RLT Activities of Living Model - Essay Example

?Care Plan Table of Contents Introduction 3 Assessment 4 Problem Identification 8 Goal ment 13 Nursing Intervention and/or Implementation 15 NMCCode (2008) 16 Evaluation 17 Conclusion and Reflection 19 References 20 Introduction As per the case scenario, Mrs. Jones is a widow of eighty years old and resides alone. She and her next door neighbour used to visit the social club frequently as a leisure activity to play bingo. However, the lifestyle enjoyed by Mrs. Jones got disrupted after she was diagnosed with the problem of falls, sever osteo-arthritis and a hip replacement need. After her diagnosis of the aforementioned health problems, she also lost her income source. At a certain instance, she was identified to have experienced a fall and was lying in her kitchen for approximately forty-eight hours, as reported by her neighbour. Her records also depict that she has a daughter who used to visit her twice in a month. In lieu of this case study, the discussion henceforth will aim at developing a care plan with the objective of offering elderly people with adequate assistance on the grounds of sociability, depression, physical health problems, loneliness and other health related issues. In accordance with the case, the healthcare facility will majorly aim at offering Mrs. Jones with healthcare services in relation to her risk of short term health troubles such as cold (hypothermia), constipation and fear of mobility. Notably, with this concern, due significance will be rendered towards implementing the guidelines suggested by the Nursing and Midwifery Council (NMC) and by using the Roper, Logan and Tierney (RLT) activities of living model. Assessment In nursing, there are many conceptual models which provides the basic framework in accordance with which nurses should evaluate and formulate plans as well as implement those plans with the objective to offer the patients with better care facilities and services (Nicol, 2013; Timmins & McCabe, 2008). Roper, Logan and Tierney (RLT) Activities of Living Model The RLT model has been formulated with the aim of supporting elderly people with adequate care and improving their psychological as well as physical conditions to enjoy a healthy living. Nurses, with the assistance of RLT model, are quite likely to be facilitated with the opportunity of offering individualised care services to ageing people (Nicol, 2013; Coyne & et. al., 2010). Additionally, this model has been undertaken with the intention of determining the issues or problems which are faced by Mrs. Jones. This model will aid nurses in offering adequate and effective services to the patient with the aim of improving her health problems as well as psychological conditions (Timmins, 2005). A problem solving approach has been adopted likewise, with the intention of devising appropriate care services. There are five concepts under this model which include the following: The 12 Activities of Living (ALs) The 12 activities of living signify the activities which are executed by every individual, irrespective of the individual’s health conditions. The 12 activities have been presented in the diagram below: Roper, Logan and Tierney’s activities of living (ALs) Source: (Dingwall, 2010) The influence of lifespan (age) The component implies that individuals pass through development phase from conception to death. The individuals throughout their life span are determined to witness and adapt change in their physical, social as well as cognitive developments (Dingwall, 2010; Singh & Misra, 2009). Accordingly, it can be observed from the case scenario that Mrs. Jones is a widow of eighty years of age and used to reside lonely in her home. However, prior to her diagnosis from frequent fall and severe osteo-arthritis, Mrs. Jones used to visit social club to play Bingo with her next door neighbour. The influence of the dependence-independence continuum The dependence-independence continuum assists in determining the activities which are carried out by individuals. The activities of individuals are based on circumstances. In this context, the major objective of nursing has been to aid patients to perform effectually in all the 12 ALs mentioned above (Dingwall, 2010). It has been observed from the case scenario that Mrs. Jones is suffering from osteo-arthritis and also has frequent falls which might be a result of her loneliness owing to the fact that her daughter lives away from her and visits only twice in a month. Factors influencing ALs There are various factors influencing ALs which include physical, psychological, environmental, socio-cultural and politico-economic (Dingwall, 2010). Loneliness, as mentioned above, sudden dependency in terms of finances and psychology as well as other factors associated with her growing age may have contributed to the severity of her health conditions. Individuality in nursing (normal living) Individuality in living signifies the experiences which are acquired by individuals throughout their life phase (Dingwall, 2010). From the case scenario, it has been identified that Mrs. Jones has gone through numerous stages of life. However, Mrs. Jones has failed to execute al the ALs which can be accounted as the prime factors to contribute towards her deteriorating health conditions. These are the five major aspects on the basis of which, care as well as treatment can be offered effectively to Mrs. Jones. Additionally, a holistic approach should be followed in this regard with the intention of evaluating the problems or issues faced by Mrs. Jones. In the holistic assessment, there are certain components comprising physical, psychological, sociological, spiritual and cultural. Physical The physical assessment of Mrs. Jones will assist in recognising her physical as well as psychological abilities to self-care. In accordance with the case, it has further been identified that she is suffering from frequent falls and acute osteo-arthritis. Moreover, as Mrs. Jones was lying for 48 hours on the floor, she may suffer from cold (hypothermia). Also, she was unable to move during this period due to which, she might also suffer from constipation and fear of mobility. In this context, she is required to be provided with suitable nursing care, so that appropriate treatment facilities and medication can be offered to recover her from these problems (Dingwall, 2010). Psychological The psychological components are further likely to aid in determining the mental condition of Mrs. Jones. It has been perceived that Mrs. Jones is eighty years of age and is a widow. She also resides alone. Her daughter though visits her twice in a month, the frequency of her visit can be considered as minimal. Contextually, it can be comprehended that she might be suffering from depression due to loneliness and dependency which further contributed to her deteriorating health (Dingwall, 2010). Sociological Sociological element can also aid in identifying the social behaviour of Mrs. Jones. She and her next door neighbour have been reported to visit social club and play Bingo quite often, which reflects her social association. However, after being diagnosed with acute osteo-arthritis, she had to minimise her social visits which might have further increased her health problems (Dingwall, 2010). Spiritual The spiritual component is comprehended to reflect religious beliefs of Mrs. Jones. However, no significant record of Mrs. Jones’ religious beliefs has been illustrated in the case reference (Dingwall, 2010). Cultural The cultural element indicates the specific needs or beliefs of Mrs. Jones. As per the case report, Mrs. Jones does not acquire any specific needs as well as beliefs with regard to treatment and caring services which is likely to make the process smoother and effective (Dingwall, 2010). Problem Identification As per the illustrated case scenario, three major problems can be identified with Mrs. Jones, i.e. cold (hypothermia), constipation and fear of mobility. In order to effectively determine the problems and their resolvements, a nursing process should be followed. It is worth mentioning in this regard that a nursing process is identified as a model of making critical thinking. Accordingly, the nursing people are required to possess the capability of making critical thinking so that they are able to resolve the health problems suffered by Mrs. Jones effectively. The abilities of critical thinking should therefore be developed from practices. In order to ascertain the problems faced by Mrs. Jones, a holistic approach should be followed. An assessment of holistic approach comprises physical as well as psychological examination. The nursing process is a five stage procedure on the basis of which care and treatment is offered to patients. In this case scenario, Mrs. Jones should be provided with adequate care as well as treatment services with the objective of aiding her both mentally and physically to recover from the problem of acute osteo-arthritis and frequent falls. The nursing process has been accordingly illustrated in the diagram below: Nursing Process Source: (Carpenito-Moyet, 2007) Nursing process is a systematic way of identifying problems or issues faced by patients and subsequently, on the basis of the obtained information, formulate appropriate plans in order to offer better care and treatment services. The five stages of the nursing process are assessment, nursing diagnosis, planning, implementation and evaluation (Carpenito-Moyet, 2007). Critical Thinking in Nursing Process Source: (Carpenito-Moyet, 2007) It is worth mentioning in this context that critical thinking in nursing process is an essential aspect which assists nurses in obtaining appropriate, reliable and suitable information or data so that proper care as well as treatment services can be offered to Mrs. Jones (Lipe & Beasley, 2004). Assessment In this stage, collection of comprehensive data or information about the problems or issues of a patient will be conducted (Ackley & Ladwig, 2010). The assessment results on the basis of the case reflect that Mrs. Jones has been suffering from osteo-arthritis. Additionally, she had frequent falls and is also awaiting a hip replacement treatment. Again, as she was lying in the kitchen floor for 48 hours, three short-term sickness problems in respect of cold (hypothermia), constipation and fear of mobility could arise in Mrs. Jones’ case. Diagnosis The nursing diagnosis is the method of analysing or examining the collected data from a patient in order to recognise his/her health issues. The symptoms should be identified as well as clustered suitably with the objective of clustering those issues in a logical pattern in this stage (Ackley & Ladwig, 2010). Understanding her short term health risks, it can be stated that Mrs. Jones might also suffer from cold (hypothermia) for lying in the kitchen floor for long 48 hours. Due to this short term health risk, Mrs. Jones may also have to face severe joint pains and therefore require necessary nursing aid as she is already a patient of acute osteo-arthritis and hip pain. Constipation problem may also arise as she was unable to move and use the toilet for 48 hours. Furthermore, Mrs. Jones may also face the short term health risk of fear of mobility due to her record of frequent fall problems. Planning Outcome On the basis examination and diagnosis, a proper plan for care should be formulated with the intention of offering appropriate care and treatment services to patients at this stage (Ackley & Ladwig, 2010). Mrs. Jones should be offered with proper medical aid to assist her in recovering from the identified short term health problems, i.e. hypothermia, constipation and fear of mobility. Besides, due significance will be rendered towards her long term health problems which have been identified as acute osteo-arthritis, hip replacement need and frequent falls. With this aim, her continuously changing health conditions will be monitored to assess the outcomes in her care plan. Planning Intervention Intervention is identified to be the procedures or ways in accordance with which patients are to be provided with care and treatment services (Ackley & Ladwig, 2010). Applying this particular stage in the referral case, it can be asserted that Mrs. Jones should get proper medical treatment for cold, constipation and fear of mobility with the aid of proper nursing intervention. Additionally, she should be offered with proper nursing care and psychological development programs with the intention of resolving any depression state probable due to loneliness. Implementation In this stage, the formulated plans are executed so that a patient is provided with care and treatment services accordingly and their health conditions are enhanced. During this phase, nurses seek to ensure effective interventions so as to accomplish the predetermined objectives of the care plan (Ackley & Ladwig, 2010). In this respect, nurses should ensure that Mrs. Jones gets a hip replacement as soon as possible. Additionally, proper medical treatment and aid should be offered to Mrs. Jones in relation to hypothermia, constipation and fear of mobility in the short term. Mrs. Jones should also be offered with suitable psychological development program assistance for proper mental growth if in case she is suffering from depression due to loneliness. Evaluation Evaluation is an integral factor of nursing process as nurses are required to evaluate the outcome of treatment and the planned intervention on a continuous basis. The nurses, with determined intervention and plan, should therefore be able to resolve the problems suffered by Mrs. Jones in relation to cold(hypothermia), constipation, fear of mobility and psychological development in a timely and manner (Ackley & Ladwig, 2010). Goal Statement A goal statement is formulated with the intention of determining the care, treatment and other services which are to be offered to patients. These objectives can be applied either or both for a short-term or on a long-term basis. These goals can be precisely formulated on the basis of MACROS criteria in order to ascertain the appropriateness of the developed goals. MACROS Components Problem 1 (Cold or hypothermia) Problem 2 (Fear of Mobility) Problem 3 (Constipation) Measurable and Observable This problem of Mrs. Jones is measurable as well as observable which shall facilitate to develop revival strategies to aid her in recovering from short term health problems of cold or hypothermia This problem is measurable as a syndrome or effect of psychological problem; might be owing to her loneliness This problem is measurable where in can be evidently asserted that this health problem is usually associated with bowel movement Achievable and Time Limit Hypothermia or cold can be observed as a fall in body temperature. To aid Mrs. Jones in this regard will be a short term goal The medication and treatment to frequent falls and psychological development should be provided in order to mitigate her risk to fear of mobility The medical treatment offered to cure her constipation will resolve Mrs. Jones’ problem on a short term Client Centred Mrs. Jones should be offered with passive re-warming, ‘active internal re-warming’ and active external re-warming treatments in order to revive her from the risk of cold or hypothermia The medication in relation to frequent falls will assist Mrs. Jones to revive from depression, psychological problems and fear of mobility Medical treatment including dietary habits, enemas and laxatives among others will assist her in recovering from constipation problem Realistic The healthcare facility should be aided with adequate equipments and required resources to execute proper treatment for hypothermia The care should be intervened with psychological development program and specialists Care should be delivered on the basis of adequate medication and specialist interventions so that a proper nursing care can be offered Outcome Written The treatment in relation to hypothermia will assist Mrs. Jones to revive her body temperature and blood pressure Nursing interventions will minimise falls and offer appropriate psychological development assistances to Mrs. Jones, mitigating her problem related to fear of mobility Proper treatment in this context shall minimise or resolve constipation problems Short or Long Term Short term Short term Short term Source: (Hogston, 2013; Smith, 2004) Nursing Intervention and/or Implementation The planned nursing intervention is quite likely to assist Mrs. Jones with adequate care and treatment services so that she could recover from the three most prominent health issues within a short time span and certainly, in an effective manner. The nursing intervention can be precisely planned as follows. Hypothermia or Cold Mrs. Jones should be provided with proper care and assistance so that she could recover from cold or hypothermia problem within a specified time frame. The nurses will therefore seek that she is offered with proper medication and proper rewarming facilities till the time her body temperature stabilises. A proper record of her progress and treatment services will also be maintained on a regular basis. She will also be provided with adequate medical tips which will aid her in reviving from these rewarming treatments (Miller, 2009). Fear of Mobility Mrs. Jones, with regard to her frequent falls problem, will be offered with effective psychological development programs in order to strengthen her mental state and mitigate her fear of mobility. Moreover, she will be offered with proper medical and regular check-ups to seek her recovery positions from her fear of mobility issue (Rubenstein & Josephson, 2006). Constipation Mrs. Jones may suffer from constipation problem and in this regard, the nurses should determine that whether her medication is improving her state with respect to her bowel movement. Additionally, the nurses should seek that her medical treatment and intake of medicines are executed properly (AHRQ, 2002). In this respect, the ageing problems which are suffered by Mrs. Jones are observed as interrelated with the RLT model of adult nursing, as all the three issues currently being experienced by Mrs. Jones are normal age problems. Moreover, the interventions offered to Mrs. Jones are to assist her in recovering and maintaining proper physical as well as psychological conditions. In accordance with the RLT model, nurses are required to offer appropriate medical aid. Accordingly, the intervention plan adopted for Mrs. Jones should provide individualised services. Moreover, on identification of the three major problems, proper care and medical aid need to be offered to Mrs. Jones so that future injuries can be prevented due to frequent falls. The nurses will also offer medical aid on the basis of prescribed treatment by the doctors and specialists. NMC Code (2008) The treatment, care and other health services, which are planned to be offered to Mrs. Jones, will further abide with the NMC Code (2008). In this regard, the care planning process will seek that the patient is offered with care as a first priority. As per the guidelines, the care facility should work in a collaborative manner with other healthcare organisations for better protection as well as promotion of wellbeing in a community. Accordingly, Mrs. Jones should be served with dignity without any discrimination. Thus, when rendering care services, I will take due responsibility of maintaining dignity of Mrs. Jones by drawing curtains while check-ups and providing significance to Mrs. Jones’ comfortability with the treatment procedure. Moreover, Mrs. Jones’s wish will be undertaken with utmost priority. Confidentiality will be maintained in relation to the treatments as well as medications offered to Mrs. Jones. The records of Mrs. Jones’ medical treatment will also be maintained with confidentiality in the care plan. The disclosure of information will only be considered with proper individuals in order to protect the right of Mrs. Jones and to respect the aspects of confidentiality of patient’s records. Thus, the professionals and other participants, such as Mrs. Jones’ daughter and neighbour, involved within the care facility, should work in a collaborative manner with the intention of offering better medical services as well as treatment to patients. Furthermore, a proper communication system should be implemented in the care plan of Mrs. Jones (NMC, 2008). Evaluation The medical treatment and care offered to Mrs. Jones should be evaluated at frequent instances to identify and control her progress. In this context, certain strategies need to be followed as per the below mentioned guidelines. Reassessing The medical records and treatments offered to Mrs. Jones should be scrutinised on a regular basis with the intention of determining progress in recovery. Reassessing Mrs. Jones’ recovery will hereby assist in comparing the findings of the collected information with the determined goals or outcomes. Moreover, reassessment will also aid in determining the nursing intervention which worked and seemed to be appropriate for the recovery of Mrs. Jones within the determined timeframe. Documentation The medical facilities, cares and treatments, which are offered to Mrs. Jones, should be recorded. Additionally, the progress towards goals or outcomes should be documented for future references. Revise the Care Plan The care plan formulated for Mrs. Jones should be further revised on regular intervals with the objective of making necessary changes or modifications for offering adequate treatment and care services to assist Mrs. Jones in recovering from the three identified issues appropriately. Conclusion and Reflection It is observed from the above discussion that RLT model is an appropriate tool for the development of ageing people with proper physical as well as psychological conditions. The ageing people are also required to be offered with appropriate nursing care and services for their best recovery within appropriate timeframe. Mrs. Jones, who is a widow of eighty years old, suffers from three problems including cold (hypothermia), constipation and fear of mobility. In this respect, a care plan must be followed in a precise manner with the aim of offering appropriate care and medical services to Mrs. Jones so that she could recover from these issues suitably and in a timely manner. It can be comprehended in this regard that nurses should formulate appropriate care plan on the basis of which care and treatment will be provided. The nurses are also required to practice their care services in accordance with nursing process which will assist them to serve patients in an appropriate manner with proper identification of problems suffered by the patients. The nurses on the basis of problems should therefore adopt certain specific nursing interventions for treatment and care of patients. Moreover, nurses should evaluate the progress and identify interventions which are seemed to be appropriate for providing appropriate care throughout the plan. References Ackley, B. J. & Ladwig, G. B., 2010. Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care. Elsevier Health Sciences. AHRQ, 2002. Managing Osteoarthritis: Helping the Elderly Maintain Function and Mobility. Research in Action, Iss. 4, pp. 1-11. Carpenito-Moyet, L. J., 2007. Understanding The Nursing Process: Concept Mapping and Care Planning For Students. Lippincott Williams & Wilkins. Coyne, I. & et. al., 2010. Clinical Skills in Children's Nursing. Oxford University Press. Dingwall, L., 2010. Personal Hygiene Care. John Wiley & Sons. Hogston, R., 2013. Managing Nursing Care. Chapter 1, pp. 1-25. Lipe, S. K. & Beasley, S., 2004. Critical Thinking in Nursing: A Cognitive Skills Workbook. Lippincott Williams & Wilkins. Miller, C. A., 2009. Nursing for Wellness in Older Adults. Lippincott Williams & Wilkins. Nicol, M., 2013. Alexander's Nursing Practice. Elsevier Health Sciences. NMC, 2008. The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. The Code, pp. 1-8. Rubenstein, L. R. & Josephson, K. R., 2006. Falls and Their Prevention in Elderly People: What Does the Evidence Show? The Medical Clinics of North America, Vol. 90, pp. 807-824. Singh, A. & Misra, N., 2009. Loneliness, Depression and Sociability in Old Age. Industrial Psychiatry Journal, Vol. 18, No. 1, pp. 51-56. Smith, G., 2004. Get Set For Nursing. Edinburgh University Press. Timmins, F. & McCabe, C., 2008. Day Surgery: Contemporary Approaches to Nursing Care. John Wiley & Sons. Timmins, F., 2005. Contemporary Issues In Coronary Care Nursing. Routledge. Read More