Treatment of Elderly Patients Who Suffered from Stroke - Essay Example

A Change Proposal to Improve the Quality Care For Stroke Elderly Patients - Pouring of Water into the Patient’s Cup - Table of Contents I. Introduction ……………………………………………………….. 3 II. Benefits of Training the Stroke Elderly Patients to Perform ADLs . 4 III. Proposed Solution in Enabling the Elderly Patients to Pour Their Own Cup of Water …………………………………………. 5 IV. Strategic Planning for the Proposed Solution …………………….. 6 IV. Kurt Lewin’s Theory ……………………………………………… 6 V. Conclusion …………………………………………………………. 7 References …………………………………………………………………. 8 - 10 Introduction Aging has a great effect on the neurological deficits, brain and physiological functioning of each individual. (Gong et al., 2004) Elderly patients who has recently suffered from stroke resulting to neurological, perceptual, or cognitive impairment such as dementia (Senanarong et al., 2003) normally lives with a significant sensorimotor deficits which impedes their performance on activities of daily living (ADL) (Mercier et al., 2001) especially when their upper extremities particularly the hand-arm functioning is affected. (van Tuijl et al., 2002) Water is the most important part of proper nutrition among the elderly patients. In the absence of water intake, it is possible for the elderly patients to suffer from serious dehydration and high sodium content in the elderly patient’s body. A lot of physiological disorders such as the loss of thirst sensation, inability to communicate with the health care providers, and kidney malfunction among the elderly patients affects their regular water intake consumption. (Maughan, 2003; Bart et al., 2004; Bobroff, 2003) The average fluid urination for each individual should be around 1,400mL and 900mL expiration and perspiration depending on the daily activity of an elderly patient. (Maughan, 2003) The amount of water output from each person decreases with age roughly lower than the recommended daily allowance (RDA) of 1,200mL. (Bartl et al., 2004) Based on a study, Persson et al. (2000) stated that water excretion measures roughly an average of 1,744mL in comparison to the normal water intake of 1,911 mL for males and 1,787 mL for females wherein 6 to 8 glasses of water is roughly around 1,400 to 1,900 mL. Even if the stroke elderly patients go through some neurological rehabilitation, there is still a big population of the stroke patients that survive experience chronic motor impairments including some limitations in performing the activities of daily living (Fasoli et al., 2004). For this reason, it is necessary to train the stroke patients to do their own activities of daily living in order to optimize their motor recovery and prevent a long-term dependency on the health care professionals. In line with optimizing the motor recovery of the stroke elderly patients, this study will discuss about the benefits of training the stroke elderly patients in performing the activities of daily living on their own and propose a new strategy to improve the quality life of the elderly patients by enabling them to pour their own cup of water in order to promote physical exercise and prevent dehydration. Benefits of Training the Stroke Elderly Patients to Perform ADLs Several studies proves that rehearsing the mental functioning of the stroke elderly individuals could produce positive effects in their actual movements (Martin et al., 1999; Driskell et al., 1994) as well as the regain of their muscle strength (Yue and Cole, 1992). A recent study shows that the use of separate physical and motor training could enhance the control of physical and mental functioning. (Gentili et al., 2006) In order to improve the recovery stage of the stroke elderly patients and avoid unnecessary dehydration, it is essential for the nurses to find ways to encourage the stroke elderly patients to pour water from the pitcher into their own cup. The stroke elderly patients could recover their proper movement of hands and mental functioning by regularly participating in a constant redistribution of activity with the use of multiple cortical motor functioning (Marshall et al., 2000) and through mental exercises such as mental imaginary of certain hand movements (de Lange et al., 2005; Stevens and Stoykov, 2003). The psychological processes in stroke patients plays a vital role in the recovery of motor functioning particularly the perceived control. (Johnston et al., 1999) Proposed Solution in Enabling the Elderly Patients to Pour Their Own Cup of Water Personally, I have noticed that the kitchen staff provides the elderly patients with a full jar of water every morning. Considering the weak muscle strength including the other physical, mental, and sensory dysfunction among the elderly patients, it is difficult for them to pour some water into their own cup coming from a jar full of water. Particularly the heavy weight of the jar makes them unable to balance their control over the jar causing them to spill some water on the floor and/or table. For this reason, it is necessary for the nurses to assist them in pouring the water into their cup. For a short period of time, I did some experiment leaving a half-filled of water in each jar. I have noticed that most elderly patients were able to manage filling their cup with water without the need for any assistance on the part of the nurse. As part of the change proposal, I approached my mentor regarding this matter. After the discussion, I was granted the permission from my mentor to approach the ward manager and the kitchen staffs who work for the elderly ward concerning my proposal for a change. At first, I had a hard time convincing them to implement the necessary changes within the ward practice since the initial response I got from the kitchen staff is their limited time to re-pour the water several times a day. Through proper communication, I was able to share my own idea as well as my opinion with regards to the situation within the elderly ward and eventually became successful in motivating them to accept the changes towards a new and more efficient practice. Strategic Planning for the Proposed Solution Strategic planning is necessary when planning for a change to take place within the health care environment. When conducting a strategic planning, an effective communication and interaction between the stakeholder(s) is essential. Resistance to change within an organization is common during the first stage of planning. For this reason, the implementor has to be ready in providing the stakeholders with a well studied evidences and explanation for the need to implement a new plan. Kurt Lewin’s Theory When proposing for a change, it is necessary for the implementor to motivate all the stakeholders (nurses, physicians, kitchen staff) or anyone who is directly involved in the implementation of a new plan in order to encourage these people to actively participate and accept the necessary changes in the quality care practices for the elderly patients. The use of Lewin’s theory works very well in the implementation of the new plan because it involves the need for a proper action plan which was done through observation that the elderly patients are having a difficult time pouring a full jar of water into their cup; and gathering of necessary facts and information by conducting a critical thinking, analysis, and experimental solution prior to proceeding to the next phase of action. This theory focus on areas which involves the human resources and uses educational programs in order to promote the necessary changes efficiently. By doing so, the implementor was able to gather enough evidences in influencing all the participants to comprehend with what is expected from them correctly. As soon as the new plan will be implemented, it is necessary to ‘unfreeze’ the method used in preventing dehydration and the promotion of activities of daily living among the elderly patients within the ward in order for the new plan to be fixated as a common practice of elderly care. The ‘moving’ process highly depends on the cognitive restructuring among the participants and their acceptance with their new role. When the implementation of the new plan has become successful, it is also essential to ‘re-freeze’ the newly implemented procedures so that the participants would stick with it and encourage the rest of the health care team to be accustomed with the proposed plan and process. (Rouda, 1995) Conclusion Elderly patients especially those the stroke elderly patients need to exert extra effort in performing their own activities of daily living in order for them to regain their physical strength and avoid dehydration. When implementing a plan for a change, the use of Lewin’s theory is effective since it involves the need for a proper action plan, and gathering of necessary facts and information prior to proceeding to the next phase of action. The careful study in each plan of action makes it effective in convincing the rest of the health care team to accept the proposal for a change. *** End *** References: 1 Bart, R. et al. (2004) ‘Continuing Education: Geriatric Nutrition’ Nutrition and Dietetics. 61 (Maughan), 236 – 239. 2 Bobroff, L.B. (2003) ‘Elder Nutrition: Aging in the 21st Century’ University of Florida. IFAS Extention. pp. 1 – 6. 3 Driskell JE, Copper C, Moran A. (1994) ‘Does Mental Practice Enhance Performance?’ J. App Psych. 1994;79:481 – 492. 4 Fasoli SE, Krebs HI, Stein J, Frontera WR, Hughes R, Hogan N. (2004) ‘Robotic Therapy for Chronic Motor Impairments After Stroke: Follow-Up Results’ Arch Phys Med Rehabil. 2004;85:1106 – 1111. 5 Gentili R, Papaxanthis C, Pozzo T. 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