Care Delivery and Care Management in Nursing - Case Study Example

Care Delivery and Care Management in Nursing Word Count: 1736 Introduction: This is an account of nursing care for Mr. John Smith applying nursing process. Mr. John Smith is a pseudonym, and his identity will remain undisclosed. This patient is a 74-year-old resident in a nursing home. He is a patient with confusion and memory impairment. While rendering nursing care to him, it is necessary that a nursing process is utilized to assess and develop a care plan for him. This takes care for an all-round care of the individual, and but in this assignment, only the part of maintenance of safe environment will be in focus. (Kurtzman and Corrigan, 2007, 20-36). This patient, Mr. John Smith has mental disability. Maintenance of Safe Environment: The nurse plans therapeutic interventions for clients with actual or potential risks for safety based on the nursing assessment of the risks and a development of a care plan for the specific client through a process called nursing process (Scott-Cawiezell and Vogelsmeier, 2006, p. 179-215). Nursing Process: The Roper et al. model for nursing offers a framework where during care, the nurse is able to ensure that his individuality is taken adequate care of and provided due weightage. The Roper-Logan-Tierney model recommends a problem-solving approach in the nursing process (Roper, Logan, and Tierney, 1983, 17-19). Deriving from this, nursing process can be defined as a systematic approach to planning and delivering nursing care. This process comprises of four main stages, namely, assessment, planning, implementation, and evaluation. After the problem is determined, the nurse can then assess the needs of the patient. Depending on the needs, a plan of care is developed, depending on which the nurse can determine nursing goals. Once the goal is set, the chosen nursing care strategies can then be implemented, after which, it is also important to evaluate the care process, since any gap can be rectified through evaluation (Roper, Logan, and Tierney, 1983, 17-19). Assessment: Assessment is a cyclical process, reviewing the collected information to identify the problems. The first question is whether Mr. Smith is able to maintain his safe environment. The answer obviously is no. It was impossible to obtain information from Mr. Smith. His main and actual problem was that he was unable to maintain his own internal and external safe environment due to his confused and impaired cognitive state. Rate of breathing, pattern of chest movement, presence of cyanosis, and pulse oximetry are important steps of assessment. It is important to remain aware that if needed, oxygen needs to be prescribed. Neurological assessment needed to be undertaken to assess the state of confusion and cognition. The aggression was also needed to be assessed. A safe external environment needed to be assessed by positioning of Mr. John Smith on bed, protective devices, and his own mobility. Apart from these, it was also important to assess whether all equipment for emergency care was within reach and was in working order. These included oxygen, suction apparatus, emergency trolley and resuscitation kit (Lesa and Dixon, 2007, 166-172). Identification of the Actual and Potential Problems: While assessing Mr. Smith, his actual and potential problems were prioritized. He was elderly with confusion and memory loss. Therefore, he was dependent for his care and needs. His religious and spiritual needs were also important parts of the assessment. His most important need was his care needs in terms of safety. Once his respiratory safety was ensured, his other actual problems were identified. He was having a problem with mobility due to age and confused state. This would call for positioning in the bed, safety arrangements in the bed and bed to chair mobility. Due to bed-ridden condition, he might have pressure sore or deep vein thrombosis (Roper, Logan, and Tierney, 1983, 43-44). Independent movement was also unsafe. He could end up having falls that is a safety risk. He was having aggression that could potentially lead to adverse cardiac events or trauma risks, again violating his safety. He was having problem of not being able to eliminate adequately or normally, potentially leading to problems with this nutrition. He was not being able to eat and drink adequately that had the potential to lead to nutritional eficit and dehydration. He was not being able to meet his own activities of daily living (Roper, Logan, and Tierney, 1983, 24-27). Planning Care: Mr. John Smith needed to be continuously and repeatedly assessed in terms of vital signs, respirations, aggression, and mobility. It was decided that he may be restrained. The plan was to promote nonaggressive, nonabusive behavior. Appropriate cares to satisfy Mr. Smith's rights were to be assumed. The plan was to focus on prevention and de-escalation before violence occurred. While implementing this plan, it was decided to avoid personal behaviour that can provoke aggression. During his care, the tone of voice, conversations, reactions to conversations were implemented in such a manner that he had no scopes to get into an argument with the nurse. Adequate calmness was shown, and on the face of his anger, apologies were made gracefully, and patronizing behaviour was avoided. Appropriate nonverbal communication was used, and he was motivated to talk in privacy with cool politeness both in terms of language and body language. His behaviour was monitored, and he was gradually taken into confidence (Bonner and McLaughlin, 2007, 810-814). His bed rails were decided to be padded, and a plan was worked out where his position on the bed would be changed every 2 hours with daily supervised walks. For elimination and toileting needs, he was encouraged to attempt toileting along with requirements of his fluid and nutrition were also planned. During his care, the initial goal was to earn his confidence by means of behaviour. This was attempted with behavioural modification with plans to minimal reduction of aggression, supervised mobility for 5 min, small bedside exercises, and elimination and fluid and nutrition regularity within 7 days that would gradually improve to control of anger, supervised mobility for 15 min, unsupervised bedside exercise, and unattended elimination in 15 days, with participation in milieu, calm behaviour, no needs of repositioning, independence in terms of elimination, fluid and nutritional intakes over a period of 3 months (Roper, Logan, and Tierney, 1983, 22-23). Evaluation: When this care plan was agreed by Mr. Smith, he was constantly and repeatedly assessed in order to evaluate. As expected, his condition was gradually improving, and this led to change in his environment. Since the goals were met, it can be stated that the intervention was successful. While assessing these, all the parameters stated above were evaluated to examine partial or total achievement of the goal, whether the problem was static demanding a change of assessment and the care plan, whether his problems were worsening violating his safety so the goal and intervention needed to be reviewed, whether the goal setting were wrong, or whether the goal required interventions from the other members of the team (Conway and FitzGerald, 2004, 121-127). Reference Bonner, G. and McLaughlin, S., (2007). The psychological impact of aggression on nursing staff. Br J Nurs; 16(13): 810-814. Conway, J. and FitzGerald, M., (2004) Processes, outcomes and evaluation: challenges to practice development in gerontological nursing. J Clin Nurs; 13(6B): 121-127. Kurtzman, ET and Corrigan, JM., (2007). Measuring the Contribution of Nursing to Quality, Patient Safety, and Health Care Outcomes. Policy Politics Nursing Practice; 8: 20 - 36. Lesa, R. and Dixon, A., (2007). Physical assessment: implications for nurse educators and nursing practice. Int Nurs Rev; 54(2): 166-172. Roper, N., Logan, W., and Tierney, A., (1983). Nursing process. 1. A nursing model. Nurs Mirror; 156(21): 17-19. Roper, N., Logan, W., and Tierney, A., (1983). Nursing process 4: identifying the goals. Nurs Mirror; 156(24): 22-23. Roper, N., Logan, W., and Tierney, A., (1983). Activities of living: a model for nursing. Nurs Times; 79(9): 24-27. Roper, N., Logan, W., and Tierney, A., (1983). Nursing process. 3. Problems or needs Nurs Mirror; 156(23): 43-44. Scott-Cawiezell, J. and Vogelsmeier, A., (2006). Nursing home safety: a review of the literature. Annu Rev Nurs Res; 24: 179-215. Read More