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Knowledge and Skills for Nursing

The Setting

The setting is a medical ward; patient was admitted due to diarrhoea and vomiting as a result of alcoholism and malnutrition. Hospital medical ward consists of patient that needs proper approach and nursing care to shorten their stay in the hospital. The patient will be treated not only physically and physiologically but also mentally since the patient was having such difficulties because of depression. The patient started to become depressed when her husband dies. She became an alcohol dependent and her health started to deteriorate due to malnutrition.

The Approach

The patient was brought to the hospital with diarrhoea and vomiting. The patient is physically not well, pale and has a poor hygiene. Based on the background check patient had suffered severe depression because her husband died and live alone. The patient became alcoholic and her health deteriorated because of malnutrition. The patient looks underweight but can survive by giving proper medication and patient care.

The nursing process can best be described as a framework for planning individualized care for patient with intellectual disabilities. Since the care for patient is a process it does not conclude into anything but rather it changes constantly and it is the nurses’ responsibility to respond to these changing needs whenever necessary. The nursing process usually comprises four or five stages depending on the resources available and work setting, and includes: diagnosis, assessment, planning, implementing and evaluation. The nursing process should be undertaken using a collaborative and participative approach with other professionals, gathering and implementing resources, in order to improve the care process (Department of Health 2000b; Department of Health 2001). The focus of this study will be on the design care plan for our patient on study.

Assessment

Assessment is the most important part of care planning and delivery. It includes areas such as health and health needs, daily living skills, activity programmes, mobility, mental health, risks to the client, finance, respite, social events/outings, support requirements, spiritual needs and, possibly, accommodation issues (Department of Health, 2000b;Sox, 2004a). As a start, a background check is needed to be able to assess the situation of the patient. Our patient is conscious but was not able to respond properly because of her condition. So we need someone close to the patient or a relative to answer questions needed for the care plan. Data such as previous hospitalization, medication taken and others related to the patient condition is important.

Diagnosis

The patient was brought in the hospital because of diarrhoea and vomiting. The initial diagnosis is that the patient is dehydrated base on the physical appearance of the patient. Diarrhoea usually gets better on their own, often without treatment. If the diarrhoea continue within several days it is best to check patient’s medical history and physical exam.

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Planning

In planning, the nurse plays an important role in the recovery and stay of the patient in the hospital. The patient upon admission was given attention on the main complain which is diarrhoea and vomiting. However further diagnosis and assessment of the medical team discovered that the patient is suffering from malnutrition. Our plan focuses on malnutrition; the reasons why the patient is having this kind of condition, and the treatment and the protocol that the nurses should follow for the welfare of the patient.

Implementation

Implementation of a care plan is the most challenging part of the nursing process. The patient is pale and has lost a lot of weight. The patient also lacks proper hygiene as a result of her appearance upon admission. The implementation of the care plan will begin upon admission. The patient will be forwarded and referred to the nursing staff on duty in the medical ward and will be given the care plan as agreed upon by the medical team and the patients relative. Malnutrition Evaluation will assess the effectiveness of the care plan and the implementation of the care. It is important to evaluate the point for care to be able to reach its desirable care plan. An updated review should be done to correct and improved the plan.

The Model

In simple language, a model is described by Pearson and Vaughan (1993) as a descriptive picture of practice which adequately represents the real thing. Riehl and Roy (1980:11) cited in Roper et al (1990) provide  a more elaborate definition of a model as "a systematically constructed, scientifically based and logically related set of concepts which identify the essential components of nursing practice, together with the theoretical bases of these concepts and the values required for their use by the practitioner."

Choosing an appropriate model is important to help the care planning effective. In UK, the model of nursing used most predominantly is that of Roper et al, 1980 that bases its principals on a model for living. It provides a holistic care approach and involving the important component of the daily activities of a person. The model is made up of five components: Activities of daily living (ADLs), Lifespan, Dependence/Independence continuum, Factors influencing ADLs, and Individuality in living. (Roper, Logan, Tierney, 2002). The case of our patient needs to be assessed physically, physiologically but also mentally. The effect of losing a husband has led our patient to become ill. The Roper, Logan and Tierney are believed to be a useful approach in dealing with our patient since it involves a holistic approach.

The model was named after the author of the model, Nancy Roper, Logan and Tierney. It was first developed in 1980 based upon the work by Nancy Roper in 1976. The model is based on the 12 activities of living in order to live. The model has been revised several times 1985, 1990 and the latest version 1998. The 12 activities involve the following: maintaining a safe environment, communication, breathing, eating and drinking, elimination, washing and dressing, thermoregulation, mobilisation, working and playing, expressing sexuality, sleeping, and death and dying. Each of the activities might be seen to be conceptualised as lying on a continuum from dependence to independence. There are times in our life that we may be more dependent on others to meet our needs. The role of the nurse is to help people move towards independence in all activities of daily living. Biological, physiological, socio-cultural, environmental and politico-economic variables are factors that impact on the individual and affect their levels of dependence /independence.

Advantages and Disadvantages of Roper, Logan and Tierney

Based on the study done by Pearson and Vaughan (1993) model of nursing is important in hospital ward or department. One of the advantages of the Roper, Logan and Tierney model is that it leads to consistency in the style of care received by patients and thus to a continuity of care patterns and treatments. The Roper, et.al. Model will give rise to less conflict within the team of nurses as a whole. Because of the rationale and definition behind the model other healthcare involved will understand better the logic of care. Roper, et. al model is said to be self explanatory or not too complicated as compared to others. It is said to be done this way in order "to assist learners to develop a way of thinking about nursing in general terms." It is mentioned above that main concept of the Roper, Logan and Tierney model is based mainly on twelve activities of living which is the main elements of nursing and is referred to as “basic human needs”. According to Roper, Logan and Tierney the activities of living have an advantage for nursing model since they are observable, describable, and in some instances, objectively measured.

The model is mainly focused on the twelve activities while the theory is built on 'living' and addresses the nursing activities as a deliberative approach to meet the twelve components of nursing care. It conceptualises the Person as a biological being with inseparable mind and body and Health as the ability to function independently in relation to the twelve components (Fitzpatrick and Whall 1989).

The Care Plan

The initial diagnosis on the patient under study is diarrhoea, alcoholism and malnutrition. However as the process of identifying the cause of the patient’s condition, nurse attending to her needs found out about the death of her husband. After background check they have found out that the patients’ husband died and became depressed because of the situation. During assessment on the patient’s health it has been noticed that the patient has mental health problem. The health needs of a patient is also important and the nurse involve should be aware of these needs. To help the patient, nursing process and nursing model should be working hand in hand to help the patient survive. Assessing the need of the patient is important. The Roper, Logan and Tierney model will ensure that the patient should be able to have a safe environment, should be communicating with her nurse attending to her, breathing, eating and drinking, working. Because of its holistic approached, Rogan. Logan and Tierney model is widely used. To evaluate the situation of our patient, the alcoholism of our patient might lead to liver disease and will be affecting the daily activities of life. The patient should trust her nurse and they should have a good relationship to have an effective care plan. The chosen model Roper et al have described the course of life as something that starts at conception and lasts until death. The model involves maintaining a safe environment; our patient should be living in an environment that she will be comfortable and clean. The patient upon admission has seen to have poor hygiene. In identifying the activities of living the individual should be engage in personal cleansing and dressing. As described in the admission of the patient, the patient has poor hygiene. The patient may have pressure sore due to her stay in the hospital. This should be treated and approached very well by the nurse handling her. Pressure sore is the result of being immobile of the patient. The length of stay of the patient in the hospital should be shortening to avoid such condition. The nurse must assess how to help the patient to cooperate on the agreed care plan.

Implementing the care plan will need the cooperation of the patient. It is important to help the patient to overcome the depression that she is experiencing. In this case the patient may not cooperate at the start of the plan but will be eventually cooperate as the process continues. The success of the plan depends on the cooperation of the patient and the nurses.

Throughout life, our ability to perform ADLs will move from one extreme and possibly back again. This aspect of the model of living, therefore, interlinks with the model of nursing with effectively, each reliant on the other. The patient will have a chance in recovering from the health problem that she is encountering. The Roper, Logan and Tierney model is appropriate to approach the case of the patient in a holistic way.

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Conclusion

The nursing process includes stages that should be completed to help the patient overcome the disease she is in. By means of this we will be able to identify which factors should be given enough attention to prevent the occurrence of such disease. The study includes the nature of care planning, person centred are planning, care management, health action planning and the care program approach. This study also introduced some relevant actions that need to be taken. The use of the Roper, Logan and Tierney model are described to help the nursing process to become successful and effective. The Roper Logan and Tierney is a holistic approach and are important to work with the nursing process. This study has also advocated the need for robust, professionally prepared care plans based on a systematic nursing assessment.

Proper planning is important in dealing with the patient especially on those that are in admitted in the hospital because of different illnesses which can be cured and overcome if proper nursing process and model will be used. A nursing process is important to evaluate, assess, cure and eliminated illnesses of person. Our patient became sick because of depression and problem, which needs to have a proper attention on different aspect. She must be treated physiologically, physically and psychologically. Nursing model should be holistic if this is the case. The patient’s daily living activity is affected and she needs to understand why such activity such is done for her wellness. Patient should be very well educated or informed on the benefits that she will be having if she will cooperate on the agreed care plan.

Reference

Roper, N; Logan, W; Tierney, A; 2002 The Elements of Nursing 4th edition. Churchill Livingstone, Edinburgh

Department of Health (2000a), Nurses, Midwives and Health Visitors (training) Amendment, London Department of Health.

Department of Health (2000b) The NHS Plan. www.nhs.com.uk

Goddard M, McDonagh MS & Smith DH (2000) Measuring appropriate use of acute beds: a systematic review of methods and results. Health Policy 53 157-84.

Coast J, Inglis A & Frankel S (1996) Alternatives to hospital care: what are they and who should decide? British Medical Journal 312 162-6.

Pearson A. and Vaughan B.(1993) Nursing Models for Practice. Oxford. Butterworth Heinemann.

Riehl J. and Roy C.(1980) Conceptual Models for Nursing Practice (2nd. Ed.) New York. Appleton Century Crofts. In Roper N., Logan W., and Tierney A.(1990) The Elements of Nursing (3rd. Ed.) London. Churchill Livingstone.

Fitzpatrick J. and Whall A.(1989) Conceptual Models of Nursing: Analysis and Application (2nd.Ed.) London. Prentice Hall Int.

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