Meeting Essential Care Needs Essay
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Mrs Gale is a 70 year old widow and retired unskilled worker. The patient lives alone and relies on her son to provide basic care, medication and meals. Mrs Gale has a history of weight fluctuation owing to lifestyle but is currently at risk of malnutrition due to Parkinson’s disease. Mrs Gale shows signs of early dementia and suffers from poor mobility and pain caused by arthritis.
Mrs Gale also has mild depression triggered by loss and has become socially isolated.
All names have 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 care, medication and meals. Mrs Gale has a history of weight fluctuation owing to lifestyle but is currently at risk of malnutrition due to Parkinson’s disease. Mrs Gale shows signs of early dementia and suffers from poor mobility and pain caused by arthritis. Mrs Gale also has mild depression triggered by loss and has become socially isolated. All names have been changed as per the Nursing and Midwifery Council confidentiality guidelines (2008).
Introducing the nature of essential care needs Daily activities of living such as; eating, breathing, and mobilising were seen by Roper (1976) as a method of identifying the needs of a patient. By understanding what a patient requires in order to function normally, a nurse can address what is missing and produce a care plan accordingly. The Roper, Logan and Tierney’s model of nursing identified the activities that are deemed essential and suggests that it is not important to treat all the activities at once (Roper et al. 2000).
Yura & Walsh (1983) believed that it is impossible to separate a person into their needs and therefore you cannot treat one without treating the others. Newton (1991) concluded that in order to conduct a holistic approach, all factors need to be considered. Along with the essential needs there are also the physical, psychological, sociocultural, politico-economic, and environmental factors that will need consideration. Factoring these into patient care produces a person centred approach (Steinbach 2009). This means that a patient will experience care that is individually tailored to them.
In order to meet the needs of Mrs Gale, the care will 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 Gale’s needs are different to those of younger adults and children (Copeman 1999; Yura & Walsh 1983). There will be particular focus on Mrs Gale’s nutritional needs as this is an area of concern due to her Parkinson’s and the risk of malnutrition associated with it. The involuntary shaky movements associated with Parkinson’s disease causes an increase of energy expenditure which can lead to weight loss.
Other symptoms and her medication can also decrease food intake. Fortunately medication such as levodopa contains medication that minimises these side effects (Green n. d. ). Mrs Gale’s poor mobility and pain levels will also affect her ability to consume nourishment 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 Gale’s appetite will be affected by her emotional state. Mrs Gale’s 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 suitable eating area, available food storage and how is Mrs Gale able to purchase food (Copeman1999; NICE 2006). Mrs Gale has been identified as being from a working 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 healthy foods, available funding, benefits and local care provisions via the social care system or local government schemes will also need deliberation (Copeman1999; Age UK 2012).
Changes due to the aging process also need to be addressed. Calcium reabsorption increases especially in women after the menopause, this decreases bone density. Lean tissue decreases as fat increases with age; there is also a decline in the percentage of body water meaning that body temperature is more difficult to control. Thirst decline and decreased renal function means that older people can become dehydrated (Copeman 1999). The function of the bowel reduces, meaning that the elderly are more susceptible to indigestion and constipation.
The risk of constipation is also increased with Parkinson’s disease (Parkinson’s 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 evidence 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; assessment, planning, implementation and evaluation by Yura & Walsh (1967) (cited Aggleton & Chalmers 2000).
This principle is still used in clinical practice today and is considered to be best practice (Bloomfield & Pegram 2012). By carrying out an assessment 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 required 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 patient’s dress, expression, non-verbal cues, deformities, and absence of parts 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 effectively there are three phases that must be considered. The first investigates the main 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 assist the patients, for example diet plans and calorie allowance (Copeman 1999). With Mrs Gale the simplest and inexpensive 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 ultimate health and wellness (Yura & Walsh 1983).
These goals are developed by open dialogue between patient and practitioner and are assigned a time 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. However, if the poor nutrition is due to money, then a time 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 act for the patient to increase their learning and awareness of their condition. However, in order for care to be implemented effectively 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 huge role in the implementation of care due to continued discussion 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 recognise their strengths and weaknesses. This will allow recognition of assistance and possible referrals to other practitioners that maybe required (Siviter 2008). This sharing of information and asking for help is part of the NMC’s code of conduct (2008).
A nurse must also have the knowledge to recognise normal and abnormal human functioning and the evidenced based interventions that can be used (Brooker & Nicol 2011). The care should also be safe, have the patient’s best interests, involve the multi-disciplinary team (MDT) and the patient, and informed consent should be obtained (NMC 2008). Evaluation of achievement is conducted to see if the best action or intervention has been used. Reflection will indicate if current goals should be maintained or if new goals are required for the patient (Siviter 2008).
However, the achievement of the goals can be subjective and difficult to measure. To evaluate if the goals have been achieved, listening and observation needs to be conducted and it is important to remember 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 appropriate 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 Parkinson’s and Diet leaflet, designed by the Parkinson’s 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 Gale’s 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 directed to age UK who can provide details of benefits, home and shopping assistance (Age UK 2012).
All of Mrs Gale’s 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 choice (NICE 2007). Personal development plan (University of Southampton 2012) Identified areas for further development Heart: 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 understanding 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 development
In 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 placement. This will improve my communication skills and my confidence (NMC 2008). Furthermore 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 need 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 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 any available funding that they might 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 Parkinson’s disease and also on my research into the use of BMI and MUST (Eknoyan 2008; MAG 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, workshops and meetings that deal with patient care and conditions. While on practice experience two, I would like 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.