Introduction
An essential element of delivering high-quality care to patients is composing a plan of care, in which suggestions are made as per the way to organize the patient’s treatment and nursing care provided to him or her based on specific patient details. The patient in the presented case is a 74-year-old Asian female initially admitted with complaints about occipital pain. The current diagnosis is encephalopathy, but it needs to be further specified, for which purpose additional tests are required. To design an adult-gerontology primary care nurse practitioner (AGPCNP) plan of care, it is necessary to recommend appropriate interventions, to explore potential and actual considerations from the perspectives of ethics, law, and culture, and to describe the pursued outcomes and the ways in which the outcomes will be evaluated.
Interventions
Intervention suggested in the framework of the AGPCNP plan of care will primarily include further diagnostic testing, scheduling, evaluation of the patient’s mental status, injury protection, and education. First of all, the diagnosis needs to be specified because different kinds of encephalopathy will require different interventions later in the treatment progress. Concerning scheduling, it is important to maintain the patient’s circadian rhythms (Baird, 2015). This can be achieved by keeping appropriate lighting in the patient’s physical setting and encouraging the patient to engage in correlated daily activities. Concerning the evaluation of the patient’s mental status, Baird (2015) suggests tracking such changes as tendencies to display childish behaviors, demonstration of intellectual impairment, or slurred speech. Also, the author recommends administering handwriting tests, in which deteriorations of the disease can be exposed.
Further, it is important to ensure patient safety and prevent injuries. These efforts should be aimed not only at modifying the physical environment in a way that minimizes risks of falls and other incidents that may cause injuries but also at engaging the patient in risk management. Latimer, Chaboyer, and Gillespie (2014) suggest encouraging patients to be proactive in terms of injury prevention and act as initiators of preventive measures that may be recommended by nursing care providers. However, to achieve such proactive attitudes, it is primarily necessary to provide appropriate education to the patient. Education should be continuous and focused on the specific aspects of the diagnosed condition. Also, it is important that the role of evaluation should not be overlooked; the patient will be asked to repeat information gained from the educational materials back to the nurse practitioner acting as the educator.
Potential and Actual Considerations
Potential and actual considerations can be related to ethical, legal, and cultural aspects of care. Ethical considerations primarily include complying with nursing ethics principles; specifically, nonmaleficence and autonomy (Cherry & Jacob, 2016). It should be ensured that the proposed interventions do not harm the patient and do not cause additional health problems or complications. For example, if the patient displays dissatisfaction with the tests administered by the AGPCNP, it may indicate that the tests worsen her confusion and should, therefore, be revised. This strategy will also show adherence to the principle of autonomy: despite the condition affecting her brain, the patient should be respected as a person capable of making independent decisions concerning her treatment and the management of encephalopathy. Therefore, if the patient resists the plan of care, feedback should be obtained from her, and the plan should be revised based on it.
Concerning legal considerations, Cherry and Jacob (2016) suggest ensuring that the proposed interventions are compliant with licensure requirements and the scope of nursing practice. To address this aspect, it is necessary to define the boundaries of nurses’ responsibilities according to the current legislation, specific licensure provisions, and the facility’s regulations. If the proposed interventions have been delivered in the facility by nursing care providers before, it can be expected that no legal complications will occur. In the context of cultural considerations, no actual circumstances are present in the case; however, if the patient displays an unwillingness to engage in the delivery of care to her or resistance to treatment measures, it may be caused by her cultural background. In this case, the patient should be asked to explain what causes her unwillingness or resistance, and if it is found out that her beliefs or traditions she adheres to due to her cultural background are the reason, the nurse practitioner should demonstrate the cultural competency. If possible, the plan of care should be modified to reduce the patient’s discomfort caused by perceived disrespect toward her culture.
Outcomes and Indicators
The pursued outcomes are associated with such areas of care as health promotion and maintenance, disease prevention, and illness management. First of all, it is expected that the diagnosis will be further specified, and the treatment plan will be adjusted accordingly. Appropriate tests will allow taking diagnostic measures, and, as a result, the patient’s symptoms will be better explained. Second, the patient is expected to commit to a planned schedule; the indicators of this outcome will be the patient’s adherence to the daily activities timetable and, importantly, her willingness to adhere. The patient’s willingness to adhere to prescriptions in general, as opposed to compliance with them (Kardas, Lewek, & Matyjaszczyk, 2013), will be an important indicator of the success of the patient education, too. If the patient does not understand the importance of certain prescribed practices, this will be considered a failure or weakness of patient education.
Another important educational outcome is the patient’s understanding of her condition and its management. This outcome can be measured by the level of patient education retention: if the patient manages to repeat key aspects of the educational materials back to the educator, education will be regarded as properly provided. If the level of retention is low, the educational session (or sessions) should be repeated. It is recommended to initially structure the educational materials into sections and points; this will allow further estimating the percentage of knowledge retained by the patient. According to White, Garbez, Carroll, Brinker, and Howie-Esquivel (2013), this approach to patient education can be more effective and efficient than the conventional provision of education without asking the patient to repeat what he or she understood.
Another important outcome is a higher level of control of the patient’s state and progress. This outcome can be measured only if mental status changes occur; in this case, they will be detected by the nursing care provider (either in observation according to predetermined criteria (see Interventions) or during daily tests, such as the handwriting test). The speed of responding and making modifications in the plan of care is the way to measure the effectiveness of these health maintenance activities. Concerning the injury prevention-related aspect of the plan of care, its effectiveness is expressed in such an outcome as the patient’s physical integrity, and the way to measure the outcome is to assess the patient’s injuries if any, and the frequency of incidents that are likely to call injuries; e.g., falls.
The described outcomes will allow evaluating the effectiveness of the proposed interventions; moreover, evidence will be obtained for the clinical application of such interventions mostly derived from the relevant academic literature. Concerning the cost-effectiveness, it is not expected that the interventions will require significant additional funding because all the measures proposed in the presented plan of care are normally part of the nurse practitioner’s scope of practice. However, the suggestions show how the work of an AGPCNP should be organized and structured, and what additional elements (such as patient education evaluation) should be integrated into it so that better patient outcomes are achieved. Finally, a crucial indicator of the success of attaining pursued outcomes is the patient’s and her family’s satisfaction (Aiken et al., 2012). It can be measured by collecting and analyzing patient feedback.
Conclusion
The presented plan of care suggests that it is primarily important to specify the patient’s diagnosis; while the necessary tests are being administered, the AGPCNP should ensure the patient’s safety and adherence to practices that make positive contributions to the treatment progress. These practices include following a certain schedule, avoiding incidents that may cause injuries, and willingly adhering to prescriptions. Patient education featuring the evaluation of retention will allow ensuring patient engagement. Regular tests (such as the handwriting tests) will help monitor the patient’s state and progress and detect any deterioration in a timely manner. Based on clinical outcomes, education retention, and patient education, the effectiveness of the proposed interventions can be further confirmed.
References
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Baird, M. S. (2015). Manual of critical care nursing: Nursing interventions and collaborative management (7th ed.). St. Louis, MO: Elsevier Health Sciences.
Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management (7th ed.). St. Louis, MO: Elsevier Health Sciences.
Kardas, P., Lewek, P., & Matyjaszczyk, M. (2013). Determinants of patient adherence: A review of systematic reviews. Frontiers in Pharmacology, 4(91), 1-16.
Latimer, S., Chaboyer, W., & Gillespie, B. (2014). Patient participation in pressure injury prevention: Giving patient’s a voice. Scandinavian Journal of Caring Sciences, 28(4), 648-656.
White, M., Garbez, R., Carroll, M., Brinker, E., & Howie-Esquivel, J. (2013). Is “teach-back” associated with knowledge retention and hospital readmission in hospitalized heart failure patients? Journal of Cardiovascular Nursing, 28(2), 137-146.