Nursing Essays - Knowledge and Skills for Nursing

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Subject Area - Nursing
Knowledge and Skills for Nursing

The Setting

The setting is a medical ward; patient was admitted due to diarrhoea and vomiting as a result of alcoholism and
malnutrition. Hospital medical ward consists of patient that needs proper approach and nursing care to shorten their
stay in the hospital. The patient will be treated not only physically and physiologically but also mentally since the patient
was having such difficulties because of depression. The patient started to become depressed when her husband dies. She
became an alcohol dependent and her health started to deteriorate due to malnutrition.

The Approach

The patient was brought to the hospital with diarrhoea and vomiting. The patient is physically not well, pale and has a
poor hygiene. Based on the background check patient had suffered severe depression because her husband died and live
alone. The patient became alcoholic and her health deteriorated because of malnutrition. The patient looks underweight
but can survive by giving proper medication and patient care.

The nursing process can best be described as a framework for planning individualized care for patient with intellectual
disabilities. Since the care for patient is a process it does not conclude into anything but rather it changes constantly
and it is the nurses’ responsibility to respond to these changing needs whenever necessary. The nursing process
usually comprises four or five stages depending on the resources available and work setting, and includes: diagnosis,
assessment, planning, implementing and evaluation. The nursing process should be undertaken using a collaborative
and participative approach with other professionals, gathering and implementing resources, in order to improve the
care process (Department of Health 2000b; Department of Health 2001). The focus of this study will be on the design
care plan for our patient on study.

Assessment

Assessment is the most important part of care planning and delivery. It includes areas such as health and health needs,
daily living skills, activity programmes, mobility, mental health, risks to the client, finance, respite, social events/outings,
support requirements, spiritual needs and, possibly, accommodation issues (Department of Health, 2000b;Sox, 2004a).
As a start, a background check is needed to be able to assess the situation of the patient. Our patient is conscious but was
not able to respond properly because of her condition. So we need someone close to the patient or a relative to answer
questions needed for the care plan. Data such as previous hospitalization, medication taken and others related to the
patient condition is important.

Diagnosis

The patient was brought in the hospital because of diarrhoea and vomiting. The initial diagnosis is that the patient is
dehydrated base on the physical appearance of the patient. Diarrhoea usually gets better on their own, often without
treatment. If the diarrhoea continue within several days it is best to check patient’s medical history and physical exam.

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Planning

In planning, the nurse plays an important role in the recovery and stay of the patient in the hospital. The patient upon
admission was given attention on the main complain which is diarrhoea and vomiting. However further diagnosis
and assessment of the medical team discovered that the patient is suffering from malnutrition. Our plan focuses on
malnutrition; the reasons why the patient is having this kind of condition, and the treatment and the protocol that the
nurses should follow for the welfare of the patient.

Implementation

Implementation of a care plan is the most challenging part of the nursing process. The patient is pale and has lost a lot
of weight. The patient also lacks proper hygiene as a result of her appearance upon admission. The implementation of
the care plan will begin upon admission. The patient will be forwarded and referred to the nursing staff on duty in the
medical ward and will be given the care plan as agreed upon by the medical team and the patients relative. Malnutrition
Evaluation will assess the effectiveness of the care plan and the implementation of the care. It is important to evaluate
the point for care to be able to reach its desirable care plan. An updated review should be done to correct and improved
the plan.

The Model

In simple language, a model is described by Pearson and Vaughan (1993) as a descriptive picture of practice which
adequately represents the real thing. Riehl and Roy (1980:11) cited in Roper et al (1990) provide a more elaborate
definition of a model as “a systematically constructed, scientifically based and logically related set of concepts which
identify the essential components of nursing practice, together with the theoretical bases of these concepts and the
values required for their use by the practitioner.”

Choosing an appropriate model is important to help the care planning effective. In UK, the model of nursing used
most predominantly is that of Roper et al, 1980 that bases its principals on a model for living. It provides a holistic
care approach and involving the important component of the daily activities of a person. The model is made up of five
components: Activities of daily living (ADLs), Lifespan, Dependence/Independence continuum, Factors influencing
ADLs, and Individuality in living. (Roper, Logan, Tierney, 2002). The case of our patient needs to be assessed physically,
physiologically but also mentally. The effect of losing a husband has led our patient to become ill. The Roper, Logan and
Tierney are believed to be a useful approach in dealing with our patient since it involves a holistic approach.

The model was named after the author of the model, Nancy Roper, Logan and Tierney. It was first developed in 1980
based upon the work by Nancy Roper in 1976. The model is based on the 12 activities of living in order to live. The
model has been revised several times 1985, 1990 and the latest version 1998. The 12 activities involve the following:
maintaining a safe environment, communication, breathing, eating and drinking, elimination, washing and dressing,
thermoregulation, mobilisation, working and playing, expressing sexuality, sleeping, and death and dying. Each of the
activities might be seen to be conceptualised as lying on a continuum from dependence to independence. There are






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times in our life that we may be more dependent on others to meet our needs. The role of the nurse is to help people
move towards independence in all activities of daily living. Biological, physiological, socio-cultural, environmental and
politico-economic variables are factors that impact on the individual and affect their levels of dependence /independence.

Advantages and Disadvantages of Roper, Logan and Tierney

Based on the study done by Pearson and Vaughan (1993) model of nursing is important in hospital ward or department.
One of the advantages of the Roper, Logan and Tierney model is that it leads to consistency in the style of care received
by patients and thus to a continuity of care patterns and treatments. The Roper, et.al. Model will give rise to less conflict
within the team of nurses as a whole. Because of the rationale and definition behind the model other healthcare involved
will understand better the logic of care. Roper, et. al model is said to be self explanatory or not too complicated as
compared to others. It is said to be done this way in order “to assist learners to develop a way of thinking about nursing
in general terms.” It is mentioned above that main concept of the Roper, Logan and Tierney model is based mainly on
twelve activities of living which is the main elements of nursing and is referred to as “basic human needs”. According
to Roper, Logan and Tierney the activities of living have an advantage for nursing model since they are observable,
describable, and in some instances, objectively measured.

The model is mainly focused on the twelve activities while the theory is built on ‘living’ and addresses the nursing
activities as a deliberative approach to meet the twelve components of nursing care. It conceptualises the Person as a
biological being with inseparable mind and body and Health as the ability to function independently in relation to the
twelve components (Fitzpatrick and Whall 1989).

The Care Plan

The initial diagnosis on the patient under study is diarrhoea, alcoholism and malnutrition. However as the process of
identifying the cause of the patient’s condition, nurse attending to her needs found out about the death of her husband.
After background check they have found out that the patients’ husband died and became depressed because of the
situation. During assessment on the patient’s health it has been noticed that the patient has mental health problem. The
health needs of a patient is also important and the nurse involve should be aware of these needs. To help the patient,
nursing process and nursing model should be working hand in hand to help the patient survive. Assessing the need
of the patient is important. The Roper, Logan and Tierney model will ensure that the patient should be able to have a
safe environment, should be communicating with her nurse attending to her, breathing, eating and drinking, working.
Because of its holistic approached, Rogan. Logan and Tierney model is widely used. To evaluate the situation of our
patient, the alcoholism of our patient might lead to liver disease and will be affecting the daily activities of life. The
patient should trust her nurse and they should have a good relationship to have an effective care plan. The chosen model
Roper et al have described the course of life as something that starts at conception and lasts until death. The model
involves maintaining a safe environment; our patient should be living in an environment that she will be comfortable
and clean. The patient upon admission has seen to have poor hygiene. In identifying the activities of living the individual
should be engage in personal cleansing and dressing. As described in the admission of the patient, the patient has poor
hygiene. The patient may have pressure sore due to her stay in the hospital. This should be treated and approached very
well by the nurse handling her. Pressure sore is the result of being immobile of the patient. The length of stay of the
patient in the hospital should be shortening to avoid such condition. The nurse must assess how to help the patient to






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cooperate on the agreed care plan.

Implementing the care plan will need the cooperation of the patient. It is important to help the patient to overcome
the depression that she is experiencing. In this case the patient may not cooperate at the start of the plan but will be
eventually cooperate as the process continues. The success of the plan depends on the cooperation of the patient and
the nurses.

Throughout life, our ability to perform ADLs will move from one extreme and possibly back again. This aspect of the
model of living, therefore, interlinks with the model of nursing with effectively, each reliant on the other. The patient will
have a chance in recovering from the health problem that she is encountering. The Roper, Logan and Tierney model is
appropriate to approach the case of the patient in a holistic way.

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Conclusion

The nursing process includes stages that should be completed to help the patient overcome the disease she is in. By
means of this we will be able to identify which factors should be given enough attention to prevent the occurrence of such
disease. The study includes the nature of care planning, person centred are planning, care management, health action
planning and the care program approach. This study also introduced some relevant actions that need to be taken. The
use of the Roper, Logan and Tierney model are described to help the nursing process to become successful and effective.
The Roper Logan and Tierney is a holistic approach and are important to work with the nursing process. This study has
also advocated the need for robust, professionally prepared care plans based on a systematic nursing assessment.

Proper planning is important in dealing with the patient especially on those that are in admitted in the hospital because
of different illnesses which can be cured and overcome if proper nursing process and model will be used. A nursing
process is important to evaluate, assess, cure and eliminated illnesses of person. Our patient became sick because of
depression and problem, which needs to have a proper attention on different aspect. She must be treated physiologically,
physically and psychologically. Nursing model should be holistic if this is the case. The patient’s daily living activity
is affected and she needs to understand why such activity such is done for her wellness. Patient should be very well
educated or informed on the benefits that she will be having if she will cooperate on the agreed care plan.

Reference






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Roper, N; Logan, W; Tierney, A; 2002 The Elements of Nursing 4th edition. Churchill Livingstone, Edinburgh

Department of Health (2000a), Nurses, Midwives and Health Visitors (training) Amendment, London Department of
Health.

Department of Health (2000b) The NHS Plan. www.nhs.com.uk

Goddard M, McDonagh MS & Smith DH (2000) Measuring appropriate use of acute beds: a systematic review of
methods and results. Health Policy 53 157-84.

Coast J, Inglis A & Frankel S (1996) Alternatives to hospital care: what are they and who should decide? British Medical
Journal 312 162-6.

Pearson A. and Vaughan B.(1993) Nursing Models for Practice. Oxford. Butterworth Heinemann.

Riehl J. and Roy C.(1980) Conceptual Models for Nursing Practice (2nd. Ed.) New York. Appleton Century Crofts. In
Roper N., Logan W., and Tierney A.(1990) The Elements of Nursing (3rd. Ed.) London. Churchill Livingstone.

Fitzpatrick J. and Whall A.(1989) Conceptual Models of Nursing: Analysis and Application (2nd.Ed.) London. Prentice
Hall Int.

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