Introduction
The assignment brief in this document is on how fundamental skills in nursing were applied to achieve the desired health outcomes of a patient within haemato-oncology care settings. The focus of the essay is on the application of critical thinking and communication skills in nursing practice. The assay is aimed at demonstrating how critical thinking and communication skills were applied to provide holistic care to a patient. The essay specifically presents a discussion of how a holistic approach to care enabled nurses within practical attachment settings to meet the biological, social, and psychological needs of the selected patient. Furthermore, the essay indicates how specific professional guidelines and standards, and healthcare policies enabled nurses to provide safe care. The details of the patient selected for the discussion in this essay are as follows: Mr. P is a 45-year-old British veteran diagnosed with acute lymphoblastic leukemia. The patient was admitted to the haemato-oncology ward to create opportunities for improving his health outcomes. Upon reading the patient’s medical history, nurses in charge of his care realized that he was homeless and had a drug abuse problem. The unique care needs of the selected patient and his refusal to comply with prescribed treatments make his case interesting.
Holistic Care
Holistic care refers to a kind of healing that focuses on treating a patient as a whole person. It entails addressing the needs of patients in the context of body, spirit, emotions, and mind (Morton, Fontaine, Hudak, and Gallo, 2017). The goal of holistic care is to achieve optimal wellness and health. Therefore, holistic medicine is a philosophy that postulates that a patient can be optimally healthy (Brooker and Waugh, 2013). Nurses apply holistic care to enable patients to balance the various dimensions of their lives. Holistic care is based on the belief that all parts of the body are interdependent (Pelzang, 2010). This means that if one part of the body is not healthy, it will affect the health of other parts as well. Nurses should understand that an imbalance in spiritual, emotional, or physical dimensions of patients affects their overall well-being and health (Papathanasiou, Sklavo,u and, 2013).
According to Morgan and Yoder (2012), nurses successfully implement patient-centered care when they consider all factors that influence or affect the health of their patients. Considerations, such as stress, sleep habits, spiritual practices, and personal problems, are crucial in patient-centered and holistic care practices (Takase and Teraoka, 2011). Holistic care is also informed by the belief that support and love are powerful elements of the healing process (Wangensteen, Johansson, Bjorkstrom, and Nordstrom, 2011). McCrae (2012) indicates that a holistic care approach enables nurses to go beyond symptoms and disease processes in the delivery of care. There are specific principles that guide the delivery of holistic care. For example, the holistic care approach is based on the philosophical argument that the body and mind are integrated (Morton et al., 2017). Therefore, the healthcare process should not be based on a separation of the physical and psychological needs of patients. Holistic care is also based on the premise that real health is not measured by the absence of disease alone. Varghese et al. (2010) explain that real health is holistically described as a state of positive wellbeing. Furthermore, holistic care is achieved when providers focus on addressing causes of disease rather than symptoms. For example, a health care provider would focus on addressing psychological problems that contribute to a patient’s physical symptoms (Rathert, Wyrwich, and Boren, 2013).
Biological Needs
Biological needs are demands that involve the conditions of a patient’s body. They include nutrition, exercise, drug use, sleep, personal safety, water, and hygiene (Marchigiano, Eduljee, and Harvey, 2011). Mr. P needed to have proper nutrition to help him maintain a positive state of physiological health. Good nutrition was part of Mr. P’s health care plan because it helps patients have adequate energy for physiological well-being. The patient also needed to have proper exercises to ensure that he remained physically fit. Whenever possible, patients are required to engage in low-intensity exercises, such as walking, to enable them to maintain physical fitness (Oja, 2011). Even though Mr. P refused to comply with his treatment, he needed medication for his acute lymphoblastic leukemia. The prescribed treatments were designed to help the patient achieve positive outcomes related to the physiological dimension of health and wellness. Furthermore, the patient needed to have adequate sleep to ensure positive physiological health outcomes. Drennan (2010) reveals that adequate sleep or rest facilitates the healing process. Mr. P was also in need of maintaining proper hygiene so that he would have a reduced risk of infections. More importantly, the patient needed a healthcare environment that was free of risks that would result in physical harm. Furthermore, Mr. P needed to be rehydrated. Therefore, he had to be encouraged to take an adequate amount of water.
Psychological Needs
Mr. P needed to have sound health of the mind. His circumstances predisposed him to a high level of stress, which would have resulted in mental illnesses, such as anxiety and depression (Alligood, 2014). The patient required interventions for addressing his stress because it contributed to his refusal to comply with the prescribed treatments. Kaddoura (2010) describes mental health as the ability of an individual to face challenges and to solve problems. Mr. P was in a poor state of mental health because he was not prepared to deal with his homelessness and ill health with a positive attitude. It seemed that stress had caused the patient to give up fighting his acute lymphoblastic leukemia. Mr. P was also in need of improving his self-esteem. Notably, being homeless had impacted negative impact on his self-esteem. The patient’s feelings were hurt, and he looked perturbed by the fact that he had lost contact with his son during the period of his homelessness. Atay and Karabacak (2012) demonstrate that the psychological needs of patients should be addressed as they result in distress, poor adherence to medication, and low quality of life.
Social Needs
Assessment of Mr. P indicated that he needed the support of friends and family members. Schuster (2015) demonstrates that holistic and patient-centered care involves meeting the love and belonging needs of patients. Mr. P indicated that he wished to unite with his son, whom he had not seen for over seven years. It was evident that the patient wanted to connect with a loved one so that he would find more meaning in life, regardless of his poor state of health. Members of the nursing team responsible for Mr. P’s care noted that his homelessness had rendered him unable to form meaningful social relationships. The patient revealed that he had not made any real friends while living in the streets. Therefore, Mr. P needed someone who would act as a friend for support throughout the period of his treatment. The patient specifically needed someone to talk to about his ill health. Yildirim and Ozkahraman (2011) show that social support in the healthcare environment involves people who are willing to listen to patients without judgment. Furthermore, Mr. P needed someone who would show him respect and appreciation for his contribution while he was serving as a soldier.
Meeting the Patient’s Biological Needs
Members of the nursing team in contact with Mr. P applied their critical thinking skills to think rationally and clearly about his psychological health. Critical thinking skills also enabled the healthcare team to understand logical relationships between the patient’s circumstances at the time and his physical health outcomes. Kaddoura (2011) demonstrates that critical thinking enables nurses to implement health care interventions objectively. In addition, nurses applied critical thinking to engage in independent and reflective thinking about the biological needs of the patient. For example, they applied analysis skills to determine the patient’s need for medication regardless of his refusal to adhere to the prescribed treatments. Schuster (2015) indicates that reflection is a vital critical thinking skill that enables nurses to assess the circumstances of patients in a holistic manner. Through critical analysis, the healthcare team realized that the patient refused treatment because he had given up hope. Therefore, nurses focused on encouraging him and demonstrating that the prescribed medications were meant to eliminate his pain. The patient was eventually convinced and agreed to take his medication to eliminate his suffering.
Critical thinking allowed nurses to question assumptions about the patient’s personal safety. They did not assume that the patient’s health care environment was free of risks to physical health. Through critical thinking, nurses were able to assess specific risks within the physical environment of the patient that would have impacted negatively on his physiological health. Examples of risks to physiological health that were addressed by the healthcare team include medication errors, hospital-acquired infections, and falls (Fero et al., 2010). Nurses ensured that the patient’s physiological health needs were met by ascertaining that he was given the correct medications as soon as he agreed to comply with his treatments. They also ensured that he was not predisposed to hospital-acquired infections, such as pneumonia, which would have impacted negatively on his health outcomes. Lunney (2013) asserts that critical thinking should be applied in assessing health-related risks for the implementation of the most relevant and appropriate prevention measures.
Critical thinking skills, such as evaluation and inference, enabled nurses in contact with Mr. P to assess his needs for nutrition and rehydration. Their decisions related to the physical health of the patient were informed by the fact that he was homeless. After the evaluation of the patient, the nurses realized that he had a poor nutritional profile. The nurses collaborated with the hospital’s catering department to ensure that the nutrition and rehydration needs of the patient were met. Lunney (2010) illustrates that critical thinking allows healthcare providers to become effective members of multidisciplinary teams within healthcare environments. Members of the nursing team also advised Mr. P to try to get adequate sleep so that he would facilitate his healing. They also assisted him while he was preparing to rest or to go to sleep. The nurses also monitored the patient’s patterns of sleep to ensure that they would recognize any physical health problems related to lack of sleep.
Meeting Patients’ Psychological Needs
Critical thinking enabled nurses to achieve the best possible psychological health outcomes of the patient, as demonstrated by Wilkinson (2011). I collected and evaluated all relevant information about Mr. P’s psychological needs before making inferences on how to address them. For example, information on the patient’s homelessness and lack of contact with his family allowed nurses to determine that he was stressed and predisposed to depression and anxiety. As a result, they acted as the patient counselors by providing him with opportunities to express his frustrations and fears. Fero et al. (2010) indicate that it is through critical thinking that healthcare providers are able to become flexible in their roles of promoting positive health outcomes among patients. The patient was encouraged to talk about his experiences of being homeless. This enabled nurses to further assess his healthcare needs. The nurses also applied their intuition and reflection skills to determine the psychological problems that led to the patient’s refusal to adhere to his treatments. Nurses encouraged him to remain positive and to focus on his recovery.
Analysis of the psychological health of the patient enabled nurses who were in charge of his care to conclude that he had self-esteem issues. The nurses improved Mr. P’s self-esteem by enabling him to feel important and worthwhile. For example, they demonstrated their appreciation of his past role as a soldier. The nurse also showed their admiration for the patient’s bravery to enable him to feel valuable. This enabled him to overcome his low self-esteem. Romeo (2010) illustrates that the evaluation of the psychological needs of patients and treatment interventions requires effective application of critical thinking skills, such as analysis, interpretation, and reflection. The decisions nurses made while addressing Mr. P’s psychological needs were also based on the application of critical thinking skills. For instance, one of the nurses encouraged the patient to get well so that he would get an opportunity to meet his son again. This motivated him to take his medication and to work towards positive health outcomes. However, the nurses were careful not to make false promises to the patient. This is because unfulfilled promises often result in the worsening of the psychological health of patients (Alligood, 2014).
Meeting Patients’ Social Needs
Critical thinking skills, such as analysis and interpretation, enabled members of the nursing team in the haemato-oncology care unit to understand Mr. P’s social needs and to determine strategies for meeting them. For example, they analyzed and interpreted the patient’s state of homelessness to understand that he needed appreciation and recognition of his courage and sacrifice while he served as a soldier. Therefore, the nurses decided to act as both Mr. P’s care providers and friends. They spared an adequate amount of time to listen to him and to show him that his current circumstances would change if he took his treatments. Acting as an encouraging friend, one of the lead nurses motivated the patient to adhere to his medications and treatments. Kaddoura (2010) argues that it is through critical thinking that providers become effective in encouraging positive health behaviors among patients. The nurse met the patient’s belonging needs by showing interest in his family. For example, the aforementioned nurse asked Mr. P’s permission to call his son and to inform him that his father was hospitalized. The patient was happy that the nurse was willing to talk to his son. The son was called and agreed to visit his father at the hospital.
Mr. P was overly happy when his son visited him. It was evident that the reunion had elevated the patient’s mood. It is through critical thinking that the lead nurse was able to evaluate the patient’s social situation and his need to reunite with his son. Critical thinking skills, such as structured reasoning and interpretation of complex social situations, also allowed the nurse to conclude that the patient’s son would influence positive health outcomes. Oja (2011) explains that the social needs of patients are effectively met by providers who apply critical thinking to plan for the implementation of interventions that promote the holistic health of patients. Mr. P’s son empathized with his health condition and encouraged him to adhere to the prescribed treatments. Effective planning of the encounter between Mr. P and his son enabled nurses to ensure that the reunion was meaningful and effective in promoting the social and psychological well-being of the patient, as recommended by Chan (2013).
Meeting the Patient’s Biological Needs
Mr. P’s nurses applied effective communication skills to ensure that his biological needs were appropriately met. Their communication competencies enabled them to engage in meaningful verbal and non-verbal interactions with the patient. Through effective communication with the patient, the nurses were able to understand and address his biological needs (McCance, Gribben, McCormack, and Laird, 2013). They communicated with clarity when they asked the patient to indicate his biological needs. The patient responded to the nurses’ questions effectively because they were both clear and brief in their communication. The nurses also ensured that their non-verbal cues, such as facial expressions, demonstrated their true concerns about the patient’s state of health. For example, they showed concern when the patient indicated that he did not plan to adhere to the prescribed treatments. Nurses specifically applied their verbal communication skills to effectively explain to the patient why it was important for him to take his medications (Pelzang, 2010). They also applied their communication skills to clarify issues related to the patient’s medication to convince him to comply with his treatment plan.
Nurses in Mr. P’s care team advocated for his right to informed consent. For instance, they gave the patient explanations on his medical condition, prescribed medications, and the consequences of not complying with the treatments simply and straightforwardly, as recommended by Bach and Grant (2015). This enabled the patient to adequately understand the consequences of non-adherence to medication, which influenced his decision to comply with his treatments. Nurses ensured that they avoided jargon in their explanations to enable the patient to understand all aspects of his treatments before he would make informed choices related to compliance. They also ensured that their gestures and body language were appropriate throughout the period they were engaged in communication processes with the patient (Kissane et al., 2012). For example, the nurses used gestures to demonstrate to the patient that walking exercise would elevate his mood and improve his physical health. Effective communication allowed the nurses to convince the patient to take walks in the open spaces within the hospital compound. While communicating with the patient, the nurses respected his personal space. In addition, they applied their verbal communication skills to educate the patient on the importance of proper hygiene and nutrition (McCance et al., 2013). The nurses used both verbal and non-verbal cues to educate the patient on how to prepare for sleep, with a goal of ensuring that he had adequate rest during his recovery period.
Meeting Patients’ Psychological Needs
The communication skills that were used to meet the psychological needs of the patient include active listening, empathy, interviewing, clarifying, and comforting (Bach and Grant, 2015). Interviewing and listening skills enable nurses to identify the needs of patients, which informs the assessment of psychological well-being and health (McCance et al., 2013). Active listening enabled providers within Mr. P’s health care team to identify the specific problems that impacted his mental health. Interviews with the patient were used to identify determinants of his psychological well-being, such as drug use, homelessness, and poverty. Clarifications were made during interviews with the patient to enable him to provide accurate information about his psychological well-being (Holmstrom and Roing, 2010). Symptoms of stress and depression were identified, assessed, and clarified to provide patient-centered care. Notably, therapeutic communication processes were aimed at promoting the psychological well-being of the patient (Bach and Grant, 2015). Nurses attending to the patient showed empathy and concern to demonstrate their willingness to improve well-being (McCance et al., 2013).
Nurses who were caring for Mr. P comforted him to promote positive psychological outcomes. Through effective communication with the patient, he was happy that the healthcare team cared and was willing to support him throughout his stay at the hospital. Cultural differences between providers and the patient were also respected, as suggested by Wittenberg-Lyles, Goldsmith, and Ferrell (2013). Bach and Grant (2015) illustrate that patient-centered care entails respecting the unique cultural beliefs and values of patients and integrating them into the planning, design, and implementation of healthcare interventions. McCance et al. (2013) indicate that the behaviors of healthcare providers communicate specific messages to patients. Therefore, patients may make decisions related to care based on the behavioral patterns expressed by healthcare providers (Norgaard, Ammentorp, Ohm, and Kofoed, 2012). While providing care to Mr. P, nurses demonstrated supportive behaviors to express their optimism about his health outcomes. The nurses also demonstrated their understanding of the patient’s circumstances through both verbal and non-verbal communication to mitigate negative psychological outcomes, such as low self-esteem.
Meeting Patients’ Social Needs
Mr. P’s social needs were met due to the establishment of meaningful patient-provider relationships. Bach and Grant (2015) show that nurses develop productive relationships with their patients through effective communication processes. Members of the nursing team responsible for Mr. P’s care applied communication skills to build trust and to encourage the patient to share useful information for the assessment of his social needs (Malloy, Virani, Kelly, and Munévar, 2010). For instance, trusting relationships between providers and the patient allowed him to share useful information, which led to the involvement of a family member in his care. Notably, the patient’s son was contacted after informed consent was obtained from the patient. Bach and Grant (2015) assert that effective nurses apply communication skills, such as interviewing and truthfulness, to collect useful information for the planning of interventions to promote the holistic health and well-being of patients.
The healthcare team that was serving Mr. P ensured that all barriers to effective communication in the healthcare environment were mitigated. For example, his nurses did not express any stereotyping messages about his homelessness. McCance et al. (2013) illustrate that stereotyping and judging patients negatively impact their social and psychological well-being. Riley (2015) demonstrates that nurses have ethical obligations to be fair and non-prejudiced to ensure that they deliver equitable and patient-centered care to patients. Mr. P’s nurses ensured that they did not show disapproval of the patient’s way of life to make him feel accepted and cared for. More importantly, the opinions of nurses who were attending to Mr. P were not biased. Slatore et al. (2012) explain that bias, prejudice, and stereotyping are powerful barriers to effective communication within healthcare environments. Bach and Grant (2015) demonstrate that nurses should be able to identify barriers to effective patient-provider communications and be skilled enough to mitigate them. Mr. P’s nurses also applied effective communication skills, such as engaging in balanced dialogue, to deal with misunderstandings that affected his compliance with medications. Arnold and Boggs (2015) indicate that effective nurses communicate without being judgmental. The patient was able to engage in active communication with nurses because what they communicated was supportive and non-judgmental.
Role of Professional Standards and Policies
The Nursing and Midwifery Council (NMC) provides nurses in the UK with a code of professional conduct that enables them to provide safe care to patients. The top priorities of the NMC code include patient safety, patient-centered care, effective care, and the promotion of trust and professionalism in nursing practice (The Nursing and Midwifery Council, 2017). The healthcare services that were directed at Mr. P were informed by the provisions of the NMC code. For example, the nursing team in charge of Mr. P’s care ascertained that the highest standards of safety were practiced in the administration of his medications and the implementation of clinical procedures. The nursing team also ensured that Mr. P’s care environment was safe from any physical and psychological harm.
The provision of patient-centered care to Mr. P was also guided by the NMC guidelines on prioritizing the needs of patients. The psychological, biological, and social needs of the patients were prioritized with a goal of ensuring that their care was based on the holistic care approach. The care for Mr. P was also guided by policy frameworks, such as the Quality Strategy 2020 (Koh, 2010). For example, healthcare professionals who were in contact with the patient worked towards improving his safety and quality of care in all dimensions of health, including psychological, biological, and social aspects of care, as provided by the Healthy People 2020 policy.
Conclusion
Holistic care provides nurses with an opportunity to meet the psychological, biological, and social needs of patients through patient-centered interventions. Mr. P’s nurses applied the holistic care model to effectively meet his biological needs, including nutrition, exercise, drug use, sleep, personal safety, water,,r and hygiene. The healthcare team also met the patient’s social needs for belonging, appreciation, and being loved through holistic care. More importantly, the psychological well-being of the patient was improved through the commitment of the healthcare team towards patient-centered care. Critical thinking skills, such as evaluation, inference, analysis, interpretation, reflection, structured reasoning, and interpretation, enable members of the health team to meet the care needs of the patient holistically. Communication skills, such as interviewing, listening, suggesting, and the use of appropriate non-verbal skills, allowed the health team to assess and meet the patient’s psychological, biological, and social needs. The healthcare intervention and processes for Mr. P were informed by the NMC professional guidelines for nurses and the provisions of the Quality Strategy 2020 (Koh, 2010).
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