Nursing - Hospital Stay Report
Table of Contents
Introduction......................2
Main nursing problem for the patient..............2
Overview of the nursing process and its link with the FOC........................2
Assessment tools used, and rationale for its use..........................................3
Rationale for the choice of patient/service user...........................................3
How to assess and care for patient, making reference to the nursing process......4
NMC (2008) Code of Conduct, Confidentiality clause...............................4
Nursing.......................................................................................5
Pen picture of the adult patient/service user...........................5
Overview of the patients presenting nursing problem and reference to the relevant pathophysiology....6
Discuss the stages of the nursing process and how it links with the fundamentals of care.............7
How the use of FOC promotes the provision of holistic care........................................7
The nursing assessment of the main nursing problem which has been identified.........................8
Brief assessment of 3 FOC that have been compromised a result of the central nursing problem..............9
Overview of assessment tools used to assess these three other associated aspects of care..............12
Provide goals of care.............12
Discuss how the nursing care was provided about primarily the central nursing problem and other problems identified through the assessment...........................................................13
Conclusion.................................................................................................13
References......................................................................................15
This report aims to explain the health conditions of the patient and its needs during the period of their stay in the hospital. The adult patient selected is facing chronic diarrhoea as well as abdominal cramping. Assessment of the patient will be completely discussed with the help of the Fundamentals of Care (FOC) framework, and the purpose of selecting the patients will also be discussed. Along with this, various aspects of care in the context of the patient’s needs will be explored and the aim of care will be analysed.
Main nursing problem for the patient
In this report, the main nursing problem of the patient is breathing, and the other three nursing issues discussed will be, eating and drinking, maintaining a safe environment, and Personal cleansing and dressing.
Overview of the nursing process and its link with the FOC
For exploring the needs of patients and different ways to meet them, an assessment is required to be carried out on the available information, which is collected by observing the general appearance of patients, the information gathered from patient and their families, observation as well as physical examination, and social and medical history. According to Johnson (2000), the nursing process is the logical and dynamic method, through which nurses can systematically practice approach-nursing for attaining set goals with patients and even make sure that care is planned properly and executed in a relevant way (Wiesen, Van Gossum & Preiser, 2006). The process of nursing includes five critical stages, first is assessment, next a diagnosis, then planning, implementation, and finally evaluation (Wiesen, Van Gossum & Preiser, 2006).
Assessment is significant in determining the care needs of the patient. The pattern and behaviour of the patient are analysed and compared with the present health status, to avoid omission of required care.
Diagnosis offers the base for choosing a nursing intervention, which is required for attaining results the nurse is accountable or not.
The planning stage supports deciding which problem should be kept as a priority. It also determines the care goals and selects interventions for creating a care plan.
Implementation includes providing care with interventions, which are relevant to the patient. It also covers care documentation (Wiesen, Van Gossum & Preiser, 2006).
The evaluation includes deciding whether the intervention supports patients or whether the plan should be changed.
Assessment tools used, and rationale for its use
The rationale for selecting the evaluation framework is that it makes use of the patient activity list, which includes daily living, breathing, maintaining a safe environment sleeping, communicating, personal cleaning and dressing, eating and drinking, and expressing sexuality. It depicts the individual requirements and shows the effect of ill health on the lifestyle of the patient (Suhonen et al., 2012). The FOC guidelines permit the professional to focus on the physiological abilities of the patient to undertake day-to-day activities independently. This report will emphasize nursing issues, through which patient is affected.
Rationale for the choice of patient/service user
In this report, an old man 74 years of age is selected, who was staying with his son in two bedroom flat before his illness. He was admitted to the hospital after he was diagnosis with abdominal pain and chronic diarrhoea. He was also diagnosis with Clostridium difficile. The patient had a history of pneumonia and chest pain. The rationale behind selecting him and this aspect of care are that I was appointed with registered nursing to undertake admission of the patient and other different aspects related to the nursing process. Selection of this patient will also improve my knowledge about care delivery through analysing responsiveness and flexibility of implementing care plans and nursing tools that can bring change in the condition of the patient and resolve nursing problems (Wiesen, Van Gossum & Preiser, 2006).
How to assess and care for patient, making reference to the nursing process
While the nursing process provides a systematic direction for viewing care delivery, on its own, it’s not helpful, because it fails in providing any indication of what has to be assessed (Whelan & Schneider, 2011). It stipulates that care should be evaluated, planned, and implemented as well as evaluated, but exactly what has to be done is not mentioned. Another way of better organizing the information needs is that nurses should follow a model “Activity of Daily Living.” This model includes four key elements that highly contribute towards living individuality, 12 activities related to day-to-day living; the continuum of lifespan including conception to death; five factors that create influence on every activity, such as psychological, physical, politico-economic, sociological, and environment (Zuidgeest et al., 2012). All the nursing process stages are summarized, and the emphasis is placed on the assessment process, relying on the activities of the patient.
NMC (2008) Code of Conduct, Confidentiality clause
As per the NMC (2008) code of professional conduct, patient information should be protected and maintained and should be applied only for the purpose it is intended (NMC, 2008). The selected patient will be examined as Mr. Cole, for the purpose of maintaining confidentiality. Multi-professional members included in patient care will be discussed.
Pen picture of the adult patient/service user
Mr. Cole is an old man 74 years of age, who previously stayed with his son and daughter-in-law in their two-bedroom apartment before moving to the hospital, due to his illness. Mr. Cole was admitted to the hospital due to cramping abdominal pain and chronic diarrhoea. After the nursing team had taken a series of tests, Mr. Cole was diagnosed with the problem of Clostridium defficile, which is also known as C. diff. Mr. Cole holds a medical history of pneumonia and cheats pain. Diarrhoea happened when the balance between secretion, absorption, and intestine motility got disrupted (Wiesen, Van Gossum & Preiser, 2006). It’s also explained as an abnormal enhancement in frequency, incontinence, quantity, as well as perianal discomfort (Edwards & Miller, 2001). In the case of Mr. Cole, this problem was related to the prolonged use consumption of antibiotics, which he took to support his pneumonia, and the same resulted in C.diff infection.
The patient was admitted to the side rooms of the ward, and Mr. Cole needs barrier nursing because his toxic were producing C.diff. Enteric isolation and diarrhoea notice were placed on the hidden room door. Other patient segregation should continue till the stool culture report is clear about infection organism (Gadewar & Fasano, 2005). My place of practice policy was related to treating dangerous conditions in a critical way and applying universal precautions like wearing gowns, gloves, and aprons, and disposing of excreta immediately so that the risk of the spread of infection to others can be reduced.
The nurse was accompanied by the patient inside the room to assess the patient (Edwards & Miller, 2001). The ward door was shut, and the curtains were drawn, for the purpose of maintaining privacy as well as the dignity of the patient. The information of patients was gathered through different sources like their family details and medical notes (Wiesen, Van Gossum & Preiser, 2006).
Overview of the patients presenting nursing problems and reference to the relevant pathophysiology
Edwards & Miller (2001) explains Clostridium difficile as slender. It includes a gram-positive anaerobic rod that helps in the formation of spores and is highly capable of surviving within an environment for an extended period (Edwards & Miller, 2001). This type of bacteria might be considered a common element of gut flourish and flora, whereas else other gut organisms are eradicated through the support of antibiotics (Edwards & Miller, 2001). In the year 1980, it was explored as the main reason behind antibiotic-related diarrhoea. Now it’s one of the commonly identified enteric pathogens and a significant reason for nosocomial infection going inside hospitals. Mr. Cole is also going through a similar problem, and it’s required that nurses offer them with proper treatment, and ensure that no infection is caused.
C. difficile never creates any problems in healthy individuals. But few antibiotics, which are used for the treatment of other health issues might interfere with other good bacteria. When this happens, C difficile bacteria gets multiply and create toxins, which later on create health problems like fever and diarrhoea (Edwards & Miller, 2001). For Mr. Cole diarrhoea relates to prolonged intake of antibiotics for curing pneumonia. Mr. Cole nursing problem relates to pathophysiology, in which the presence of negative fluid balance had created dehydration. Mr. Cole had less intake of water and even had a fluid shift (Edwards & Miller, 2001). The condition of Mr. Cole had gone worse due to a reduction in full body water that caused a decrease in the extracellular and intracellular volume of liquid. During dehydration, water is usually pulled through the cells in the extracellular space. To compensate for this, cells try to generate osmotically particles, which draw water into cells and try to maintain the cellular volume of fluid (Edwards & Miller, 2001). It’s the responsibility of the nurse to focus on these points and try to increase the intake of fluid in the patient’s body (Edwards & Miller, 2001).
Discuss the stages of the nursing process and how it links with the fundamentals of care
Assessment- the documents linked with the nursing practices are required to be reviewed. Information extracted relates to the patients day to day activities. All information is examined, and team members were responsible for checking the patients’ needs and providing them with the best care (Steel, Gertman, Crescenzi & Anderson, 2004).
Diagnosis- This stage includes diagnosing patient problems according to set nursing standards or fundamentals of care. FOC supported in extracting information related to self-care, physiology, and environment.
Planning- FOC play important role in the planning stage, as it helps in exploring a decent nursing team, and organize different discussion that can offer data about assisting patients (Steel, Gertman, Crescenzi & Anderson, 2004).
Implementation- Main elements of the nursing process are explored and are explained as per fundamental of care guidelines (Edwards & Miller, 2001).
Evaluation- the results are derived and evaluated according to the guidelines of fundamental care, and the nurse will examine how this information can be placed into practice (Steel, Gertman, Crescenzi & Anderson, 2004).
How the use of FOC promotes the provision of holistic care
Fundamental care aims to enhance the quality of different aspects related to health and the social care of patients. FOC integrators are connected with educational, performance management, and commissioning frameworks for Social Services, NHS, and Care Standards Inspectorate (Welsh Assembly Government, 2003). To offer holistic care, FOC analyses the service user as the most important stakeholder, in both the development and promotion of quality services and best practices. FOC believes that every patient should be treated as per their wish and needs (Welsh Assembly Government, 2003). Every patient should attain the best quality of care and service provider are responsible for this. FOC also tries to stimulate the enhancement of quality and the manner, in which care providers respond and meet the requirement of the service user. FOC also enables the user to precisely assess themselves, and understand, whether the received care is relevant to their personal circumstances (Pearson & Vaughan, 1996).
The nursing assessment of the main nursing problem which has been identified
Breathing is the main nursing problem faced by Mr. Cole in the hospital. The breathing process is an essential aspect of life, and it’s quite inevitable, and might even lead to fatal results when the process gets interfered (Hill & MacGregor, 2001). Breathing supports making a balance between oxygen and carbon dioxide in the blood. Oxygen is needed by the body for the purpose of releasing energy at the level of the cell so that individuals could easily take part in activities (Hill & MacGregor, 2001). Waste is produced by applying oxygen to carbon dioxide (Hill & MacGregor, 2001). In this assessment, it was explored that recently Mr. Cole came across some key issues related to chest pain and pneumonia that might leave a particular effect on his health and breathing of Mr. Cole. Respiration provides the body with oxygen and supports in removing carbon dioxide by diffusion among blood in capillary and alveolar lungs; its change can result in bradypnoea. The respiration rate of Mr. Cole was observed by nurses and recorded at around 16 breaths each minute, saturation of oxygen was 98%, and it was identified that he could breathe clearly without any problem, and there is no whizzing noise while breathing (Whelan, Judd, Preedy & Taylor, 2004). The ability to accept the assessment of the patient's ability towards breathing and instigate the rescue of breathing if needed is important. Factors that might impact breathing include psychological factors like depression or anxiety, stress; sociocultural factors such as level of family help and smoking; environmental factors like work-related issues or pollution; political-economic factors like less revenue and poor diet, past illness, and past history (Hill & MacGregor, 2001).
Brief assessment of 3 FOC that have been compromised as a result of the central nursing problem
Mr. Cole also faced other nursing problems, besides breathing and it was eating and drinking; Personal cleansing and dressing; maintaining a safe environment, and eliminating.
Eating and drinking
As per Hill & MacGregor (2001), good status nutrition is essential for the health and well-being of an individual. The poor state of nutrition is related to delayed recovery and had risen in mortality which also enhances the price of healthcare (Hill & MacGregor, 2001). With the ongoing assessment, the family of Mr. Cole was encouraged by a nurse to discuss the patient’s medical and diet history, weight, and social setting. Information collected depicts that Mr. Cole has shade some weight in the last two weeks, and due to the present condition, Mr. Cole is highly prone to reducing more weight if his diarrhoea is not cured.
Orem, Taylor & Renpenning (2001) mentions that diarrhoea might have certain profound psychological and physiological results on the health of the patient. An extended time of diarrhoea might lead to the occurrence of malnutrition, dehydration, and electrolyte imbalance. An aversion to food might develop, or in another case, the patient might stop eating, because they might forestall consequent diarrhoea. Consequently, this leads to a loss in weight, and malnutrition might take place. Mr. Cole denies consuming food or drink, since the time, he is admitted to the hospital. It is noted by a nurse that, his height and weight were measured for the purpose of calculating his body mass index (BMI). It will support monitoring weight patterns, whether they gain or decrease. According to Øvretveit (1993), it is mentioned that BMI is the commonly used indices, which is used for assessing the status of adult patient weight. The BMI measurement of Mr. Cole was around 18 which implies that he is going through the problem of malnutrition and he is even underweight.
Rowbotham & MacIntyre (2003) argues that in the nursing process, it is crucial to analyse anatomy as well as body physiology, with an aim to explore abnormalities and make a necessary intervention. Westbrook (2000) mentioned that in the nursing model, an individual state in physiological and anatomical terms is known as planning as well as implementing appropriate nursing intervention and it supports evaluating the impact, as it can help Mr. Cole in maintaining enough water and food intake. Mr. Cole was prescribed IV fluids 200ml each hour and provided with an energy drink. The family of Mr. Cole was also initiated to come up with a preferred drink for Mr. Cole and food that he might like, and the same can restore the patient’s appetite (Westbrook, 2000). The patient was provided with meat that he gets at home, which even reflects his ethnic and religious background. Less quantity of food was offered to him, as a significant portion might make him experience abdominal distension and chest pain. Multi-disciplinary team members like dieticians were given the patient’s nutrition status.
Dressing and personal cleansing
It includes an act of cleaning the skin to decrease potential for injury and infection. Both dressing and personal cleaning are significant in initiating the social, psychological, cultural as well as complete well-being of the patient (Wiesen, Van Gossum & Preiser, 2006). Examining the patient is crucial so that a certain level of assistance is provided and the patient is offered the required information so that it can support in maintaining the need for personal hygiene (Westbrook, 2000). Mr. Cole is independent of his personal care, and he even doesn't need any help maintaining his personal hygiene. But he needs someone to prompt him, as mentioned by his son because in case of cases, patients might neglect themselves.
Information depicts that the patient stays with their son as well as a daughter-in-law, but he will soon move into the shelter house. It is noted that his move might leave an emotional and psychological strain on the family and himself, mainly referring to the new environment in which he will stay. The family is quite worried, about how Mr. Cole will deal with it. White (2003) argued that anxiety might become a strategy of coping, such as Mr. Cole thinking that his health issues will inhibit him from staying with his family; therefore, there is a high anxiety level. Wilkinson (2007) believes that the anxiety standards of the patient might contribute symptoms to getting worse, as compared to what they were. According to the assessment, it is learned that psychological support is imperative for patients, who are anxious (Wilkinson, 2007).
Building safe environment
It is significant that patients should be safe in any particular environment, mainly when they are not supervised. It includes orientation, mental health as well as alertness. It is noted that Mr. Cole was quite altered when he came to the hospital and during his assessment sessions; he had no sight challenges, no learning, and physical disability (Wilkinson, 2007). But he was very restless as well as uncomfortable, as he had abdominal pain.
Eliminating
The elimination process is crucial for life, but the ability to rightly maintain the balance between what exactly one has to retain and excrete is significant for the well-being of the patient and for preserving his life. It can be referred to as a very sensitive issue to be discussed with patients because it is noted that many patients get despair about the thought of not being able to rightly manage their needs for the toilet (Wilkinson, 2007). Various nursing interventions required are of intimate nature, and attaining the trust and consent of the patient, along with their approval is quite remarkable. Mr. Cole even came in contact with frequent bowel movements that happened around four times each hour. He even faced abdominal pain every time. During the process of assessment, Mr. Cole was quite distressed, as he had to deal with increased bowel movements, proctitis, abdominal cramp, and anal pain. The patient was incontinent and was offered with commode for its private use, to preserve his dignity and privacy, during diarrhoea. The patient never had a problem with diarrhoea, but it started after high consumption of antibiotics. After the assessment was done by a nurse, a fluid and stool chart was immediately prepared, which includes details about stool colour, consistency of stool, smell, blood presence, and stool type. To complete the fluid chart was updated after each bowel movement, which was recorded as per Bristol Stool scales. As per Kelly, Patrick & Hillman (1983), this treatment includes offering supportive care and discontinuing antibiotics. The patient was given 500mg vancomycin every 6 hours and 500mg of paracetamol every 6-8 hours, to control diarrhoea and pain. The faeces sample was, later on, send to the lab for an investigation.
Overview of assessment tools used to assess these three other associated aspects of care
Assessment is done on patients and caregivers. The tools of patient assessment are necessary for estimating the quality as well as holistic acre effectiveness. The assessment tool in the case of Mr. Cole includes information about the patient and his family and even includes data about the individual level of the patient. A structured tool is used that offers use of clinical care and asks the patient about his symptoms like pain, and care quality. It also assesses whether the pain is under control or not, and the effect of holistic acre intervention (Reintam, Parm Kitus, Starkopf & Kern, 2008). This tool also offers patients and provides reports about physical symptoms such as pain; mental health problems like depression; the outcome of caregivers like stress and quality of life, and care processes like continuity and communication. Estimating holistic care effectiveness needs valid and reliable assessment tools.
Goal-oriented care can help in enhancing bowel movements and results during the illness. The nurse can form management strategies, which rely on the reason behind the occurrence of diarrhoea, but in various cases, electrolyte replacement, rehydration, and enteral feed are crucial. It is noted that early protocolized, as well as goal-oriented care, can enhance the function of organs and the results of patient health during illness (Reintam, Parm Kitus, Starkopf & Kern, 2008). In the case of Mr. Cole, when diarrhoea is recognized, a secure protocol should be implemented that explores the cause, minimize transmission of infection risk and treat with rescindable aetiology.
Discuss how the nursing care was provided about primarily the central nursing problem and other problems identified through the assessment
As per the assessment, the nurse, as well as multi-disciplinary team members, effectively liaised to offer care by responding to a query, which was put up by nursing teams, such as psychologists for the patient and his family, for dealing with emotional worry and anxiety issues. As per Thibault (2013), the needs of socio-culture might imply the requirement associated with mind enlightening, mainly by the help of intellectual activities, kinship system, culture, customs, habits, lifestyle, and mutual relations among people and an environment, in which one is growing up. The function shows that it is crucial to sustaining life because severe diarrhoea can lead to fatigue, depression, anxiety, feeling isolated, and sleep disturbance. The effect of the ability to get involved in required activities might lead to an increase in dependence on others, loss of family roles, and even a reduction in quality of life (Hiesmayr, 2009). Mr. Cole comes from a Christian community; therefore, he was initiated by his family to regularly visit the church, and even take part in celebrations like festivals or birthday parties. Support from family is quite important because it reduces the stress of an individual (Kumar, 2012). Failure in offering consistent support might contribute to psychological stress.
In conclusion, it can be noted that the framework used supported clearly determining the ability of a patient in the context of his day-to-day activities. It also assists in delivering holistic care as every activity factor is assessed and the independence level determines to offer appropriate nursing intervention and level of care. This framework directs the thinking towards a more following and logical way, and if each aspect of the activity is included when patients are assessed with the right picture of the requirement of the patient, it can get involved without deletion of any integral element. But sometimes this model is criticized not for fulfilling the requirement of the patient, having mental health issues or a learning disability. It also includes the threat of a reductionist approach, under which patients are made to adjust, instead of having flexibility.
The intervention of nursing is crucial in assisting patients to regain back to their normal life quickly. One such response covers up the pharmacological approach and offers a comfortable environment, which easily enables patients to maintain their dignity as well as sexuality. For each nursing practice, there exists a purpose for taking decisions according to facts, which are based on research, instead of experiences, because the same can defend caregiving, and even safely guide the patient. An effective care needs not only to provide a complete analysis of the illness of the patient but also offer a base on physical and social science so that each family and experience can be rightly interpreted.
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