The Roper Logan Tierney Model of Nursing - Essay Example

Nursing Adults - Holistic Assessment Introduction COPD is becoming a significantly public and personal health problem. Studies have indicated that COPD is ranking the fifth amongst causes of worldwide mortality. Without much attention to curb the disease, it will rank third cause of deaths by the year 2020 the world over. For instance, it is the fourth cause of deaths in the USA while its prevalence rates in Germany are approximately 2.7 million. In addition, there are 3 million patients in the UK, 1.5 million in Spain, and 2.6 million each in France and Italy1. Further, in UK, the COPD rates are experiencing a plateau while those of women are on the increase. Estimations point out that the approximations draw evidence from the developed countries, and the burden of disease has received considerable underestimations. Therefore, issues like diminishing quality of life, disability, high healthcare costs, and the sophisticated needs of COPD patients will remain a challenge to the patients, families, and the healthcare providers2.With the succinct encounters with patients in the physicians’ offices and hospitals, the healthcare professionals face a challenge to understand how people integrate the disease to their lives. Stories and patient experiences via comprehensive and qualitative research studies help the nurses to gain a novel perspective on the everyday challenges. These challenges are inherent in the progressive and multifaceted chronic disease like COPD3. Therefore, it is vital to have an inclusive study, analysis, and development of suitable prognosis to guide the patients through their lives regarding COPD and especially breathlessness. A brief description of the patient and the care setting In an attempt to develop a comprehensive, critical, and holistic examination of the patient suffering from COPD, the nursing assessment fully has foci on the breathlessness aspect. In this context, the patient under observation is John, a 51-year-old male. His admission follows SOB due to exacerbation of COPD. His condition has become increasingly progressive over the past two weeks, and it is most noticeable during exertion. The patient has exhibited non-compliance to medication because of the financial difficulties that lead to unaffordability of prescriptions. Apparently, there is no support offered from the benefits agencies. Owing to his age, he is unable to access aid due to anxiety and language barrier. Reasons for assessments and the holistic approach The patient-centered care is a model that aims at engaging patients and the healthcare givers in collaborator relationships while placing the client at the focal point. For instance, with the contentious American reform of the healthcare system, the PCMH has emerged as an alternative model to reduce the patient costs. It is helpful in coordinating the healthcare efforts by effective utilization of the information technology within the healthcare platforms. Further, it allows patients to obtain high quality and better outcomes of health. In this system, the healthcare professionals have an obligation to develop and implement inter-professional and inter-disciplinary care plans. These programs need to allow the integration of the health promotion within the community and encourage disease preventive paradigms4. Klein et al., (2013) assert that the PCMH concept addresses the common problems associated with primary healthcare5. For example, the poor communication and coordination among the professionals plus the frustrations observed when patients try to reach out to the providers for questions and clarity. In addition, it intends to avert the difficulties seen when trying to secure follow-up appointments and the pervasive increment on payment schemes. Therefore, with a focused PCMH model, there is a cohesive promotion of care and the model aims at the high-quality care with lowered costs. Realizing the benefits involve a timely, preventive, and enhanced engagement of patients through the continuum of care6. The Roper Logan Tierney Model of Nursing The Roper Logan Tierney nursing model (RLT-model) has brought a great impact on the department of healthcare in the United Kingdom, all over Europe and the world at large. The concise monogram puts together and elucidates more of Winfred Logan’s, Nancy Roper’s, and Alison Tierney’s collective thoughts. Realization and documentation of this scholarly idea took place long before the elements of nursing came into being in the year 1980. The department of health recommends new directions towards the care and management of the COPD. There are shifts in the COPD services directed away from the big institutions and an essential change in the functions of the COPD nurses. The changes of role intertwined with increased complexity of the COPD nursing interventions, explains the inherent reasons why the nurses ought to adequately assess the patients, record, and carry out evaluations on the care given. The Roper Logan Tierney nursing model facilitates the delivery of these services by the provision of guidance in the nursing practices and boosts the quality of care7. Reasons for choosing the model TheRLT-modelof nursing is majorly a hospital orientatedmodel. The model can serve purposes in any discipline of the nursing profession though criticisms hold that varied nursing contexts need different models of nursing. While giving care to the patients suffering from COPD, it is advisable to stress the importance of the nursing focus. The model can find use in all the cases of COPD settings, ward environment, and at the community level8. He further suggests that, in coordination with the other components of the model, it is vital to note the pivotal role of the biological, sociocultural, politico-economic, psychological, and the environmental factors. Findings under the aspect of breathlessness Vital signs Upon admission of the client, there was a conduction of numerous examinations to decipher the point of concern in response to the patient’s illness. Recording of such observations received a label as vital signs upon admission, which includes BP at 152/70, HR of 100bmp, and 30 rates of respiration per minute. In addition, the oxygen concentration was at 83% with 380C body temperature, and EGC resulted in sinus tachycardia. These vital signs help in the detection of the severe disease infections at the emergency department. For instance, abnormal vital signs cause high rates of hospital admissions9. Blood gas results indicated a pH of 7.41 with concentrations of 24mmol HCO3, 8.8kPa of PaO2, and 5.3kPa of PaCO2. Further examinations revealed a previous FVE1 at 50%, and this did not change even after the administration of the bronchodilators. Clinical observations showed scale 2 MRC, BMI of 18, a weight of 61kg, and a height of 1.80m. There was a regular production of white sputum although the septum analysis confirmed a null bacterial infection. The vital signs help to provide a recommendation for the frequency that the nurses need to monitor the patients. It also determines the need for the clinical reviews together with the requirements of competence of the clinical professionals that should take part in the reviews. Essentially, the reports ensure that the response teams that offer acute care remains clearly designated. It is important that they are free from the various clinical responsibilities to allow them operate throughout the clock in all critical facilities. Further, concerning the patients that possess high NEWS, the reports help in providing recommendations to offer the best milieu for continued critical care10. Inspection In the respiratory examination, there was no observed clubbing of fingers. The patient had some peripheral cyanosis, and there was evidence of using the accessory muscles. Insightful analyses on the fingers indicated that the patient is a heavy smoker with ten smokes per day. The patient has an abnormal posture, whereby he leans forward with pursed lip breathing. Despite these problems, the patient could speak in short sentences, and there was no evidence of ankle or foot edema. Percussion Typical percussion includes tapping the surfaces of the body slightly with a sharp and in a quick motion. The situation produces rhythmical sounds that aid in determining the shape, size, and position, and density of the tissues and organs that underlie. The procedure enhances sound into the body through making the body vibrate. Further, the examiner keenly listens and determines the characteristics of the returning sound. The sound helps in determining the nature of the body cavity and its contents. The method is common over the abdomen and the chest to validate the information collected from history taking, palpation, and inspection. The technique assists in signaling the existence of solid of air within the organs and the tissues. It helps to recognize the shape, size, and position of the organs through an outline of their borders and approximation of their depths. A detailed examination of percussion on John brought to the attention a bilateral hyper-resonant sound over the inflated lungs11. Auscultation Auscultation refers to the process through which a medical profession listens to sounds made in the body in the attempt to identify abnormal or normal sounds that help in the process of diagnosis. It is a common method of identifying adults with distress in respiration. Majorly, it aims at the identification of adequate and normal breath sounds and the features of the breath sound. In addition, it determines the phase and location of the sound and the adventitious sounds of breathing12. Moreover, an auscultation examination on the patient confirmed a wheezing sound while the chest x-rays affirmed negative signs of pneumonia, although there were some hyperinflations that lacked apparent opacities. The psychological aspect Breathlessness is a troublesome and common symptom that is evident in patients with COPD. Widely dyspnea or breathlessness has been described as a discomfort in inhalation and exhalation that has qualitative distinctive sensations varying in intensity. They are complex or multidimensional with an interrelation of psychological, physiological, and sociological aspects. Patients with COPD are likely to suffer from numerous stressors and hence they are in a position to experience psychological distress thus a decreased ability to cope and mitigate their health conditions13. Essentially, there is a perceived high degree of depression and anxiety in COPD patients. The features are critical has they purportedly hinder diagnosis and treatment that aims at self-management and supportive care. Family-based caregivers experience a feeling of distress and hopelessness14. It is more when delivering care to their loved ones suffering from COPD. Especially spouses to patients feel powerless when giving care to a loved one with COPD. Al-Gamal asserts that the role of caring for loved ones who suffer from breathlessness is demanding and stressing15. Nevertheless, breathlessness is a major cause of distress and concern for the informal caregivers and the patients suffering from COPD. Breathlessness pervades the aspects of the patient life and the suffering difficult to manage more patients suffering from the perceived COPD. Measuring the psychological aspect of the patient Demographic information In measuring the psychological dimension of patients with COPD, it is advisable to find out the information relating to age, gender, and the education levels. It is also important to consider the income levels, smoking history, and medical history that the patients and their spouses experience. In this context, the patients then complete out a question on the general health. There is a provision of the options of good, very good, fair, very poor, and poor. The patients are meant to choose the best option that describes their health status per second. The circumstance aids the health professionals to measure the extent of the COPD on the psychology of the patients. Dyspnea 12 scale The equipment helps in quantifying severity of breathlessness by the use of descriptions from the patients pertaining its affective sequelae and its qualities. The D-12 scale then forms a measure regarded as dimensional, which reflect emotional and physical characteristics of breathlessness. The methodology has 12 items that encompass a range of 0-36 with a good reliability and the COPD validity. A high score shows severe dyspnea while low scores indicate less severe breathlessness. Hospital anxiety and depression scale It consists of an HADS questionnaire. The HADS is typically a scale rating of 14 parts with four sections of Likert scale range. It measures the varied dimensions of depression and anxiety and their possible outcomes of anxiety and depression emanating from the population. The scale aids in measuring depression and anxiety. A score of 8 is commendable for good reliability. The social aspect In the recent past, research on the organ inflammation has become an increasing phenomenon in the socio-medical sciences. The evidence of new datasets that aid in the integration of biological data with the behavioral, emotional, and social aspects have given room to the scholars to study how the non-biological factors predispose individuals to inflammation16. Further, these conditions aid in shaping the relationships and the social opportunities. In this respect, the chronic illnesses can have an impact on quality of life through the periods that people live with the chronic diseases. In acute inflammations that result from injury, illness is not likely to induce a major differential bias. Increases in the levels of CRP due to acute inflammation always tend to be temporary and small17. Demonstrations indicate that, average levels of CRP increase with an increase in age while the values of relative distribution remain stable over time. Vast literature exists on the implications of inflammatory diseases on the perceived quality of life. For instance, adverse interactions, internal stress, sexual dysfunction, and straining to cope with consequences of negative social interactions cause shrinkage in the social life18. There are numerous beliefs that accompany the social aspect of patients suffering from COPD. For example, it strained breathing associates with tuberculosis (TB). The people tend to believe that once a person is having trouble in breathing, they are most likely to suffer from TB. There is also a generalized opinion that people who suffer from TB ail from HIV. The situation brings about distress to the patients who fail to take a step for medication. There is stigmatization of such patients in the communities leading to a shrinking social life, which finally affects the quality of their life. Spiting for the patient alienates him from the public scenery, as he is afraid of sudden spits. The cultural association of the men in the societies does not allow them to engage in “shameful” acts of careless spiting. In that course, John’s social dimension is at risk. Pertinent to his engagement in smoking, he is quite aware of the side effects that accompany the behavior19. Rather, he is willing to stop smoking but due to the comfort accompanying it, he is unable to quit. The circumstances of smoking delineate the reasons as to why John’s social life is at risk. For instance, he cannot interact much with the people that do not smoke due to a sequential behavior of smoking. Taking ten smokes per day is a great risk for the health of this patient both socially and biologically. Actually, John is losing his social friends due to the inability to walk. Conclusion With inherent arguments on the models that aids in delivery of healthcare services, it is vital to develop a comprehensive care model that details the patients’ social, biological, emotional, and behavioral aspects. The patients with COPD especially those suffering from breathlessness undergo challenges both in the social and emotionaldimensions. Therefore, it is essential to ensure integrated care that offers quick, low-cost, and effective curative services. The RLT-model of nursing is important to provide support to the professional nurses in the aid of the COPD patients. Reference List "Performing Percussion., Nursing 13.2 (1983): 63-64. Academic Search Premier. Web. 1 May 2015. Aldrich, M. C., Munro, H. M., Mumma, M., grogan, E. L., Massion, P. P., Blackwell, T. S., and Blot, W. J. “Chronic obstructive Pulmonary Disease and Subsquent Overall and Lung cancer mortality in Low-Income Adults.” PLOS ONE, March 26, 2015, pp.2 Al-Gamal, E. “Perceived breathlessness and psychological distress among patients with chronic obstructive pulmonary disease and their spouses,” Nursing and Health Science, vol. 2014, no. 16. Pp.103-104. Aylott, Marion. "Observing the Sick Child: Part 2C Respiratory Auscultation." Paediatric Nursing 19.3 (2007): 38-45. Academic Search Premier. Web. 1 May 2015. Bentesen, S. B., gundersen, D., Assmus, J., Bringsvor, H., and Berland, A. “Multiple symptoms in patients with chronic obstructive pulmonary disease in Norway.” Nursing Health Sciences, vol. 2013, no. 15, pp. 292. Bentsen, S., Henriksen, A. H., Wahl, A. K., Wentzel-larsen, T., and Rokne, B. “Anxiety and depression following pulmonary rehabilitation.” Scandinavian Journal of caring Sciences, 2012. Pp.541 Cooper, J., & McCanter, K. A. “Home-Based Chronic care Management Program for Older Adults.” Public Health Nursing, 2013, vol. 31, no.1, pp. 38 Fraser, D. D et al., “Living with chronic obstructive pulmonary disease: insiders’ perspectives,” Journal of Advanced Nursing, vol. 55, no. 5, 2006, pp.551 Gooneratne, N. S., Patel, N. P., and Corcoran, A. “Chronic Obstructive Pulmonary Disease Diagnosis and Management in Older Adults.” Journal of Compilation, 2010, 58. Pp. 1154 Hagglund, D., &Hrisanfow, E. “Impact of cough and urinary incontinence on quality of life in women and men with chronic obstructive pulmonary disease.” Journal of Clinical Nursing, 2012 (22), pp. 98 Jones, A., and Carnegie E. “Improving the management of asthma in older adults,” Nursing Standard, vol. 28, no. 13. Pp.51-53 Klein, D B., et al., “The Patient-Centered Medical Home: A Future Standard for American Health Care?” Public Administration review, September/October 2013, pp.83 Mdodo, R., Frazier, E. L., Dube, S. R., Mattson, C. L., Sutton, M. Y., Brooks, J. T., and Skarbinski, J. “Cigarette Smoking Prevalence Among Adults With COPD.” Annals of Internal Medicine, 2015, vol. 62, no. 5, pp. 336 Murphy, K., Cooney, A., Casey, D., Connor, M., O’Connor, J., and Dineen, B. “The Roper, Logan and Tierney (1996) mode: perceptions and operationalization of the model in psychiatric nursing within a Health Board in Ireland.” Journal of Advanced Nursing, 2000, vol. 36, no. 6. pp.1334, 135 Nowakowski, A. “Chronic inflammation and Quality of Life in Older Adults: A Cross-Sectional Study using Biomakers to Predict Emotional and relational Outcomes,” Health and Quality Outcomes, vol. 2014, no.1 Paap, M., Bode, c., Lenferink, L., Groen, L., Terwee, C., Ahmed, S., Eilayyan, O., and Palen, J. “Identifying key domains of health-related quality of life for patients with Chronic Obstructive Pulmonary Disease: the patient perspective.” Health and Quality of Life Outcomes, 2014, 1:106 Royal College of Physicians. National Early Warning Score (NEWS): standardising the assessment of acute-illness severity in the NHS. London: Royal College of Physicians.2012. Pp. xi Storm-Versloot, Marja N., et al. "Clinical Relevance Of Routinely Measured Vital Signs In Hospitalized Patients: A Systematic Review." Journal Of Nursing Scholarship 46.1 (2014): 39-49. Academic Search Premier. Web. 1 May 2015. Troosters, T., Molen, T., Polkey, M., Rabinovich, R. A., vogiatzis, I., Weisman, I., and Kulich, K. “Improving physical activity in COPD: towards a new paradigm,” Respiratory Research, vol. 2013, no.14. Pp.1-2 Read More