Introduction
The nursing career has been defined as a very personal and interactive job (Yura and Walsh, 1998) also to deliver and offer good patient caution many authors have suggested that individualised health care ensures that the individual can be regarded as a person so that an individual within a couple of certain circumstances (Meleis, 1991).
To ensure patients are viewed as an individual within a couple of circumstances (Meleis, 1991) it is useful for nursing experts to look at a holistic method of care.
Holistic medical is thought as a process where in fact the patients aren't simply treated because of the physical symptoms of a disease or condition, but are considered all together and the the totality of the person being cared for is explored to add: mental, mental, spiritual, social, cultural, relational, contextual and environmental aspects (Mueller, 2010).
This task will concentrate on a patient research study and can explore the medical intervention, analysis and individualised care the individual received.
When presenting a patient case study it is essential to acknowledge the problems encompassing confidentiality.
The Nursing and Midwifery Council talk about in the code of benchmarks of do, performance and ethics for nurses and midwives (NMC, 2008a) that it is essential to 'make the treatment of people your first matter, treating them as individuals and respecting their dignity' which is an important factor when writing an article based on a research study.
To ensure that this assignment complies with the Code of Professional Practice (NMC, 2008a) the writer will ensure that consumer confidentiality will be maintained and well known throughout.
To ensure that customer confidentiality is upheld, the client selected for this assignment will only be known as Mrs P so that no personal recognition or features of their care is highlighted; furthermore to ensure confidentiality is upheld, although this assignment case study has been determined from a customer encountered by the writer in scientific practice from other training and scholar development, no identifying medical center details, places of research, names of providers or schedules of intervention will be offered.
Mrs P - A Clinical Circumstance Study
Mrs P is a 78 year old lady who presently lives exclusively in a centrally located council managed property in a town in the Western world Midlands.
Mrs P was hitched in the 1950's and her hubby worked in an engineering manufacturer until he had to retire anticipated to ill health and he then regrettably passed away in the mid 1990's.
Mrs P has resided alone since this time, moving in 2001 of their house to an inferior council held first floor toned.
Mrs P was created in the Western Midlands to an Irish father and English mother and she actually is the only surviving sibling of a family of six. Mrs P has two sons and a little princess, who unfortunately perished from breast cancer, aged 56. Mrs P's two sons who live locally.
Mrs P kept school era 14 and went to work as a cleaner in a manufacturing plant; she left employment to raise her children but prior to this she proved helpful in a munitions factory during the war. Mrs P didn't work again once she was wedded and has already established financial support through the governments benefit system and through a little private pension obtained through her husband's company.
Mrs P has a relatively unremarkable health background up until retirement when she required a hip procedure to correct a fracture following a fall. Since this time around Mrs P shows that her health began to 'struggle' and she's been diagnosed with hypertension, type 2 Diabetes, in 2006 she had a stroke and recently has seen her GP at the insistence of 1 of her sons about her storage, it has been recognized by the GP that pursuing her heart stroke Mrs P is rolling out a slight cognitive impairment which 's the reason for the problems she actually is having with her memory.
Mrs P was much smoker until she acquired her stroke in 2006, she only uses alcoholic beverages on 'special events' and describes her diet as generally healthy with a 'few treats' now and again.
Where Mrs P lives there is a little community of older people in the same building and the warden arranges activities on a regular basis such as espresso mornings and bingo. Mrs P; although friendly with her neighbours; will not attend these activities as she 'doesn't want to socialise specifically' with them.
Mrs P attends her local Church on a Sunday and describes herself as a 'Christian', she depends on her son to have her and another member of the congregation to bring her home, if her Son is away with work she actually is unable to enroll in.
Mrs P generally goes out to the neighborhood shops on a daily basis to get food and a magazine; she will not go out currently for any public activity unless she is taken to one of her sons for tea or is taken to chapel. Within recent weeks Mrs P has not been going out quite definitely as she's 'not felt up to it'.
Dimensions of Care
The elderly human population in the united kingdom is growing significantly in number and recent results produced by any office for National Reports (2010a) suggests that over the last 25 years the ratio of the populace aged 65 and over increased from 15 % in 1984 to 16 per cent in 2009 2009, an increase of 1 1. 7 million people. On an area level where Mrs P lives this nationwide pattern is also shown with evidence of a growing people of individuals over the age of 65 (Office for National Statistics, 2010b).
The occurrence of strokes in older people is significant and research shows that each yr around 110, 000 individuals in England and Wales have a stroke and a further 30, 000 people continue to obtain further strokes (Office of Health, 2001). Heart stroke is the solitary most significant reason behind severe disability and the 3rd most common cause of death in the UK (Wolfe et al, 1996).
Memory problems are the cognitive complaint following stroke (das Nair and Lincoln, 2008) which is not uncommon for people who have developed problems with their memory to go on and develop more serious problems such as dementia (Maud, 2006).
The trip to Mrs P at home by medical researchers was to obtain a blood sample and to check her blood circulation pressure. Mrs P had rang the surgery previously in the week and requested a home visit from the GP, although no acute medical problem have been recognized, the GP sensed it was appropriate to follow his assessment up with some tedious tests.
Mrs P was warm and inviting and it was told her that the writer was students, she was agreeable to being area of the learning experience and provided her arrangement that she would be prepared to talk about herself and her health issues. As previously discovered confidentiality plays a substantial part in the partnership between patient and specialist and to clarify a duty of confidence occurs when one individual discloses information to another in circumstances where it is realistic to expect that the info will be performed in confidence (NMC, 2008b). It was told Mrs P what the info would be obtained for (for nursing records and for this assignment) and she provided her verbal consent that she decided to this, once she have been prepared about confidentiality aspects.
The trip to Mrs P was to perform two clinical procedures; taking blood and taking her blood circulation pressure; and it was detected that the skilled nursing practitioner asked Mrs P prior to conducting each technique if she decided to have them done. On both occasions Mrs P provided her agreement.
This process is known as obtaining consent and it is important part of medical practice to ensure that as a practitioner consent is obtained from the individual before any method or care and attention is completed and that esteem must be paid to people who decline care and attention or treatment. The NMC (2008a) Code of Professional Practice evidently sets out guidance in relation to obtaining consent and to fail to do so could be looked at as a breach of do.
One of the problems recognized in the code of do shows issues about consent and those who lack capacity.
The Mental Capacity Act (2005) was created to protect people who can't make decisions for themselves or lack the mental capacity to take action. This may be anticipated to a mental health, a severe learning difficulty, a brain accident, a stroke or unconsciousness scheduled to the anaesthetic or quick accident (NHS Choices, 2010). The purpose of the act is to ensure folks are able to make as many choices for themselves as they can so that a measure of protection for individuals who may not have the ability to make decisions for themselves because of the reasons listed above.
Mrs P acquired experienced a stroke and have been diagnosed with a mental health condition (cognitive impairment), factors which could contribute to an individual not being able to make decisions for themselves because they lack capacity.
The qualified specialist explained to the author following visit that whenever Mrs P acquired seen her GP on her behalf memory problems, he had conducted a mental capacity evaluation to see if she was still able to make decisions for herself regarding her care and attention.
A capacity analysis clearly says that the 'assumption of capacity' is the overriding rule of capacity assessment (Chapel and W, 2007). The work clearly places out a person is deemed to have capacity unless it is demonstrated they have an impairment or disruption of mental functioning (such as an intellectual disability, dementia or other cognitive impairment, obtained brain accident or mental disorder) and this impairment is enough to have an effect on their capacity to make a particular decision (NHS Alternatives, 2010).
Mrs P's GP acquired determined in the files that although Mrs P got experienced a heart stroke and acquired developed cognitive problems third, , she still experienced the mental capacity to make decisions for herself regarding her treatment and treatment.
The qualified specialist suggested that although this analysis had been created by the GP and we were aware she had been assessed to obtain capacity to produce a decision for herself about having bloods used and having her blood pressure examined, it was important to keep in mind that if Mrs P was to be seen and her demonstration had changed, for example, if she was more forgetful or baffled, then it would be essential for her capacity to be assessed again before seeking her consent to possess procedures and care delivered.
Prior to the blood test and bloodstream pressure being used, Mrs P was asked if her sink could be utilized so that hands washing could happen.
Hand cleaning is prompted by the local Health care Trust and nationally by the NHS; it is viewed as everybody's responsibility to understand infections control issues. There's a specific local insurance policy to be adhered to and this is not just for hospital centered staff it is made for community staff to adhere to as well.
Hand washing is the single most effective measure in preventing spread of an infection and there are five main points in the delivery of patient health care when hand cleaning should be demonstrated; these are; before touching an individual, before a clean/aseptic technique, after body smooth exposure, after patient contact and after coming in contact with patient environment (Health Protection Firm, 2009).
Hand health is also considered as one of the most crucial measures to lessen the transmitting of illness (Pittet et al, 2000) and studies have frequently documented the value of hand washing even though as a simple procedure it isn't sufficiently accepted by healthcare workers (Pittet et al, 2000).
The local trust coverage clearly expresses that hand washing is compulsory prior to doing any clinical procedure therefore this task was completed prior to the bloods being taken to ensure the risk of contamination was reduced. After the bloods and blood circulation pressure had been considered, alcohol palm gel was applied to the practitioner's hands as yet another infection control strategy.
Alcohol side rubs are advised at a local and national plan level as it is an effective and quicker to use approach to hands hygiene, it is much better tolerated by the hands which is convenient as it is carried around on the person (National Patient Safety Firm, 2008).
The hand washing was conducted in Mrs P's kitchen and it was noted by the certified practitioner that there is out of date food privately and this her dosette box which held her medication was indicating that she had not considered her medication on at least five individual occasions over the course of the the other day.
Whilst the certified specialist was taking the bloods, Mrs P was asked about how she gets her shopping and what she cooks for herself on a daily basis. Mrs P suggested that she goes to the retailers daily and cooks for herself, however with her not feeling physically more than the last week she had not been able to venture out and get shopping. The qualified practitioner asked Mrs P if her son would be able to get her some shopping if she'd give her consent to the specialist giving him a wedding ring to ask him to get some essential items for her. Mrs P agreed.
The qualified specialist also asked Mrs P about her medication in the dosette container and was educated that sometimes she 'forgot to use it' and if her son rang he'd remind her, but if he was away with work (like he previously been that week) she possessed to remember herself.
Mrs P was asked if she'd be ready to look at a referral to interpersonal services for an analysis to see if there could be any extra help provided to her at the existing time when she had not been feeling physically sufficiently to shop and that they can also be in a position to provide support with planning meals and prompting medication.
Mrs P stated plainly that she did not need any help and felt that she could control independently without the support, she disclosed that her sons experienced 'been on at her' just lately to accept public services care and attention, however she experienced she didn't need it as she could deal with. Mrs P also explained that she didn't want social workers 'interfering and being nosy' and this she 'didn't trust them as they might probably want to place her in a home'.
Mrs P offered a very clear judgment on why she did not want to consent to a social good care assessment and although the evidence in the home environment (rotten food, no evidence of meal planning, poor medication conformity) would suggest she does need some interpersonal care and attention support, Mrs P was organization in her decision never to consent to an examination.
Under the Mental Capacity Take action (2005) there is certainly clear mention of the decision making procedure for individuals and exactly how they could make 'unwise decisions'. In this situation Mrs P seems to be making an unwise decision never to allow help, however she's been assessed to have the capacity to get this to choice predicated on her own educated perception and value system.
The qualified specialist did not go after this further with Mrs P but in a telephone discussion with Mrs P's eldest kid later that afternoon she does ask him about cultural services engagement and was educated that Mrs P has already established a lifelong distrust of public services who she believed were 'occupied bodies' plus they had attempted on numerous occasions to get her to agree to having some help at home but she acquired refused. Mrs P's boy indicated that they didn't know why she was so against sociable services nevertheless they felt it might be down to something that occurred when their father was unwell and was seen with a social worker in medical center who Mrs P got told them had wanted to place him in a attention home somewhat than let him go back home, which had annoyed her greatly at that time.
The kid also had educated the qualified practitioner he would request some shopping to be supplied and for just about any out of date food to be thrown away.
With the medical techniques completed, Mrs P was thanked for her hospitality and on her behalf agreement in taking part in the clinical methods and in the assortment of information for this assignment. Again problems with respect to confidentiality were repeated to Mrs P and she again explained that she understood and offered her agreement for the information to be utilized as a learning process.
Although Mrs P refused to have an diagnosis from a public staff member with a view to receiving home treatment support, there would probably be other avenues of support available which might be beneficial to improving Mrs P's quality of life and health position.
In regards to the problem regarding compliance with medication it could be possible to suggest to a family member that they band Mrs P to prompt her for taking her medication or to explore resources such as medication alarms that set off to remind visitors to take their medication which can be bought from traditional pharmacists or from specialist websites for people with memory space problems or dementia.
By not taking her medication Mrs P places herself at risk of further health issues, particularly as you of her medications is made for reducing high blood pressure (hypertension) which is important in minimizing the occurrence of further strokes (Office of Health, 2001).
Mrs P is reliant on her behalf son to consider her to chapel and this is a way of her conference not only her religious needs but her social needs as following the service she will collect with other elderly guests for a glass of tea in the church hall before being helped bring home. If her son struggles to bring her she will not go to. One way of addressing this would be to consider if there are any voluntary motorists as part of the cathedral community or if there is a council run system like a 'diamond ring and ride' bus which could take Mrs P to chapel on the times her kid is away working.
It is important for Mrs P to keep her interpersonal contact as interpersonal isolation in the elderly is one of the main contributing factors to the development of other health problems such as depressive disorder (Team of Health, 2010; Smith, 2010).
Whilst Mrs P is sensing physically unwell and not able to walk to the outlets everyday it might be valuable to get shopping and food supplied. Voluntary businesses such as Age group UK (previously Help the Aged and Age group Concern who have combined to create Age UK) might be able to offer support such as a shopping service or to assist Mrs P with buying ready meals from either a sizable supermarket chain who deliver or from a business specifically create to provide and deliver meals for older people.
Age UK may also be able to provide Mrs P with a proper check to ensure that all her needs are being satisfied, for example they would be able to review her benefits to ensure she is getting all the she is entitled to; they could also have the ability to provide befrienders who might be able to reduce the threat of Mrs P staying socially isolated by visiting regularly particularly when her boy is away working.
Conclusion
Mrs P came to the interest of the medical service carrying out a referral from her GP for a blood vessels test and for monitoring of her blood pressure. These clinical duties were completed, however this task has identified that there are many issues that can present when nursing staff are going to and assessing an individual, particularly when they may be in their own home and particularly if providing a all natural nursing approach to individualised care and attention.
Throughout the analysis and participation with Mrs P it was seen that the experienced practitioner not only completed the duties required for a physical health screen, she also evaluated other components of Mrs P's well-being and health including her social, nutritional, mental, religious and emotional wellness.
This strategy encapsulated the concept of holistic nursing where the patient has been seen and assessed as a whole rather than simply being viewed as someone that required bloods and blood pressure to be studied.
Viewing Mrs P holistically allowed the qualified practitioner to see that there is a complicated and interwoven set of needs and conditions that require handling for Mrs P to maximise her health insurance and the respond to reaching these needs was individualised and tailored specifically for Mrs P.
The concept of an holistic method of nursing care which is individualised and of significant quality is firmly encouraged and advocated in the nursing literature, it is a process which ensures needs are attained through comprehensive diagnosis and eventually benefits the individual and supports the process of health improvement and need lead care.
Holistic nursing movements from prescriptive medical and the medical model of care and moves more into a needs lead procedure rather an illness lead methodology, which in the end benefits the patient and gets the potential to have the most rewarding and positive effect on their life and health.
