In this essay, I will focus my discussion on one problem, the type of nursing model used and the intervention given to a patient during my nursing placement. Also, I will briefly describe the pathophysiology of the patient’s diagnosis. However, I will ensure absolute confidentiality of the patient according to the Nursing and Midwifery Council (NMC) code of professional conduct (2004).
Jack was noticed by his wife of several behaviours and personality changes which includes confusion, inability to handle his finances, inability to complete normal daily tasks which involves domestic chores and office work, disorientation, changes in sleeping pattern, inability to retain information, isolating himself from work and social activities, anxiety, depression, suspicious, and inability to retrace his steps. More so, Jack’s wife brought Jack to the Medical health centre and explained that he has been experiencing these symptoms for 8 months and she felt the need to quickly seek medical attention. Also, Jack’s wife revealed that Jack was a smoker, a heavy drinker and fun loving. However, he has been isolating himself from social activities due to the symptoms that he has been feeling. The General Practitioner (GP) further diagnosed Jack of Mild stage Alzheimer’s Disease (AD) and referred him to a care home admission.
I had my placement at a care home. This care home offered care to older people between the ages of 50 – 80 years old suffering from Parkinson’s disease, physical disabilities, dementia and Alzheimer’s Disease. This care home provided a well-structured care and a safety environment to improve patient’s quality of life.
Alzheimer’s Disease is the degeneration of brain neurons which is clinically characterised by increased growth of cognition impairment, behaviour and functionalities that causes impairment in daily activities (Imbimbo, Lombard & Pomara, 2015). Also, Alzheimer’s Disease is as a result of cerebral degeration (Selkoe, 1991). Alzheimer’s Disease is caused by plaques of amyloid protein and tangles of neurofibrils which also involves the death of cells in specific areas in the brain (Nagy, Esiri & Smith, 1998). Morphologically, Alzheimer’s Disease is mainly characterised by atrophy of the brain and the enlargement of the cerebral ventricles (Imbimbo, Lombard & Pomara, 2015).
Aggleton & Chalmers (2000) advised that nursing model helps in activating the nursing process. The nursing model identifies major components such as the nature of individuals and the need that needs to be met. More so, the team providing the care must ensure that they share the same sentiment of care which is known as the pillar of nursing model (Archibad, 2000). Newton (1991) concluded that due to the continuation of care, using one major nursing models stands as a guide for nurses to work towards the same goal.
The specific model that I used during my placement is known as the Roper et al. model (1996). This model forms the holistic and humanistic approach to the process of assessment. This model enables nurses to comprehensively take individual’s care into account during nursing care and ensures the integration of all aspect of patient’s life into a care plan that meets their needs. Roper’s model is focused on client’s assessment and identification of problems which involves both actual and potential. These problems are divided into 12 daily activities which includes breathing, maintenance of safe environment, mobilisation, sleep pattern, communication, working and playing, regulating body temperature, dietary intake and elimination, personal hygiene, dying and sexual expression (Roper et al., 1996).
During patient’s assessment, the nurse facilitating the assessment must have a good communication skill to interview, observe and listen (Wilson, 1996). Alison (2000) explains that assessment ensures that the nurse can identify the major problem to the patient’s status and design a care plan that meets the patient’s needs. In the process of using Roper model for the assessment, several problems were discovered, but for the purpose of this assessment, I will major my discussion on one of the identified problems which is poor hygiene which is related to washing and dressing activity. Identifying this problem helped us to design an effective plan for his needs using the scheduled daily activities and engaged others to ensure that his needs are met holistically. Also, the identification of Jack’s problem spring up the generation of an effective care plan (Archibad, 2000).
Care plan is the next step of nursing process which is developing a care plan that will guide a direct therapeutic intervention (Wilson, 1996). This involves setting goals which is short, intermediate or long term which specifies the objectives, prioritising and identification of care required at a given period and the process to ensure these goals are achieved (Tschudin, 2003). Jack’s identified problem was achieving a good personal hygiene and supporting him when dressing up. For Jack’s needs to be met, goals were set using the smart criteria which is specific, measurable, achievable, realistic and time set. Jack’s short-term goal was ensuring that he was able to shave, bath, dress and care for his personal needs in 3 weeks, while his long-term goal was to have the ability to maintain a very good hygiene in 3 months.
In order to achieve these goals, a plan of action was designed which includes shaving, bathing and dressing daily, keeping his finger nails and hair neat, short and tidy. The chiropodist was invited for effective nail maintenance. Chiropodist is someone that treats the nails including disease and treatment. Inviting the barber to cut his hair weekly. Jack was engaged in his care plan which was mutually agreed upon by the nurse and Jack. I supported Jack to make informed decision by telling him about his care plan and how we could collaborate as a team engaging his family as well in order to achieve these goals. I signed the care plan, my mentor counter signed, and it was dated.
In the implementation of Jack’s care plan, nurses ensure direct and indirect practical implementation of plans to supports Jack to achieve the goals. This includes working collectively with other healthcare teams, Jack, and his family. The healthcare team must seek Jack’s consent before intervention in his care. The nurse ensures accurate record of the outcome for further care and must be signed with date by the nurse (Walsh, 2002). Activities was planned weekly to engage jack throughout the day. Jack was encouraged to brush his teeth, shave, bath and dress up every 07:00 in the morning and then followed by breakfast and medication. Furthermore, he was encouraged to use the toilet after lunch. The chiropodist meets him every weekend and I was involved by my mentor in Jack’s intervention to shave and bath daily.
Correspondingly, Hood and Dincher (1984) advised that nursing is beyond laying hands on patient but involves the support and encouragement for personal care to enhance self-dependence. It is crucial for nurses to obtain consent before providing care which applies equally to every individual with mental health condition. Daily plans on hourly bases is used to action the daily activities once information about their pleasurable activities is acquired. The objective is to enhance the level of activities and improve pleasure. Gibson (1991) highlights that empowerment is the process of supporting individuals in advocate control over their life problems. Nurses engages in collaboration with patient’s by enhancing independence and reducing dependence.
The care plan needs to be evaluated. This evaluation can reveal the effective and ineffective intervention and allows plan modification. Hence, the nurse evaluates the patient’s progress and compares the result with the expected outcome which is the goal. In this phase, the patient’s attitude to treatment and the patient’s needs is appraised. Newton (1991) explains that this phase is a platform for the patient to be re-assessed, re-examined and modification of statement of the problem, the deadline for the goal, and the care provided. Timby (1996) advised that it is crucial to discuss the reason for no progress in the patient’s care plan with the patient prior to care plan revision, and this discussion can lead to agreement by both the nurse and the patients on daily activities to eliminate, include or change. More so, suggestion is welcomed from other health teams who understands and familiar with the patient’s problem.
Overall, the outcome of the care plan shows high relevance to Jack’s problem. Jack’s independence was improved and he was able to comply with medication, take over his personal hygiene such as bathing, shaving, brushing his teeth, dressing up, visiting his chiropodist and able to identify the clothes to where when it is cold or warm which showed that the short-term goal is achieved, however, the long-term goal is ongoing.
Conclusively, his assignment has explained the diagnosed illness of the patient and the pathophysiology of the diagnosis. Also, this assignment has identified one problem that this patient is facing, the appropriate nursing intervention and the nursing model used in the nursing process. Finally, the outcome of this assignment have shown the importance of care plans and patient-centred approach to mental health patient and has fulfilled the NMC (2004) code of professional conduct by using a pseudonym Jack for confidentiality.
- Nagy, Z. S., Esiri, M. M., & Smith, A. D. (1998). The cell division cycle and the pathophysiology of Alzheimer’s disease. Neuroscience, 87(4), 731-739.
- Selkoe, D. J. (1991). The molecular pathology of Alzheimer’s disease. Neuron, 6(4), 487-498.