly isolated. All names guide been changed as per the Nursing and Midwifery Council confidentiality guidelines (2008).Mrs Gale is a 70 year old widow and retired unskilled worker. The patient lives alone and relies on her son to provide basic safeguard, manage of medicine and meals. Mrs Gale has a history of weight fluctuation owing to lifestyle but is currently at risk of malnutrition due to Parkinsons disease. Mrs Gale shows signs of early dement ia and suffers from poor mobility and pain caused by arthritis. Mrs Gale also has mild depression triggered by loss and has become soci every last(predicate)y isolated. All names feed been changed as per the Nursing and Midwifery Council confidentiality guidelines (2008).Introducing the nature of essential awe take Daily activities of living such(prenominal) as eating, breathing, and mobilising were seen by Roper (1976) as a method of delineateing the commands of a patient. By understanding what a patient requires in read to consumption norm all in ally, a nurse tummy address what is missing and produce a care plan accordingly. The Roper, Logan and Tierneys pattern of breast feeding identified the activities that are deemed essential and suggests that it is not primal to treat all the activities at once (Roper et al. 2000).Yura & Walsh (1983) believed that it is im vi fitting to separate a psyche into their inevitably and therefore you washbasinnot treat one with step t o the fore treating the others. Newton (1991) reason come out of the closet that in order to conduct a holistic approach, all factors ask to be considered. Along with the essential brings there are also the physical, psychological, sociocultural, politico-economic, and environmental factors that entrust command consideration. Factoring these into patient care produces a person centred approach (Steinbach 2009). This means that a patient pass on cognise care that is individually tailored to them.In order to meet the pauperisations of Mrs Gale, the care pull up stakes be assessed according to differences in her human needs, her social role, her expectations of care and her lifestyle behaviours. This is because as an older adult, Mrs Gales needs are different to those of younger adults and children (Copeman 1999 Yura & Walsh 1983). There will be particular reduce on Mrs Gales nutritionary needs as this is an area of reside due to her Parkinsons and the risk of malnutrition associated with it. The involuntary shaky movements associated with Parkinsons disease causes an increase of energy expenditure which smoke lead to weight loss. some other symptoms and her medication kitty also decrease fodder intake. Fortunately medication such as levodopa contains medication that minimises these side effects (Green n. d. ). Mrs Gales poor mobility and pain levels will also affect her aptitude to consume living as well as the ability to prepare, serve and purchase food and drink. Roper et al. (1996 cited Bloomfield & Pegram 2012) stated that when addressing psychological needs it is important to understand that Mrs Gales appetite will be affected by her emotional state. Mrs Gales cognitive impairment may also lead to her forgetting to eat or consuming too much (Beardsley 2000).The environmental factors to consider for Mrs Gale are the layout of her home, having a suit adequate eating area, easy food storage and how is Mrs Gale able to purchase food (Copeman 1999 NICE 2006). Mrs Gale has been identified as macrocosm from a works class family this means she has learnt behaviours which may impact on her health such as not buying suitable foods (Browne 2005). The financial costs of lusty foods, available funding, benefits and local care provisions via the social care dodge or local government schemes will also need figuring (Copeman1999 Age UK 2012).Changes due to the aging exercise also need to be addressed. Calcium reabsorption increases especially in women after the menopause, this decreases bone density. consort tissue decreases as fat increases with age there is also a decline in the percentage of carcass water meaning that body temperature is more difficult to control. Thirst decline and decreased renal function means that older friendship can become dehydrated (Copeman 1999). The function of the bowel reduces, meaning that the elderly are more susceptible to stomach upset and constipation.The risk of constipation is also increased with Parkinsons disease (Parkinsons UK 2011). The final consideration is the deterioration of the sensory system. Taste, smell, vison, pain and touch all decline meaning that food may not be as appealing (Copeman 1999). Exploration of the inference underpinning the delivery of care In order to determine the nutritional care of Mrs Gale the nursing process will be used. Nursing was described as a problem-solving process with 4 stages termed sound judgement, proviso, carrying into swear out and evaluation by Yura & Walsh (1967) (cited Aggleton & Chalmers 2000).This principle is still used in clinical bore today and is considered to be best practice (Bloomfield & Pegram 2012). By carrying out an judgment nurses can identify the causes of problems that require medical involvement. Nettina (2006) described assessment as the collection of data that will identify actual or potential health problems. This means that a health assessment is carried out to determine what care is currently infallible or care that will be required in the future.Assessment begins with a complete nursing history and finishes with a nursing diagnosis which is based on facts and evidence (Yura & Walsh 1983). Assessment is carried out by observing the patient as a whole and includes making notes on the patients dress, expression, non-verbal cues, deformities, and absence of separate such as teeth (Yura & Walsh 1983). Data collection is done by using various assessment tools such as measuring weight and height, calculating body mass index (BMI) and screening tools such as the Malnutrition Universal Screening Tool (MUST) (Copeman1999 Stratton et al. 006). The use of BMI alone has raised questions due to people falling outside of the normal range and still being healthy (McWilliams 2008). Evidence for the use of the MUST was concluded from research that was conducted by Stratton et al (2006). However, the MUST is recommended by NICE and is used regularly to identify those at risk of malnutrition (McWilliams 2008). In order to plan care in effect there are three phases that moldiness be considered. The first investigates the main(prenominal) concerns of the practitioner and patient.Subsequently the goals of the practitioner and client are determined. Finally the required nursing interventions are recorded (Carpenito-Moyet 2006). Planning can be used to design strategies to assistance the patients, for example provender plans and calorie allowance (Copeman 1999). With Mrs Gale the simplest and crummy intervention will be to promote a healthy diet and encourage foods with high-nutrient content (Holmes 2012). During planning, goals are determined that will lead to net health and wellness (Yura & Walsh 1983).These goals are let outed by open duologue between patient and practitioner and are assigned a age scale to be completed by (Carpenito-Moyet 2006). For example Mrs Gale has poor nutritional intake as a diagnosis and a goal could be to improve this. H owever, if the poor nutrition is due to money, then(prenominal) a clip scale of a few weeks would allow time to sort out benefits and buy the correct nutrition. If the poor nutrition was due to behaviour issues, then a longer time period would be assigned in order to assist with help in changing that behaviour (Carpenito-Moyet 2006).The Orem model of nursing (2001) states that the nurse must(prenominal) act for the patient to increase their encyclopaedism and awareness of their condition. However, in order for care to be implemented in effect a nurse must have intelligence, interpersonal and technical skills (Yura & Walsh 1983). The ability to build relationships with clients and other practitioners is important to form trust and identify where a multi-disciplined approach can be used (Aggleton & Chalmers 2000). Communication plays a massive role in the execution of care due to cut throughd sermon and questioning with the patient.The nurse must look for verbal and non-verbal cues from the patient and continue to collect data (Aggleton & Chalmers 2000). By doing this the nurse will be able to use their clinical judgement and have an adaptive approach to care (Yura & Walsh 1983). A nurse must also be realistic and differentiate their strengths and weaknesses. This will allow recognition of aid and possible referrals to other practitioners that by chance required (Siviter 2008). This sharing of information and asking for help is part of the NMCs code of conduct (2008).A nurse must also have the association to recognise normal and abnormal human functioning and the bear witness based interventions that can be used (Brooker & Nicol 2011). The care should also be safe, have the patients best interests, involve the multi-disciplinary team (MDT) and the patient, and conscious consent should be obtained (NMC 2008). Evaluation of exercise is conducted to see if the best action or intervention has been used. Reflection will indicate if current goals should b e maintained or if new goals are required for the patient (Siviter 2008).However, the achievement of the goals can be subjective and difficult to mea current. To evaluate if the goals have been achieved, sense of hearing and observation needs to be conducted and it is important to suppose that non-achievement is not failure. It is possible that new more achievable goals are needed or that the current intervention is not effective for the patient (Brooker & Nicol 2011). Short term an set aside goal will be the achievement of weight maintenance or gain and long term will be the changing of negative health related behaviours (Siviter 2008).This will be educated via referral to a dietician and via information guides such as the Parkinsons and Diet leaflet, designed by the Parkinsons Disease Society (2008). Diet can also be supplemented with high energy and protein drinks such as Fresubin and are prescribed via a dietician or General Practitioner (Holmes 2012). Mrs Gales weight can be monitored every 4-6 weeks, if there are changes in her medication or every 3 months if stable (Green n. d. ). Mrs Gale can also be enjoin to age UK who can provide details of benefits, home and shopping assistance (Age UK 2012).All of Mrs Gales nutritional needs have been assessed, planned and evaluated. The implementation of this care will depend on the cooperation by Mrs Gale. Practitioners have to remember that patients have the right to refuse treatment. After all the evidence is presented and all questions and concerns are addressed the patient will have an informed picking (NICE 2007). Personal learning plan (University of Southampton 2012) determine areas for further development spunk Intrinsic motivation (Developing compassionate care)On refection I believe I need to develop my communication skills, especially when dealing with older people and cognitive impairment. This will make sure my care remains person centred (Steinbach 2009). I must also develop my understand ing of how and when to use the available assessment tools so that I can complete the nursing process (Yura & Walsh 1983). I must also improve my questioning techniques so that when I am faced with a client, such as Mrs Gale, I can collect all the relevant information I will need to plan her care (Aggleton & Chalmers 2000). Suggested activities and experiences that will assist in future developmentIn order to facilitate my development I will need to nurse patients with a variety of medical and cognitive conditions this can be achieved while on billet. This will improve my communication skills and my confidence (NMC 2008). what is more I need to observe nurses in a ward or community setting while they implement the most appropriate assessment tool for their patient. This can be done while on placement and by contacting the community care team and arranging to shadow a community nurse. While completing practice experience one, I was able to take part in the planning process.I will ne ed to continue with this so that I am confident in planning essential care. Identified areas for further development Nerve Self-belief and self-efficacy (Developing themselves and advocating for the service drug user or carer) To develop my self-belief and to be an advocate for my patient I will need to work on my confidence (NMC 2008). I will need confidence in applying the best nursing practice (Yura & Walsh 1983). I will need confidence in speaking up and making sure my patients receive the correct care and all available funding that they great power need.If I am unable to provide this service I must have the ability to refer my patients or to ask questions so that this can be achieved. Suggested activities and experiences that will assist in future development To develop this confidence, I must work alongside mentoring staff and observe dieticians, community nurses and general practitioners. By doing this I will appreciate how other professions care for my patient. Similarly I will gain understanding of which profession I would refer my patient to for future treatment.Working as part of a multi-disciplinary team will improve my confidence and allow for questioning (NMC 2008). Identified areas for further development Brain Critical and analytical skills (Application of appropriate theory/research to practice) In order for me to apply theory into practise, I must research the care of various conditions and begin to understand the theoretical knowledge behind that care. This process has begun with the research I have conducted on Parkinsons disease and also on my research into the use of BMI and MUST (Eknoyan 2008 cartridge holder 2003).I will also need to visit other areas of practice to see the nursing process being applied (NMC 2008). Suggested activities and experiences that will assist in future development I must attend any available courses, shops and meetings that deal with patient care and conditions. While on practice experience two, I would li ke to attend a nutrition workshop and discover the benefit of supplementary foods and drinks available. I will arrange to work with and observe dieticians within a hospital setting and question them on transferring this knowledge to community settings.