澳洲論文代寫：Case study -Nursing strategies for Antheia代寫
Case study -Nursing strategies for Antheia
This article is based on the case scenario about Anthesia. Aimed at her health concerns, the article tries to construct some questions for assessing Antheia’s health situation by using Gordon’s Functional Health Patterns (Jones, Duffy, et al., 2012), and then explore some suitable nursing strategies to help Antheia with her health concerns, communicate effectively with her, and meet her spiritual and psychological needs. At last, there is a reflection about aging.
An holistic, comprehensive health assessment for Antheia
According to (Paans, Bruylands, et al., 2013), the Nursing Process includes five procedures: a) an overall assessment; (b) adequate and precise nursing diagnoses; (c) consistent assessments and nursing reports; (d) effective nursing interventions; and (e) outcomes based on evidences. Nursing consists of a series of diagnostic and therapeutic behaviors which aim at the promotion, protection, recovery, and optimization of the patients. As the Nursing Process is directly faced to the patients and their families, the quality of the Nursing Process can be seen and supervised directly by them. Therefore, the quality of the Nursing Process of an organization of client care reflects its competitiveness and professional abilities.
A well-structured assessment framework is useful for the focus, organization, and synthesis of the clinical objectives and subjective assessment data. Gordon’s Functional Health Patterns (FHP) (Jones, Duffy, et al., 2012) had been proved an efficient assessment framework for the nursing process. It provides a well structured framework to uncover and describe human’s reactions in a comprehensive way by integrating bio-physiological and behavioral functioning. The theory consists of 11 FHPs which cover both physical and mental health.
In Antheia’s case, the top three FHPs to be concerned in the assessment framework include cognitive-perception pattern, activity-exercise pattern, and self-concept pattern. The reasons for choosing cognitive-perception pattern are lie in that Antheia has the early stage of dementia, and that her ability of speaking and understanding English has declined recently. As Antheia need therapies aimed at the series of degeneration of cognitive-perception, the assessment of cognitive-perception pattern is necessary. Following that, it is mentioned in the case scenario that Antheia’s ability to use her hands was affected due to severe Rheumatoid Arthritis and she has to walk with a four wheel frame. Besides, urinary incontinence is another health problem for Antheia, for which she has to wear pads. All these above indicate that Antheia is really very weak in taking care of herself. Let alone basic activities and exercise. She really needs improvement in this aspect, that’s why activity-exercise pattern is chosen in this case. It is mentioned in the case scenario that Antheia has strong self-esteem and feels contemptuous about her disability. Moreover, she expressed her distress and anger towards the coming of the nursing staff. These symptoms are very harmful for her mental health, so self-concept pattern was chosen as the third one for the nursing assessment.
For the assessment of cognitive-perception pattern, questions are constructed like this:
l How are the patient’s vision, hearing, taste, smell, and other perceived functions?
l How are the patient’s thinking, language, directional ability, and state of consciousness?
l What are the potential risks for the patient due to changes in perceptions and cognitive functions?
l How does the patient react to the changes in perceptions and cognitive functions?
As Antheia is already 82 years old, her vision, hearing, taste, smell, and other perceived functions may get deteriorated seriously, therefore, the set of the first question is not only for the nursing, but also for better nursing. The reason for the second and third questions lie in that Antheia is in the early stages of dementia. Her thinking, language, directional ability, and state of consciousness are important metrics for the quality of nursing, and assessing the potential risks are the guarantee of safety. The fourth question is to see if the physical discomfort affects the patient’s mental health and how.
As activity-exercise pattern includes physiological basis, activity tolerance, and activities of daily living, questions can be set as below:
l How are the patient’s physiological conditions including cardiac output, pulmonary ventilation, and maximal oxygen consumption?
l How is the patient’s physiological endurance towards activities?
l How is the patient’s psychological endurance towards activities?
l What activities does the patient rely on to maintain self care and relaxation?
The reason for the first and second questions is to assess the physiological status of the patient. The third question aims to assess the patient’s psychological endurance. The activities tolerance of the patient is the basis of designing nursing activities. The fourth question is for better understanding of the patient’s favors and better planning of the patient’s daily life.
Self-concept pattern mainly refers to self-recognition and self-evaluation. Questions can be set as follows:
l How is the patient’s body image?
l How is the patient’s social identity?
l How is the patient’s personal identity?
l How is the patient’s self-esteem?
As self-concept consists of body image, social identity, personal identity, and self-esteem, the four questions are necessary for the assessment of the patient’s self-concept pattern.
Health concerns and nursing strategies for Antheia
Risk factors for confusion – the early stage of dementia includes diabetes mellitus, hypercholesterolemia, hypertension, cigarette smoking, alcohol use, and lack of cognitive engagement (Daviglus, Pirzada, et al., 2011). To mitigate these risk factors, the nursing work should be carried out from 4 aspects: nutritional supplements and dietary, physical activities, smoking and alcohol control, and cognitive engagement. For the first, the nutritional supplements and dietary should be carefully and reasonable arranged for that diabetes mellitus, hypercholesterolemia, and hypertension are the risk factors for dementia. The nutritional supplements and dietary should avoid those foods with high sources of fat and sugar, and at the same time ensure enough nutrition. Following that, arranging proper physical activities according to the status of the patients is considered to be able to mitigate confusion and dementia (Flicker, 2009). Then, as smoking and alcohol increases the severity of confusion and dementia, the nursing strategies should include smoking and alcohol control. Cognitive activities are proved to be a good prevention measure and do well in decrease of confusion (Flicker, 2009). Thus, cognitive trainings should be arranged regularly for the patients to improve the patient’s cognitive functions including memory, attention, and problem solving.
A strong risk factor for urinary incontinence is obesity (Subak & Vittinghoff, 2009). Besides, another research (Offermans, Du Moulin, et al., 2009) show that sex, age, cognitive function, dementia, bedfast and locomotion are also connected with urinary incontinence. Therefore, on one hand, scheduled toileting should be arranged, on the other, the nursing should emphasize the weight change and emotional needs of the patient by reasonable arrangement of diet and regular relaxing activities.
As Antheia has to use a four wheel frame and has severe Rheumatoid Arthritis, to promote safety of Antheia, the nurse in charge should ensure the wheel working smoothly every day, and keep close with Antheia. Besides, it is suggested to locate the dining near Antheia’s room and ensure the activities for Antheia within her physical and mental ability. Then, it is advised to do regular health examination for her both physically and mentally. Improving Antheia’s independence is a good way for decreasing her self-contempt and meeting her own dignity. However, as she is very old and unable to move freely, it should be conducted very carefully. Measures for promoting her independence include organizing activities like arm exercise, singing, and cognitive trainings, and having her herself done all the things she is able to like dressing and brushing her teeth. According to Baillie (2009), the providing privacy and interactions could promote the dignity of patients. Therefore, it is suggested to provide the physical environment which is conducive for privacy protection, cultivate dignity-promoting culture in the nursing home.
How to communicate effectively with Antheia
Communicating effectively is essential to patient satisfaction. To communicate effectively with Antheia, at first, it is suggested to keep her informed of all the information about her diagnosis, care, and treatment, listen to her opinions, and discuss with her. According to (Ferguson & McMurtry, 2013), patients wanted to get access to the information about their health status and care strategies and they were unsatisfied with those healthcare professionals who were not willing to discuss with them. Following that, the healthcare professionals should listen really carefully to the needs of Anthesia and then reflect in decisions or explain the reasons why her opinions are not adopted. As patients are the focus of nursing, they have right to take part in the decision-making of nursing. The decision makers should try the best to meet the patients’ needs. Only by doing this can make the patients feel being valued and willing to further communicate with the healthcare professionals.
It can be seen from the case scenario that Antheia used to be very independent and the diseases make her self-esteem wounded. Besides, she is a devout Catholic, however being difficult to getting about makes her inconvenient to go to church and take part in the church party. She even has to give up her crazy hobby- gardening. Moreover, she has to live in an unfamiliar environment- the nursing home. She need a feather in her cap to rebuild her self-esteem and confidence, she need a new hobby for her to live a fulfilling life, she need some church members to share life experience, to talk, and to laugh. To help her going through all of these, the nursing home can hold a welcome party for her, telling her how warm the nursing home is and how important she is. Besides, it can hold tea parties for all the Catholic members in the nursing home. The belief in religion can release her inner anxiety and fear and get her feel more comfortable. Then, the healthcare professionals should try to safeguard her dignity and self-esteem by getting her involved in the specific nursing strategies, protecting her privacy, and praising her now and then. To get her life more fulfilling, the nurse in charge can try to help her cultivate another hobby which she is able to like singing. Moreover, she felt depressed and angry on the arrival of the care facility, which means she may have no confidence to the nurse home and feel abandoned by her daughter. She needs to feel being loved. Therefore, the patient-centered care strategy should focus on making her feeling being loved from the nursing home, and from her daughter.
When it comes to aging, people present different attitude. Some people regard aging extremely horrible, since they enjoy what they have in current age, including time and energy and hope of future. When they grow older, time is getting less, energy is leaving and so do the hope of future. Moreover, the fear of death will occur. As for me, however, aging is not that horrible. As a young nurse, I know how beautiful the world is, and how lovely our lives are. If someday when I grow older, I will see the world in a different way and think about our lives in a different way. Then the fear will fade.
This attitude helps a lot in the career of nursing. While taking care of the elders, physical health as well as psychological health is both significant. In most occasions, what the elderly need is not medicine or injection, but company and compensation. Therefore, a nurse with positive attitude helps a lot to release the stress of the elderly and make them happier. And for me, this attitude is also important. Seeing too much negative clients will to some degree change my value of how to see the world and how to see life. Thus, adjusting what I think from negative to positive is necessary for my future.
This article tried to figure out some strategies for a patient-centered care by not only emphasize the patient’s physical health, but also stress the patients’ emotional needs. The patients’ spiritual and psychological needs are as important as their physical health. Besides, healthcare professionals should listen carefully to the patients, get them involved in the nursing and take their opinions seriously. They need to be listened, to be loved, to be cared, to feel useful, not just a house to live in, a bed to sleep on, a nurse to ensure safety. Only by doing this can the nursing home becomes the true home of the patients.
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