Patient Problems Assignment

INSTRUCTION: Write a paper of a minimum of 12 pages in length, excluding title page, abstract, and references. The paper must be constructed according to APA format (APA, 2010). Headings are to be included (see below). See Rubric for point allocation & sample.Patient Problems Assignment Essay

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Introduction: (i) Purpose statement/research question· (ii) Significance of the patient problem, supported by the literature. (iii) Select one IOM/QSEN Nurse Competency (Cronenwett et al., 2007)

Review of the Research Literature: This section includes a review of the 5 articles relating the patient problem to an IOM/QSEN competency. (ie related to the purpose statement /research question, and to substantiate the significance of the patient problem )Patient Problems Assignment Essay

Case Example: The case example must exemplify the problem statement/research question and be related to the identified IOM/QSEN competency. The case example should describe the patient condition, disease(s), clinical issues, medications, nursing care, etc.

Transition Theory (Im, 2006): frames the Capstone paper, and incorporating this theory is a required component of the paper. The following question(s) must be addressed when incorporating Transition Theory (Im, 2006):

a) What transition(s) is the patient in?

b) What are the facilitator’s and inhibitors?

c) What is or was the patient’s response?

d) What was the nursing intervention?

Conclusion: Integrate nursing implications from your literature review and relate them to your patient’s problem. Include nursing implications in these three areas:

(a) Practice: What is the best nursing practice for this issue?

(b) Education: What are the current guidelines for educating nurses, patients/families about care for this problem?

© Research: What are the priorities for further study (from a nursing perspective) related to this problem?Patient Problems Assignment Essay

**PICO question: Among patients with type-2 diabetes, does patient education improve compliance/self management?

Article 1: Carpenter, R., Dichiacchio, T., & Barker, K. (2019). Interventions for self-management of type 2 diabetes: An integrative review. International Journal of Nursing Sciences, 6(1), 70-91.

Article 2: Bagnasco, A., Di Giacomo, P., Da Rin Della Mora, R., Catania, G., Turci, C., Rocco, G., & Sasso, L. (2014). Factors influencing self‐management in patients with type 2 diabetes: A quantitative systematic review protocol. Journal of Advanced Nursing, 70(1), 187-200.

Article 3: Brackney, D. (2018). Enhanced self‐monitoring blood glucose in non‐insulin‐requiring Type 2 diabetes: A qualitative study in primary care. Journal of Clinical Nursing, 27(9-10), 2120-2131.

Article 4: Chrvala, Sherr, & Lipman. (2016). Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Education and Counseling, 99(6), 926-943.

Article 5: Boström, Isaksson, Lundman, Graneheim, & Hörnsten. (2014). Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes. Patient Education and Counseling, 94(2), 187-192.Patient Problems Assignment Essay

Article 6: Cronenwett, Sherwood, Barnsteiner, Disch, Johnson, Mitchell, . . . Warren. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3), 122-131.

Article 7: ALLIGOOD, Martha R., TOMEY, Ann M. (2006). Nursing theorists and their work. 6th ed. Philadelphia: Mosby Elsevier. ISBN: 978-0323030106

FYI: Attached is the sample of a nursing capstone paper, and the last 2 articles the QSEN and the IOM/ transition articles

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.Patient Problems Assignment Essay

This essay deals with the holistic assessment of a patient who was admitted onto the medical ward where I undertook my placement. Firstly, the relevant life history of the patient will be briefly explained. Secondly, the Roper, Logan and Tierney model of nursing that was used to assess the care needs of the patient will be discussed, and then the assessment process will be analysed critically. Identified areas of need – breathing and personal cleansing – will be discussed in relation to the care given and with reference to psychological, social, and biological factors as well as patho-physiology. Furthermore, the role of inter-professional skills in relation to care planning and delivery will be analysed, and finally the care given to the patient will be evaluated.

Throughout this assignment, confidentiality will be maintained to a high standard by following the Nursing and Midwifery Council (NMC), Code of Conduct (2008). No information regarding the hospital or ward will be mentioned, in accordance with the Data Protection Act 1998. The pseudonym Kate will be used to maintain the confidentiality of the patient

Kate, a lady aged 84, was admitted to a medical ward through the Accident and Emergency department. She was admitted with asthma and a chest infection. She presented with severe dyspnoea, wheezing, chest tightness and immobility. Kate is a patient known to suffer from chronic chest infections and asthma, with which she was diagnosed when she was young. She takes regular bronchodilators and corticosteroids in the form of inhalers and tablets. Kate lives on her own in a one bedroom flat. She has a daughter who lives one street away and visits her frequently. Her daughter stated that Kate has a very active social life; she enjoys going out for shopping using a shopping trolley.Patient Problems Assignment Essay

Elkin, Perry and Potter (2007) outlined nursing process as a systematic way to planning and delivering care to the patient. It involves four stages: assessment, planning, implementation and evaluation. Assessment is the first and most critical step of the nursing process, in which the nurse carries out a holistic assessment by collecting all the data about a patient in order to identify the patients nursing problems (Alfaro-Lefevre 2008). Holland (2008) stated that assessment as an on-going process used to identify needs, preferences and abilities of a patient. Rennie (2009) stated that subjective and objective data, as well as medical and social history are collected during patient’s interview. Among the physical aspects assessed are vital signs and general observations of the patient. Assessment is extremely important because it provides the scientific basis for a complete nursing care plan (Wilkinson 2006). Assessment is of benefit to the patient because it allows his or her medical needs to be known, but it can feel intimidating or embarrassing so the nurse needs to develop a good rapport (NursingLink 2012). Under time pressure this can sometimes be neglected. Are tools used? Are the tools user-friendly? What are they for? Why do we have them?

After assessment, care plan is formulated. Barrett, Wilson and Woollands (2012a), defined a care plan as an integrated document that addresses each identified need and risk. Care planning is important because it guides in the on-going provision of nursing care. Good care planning allows healthcare professionals make evidence-based decisions about care based on a comprehensive assessment, and to prove this, if necessary (Barrett, Wilson and Woollands 2012a). Care plans can be problematic when they are not filled in correctly or are completed carelessly. This can jeopardise patient care. Every nurse has a professional responsibility to make sure that care plans are filled in to the best of her ability to help herself and her colleagues to continue the process of giving the best care possible necessary (Barrett, Wilson and Woollands 2012a).Patient Problems Assignment Essay

Before assessment takes place, the nurse should explain when and why it will be carried out; allow adequate time; attend to the needs of the patient; consider confidentiality; ensure the environment is conducive; and consider the coping patterns of the patient (Jenkins 2008). The nurse should also introduce herself to help reduce anxiety and gain the patient’s confidence. During assessment, the nurse needs to use both verbal and non-verbal communication. Using non-verbal communication means that she should observe the patient, looking at the colour of the skin, the eyes, and taking note of odour and breathing. An accurate assessment enables nursing staff to prioritise a patient’s needs and to deal with the problem immediately it has been identified (Esmond 2011). Documentation is also very important in this process; all information collected has to be recorded either in the patient’s file or electronically (NMC, 2009b).Patient Problems Assignment Essay

Kate was allocated a bed within a four-bed female bay. Her daughter was with her at the bedside. Gordon (2008) stated that understanding that any admission to hospital can be frightening for patients and allowing them some time to get used to the environment is important for nursing staff. Both Kate and her daughter were asked if it was okay for her daughter to be around while assessment was carried out, so that she could help with some information, to which both agreed. As Kate was an adult and was judged by the nurses present to understand what she was consenting to, it was acceptable for her to consent to having her daughter present (Ebersole and Hess 1998). Her confidentiality was not compromised because she agreed to the presence of a family member. Alfaro-Lefevre (2008) recommended that nursing assessments take place in a separate room, which respects confidentiality, and that the patient be free to participate in the assessment. Although there was a room available, Kate and her daughter said it was fine for the assessment to take place at the bedside especially that Kate was so restless. The curtains were pulled around the bed, though Sibson (2010) argued that it ensures visual privacy only and not a barrier to sound. NMC (2009a) acknowledges this, along with the need to speak at an appropriate volume when asking for personal details to maintain confidentiality.Patient Problems Assignment Essay

In this ward the Roper, Logan and Tierney model of nursing, which is based on the twelve activities of living, is used as a base for assessing patients (Alabaster 2011). This model is extremely prevalent in the United Kingdom and it is used as a checklist on admission in order to get as much background data about the patient Holland (2008, p.9).

The assessment form that was used during Kate’s assessment addressed personal details and the twelve activities of living. Personal details such as name, age, address, nickname, religion, and housing status were recorded. Information was also recorded about any agency involved, along with next of kin and contact details, and details of the general practitioner. Holland (2008) stated that these details should be accurate and legible so that, in case of any concerns about the patient, the next of kin can be contacted easily. The name and age are also vital in order to correctly identify the patient to avoid mistakes. Knowing what type of a job the patient does or the type of the house she lives in helps to indicate how the patient is going to cope after discharge. Holland also insisted that religion should be known in case the patient would like to have some privacy during prayers, and this should be included in the care plan.Patient Problems Assignment Essay

The second assessment to be done focused on physical assessment and the activities of living. Barrett, Wilson and Woollands (2009) suggested that when enquiring about the activities of living, two elements should be addressed: usual and current routines. Additionally, identifying a patient’s habits will help in care planning and setting goals. During physical assessment, Kate demonstrated laboured, audible breath sounds and breathlessness. Use of accessory muscles and nose flaring was also noted. She was agitated and anxious. Her vital signs were: pulse 102 beats /min; respirations 26/min; temperature 37.4 degrees Celsius; oxygen saturation 88%; and peak flow 100 litres. Taking and recording observations is very important because it helps to recognise the significance of changes in vital signs. Observations also help to detect any signs of deterioration or progress in the patient’s condition (Field and Smith 2008). Carpenito-Moyet (2006) stated that it is important to take the first observations before any medical intervention, in order to assist in the diagnosis and to help assess the effects of treatment. How did all this affect her ability to provide you with information during the assessment?Patient Problems Assignment Essay

Kate’s initial assessment was carried out in a professional way, taking account of the patient’s particular circumstances, anxieties and wishes. After the baseline observations were taken, the twelve activities of living were analysed and Kate’s needs were identified. How gave the information, Kate or the daughter? Did this affect the way the questions were asked? Or the information received? Could Kate answer all the questions? Did the daughter know the answer to all the questions? Among the needs identified, breathing and personal hygiene (cleansing), being priority needs, will be explored.

Breathing will be discussed first being an underlying problem which Kate presented with before moving on to personal cleansing. Wilkinson (2006) states that a nursing diagnosis is an account about the patient’s current health situation. The normal breathing rate in a fit adult is 16-20 respirations/minute, but can go up to 30 due to pain, anxiety, pyrexia, sepsis, sleep and old age (Jenkins 2008). In old people, muscles become less efficient, resulting in increasing efforts to breathe, causing a high respiratory rate (Mallon 2010). On assessment, Kate’s problem was breathing that resulted in insufficient intake of air, due to asthma. She was wheezing, cyanosed, anxious and had shortness of breath.Patient Problems Assignment Essay

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Wilkinson (2006) explained that a goal statement is a quantifiable and noticeable criterion that can be used for evaluation. The goal statement in this case would be for Kate to maintain normal breathing, which is normally 12 – 18 breaths per minute in adults (Mallon 2010), and to increase air intake. The prescription of care for Kate depended on the assessment, which was achieved by monitoring her breathing rate, rhythm, pattern, and saturation levels. These were documented hourly for early identification of any deterioration of condition; it also encouraged early identification of interventions. Readings were compared with initial readings to determine changes and to report any concerns. The other part of the plan was to give psychological care to Kate by involving her in her care and informing her about the progress, in order to reduce anxiety. Barrett, Wilson and Woollands (2012a) stated that it is very important to give psychological care to patients who are dyspnoeic because they panic and become anxious.Patient Problems Assignment Essay

Checking and recording of breathing rate and pattern is very important because it is the only good way to assess whether this patient is improving or deteriorating, and it can be a very helpful method for nurses to evaluate the care of the patient (Jamieson 2007). Mallon (2010) stated that, if the breathing rate is more than 20, it indicates that the body is trying to increase its intake of oxygen to meet unusual demands. This can happen even after doing exercise, not only in people with respiratory problems (Blows 2001). Griffin and Potter (2006) stated that, respirations are normally quiet, and therefore if they are audible it indicates respiratory disease, wheezing sound indicates bronchiole constriction. Kate’s breathing was audible and the rate was also above normal and that is why breathing was prioritised as the first need

Oxygen saturation level was also monitored with the use of a pulse oximeter. The normal saturation level is 95-99% (British National Formulary ((BNF)) 2011a). Nevertheless the doctor said that 90-95% was fine for Kate, considering her condition and her age. Kate was started on two litres of oxygen using nasal catheter and she maintained her oxygen saturation between 90 and 94%. With nasal catheter, Kate was able to communicate with the nurses and her daughter what about comfort?. The peak expiratory flow was monitored and recorded to identify the obstructive pattern of breathing that takes place in asthma (Hilton, 2005). This is another method that is used to assess the effectiveness of the medication (inhalers) the asthmatic patient is taking, and this test should be carried out 20 minutes after medication has been absorbed. It is the Trust’s policy to do hourly observations on patients who have had one, two or three abnormal readings, until readings return to normal.Patient Problems Assignment Essay Kate was observed for any blueness in the lips and oral mucosa as this could be a sign of cyanosis. All the prescribed nebulisers, inhalers, bronchodilators, corticosteroids, antibiotics and oxygen therapy were administered according to the doctor’s instructions. Bronchodilators are given to dilate the bronchioles constricted due to asthma, and corticosteroids reduce inflammation in the airway (BNF 2011b). Kate was also started on antibiotics to combat the infection because, on auscultation, the doctor found that the chest was not clear.

Kate was being reassured during care, her daughter was encouraged to be visiting her mum regularly because she used to be settled whenever the daughter was around. The call bell was always in reach for to call when in need.Patient Problems Assignment Essay

Kate was nursed in an upright position using pillows and a profiling bed in order to increase chest capacity and facilitate easy respiratory function by use of gravity (Brooker and Nicol, 2011). In this position, Kate was comfortable and calm while other vital signs were being checked. Pulse rate and temperature were also being checked and recorded because if raised, they indicate infection in the blood.

Considering Kate’s age and her breathing problem, she needed multi- professional teamwork. NMC (2008) encouraged teamwork to maintain good quality care. Kate was referred to the respiratory nurse who is specialised in helping patients with breathing problems. Specialist nurses have expert knowledge of a particular area of nursing, and as well as offering direct care, like ‘normal’ nurses, they educate patients in the management of their condition and can provide a consistent point of contact for sufferers of particular illnesses, which can help with psychological well-being (Royal College of Nursing 2010). Kate was on oxygen since admission; therefore she was taught about importance of healthy breathing and taught her about breathing exercises to help her wean from oxygen.Patient Problems Assignment Essay

Due to breathlessness and loss of mobility it was difficulty for Kate to maintain her personal hygiene. Hygiene is the practice of cleanliness that is needed to maintain health, for example bathing, mouth washing and hair washing. The skin is the first line of defence, so it is vital to maintain personal cleansing to protect the inner organs against injuries and infection (Hemming 2010). Field and Smith (2008) stated that personal cleansing also stimulates the body, produces a sense of well-being, and enables nurses to assess the patient holistically. Personal hygiene is particularly important for the elderly because their skin becomes fragile and more prone to breaking down (Holloway and Jones 2005). This is due to slower epidermal cell renewal and a reduction in collagen (Hess 1998). Therefore this need was very important for Kate; she needed to maintain her hygiene as she used to, before she was ill.

The goal for meeting this need was to maintain personal hygiene and comfort. The care plan prescribed involved first gaining consent from Kate, explaining what was going to be done. Hemming (2010) recommended that identifying the patient’s usual habit is very important because each individual has different ideas about hygiene due to age, culture or religion. Identifying usual habits helps individuals to maintain their social life if things are done according to their wishes. Though Hemming said all human beings need personal hygiene, Holland (2008) argued that it is important to ask patients how they feel about being cleaned, especially genital area. Kate indicated that she didn’t mind being assisted with washing and dressing. She preferred washing daily, shower and a hair wash once a week, and a mouth wash every morning and before going to bed.Patient Problems Assignment Essay

Kate was assisted with personal care after having her medication, especially the nebuliser. Individuals with asthma experience shortness of breath whenever they are physically active (Ritz, Rosenfield and Steptoe 2010). After having medication Kate was able to participate during personal hygiene. According to NMC guidelines on confidentiality (2009a), privacy and dignity should be maintained when giving care to patients. Therefore, whenever Kate was being assisted with personal care, it was ensured that the screens were closed and she was properly covered. Field and Smith (2008) suggested that assisting a patient with personal hygiene is the time that nurses can assess the patient holistically. Since Kate was immobile, it was very important to check her pressure areas for any redness. She was also checked for any pallor, jaundice, cyanosis or dry skin that needed attention. The care was always carried out according to her wishes.Patient Problems Assignment Essay

Kate responded well to the medication she was prescribed; normal breathing was maintained, her respirations became normal, ranging from 18 to 20 respirations per minute, and her oxygen saturation ranged from 95% to 99%. Kate was able to wash and dress herself with minimal assistance. She was discharged on a continuous care package comprising care three times a day, although discharge was delayed by one week so that the care package could be ready.

The model of the twelve activities of living was followed successfully on the whole. The nurse collected subjective and objective data, allowing a nursing diagnosis to be formulated, goals to be identified and a care plan to be constructed and implemented. Privacy is very important in carrying out assessments, and this was not achieved fully in Kate’s assessment. However, this lower level of privacy has to be balanced against causing anxiety to the patient. Kate’s daughter thought that the bedside assessment would be more comfortable for her mother, and therefore cause least anxiety. This was very important because of the effects of potential panic on breathing; therefore, this was the correct balance to strike.Patient Problems Assignment Essay

A multi-disciplinary team was involved in meeting Kate’s care goals. This is a good example of the use of inter-professional skills, as a number of different departments were involved in creating and implementing the care plan. However, the system was not as efficient as it should have been: Kate spent unnecessary time in hospital after recovery because the care plan was not yet in place.

Assessment can also take a long time, especially with the elderly who are usually slow to respond. Therefore, more time is needed to be sure that the necessary progress has been achieved before taking further steps. However, poor staffing also affects performance in this area, an observation supported by the Royal College of Nursing (2012).Patient Problems Assignment Essay

In conclusion, the assessment of this patient was completed successfully, and the deviation from best practice recommendations (the lower level of privacy) was justified by the clinical circumstances. Progress from assessment to care goals was good, and at this point an inter-disciplinary team was used successfully. However, the one flaw in this process was delays, caused partly by the difficulties of working across different departments, and partly, it seems, by staff shortages.Patient Problems Assignment Essay

The nursing career is among the most important professions in the world. There have been changes in the health care profession, which has an impact on the workload of the nurses, patient safety and the quality of care accorded. It is for this purpose that the chosen study topic is “Nurses Perception of Patient Workload on Nursing Effectiveness.” Whenever there is staff burnout in the vocation, it develops a critical problem as it is a human service profession. It leads to debilitation of workers, becomes expensive to agencies, and it is detrimental to the clients. Understanding the perception that nurses have towards patient workload is essential in identifying other factors affecting their effectiveness such as job stress. Therefore, the topic focuses on the nurses and their perception of the current situation on workload. If they consider that it is heavy, it may be affecting their output, which may be detrimental to the patients.Patient Problems Assignment Essay

JUSTIFICATION FOR TOPIC CHOICE
As earlier stated, nursing is one of the most stressful professions. Job stress entails a psychological syndrome that an individual has in response to chronic exposure to interpersonal and emotional stressors while on the job. The psychological markers of stress sometimes may occur without an individual’s awareness of the demands of the environment. They include increased cardiovascular activity and heightened psychological arousal (Warner, 2014). Often, the environment at the healthcare facilities lacks adequate support staff, which may further contribute to the job’s stressful nature. The profession is also facing shortage of nurses. Analysis indicates that there may be a shortage in the workforce of the nurses in the future. As the baby boomers age, there will be increased demand for nurses due to the augmented need for healthcare. The current supply of nurses is from the registered nurses and the licensed practical nurses. There are various issues contributing to the nursing shortage. First, there is a shortage in the nursing school faculty, which is restricting the enrollment into the nursing profession (AACN, 2014). In 2012, the U.S. nursing schools turned away almost 80,000 qualified applicants who were interested in pursuing baccalaureate and graduate programs in nursing. The main reasons were insufficient faculty, classroom space, clinical sites, budget constraints, and clinical preceptors (AACN, 2014).Patient Problems Assignment Essay

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Second, there is a notable section of the nursing workforce that is nearing retirement. According to a 2013 survey, about fifty-five percent of registered nurses are aged 50 or older (AACN, 2013). In the next decade, more than one million nurses will retire. Third, there are changes in the demographic composition that is signaling the need for additional nurses. It is mainly due to the increasing aging population. The birthrate is reducing, which means that there will be fewer people to work as nurses as the current lot retires. Moreover, as the aged population increases, the demand for healthcare will increase. Fourth, studies have indicated that there is high-stress level in the profession due to insufficient staffing, which is affecting their satisfaction. As a result, many nurses are leaving the profession. It is also characteristic for nurses to change professions after a short period of service (AACN, 2014). The safety of patients and quality of the services that they receive is reliant on the satisfaction of the nurses. It is also reliant on the nurses’ ability to handle their workload efficiently.Patient Problems Assignment Essay
When the number of nurses is not sufficient, the care and safety of patients may be compromised. At the same time, the nurses may be dissatisfied, overwhelmed and distressed. Increased nurse-patient ratio lead to frustration and job burnout, which is the key cause of turnover in the profession. When there is a shortage in the nurses’ workforces, it becomes necessary to develop strategies that will enable the rectification of the issue (AACN, 2014). It is also evident that the nurses’ shortage problem is not only an American problem, but also a global problem. Numerous countries are affected by the same problem, and finding the current situation is a step towards getting the solution. It is essential for the nurses operating in all institutional specialties, as well as, those in leadership and administrative positions to examine the factors contributing to the current shortage. In addition, there should be familiarization of the nurses to the situation and make a determination of what ought to be implemented in order to influence improvement strategies. Therefore, the choice of the topic will guide the study into identifying the situation in the nursing profession, and the perception that the nurses have towards their roles. Additionally, there will be an investigation of the patients’ situation due to the prevailing situation. In addition, the findings can be applied in the findings of a solution.Patient Problems Assignment Essay

IMPORTANCE OF THE PROJECT TO NURSING
Nursing course requires understanding the practical and theoretical issues relating to the profession. In addition, it is necessary to understand the actual environment. As the research indicates, a considerable number of nurses do not pursue the profession for more than two years after they start practicing (AACN, 2014). It means that they are usually unprepared for the actual work experience. Understanding how to become a nurse or the medical issues associated with it is important, but practicing is the ultimate goal. Therefore, loses its purpose to have a large number of qualified nurses who are not willing to practice. The project will assist in analyzing the situation from the nurses’ perspective. They will provide information that will assist students to understand the situation in the actual field and prepare for it. As the discipline entails different aspects of training, an additional reinforcement to the training can assist develop high-quality nurses who are prepared for the actual work is necessary. As a nurse, the main target is to become useful in the field. In addition, the discipline may not be highlighting different issues affecting the profession. For instance, there should be preparation for the students to work under pressure. The study will make recommendations to relevant authorities on the factors affecting the profession. Patient Problems Assignment