Nursing as a Practice-Based Discipline, Clinical Education as an Essential Component of the Nursing Education Program - Assignment Example

Name: Student No: Course: Convenor: Campus: Due date: Word count limit 2500 PART A: LESSON PLAN Word Count: 313 CONTEXT You are a community nurse and required to teach your new client (Peter Singh, 70-years-old) and his partner Chris, how to manage and monitor his newly diagnosed condition of hypertension. In the process you will need to educate Peter on the condition and explain the need for ongoing management. You aim to do this teaching session on your second visit to Chris’ and Peter’s home. The home visits are 1-hour duration. Venue: Client’s home. Number of clients: 2 Clients Characteristics; 70 years old client Time Available: 1 hour LEARNING OBJECTIVES/OUTCOMES By the end of the lesson the client will be able to: Describe the disease process of hypertension List the complications related to uncontrolled blood pressure Identify personal risk factors Explain the benefits of increased physical activities in relation to managing hypertension Explain the benefits of a healthy eating program in relation to managing hypertension Demonstrate self-monitoring of BP levels Interpret the results of the sphygmomanometer CONTENT: Pre-test on the basic understanding of hypertension to be done by Peter Singh and Chris. Detailed information on the development of hypertension and its progression Pamphlet 1, CDC podcast. Explain the importance of maintaining a healthy weight, and following a healthy diet program in managing hypertension. Pamphlet 2 and 3. Demonstrate the use of a sphygmomanometer and interpreting the results. User guide Answer any questions arising Arrange for a follow-up plan RESOURCES: Pamphlet1: you and your heart Pamphlet 2: Active living Pamphlet 3: Healthy eating CDC podcast: Dealing with high blood pressure User guide specific to the client’s choice of blood pressure monitor. Pre-test, post-test and performance assessment forms. ASSESSMENT: Pre and post assessment tests to evaluate the effectiveness of the session on imparting new knowledge. Observe Peter Singh and Chris operate the sphygmomanometer to measure BP levels while filling a competence form to ensure that they follow the right technique. Clients to fill a self-evaluation form Bibliography: Sha14: , (Shahsavari, Yekta, Zare, & Sigaroodi, 2014), Fir12: , (Firoozehchian, Ezbarmi, & Dadgaran, 2012), Ash12: , (Ash, Walters, Prideaux, & Wilson, 2012), Nat10: , (National Heart Foundation of Australia, 2010), Cot12: , (Cottrell, Chambers, & Connell, 2012), Aga11: , (Agarwal, Bills, Hecht, & Light, 2011), Tun10: , (Tunstall Group Ltd, 2010), Mon13: , (Monash University, 2013), Mon13: , (Monash University, 2013), Nat14: , (National Heart Foundation of Australia, 2014), Nat10: , (National Heart Foundation of Australia, 2010), PART B: LESSON PLAN Word Count: 1952 Nursing is a practice-based discipline, and clinical education is an essential component of the nursing education program[Sha14]. Clinical experiences help to bridge the gap between theory and practice and enable nursing students to be well prepared for real clinical situations. Clinical education as part of nursing allows the student to apply conceptual knowledge in practice as they care for their patients[Fir12]. Identifying issues pertinent to clinical education and tackling existing problems contribute to accomplishing education objectives. Education programs that are not properly planned and executed cannot achieve established goals, and they cause irrevocable damage to the graduates, the society and the institutions reputation. A well-planned clinical education encourages students to develop critical thinking skills, clinical judgment, clinical knowledge and attitudes. It also has an impact on the students’ competency, interpersonal relationships, socialization and professionalization[Sha14]. In the recent past, the need for comprehensive people-oriented health services with a focus on long-term care has been on the rise[Ash12]. Most of this care occurs in primary, community and ambulatory settings rather than hospital settings as they allow students to become more involved in their clinical environments have more patient contact and receive better supervision. Hypertension is a condition in which the heart pumps blood at a higher pressure through the arteries. Elevated levels of blood pressure (BP) are linked to increasing rates of stroke, heart failure, coronary heart disease and death while lower BP reduces these events. Systolic BP is a stronger indicator of cardiovascular events than diastolic BP. universally; hypertension is responsible for far more deaths than biomedical risk factor[Nat10]. There is a very thin line between normotension and hypertension and the decision to intervene depends on the patient's risk profile. Drug therapy and lower BP targets are recommended for all patients in order to control BP. Optimal BP control is linked to delay in development of end-organ kidney failure, prevents stroke and delays the development of chronic heart failure (CHF). At the start of the lesson, I will administer a 5 minutes pretest to test whether the client has a basic understanding of the heart, its functions and hypertension. The test will consist of well structured questions such as what is the function of the heart?, What is hypertension?, In a blood pressure reading 150/95, what is represented by the two numerical figures?, Which is the most effective way to control hypertension?, What are the complications of hypertension?. I will then demonstrate the function of the heart using an elastic band and a balloon and compare the effects of stretching with the heart and arteries. The heart pumps blood to the body tissues through the blood vessels. Blood pressure is defined as the amount of pressure applied on the walls of the arteries by the pumping blood. High blood pressure develops when the blood pumps with elevated force than normal. High pressure causes the heart and arteries to stretch, when the process happens consistently the heart muscles lose their elasticity. With reduced elasticity, the heart is unable to pump blood efficiently to the tissues. BP is measured using mercury sphygmomanometers. Self-measurements by the patients provide an accurate BP profile which provides the basis of therapeutic decisions. They present a number of measurements over a long period and are essential in long-term follow-up. Patients who take self-measurements understand their hypertension and the effects of treatment. This enables them to be more involved in self-management and improves compliance to treatments[Nat10]. In addition, self- measurements is used to assess changes due to change in anti-hypertensive’s, to detect changing trends in BP levels and to verify or refute any suspected relationships between episodic symptoms and episodes of high and low BP. In order to record accurate measurements of BP, a patient requires an accurate device that is serviced regularly and re-calibrated after every six months. A trained health professional should train the patient how to operate the device and preferably provide written instructions that they can refer to when at home. Further, the healthcare professional should plan follow-up visits to ensure correct technique[Nat10]. Since BP varies depending on activities, multiple readings taken at different times of the day are required. When the BP levels are stable and the target levels established, the frequency of taking readings can be decreased. Hypertension carries tremendous risks due to its asymptomatic characteristics and some patients may not adhere to medication. It is also poorly controlled and managed a factor that leads to avoidable cost implications. Intermittent clinic BP tests are inadequate and patient self-test is encouraged as a means of enhancing accurate diagnosis and management. Telehealth is increasingly being adopted to help patients and healthcare professionals monitor hypertension. Research has shown that home Telehealth lowers mortality, emergency visits, hospital admissions, cost of care while improving quality of life[Cot12]. Telehealth is void of the white coat effect associated with BP values obtained in a hospital environment. It reduces the variable cardiovascular effect of emotion making BP values obtained at home reproducible[Aga11]. A Meta-analysis indicated that monitoring BP at home may improve hypertension control. This improvement is attributed to improved adherence to hypertension therapy and management of masked hypertension. Telehealth interventions have proved useful for delivery of healthcare to patients in remote areas where distance and inadequate health specialists is a challenge to quality healthcare delivery. The devices required for a comprehensive home based monitoring are blood pressure monitor, weighing scales, pulse oximeters and hypertension health interviews. Patients take their measurements and complete set of health interview questions based on established clinical guidelines. These set of questions are used to establish how the patient is feeling. The complete information is then transmitted automatically to a clinical software platform that validates data and monitors health status. The ultimate goal of treatment is to reduce the BP to less than 140/90 mmHg and telehealth identifies changes to a patient BP enabling the healthcare provider to adjust medication. Hypertension patients are predisposed to increased depression and anxiety, and telehealth enables them to monitor their symptoms to bring them reassurance and reduce anxiety levels. Patients are more receptive to coaching when the condition id stabilized this eventually leads to improved quality of life[Tun10]. During this 20 minutes session, I will guide the patient in the right technique of taking his BP readings using the sphygmomanometer, determine his weight using the weighing scale, filling the questions and how to send the results. I will also provide the patient with a user guide with step by step instructions on how to operate all the devices. In most cases, hypertension is as a result of lifestyle and genetic factors but a few cases arise secondary to other disease processes. Hypertension is classified as a lifestyle disease and some of the health behaviors that are implicated in its onset include physical activity and diet. Lifestyle changes are encouraged even when drug therapy is recommended as lack of them would affect the efficacy of the drug and risk several other risk conditions associated with the lifestyle factor. Behavioral change is encouraged through motivational interviewing and the 5a’s[Mon13]. These tools are used to establish if the patient believes in the importance of behavioral change by exploring issues from their point of view, encouraging them to consider the suitability of their beliefs and support change themselves. Motivational interviewing is a counseling technique that enables patients to assess their believes about health and lead them to seek change. This technique is more effective in driving change as compared to a health professional dictating change to the patients. Motivational interviewing is defined by five principles; empathy, investigates resistance, explore discrepancy, avoid arguments and support self-efficacy. The 5A’s stand for ask, assess, advise and assist and arrange [Mon13]. Sedentary lifestyle is a major factor that contributes to the development of high blood pressure. Integrating physical activity in everyday routines enhances active living as well as helping people to lead a healthy life. According to the National Heart Foundation of Australia (2014), regular exercise has independent cardioprotective effects and regular aerobic exercise can drop systolic BP by about four mmHg and diastolic BP by about 2.5 mmHg[Nat10]. The heart foundation helps people to lead healthy and more active lives by providing a wide range of professional information and resources[Nat14]. The patient can increase activity levels by starting with realistic goals like setting a daily 20 min walk, using stairs rather than the elevator to access their offices and to park a distance away from their places of work to incorporate a walking distance. The third session will take 20 minutes and will cover the importance of lifestyle changes in managing hypertension. At the end of this session, I will hand the patient pamphlets detailing the physical activities facilitated by the heart foundation of Australia and assist him in establishing which activities would be most appropriate for him. Eating is aimed at maintaining a healthy weight, providing the energy necessary to live life to the full and maintaining a healthy heart. It involves lowering intake of saturated fat, some of the tips used to help the patient reduce intake of saturated fats and energy are; substituting energy drinks with water when thirsty, using vegetable based sauces instead of cream-based ones, limiting intake of high fat content take away and trimming meat . Research shows that salt restriction can lower systolic BP by about 4 mmHg in hypertensive patients and by about 2 mmHg in normotensive individuals[Nat10]. The recommended daily salt intake levels are 65 mmol/day[Nat10], and these levels can be achieved by choosing foods labeled ‘no added salt' and by avoiding salty snacks. Patients with normal renal function can increase the intake of potassium by eating a variety of vegetables, fruits and legumes. The pretest will also test the basic understanding of foods that are high in salt content by asking questions such as which of these foods are high in sodium?. At the end of this session, I will leave the patient a detailed pamphlet detailing the recommended diets for hypertensive patients. Increased levels of physical activity combined with a healthy diet enables obese individuals to lose weight. According to National Heart Foundation of Australia, the recommended waist circumference in males is less than 94cm and less than 80 in females while the recommended body mass index (BMI) is less than 25kg/m2 [Nat10]. I will encourage the patient to maintain a healthy weight by ensuring that the daily energy input is lower than the expended energy. To achieve this, he will need 30 minutes or more daily of moderate to intense physical activity. 1 % reduction in body weight reduces systolic BP by about 1mmHg while reduction of body weight by 4.5 kg lowers BP and prevents hypertension in a substantial proportion of overweight people. Loss of 10kg body weight can drop systolic BP by 6-10 mmHg. Patients respond differently and so advice is tailored to meet the specific needs of an individual as well as according to the set goals. Patients are motivated by regular encouragement from healthcare professionals to assist them further to follow the right technique, provide a written instruction and review progress regularly. To evaluate the effectiveness of the lesson, I will give a post-test and compare it to the results of the pretest, allow him to operate the devices with the assistance from his partner to assess proper technique. Finally we will plan for a follow-up plan to assess the progress of the client. Bibliography Agarwal, R., Bills, J., Hecht, T. J., & Light, R. P. (2011). Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control. A systematic review and meta-analysis. AHA journal, 29-38. Ash, J. K., Walters, L. K., Prideaux, D. J., & Wilson, I. G. (2012). Medical education: the context of clinical teaching and learning in Australia. Medical Journal of Australia, 475-479. CDC. (2008, April 1). Podcasts at CDC. Retrieved from CDC: http://www2c.cdc.gov/podcasts/player.asp?f=11112 CDC. (2014, July 7). High blood pressure education materials for patients. Retrieved from CDC: http://www.cdc.gov/bloodpressure/materials_for_patients.htm CDC. (2014). Promotora Guide. Retrieved from CDC: http://www.cdc.gov/bloodpressure/docs/Promotora_Guide.pdf Cottrell, E., Chambers, R., & Connell, P. (2012). Using simple telehealth in primary care to reduce blood pressure: a service evaluation. BMJ Open. Firoozehchian, F., Ezbarmi, Z. T., & Dadgaran, I. (2012). Nursing-Midwifery students and teachers' views of effective factors in clinical education. Procedia- social and behavioral sciences, 1832-1837. Monash University. (2013, February 11). Lifestyle Modification. Retrieved from Monash University website: http://www.monash.edu.au/pharm/current/step-up/clinical-roles/lifestyle.html National Heart Foundation of Australia. (2010, December). Guide to management of hypertension; Assessing and managing raised blood pressure in adults. Retrieved from Heart Foundation: http://www.heartfoundation.org.au/SiteCollectionDocuments/HypertensionGuidelines2008to2010Update.pdf National Heart Foundation. (2014). Retrieved from National Heart Foundation of Australia: http://www.heartfoundation.org.au/your-heart/Pages/default.aspx National Heart Foundation of Australia. (2014). Active living. Retrieved from Heart Foundation: http://www.heartfoundation.org.au/active-living/Pages/welcome.aspx National institute of health. (2012, August 2). What id high blood pressure. Retrieved from National Institute of Health: http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/ Shahsavari, H., Yekta, Z. P., Zare, Z., & Sigaroodi, A. E. (2014). Iranian Effective Clinical Nurse Instructor Tool: Development and Psychometric testing. Iranian Journal of Nursing and Midwifery Research, 132-138. Tunstall Group Ltd. (2010). Hypertension management: integrated care platform. Retrieved from Tunstall Healthcare: http://www.tunstallhealthcare.com.au Read More