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Health and care of a loved one is always a sensitive issue. Too often children make the difficult decisions for their loved ones, instead of having collaboration. It is important to provide an individual plan in order to care for all aspects of the person's needs. In the case of Susan Smith, her desires and wishes need to be addressed along with the concerns of her children. Issues such as Mrs. Smith's health, safety, socioeconomic status, ethical concerns, legal issues, along with any other important issues will be discussed in further detail. By identifying these key health concerns the burden can be decreased allowing for an improved quality of life, while providing reassurance to the family that their loved one is safe.
Health status is closely related to quality of life. It has been reported that most Americans will be living with an average of two chronic illnesses, which makes providing care difficult. Patients present with not only the acute symptoms, but along with the chronic issues such as diabetes or arthritis. In the case of Mrs. Smith, she has a health history of CAD, insulin-dependent DM, significant hearing loss, osteoarthritis of the hips, hands and knees, spinal stenosis, history of breast cancer, and dry macular degeneration. All of these disease processes can significantly affect the quality of life of Mrs. Smith. Beginning with CAD, as a healthcare provider, education needs to be provided on the importance of a low fat diet. Mrs. Smith should also be informed that her race predisposed her to heart disease and the need for change is highly suggested. This important lifestyle change should also be incorporated with some type of exercise regime to decrease the LDL's while increasing HDL, while decreasing cholesterol. Lastly since Mrs. Smith is older, it is also important to discuss the use of medication to decrease her risk of a heart attack. In doing so she needs to be aware of the medications purpose, frequency, and importance side effects.
Strict control of Mrs. Smith's diabetes needs to be a top priority also. If she had a history of uncontrolled diabetes it can lead to complications such has diabetic retinopathy and kidney problems. Continuous education should be provided to ensure proper dosing and control. Since Mrs. Smith has a diagnosis of dry macular degeneration, it is important to assess how her insulin is being given. If she is drawing up the insulin, are the numbers on the syringe large enough, or if from an insulin pen is she able to see the number of units from her peripherals? All of these concerns need to be addressed. The best way to ensure proper administration would be to watch her give her insulin. If she is struggling with administration, an insulin pump may be suggested to insure adequate insulin dosing.
Another issue to be discussed with Mrs. Smith is her osteoarthritis. She suffers from this degenerate joint disease in her hips, hands, and knees which can greatly decrease her ability to do every day task. As a nurse, evaluation of current treatment needs to be done. Determine whether or not Mrs. Smith believes her current treatment is adequate in controlling pain. If not, collaboration with the physician needs to take place to determine what medications can be prescribed to allow her to function to the best of her ability. If she feels that medication has proven unsuccessful, joint replacement can be discussed. This is the only cure for this ailment, which needs to be made clear. Also education needs to be provided about planned rest activities to deal with the pain and the importance of weight bearing exercises to decrease stiffness. Lastly as a nurse, alternative methods of treatment can be suggested such as hot/cold packs, massage, and acupuncture.
As the body ages it is normal for some wear and tear. However in Mrs. Smith's case, her vision is going along with her hearing. Since she has been diagnosed with dry macular degeneration, as a healthcare provider it needs to be stressed the importance of biannual vision checks or if there is a sudden change the importance that this is a medical emergency and medical attention should be sought. Treatment options also need to be discussed such as laser photocoagulation therapy and vitamins such as vitamin E,C,A, and Zinc Oxide to name a few. Educating the patient on how to deal with this vision change is required in order maximize function. Patient education focusing on where to place literature such as in the peripheral vision, maximizing lighting to insure adequate vision, and the use of assistive devices as talking phones are of the utmost priority. Not only does Mrs. Smith have a vision problem she also suffers from hearing loss. Communication needs to be face to face with minimal distracts. Clarification may be necessary to make certain the message has been received. Lastly like with vision impairments, educating Mrs. Smith on annual screenings, use of a hearing aid if necessary, and assistive devices such as a vibrating alarm clock can be suggested.
Overall these are some of the major heath issues that need to be addressed. Care should be focused as whole instead of on each specific disease process. Throughout the caring process, Mrs. Smiths needs and desires need to be addressed. Empowering the patient when it comes to his or hers' own health will allow for a better outcome. The patient is more apt to follow the designated plan since it is individualized to him or her. Family also needs to be included in all health discussions since most of the care will be provided by the family. Proper communication about health can make treatment much more successful as a whole.
Safety is of the utmost importance when it comes to the elderly population. Mrs. Smith is 81 years old and has recently become more confused and accident prone in the last six months. Mrs. Smith and her children need to discuss major concerns either of them may have. Driving limitations may be required due to the increase in recent accidents. Suggestions may be limiting driving to only during the day. It may also be necessary to have Mrs. Smith retake the driving test to determine whether or not she is capable of driving. Another safety issue that needs attention is the fact that she is living alone. She believes that she if fully capable of living in her home, however there was a house fire that caused significant damage. A safe environment is key having properly working smoke detectors, carbon monoxide detectors, fire extinguishers, and much more. Lastly, placement of Mrs. Smith needs to be determined. Since her closest relative is six hours away a designated care giver needs to be decided. Whether Mrs. Smith moves in to an assisted living home, rebuilds and has roommates, or has an in home nurse check in periodically a care plan must be determined. It is importance to include both the family and Mrs. Smith in this life changing decision.
It is becoming increasingly difficult for Americans to thrive financially especially the elderly. Many are on fixed incomes and the nest egg which may have been saved isn't going as far due to the economic hardships. Mrs. Smith is on a fixed income, so the idea of a nursing home or any type home health nurse would be very expensive, this may cause a financial burden on her children. It also needs to be acknowledged that she has over drawn her accounts three times. Many companies allow for automatic withdraw programs which would allow for her bills to be paid on time. One of her children may need to oversee Mrs. Smith's finances to prevent over draft fees from occurring. She should still have access to her accounts to allow for her independence but have a co-signer on the account to make sure everything is in order. Also discuss with the banks about possible setting up an account just for her with a limited about of money with overdraft protection, which can be used as sort of a monthly allowance. Lastly Mrs. Smith is adamant about returning home. A serious discussion between her and her children needs to occur to determine whether or not she is financially able to rebuild and if it is in her best interest.
The placement of Mrs. Smith is a huge ethical dilemma. Her children want her to move either closer to one of them or into a nursing home. She however wants to return home. The question becomes who to follow. Both sides of the argument need to be addresses to find a common middle. All aspects of care need to be addressed such as health, safety, and finances to determine the best placement. Other ethical issues such as finances exist. Mrs. Smith still needs to be in control of her finances with some supervision of her accounts by her children. Lastly, these decisions will affect mainly Mrs. Smith so it is important for her input to be included.
After being released from the hospital Mrs. Smith went to Chicago where she stayed with her one child while her house was being rebuilt. This gave her time to spend time with her child and grandchildren. This temporary stay was an alternative to the nursing home which greatly reduced the cost on Mrs. Smith during the rebuild. After careful discussion with her children, Mrs. Smith decided on the option of having a home health nurse come and visit. This allowed still for her independence yet gave the family reassurance that someone was there if ever needed. Mrs. Smith was also signed up for Meals on Wheels program to decrease some of the hazards related to cooking. Besides this service the home health nurse will be responsible for the cooking of meals. This will take some of the hassle away from Mrs. Smith when going to the store. The transition her child's home to her rebuilt home occurred smoothly. Health wise, Mrs. Smith has all the previous health conditions but with some difficult due to the burns. She has difficulty with sensation after the fire. She has been educated to use mittens when touching hot or cold objects. the home health nurse takes her to her weekly physical therapy sessions to improve her ADL's and improve quality of life. Financially she has not had any problems with over withdrawing her account since her children have over taken her accounts. She still enjoys her independence with the allowance she is given weekly to spend however she would like. She is able to go to the local market with assistance from her home health nurse to buy local produce and flowers. She has also begun going to the local senior center to enjoy the company of her fellow community members. Overall Mrs. Smith's transition to home happened without any significant problems. Mrs. Smith is able to enjoy the rest of her life in the comfort of her own home with some assistance from the outside.
NURS 430 Final Synthesis Paper Grading Rubric
Student ______________________________________________ Date__________________________________
Does Not Meet
Identifies key issue(s) and converts to a problem statement
Does not show comprehension of the situation to be able to identify the key issues
Shows comprehension of the situation and correctly identifies some key issue(s) but does not articulate a reasonable problem statement
Shows good comprehension of the situation and correctly identifies most key issue(s) and articulates reasonable problem statement(s)
Comprehends situation to be able to identify key issue(s) and articulate valid problem statement(s)
Considers the situation from multiple perspectives
Does not consider the problem(s) from different perspectives to view it comprehensively
Brings out some of the perspectives applicable to the issue(s), but leaves out some aspects; hence, problem identification suffers from this bias/skew
Does not show the ability to combine these different perspectives to view the issue(s) more comprehensively
Considers the issue(s) using a few applicable alternate perspectives, but does not use this to "frame" the key issue(s) realistically/originally
Shows evidence of combining some of the alternate perspectives to present well rounded issue(s)
Considers the issue(s) from multiple perspectives and uses this to "frame" the key issue(s) realistically/originally
Is able to combine different perspectives and relate them to each other effectively to comprehend the issue(s) more comprehensively
Demonstrates ability to identify and evaluate information
No evidence of search, selection or source evaluation skills
Demonstrates ability to search and select information sources, but evaluation of sources is not quite adequate
Demonstrates adequate skills in searching, selecting and evaluation information sources to meet information needs
Evidence of search, selection and source evaluation skills to meet information needs
Displays ability to identify uniquely salient sources
Displays ability to explore alternate options to the identified problem
Does not come up with alternate feasible and original options
Makes an effort to minimally explore alternate solutions but plays safe, does not risk uncertainty associated with original solutions
Explores alternate solutions to the problem but these are not very original, tends to play safe to an extent
Explores and comes up with original, relevant alternate solutions to the problem
Makes convincing arguments for recommended option, aligned to the given context
Fails to identify conclusions, implications, and consequences of the issue
Doesn't propose solution to problem
Does not clearly identify conclusions, implications, and consequences of the issue
Proposes solution to problem(s) without much investigation and analysis
Analyzes conclusion, implications, and some consequences of the issue
Proposes solution to problem(s) with some investigation and analysis
Analyzes conclusions, implications, and the majority of consequences of the issue
Proposes solution to problem(s) based on detailed analysis
Justifies the recommended option and recognizes the implications
NURS 430 Final Synthesis Paper Grading Rubric (cont)
Does Not Meet
Overall Organization, Format and Style
Provides a structure and organization that is not cohesive or coherent
Provides a structure and organization that is somewhat cohesive and coherent
Provides a structure and organization that is generally cohesive and coherent
Provides a structure and organization that is strongly cohesive and coherent
APA Format and Style
Demonstrates improper use of appropriate document formatting guidelines
Integrates quotation and exhibits inappropriately
Demonstrates inconsistent use of appropriate document formatting guidelines
Integrates quotations and exhibits inconsistently
Demonstrates appropriate use of appropriate document formatting guidelines
Integrates quotations and exhibits appropriately
Demonstrates excellent use of appropriate document formatting guidelines
Integrates quotations and exhibits effectively into the analysis