BNUR1900F24 Caring in Nrsg Practice Case Study Review PDF

BNUR1900 Case Study Presented by Peter Kennedy RN, BScN, MBA November 7, 2024  Excerpt from Sample Case Study 2023  This case study presents a client encountered by the Introduction author during clinical placement. A brief overview of the client...

BNUR1900 Case Study Presented by Peter Kennedy RN, BScN, MBA November 7, 2024  Excerpt from Sample Case Study 2023  This case study presents a client encountered by the Introduction author during clinical placement. A brief overview of the client’s history will be provided, followed by a description of their primary diagnosis. The role of allied health professionals will be presented. A discussion of the implications for nursing care…  Excerpt from Sample Case Study 2023  J. Doe is an older adult living in long term care (LTC). As a child they were diagnosed with epilepsy. Several treatment plans were trialed without success, and as a young adult the client underwent a craniotomy. This Brief Overview of Client effectively managed their epilepsy, but left them with an Health History Acquired Brain Injury (ABI) to their right temporal lobe….  Also, in early adulthood the client was diagnosed with schizophrenia and began taking oral antipsychotic medications. For many years J. Doe lived in the community, with varying levels of formal support…  Excerpt from Sample Case Study 2023  J. Doe’s primary diagnosis is ABI, described as a right temporal lobe encephalomalacia… Primary Diagnosis  It is often associated with stroke, however in this client it is the result of a craniotomy. The temporal lobe is associated with hearing, as well as comprehending and producing speech (Rathus et al., 2023)…  Excerpt from Sample Case Study 2023  The client’s Allied Health Professionals team support Allied Health Professionals various aspects of their care. A dietician assesses J. Doe at least once every three months to monitor their nutritional status and weight. The dietician has also recommended a minced diet as the client has difficulty swallowing...  Excerpt from Sample Case Study 2023  J. Doe requires a significant amount of nursing support. This includes medication management, health Implications for monitoring and promoting dignity. The client’s cognitive Nursing Care deficit makes them unable to manage their own medication…  …J. Doe’s movement disorder would make it difficult to manage the psychomotor aspects of this task…  Excerpt from Sample Case Study 2023  This case study provided an example of how nursing care is customized to the needs of a specific client. J. Conclusion Doe’s medical history was presented, along with information about their primary diagnosis and how other health professionals provide them with support…  Excerpt from Sample Case Study 2023  Piaget’s Theory of Cognitive Development Period 3: Concrete Operations  Evidence to support this stage: Table:  client understands numeracy, can think about Identify the current actions without performing them, and can share developmental information about experiences… stage of the patient/client. Consider how this impacts  Client does not demonstrate features of Period 4: your nursing care. Formal Operation  Appears unable to comprehend complex, abstract concepts…  Implications for nursing care:  Client will require nursing support to recognize changes to their health and…  Excerpt from Sample Case Study 2023 Table:  Physical Clearly indicate any age-  Integument, Musculoskeletal, Neurological… related changes that are of relevance to the  Psychosocial: patient/client. This  As a result of the client’s neurocognitive deficit, they includes psychosocial, do not appear to be displaying the typical physical, sensory, psychosocial changes related to age… communication, or emotional changes.  NEW Table: Discuss the types of social support your patient/client  Informal and formal supports…is the client estranged has, how these supports from family, supported by an ACT team… influence their physical and  Domains where support is required versus what is mental health, and how available to the client…consider hospital to community you would incorporate this transition planning… understanding into their care plan.  Excerpt from Sample Case Study 2023 Table:  Skill taught: Handwashing with alcohol-based hand rub Describe a health teaching (ABHR) experience with the  Student nurse incorporated principles of patient/client. Provide a communicating with clients experience speech brief description of what difficulties and cognitive deficits (i.e. allowing extra time you taught. Reflect on how for responses, providing demonstration along with this relates to the verbal instructions) (Touhy et al., 2019)… patient/client’s current health status.  Excerpt from Sample Case Study 2023 Table:  Moment: The client was seated near the dining room, Consider and describe a waiting for breakfast. Their morning care had recently specific moment of care. been completed… Apply this to the  Student nurse considered four Standard Statements: therapeutic nurse-client relationship.  Therapeutic Communication: used client’s name, listened to and respected client’s opinions and needs, modified communication style to need of client (i.e. allowing extra time)… BNUR1900 Nursing Fundamentals Module 7: Caring in Nursing Practice Presented by Peter Kennedy RN, BScN, MBA November 7, 2024  Entry to Practice Competencies 1.22 5.5 5.7 5.8 Incorporates Participates Prepares Prepares knowledge in decision- clients for clients for from nursing making to transitions in discharge. science, manage care. social client sciences, transfer humanities, within health and health- care related facilities. Plan  What does caring mean to you? Caring is the essence of What do you know Nursing about caring and - Jean Watson nursing? What do other people do that make you feel like they care?  How Can we Demonstrate Caring? Caring in practice: Being attentive, open, and respectful Being present, providing a caring touch, and listening Treating the patient as a person Caring is a product of culture, values, experiences and relationships with others Focus on the human relationship Patient-centered approach Caring and compassionate approach  A nurse enters a patient's room, greets the patient warmly while touching the patient lightly on the shoulder, makes eye contact, sits down for a few minutes, and asks about the patient's thoughts and concerns. The nurse listens to the patient’s story, looks at the intravenous solution being administered, briefly examines the patient, and then checks the vital sign summary on the bedside computer screen before departing the room. A second nurse enters the patient's room, looks at Scenario the intravenous solution being administered, checks the vital sign summary sheet on the bedside computer screen, and acknowledges the patient but never sits down or touches the patient The nurse makes eye contact from above while the patient is in the vulnerable horizontal position.. The nurse a few brief questions about the patient's symptoms and then leaves.  Help Psychological Meeting & Emotional Patient’s Support Needs Caring Health Services Maintenance Provision & Disease Prevention  Caring With a caring nurse, the patient senses commitment on the part of the nurse People perceive and experience caring behaviours differently When patients believe that their HCP is invested in their health and well- being, and truly cares about them, they tend to be a more active participant in their plan of care  Caring is a moral imperative Through caring for others, dignity is protected, preserved, and enhanced (Watson, 1988) Ethics of care is concerned with the relationship between the client and nurse Ethics of Caring and the attitude of each toward the other Places the nurse as the client’s advocate who resolves ethical dilemmas by creating a relationship The nurse is sensitive to unequal relationships that could lead to an abuse of power (whether intentional or non- intentional)  Benner: Caring is primary Theoretical Views Leininger: Caring is universal Watson: Caring is transformative on Caring Swanson: Caring is nurturing Roach: Human act of caring  Caring is the essence of professional nursing practice Caring means concern about a person, event, project, thing Allows us to understand patients, recognize their problems or concerns, and work collaboratively to identify solutions Caring is a word for being connected Benner (1984) Caring reflects what matters to a person and creates possibility Can help people make sense of or find meaning in their healthcare journey Ethic of caring must be learned experientially – develop skills and knowledge on how to relate to the concerns of others and respond using a respectful and supportive approach  Described the concept of care as the essence and the central, unifying, and dominant domain that distinguishes nursing from other health disciplines Care is an essential human need – and caring improves the human condition Vital to recovery from illness and Leininger (1978) maintenance of healthy life practices in all cultures Caring is very personal, and expressions of caring differ for every patient Importance of understanding the cultural aspects of care  Theory of caring - a conscious intention to care promotes healing and wholeness Integrates caring processes with healing environments, which can heal and nurture both patients and nurses Care as more important than cure Caring is almost spiritual and preserves Watson (1979) human dignity in a demanding, technological, cure-dominated healthcare system The model is transformative because the caring nurse-client relationship influences patients and nurses 10 carative factors or caritas processes  Five categories or processes: Knowing - striving to understand an event as it has meaning in the life of the other person ‘Being with’ - being emotionally present for the other person ‘Doing for’ - doing for (assisting) the other person with actions that he or she would do for himself or herself if it were at all possible Swanson (1991) Enabling - facilitating the other person’s passage through life transitions (e.g., birth, death) and unfamiliar events Maintaining belief - sustaining faith in the other person’s capacity to get through an event or transition and face a future with meaning  Human Act of Caring theory - focused on the integration of caring and spirituality Compassion - a quality of presence that allows one to share room with and make room for the other Competence - state of having knowledge, judgement, skill, energy, experience, and motivation required to respond adequately Roach (1992) to professional responsibilities Confidence - quality that fosters trusting relationships Conscience - state of moral awareness Commitment - complex affective response characterized by a convergence between one’s desires and one’s obligations  “Comfort is a personal and intrinsic balance of the most basic physiological, emotional, social, and spiritual needs. Comfort is uniquely defined, experienced, and expressed by each person as a member of a family, community, and culture” (Boscart et al., 2023, p. 244). Comfort Comfort and caring are needed to support patients and families through their individual journey. We can provide care, but we also need to be caring in our approach; this is how we make patients feel valued and important.  Provides comfort Form of nonverbal communication Creates a connection Contact touch Touch Noncontact touch Protective touch Task-oriented touch  Listening involves Patients often want paying attention to to share their story the individual’s of their illness and words and tone of discuss the voice and meaning of this understanding their illness to them perspective Listening True listening allows the HCP to This can mean that gain a deeper you need to sit in understanding of silence with a what the patient patient in order to needs and how you truly listen can respond most effectively  Being present, being with Includes: Providing Body language Positive and encouraging attitude Presence Eye contact Tone of voice Active listening  The therapeutic nurse-client relationship develops over time What Does it This is a core process of clinical decision making Important for critical thinking and sound Mean to judgement ‘Know’ the Aspects of knowing include: Responses to therapy, routines, and habits Patient? Coping resources Physical capacities and endurance How to ‘know’ the patient? Treatment of patients as unique individuals Requires involvement Requires presence  Spirituality offers a sense of connection: Intrapersonally (connected with oneself) Interpersonally (connected with others and the environment) Transpersonally (connected with an unseen higher power) Spiritual The nurse-client relationship can support healing by: Caring Mobilizing hope for the patient and for the nurse Finding an interpretation or understanding of illness, symptoms, or emotions that is acceptable to the patient Assisting the patient in using social, emotional, or spiritual resources  The science of hope “Hope is a contextual term that has different connotations depending on the setting. We analyse the concept of hope with respect to its applicability for oncology. We review studies that present hope as a direct or secondary mediator of outcome. We posit that an individual's level of hope is often determined by innate personality characteristics and Concept of environmental factors, but can also be physiologically influenced by immune modulators, neurotransmitters, Hope affective states, and even the underlying disease process of cancer. We argue that hope can be a therapeutic target and review evidence showing the effects of hope-enhancing therapies. Given the potential for hope to alter oncological outcomes in patients with cancer and the opportunity for improvement in quality of life, we suggest further research directions in this area.” DOI: 10.1016/S1470-2045(20)30210-2  Caring for patients often involves caring for their family Family is whoever the patient says they are The family is an important resource in health and illness Family may provide informal caregiving to their loved one Include the family in care and planning (as Family Care appropriate) Keep them informed Provide clear expectations Show interest in the family and answer their questions Answer their questions honestly, openly, willingly Provide teaching as needed  In preparation to move a 96-year-old resident from a Long-Term Care home’s general unit to the Memory Case Study Care Unit, how would you prepare this client and their family to adapt to this transition?  Share an example of Learning how you provided Activity care and comfort in clinical last week The Concept of Pain The Wong-Baker Faces Scale provides a visual interpretation of pain.  A sensation of distress Pain can occur at a physical, psychological, and spiritual level For example, physical pain from chronic disease can evoke the psychological pain of depression Pain The experience of pain can result in reduced socialization, impaired mobility, and questioning of the meaning of life Impacts function Influenced by an individual’s history and the meaning they ascribe to pain  Acute pain Temporary pain resulting from trauma, post surgical or procedural interventions Typically, relieved with short term use of Acute vs analgesics Persistent Persistent (chronic) pain Pain Not time limited May come and go over the day, and with certain activities May peak and recede in intensity Not always predictable Chronic and degenerative diseases are common causes of pain, e.g., osteoarthritis  “Pain is whatever a person says it is” Assessment Observation Watch for nonverbal cues Pain Assessment Behaviours may be an indication of pain Consider the psychosocial and spiritual aspects of the pain experience Myths About Pain and Aging Myth Fact Pain is a normal part of aging. Pain is not part of the normal changes in aging; however, its occurrence increases with age. Pain sensitivity and perception decrease Not true. However, some older adults may have a greater tolerance for pain because of their with aging. adjustment to inadequate pain relief of long-standing pain. If people don’t complain of pain, they do not People may not report pain for a variety of reasons; they may nonetheless have pain. Some have pain. persons feel that it is culturally inappropriate to complain of pain. Some feel that they are burdensome to those around them, including their nurses. A person who has no functional impairment People have a variety of reactions and responses to pain. Some people are stoic and refuse or who appears occupied is not in significant to give in to their pain. pain. Narcotic medications are inappropriate Opioid analgesics are often the best treatment for moderate to severe persistent pain in unless used for short periods. order to help restore the person’s ability to function and quality of life. Potential side effects of narcotic medication Narcotics are safe to use with older persons. make these medications too dangerous to use with older persons.  Pain is often underreported This may be especially true when working with individuals with cognitive impairment HCPs often report difficulty in assessing pain in individuals with dementia or cognitive impairment Therefore, pain is often undertreated for individuals with dementia or cognitive impairment Pain and the Individuals with communication impairments may also make reporting pain challenging for the person Older Person Older persons often experience more side effects from pain medication They are also at greater risk for harm and injury Use of non-pharmacological approaches can be especially helpful in this population to minimize the overuse of pain medication  Pain requires assessment – you may hear that ‘pain is the 5th vital sign’ Nursing intervention Pain and the Promote comfort and maintain the highest level of functioning and well-being possible Older Person Encourage the older person to stay as active as possible Recommend a pain journal or diary Document pain, aggravating, and alleviating factors Careful use of non-pharmacological and pharmacological pain management strategies  Pain Assessment in Advanced Dementia (PAINAD) Scale 0 1 2 Score Breathing Noisy labored breathing. Occasional labored breathing. Short period Independent of Normal Long period of hyperventilation. Cheyne- of hyperventilation. vocalization Stokes respirations. Repeated troubled calling out. Loud Negative Occasional moan or groan. Low level speech moaning or groaning. None Vocalization with a negative or disapproving quality. Crying. Smiling or Facial Expression Sad. Frightened. Frown. Facial grimacing. inexpressive Tense. Rigid. Fists clenched, knees pulled up. Relaxed Distressed pacing. Pulling or pushing away. Body Language Fidgeting. Striking out. No need to Consolability Distracted or reassured by voice or touch. Unable to console, distract or reassure. console TOTAL  Non- Pharmacological Touch Approaches to Transcutaneous nerve stimulation Pain Cutaneous nerve stimulation Management Distraction Biofeedback Relaxation, meditation, imagery  Pain is an individualized experience Patient’s perception of pain is impacted by lived Comfort in experiences, family expectations, past experiences with pain/discomfort Pain People often think of pain as strictly a physical symptom or component, but pain also has psychological and spiritual components Application to Practice: What is a caring event? What are examples of a caring Caring Event event?  Jay has been living with diabetes for 6 Perpetual months now. His partner, Mark, is very anxious about monitoring his blood glucose Case Study levels, and is always concerned about Jay experiencing hypoglycemia. Jay is getting frustrated with Mark as he is feeling smothered by Mark’s concern. This has started having significant impact on their relationship, and Jay is starting to keep any of his health concerns to himself. David met with the gerontological neurologist two months ago. He underwent extensive diagnostic testing which determined that David does have the early signs of Alzheimer’s disease. The family is devastated by this diagnosis and has reached out to the Alzheimer’s society for support. Jenny is overwhelmed with the news and is struggling to keep positive in front of her parents.  Answer the following questions based on the information you have about the family, and Perpetual your knowledge from today, and previous classes. Case Study 1. Apply each stage of Swanson’s caring theory to assist Jay and Mark in their struggles with living with a chronic health condition (Slide 26). Self Actualization 2. As a visiting nurse, from the Alzheimer’s society, construct how you would explain Esteem (Respect) sympathy vs empathy to Jenny. Consider applying Maslow’s hierarchy of needs to this situation to help guide Jenny in her Love (Affection, Belongness) responses/support with her dad. 3. At one visits, David confides in you that Safety he sometimes gets lost on his daily walks. He asks you not to tell his wife as she will stop him from walking alone and he Immediate Physiological Needs wants to keep as much independence as he can, while he is able. Construct a response to David using Roach’s 5 components of caring (Slide 27). Questions