Introduction
Quality care can be provided to patients in healthcare settings through a person-centered approach. It involves developing care plans based on providing care that meets a patient’s needs, values, and beliefs. A holistic person-centered approach allows the clinician to plan care based on the individual patient. It involves the clinician caring for the patient’s psychological, spiritual, social, and physical needs. This paper analyses Graham’s case, providing assessment information, interventions, and a reflection on the experience.
Case Background
Graham, a 52-year-old man with emphysema and a history of hypertension, did not receive a flu vaccination notification from his GP. Despite his diagnosis, he continues to smoke and struggles with his job as a self-employed removal man. Concerned about his worsening condition, including rust-colored sputum, his partner and teenage son took him to the A&E. He was admitted to the respiratory ward for exacerbation of COPD (Chronic Obstructive Pulmonary Disease) due to pneumonia, indicated by arterial blood gas analysis. Graham exhibits symptoms of hypoxia, tachycardia, tachypnea, fever, and profuse sweating. He is also highly anxious and using accessory muscles to breathe, and he has started nebulized medication.
Assessment
The nurse caring for Graham would conduct a patient assessment, establish a diagnosis, create a care plan, implement interventions, and evaluate him. According to Field, Holmes, and Newell (2019), assessment is essential in gaining insight into the patient’s presenting problem. The nurse assessing Graham would employ physical, social, and psychological assessments (Al-Khabbaz, Nkosi, and Nakawesi, 2020). In Graham’s case, the assessment would involve evaluating psychosocial and biomedical factors and incorporating the biopsychosocial care model (Najem et al., 2023). This model helps nurses to understand the interaction between psychosocial and biological factors to improve the nurse-patient relationship.
Wu et al. (2021) suggest that a breathless medical dyspnea scale can be used to assess a patient’s level of breathlessness. Graham has grade 5 breathlessness since he cannot carry out his daily activities, necessitating the intervention of sustained deep breathing (Appendix). It is necessary to conduct baseline assessments using nursing models of care such as Roper, Logan, and Tierney to determine the impact on daily living. However, Graham’s assessment will involve open-ended questions and information from his wife and son.
His physical illness requires a biomedical approach, but the disease has social and psychological implications. The psychological assessment would make the nurse understand thoughts and emotions related to the patient’s condition (Sun et al., 2020). Psychological assessment results showed that Graham was anxious and distressed, probably due to his struggles in performing daily work. This impacted his physical health since he used his accessory muscles to breathe. Social assessment involves evaluating how cultural, economic, and environmental factors affect the patient (Asadi-Pooya et al.,2021).
The nurse can assess social factors, including Graham’s employment status, financial resources, and housing. Assessment of his financial ability would inform the nurse of his ability to pay for treatment. The nurse should assess his housing situation and access to healthcare to understand his convenience of attending future appointments. The economic assessment indicates that the patient has endeavored to maintain his independence since he struggles to work.
Graham was intubated, considering the rate of his saturated oxygen (SPO2) was deteriorating after examining him on a non-rebreather. Carter et al. (2020) suggest that patients’ non-responsiveness to non-invasive ventilation and continued SPO2 deterioration should be urgently escalated with the possibility of intubation while accessing invasive ventilation. Based on his medical and surgical history, he was diagnosed with emphysema, which forced him to undergo surgery. However, after surgery, he did not get a notification to receive the flu vaccination and continued to smoke. Nguyen et al. (2021) suggest that smoking is a risk factor that can further exacerbate Graham’s condition. Further assessments for diagnosis included laboratory tests where arterial blood gas analysis was conducted.
When managing a patient, the nurse should consider stages of care planning where they make informed judgments about complex assessment and planning. Extrinsic factors affecting care, such as nursing skills, impact patient outcomes. Ajibade(2021) proposes that care planning requires nurses to use high-level critical thinking, problem-solving, and decision-making skills. Healthcare professionals should consider their consultation style when communicating with the patient.
Collaborative consultation encourages and enables clients to participate in their care, thus creating a rapport, whereas the paternalistic approach minimizes participation, thus compromising care (Ajibade, 2021). Intrinsic factors such as age, beliefs, and health status affect their adherence to the treatment offered (Ajibade, 2021). Therefore, health workers must collaborate with patients to make a shared decision.
Coordination and integration of care involve the use of a multidisciplinary approach. This would involve incorporating professionals such as nurses, doctors, psychologists, and occupational therapists in Graham’s care. Pierucci et al. (2021)argue that a holistic approach to care through assessment, coordination, and care integration improves the outcome’s quality. Petrin et al. (2023) reiterate that a multidisciplinary approach can improve patient care and outcomes since they receive comprehensive care. The approach accounts for all aspects of patient care and ensures interventions are person-centered.
The nurse should consider the ethical and legal implications of the decisions when assessing and planning for Graham’s care. Mulchan et al. (2022) suggest that ethical implications involve observing the patient’s autonomy, respect, dignity, equity, and goodwill. When assessing the patient, the nurse should consider the organization’s service needs and individual needs. For instance, it is necessary to ensure that treatments provide compelling organizational services needs and meet patient needs. According to Johnson (2021), a patient’s unconscious bias might affect how they process information, thus impacting their decision-making ability. Therefore, nurses should be mindful of their assumptions about Graham’s condition to prevent prejudices and stereotypes.
Person-Centered Interventions
Educate Graham on COPD and Its Management
The interventions for Graham based on two of his needs would cover physical aspects of care, as shown in the appendix. The nurse should educate Graham on the causes of COPD and how the disease can be prevented. The nurse should create awareness of the importance of cessation of smoking. Zhao et al. (2020) argue that smoking increases the risk of developing COPD. The caregiver should educate Graham on management options and potential complications for managing the condition poorly. Ravshanova (2023) suggests that poor management of COPD can result in chronic respiratory failure and pulmonary emphysema. Therefore, Graham can manage his symptoms through patient education and adhere to treatment to prevent complications.
Encourage Sustained Deep Breathing
Encouraging Graham to use sustained deep breathing would aid in managing his physical need for oxygen. Graham uses his accessory muscles to breathe as a compensatory response due to hypoxia since the body has a limited oxygen supply (García-Grimshaw et al., 2021). To obtain more oxygen, he must use accessory muscles for breathing (Cabanillas-Barea et al., 2021). The nurse can use demonstration since it is one of the easiest ways of encouraging patients to have sustained deep breathing.
The nurse can verbally educate the client on the importance of inhaling slowly, holding the inspiration for a few seconds, and then releasing the exhalation passively. Visual aids such as videos can be essential in demonstrating to the patient how to breathe deeply (Kupershmidt and Barnable, 2019). Graham can use an incentive spirometer to measure volumes of air inhaled and exhaled to track his progress (Mohammed Yusuf et al., 2023). The other method is yawning, which allows for opening airways and relieves shortness of breath (Chaudhary et al., 2020). Yawning can benefit the patient since it reduces anxiety and helps the client relax.
Reflection
After managing Graham, I gained more insights and skills essential for my professional growth. My competencies in assessment and planning theories have increased after evaluating the case. I gained knowledge of the importance of multidisciplinary approaches, such as teamwork within the healthcare setting. Teamwork enables sharing roles and ideas, reducing burnout and stress (Htay et al., 2021). I will apply this learning in practice by holding discussions with my colleagues, doctors, and psychologists when handling patients.
I gained critical appraisal and thinking skills through this experience and identified my further learning. Critical appraisal and thinking are essential for health workers since they aid them in evaluating their practice and providing accurate, safe, and high-quality patient care (Guerrero, Ali, and Attallah, 2022). I noted areas I need to improve through the critical appraisal of my assessment of Graham. For instance, I needed to document all the findings of failure, which would result in missing information.
According to Geisz-Everson, Wilbanks, and Boust (2020), adequate documentation by nurses can lead to better patient outcomes. This experience taught me the importance of holistically considering a patient’s needs. According to Straßner et al. (2019), holistic assessment and care of patients improve their outcomes and quality of life. I will apply this in practice by collecting patient information through consideration of their social, physical, psychological, and spiritual needs. However, I intend to conduct further learning through research assessment of patients for spiritual needs and probable interventions.
This experience has taught me the importance of giving attention to detail when documenting during patient assessment. My further learning would involve improving my skills in developing care plans for patients with various medical diagnoses. This would prompt me to conduct more research and read articles to understand better the importance of tailoring the care plan to the client. After evaluating Graham’s case, I have understood the importance of making informed judgments in patient care. Horton (2023) suggests that informed judgments can result in increased knowledge of the patient, self-confidence, decreased anxiety, and satisfaction with the care provided. I learned the significance of assessing patients’ beliefs and values.
According to Alharbi and Alshehry (2019), values and beliefs influence individual behavior and coping mechanisms. This is essential in ensuring the intervention does not conflict with the patients’ beliefs. I intend to use this learning by critically evaluating the patient’s belief systems. I learned that evidence-based practices provide a scientific rationale for treatment approaches and benefit the patient. D’Antonio et al. (2022) propose that evidence-based practices increase patient satisfaction, improving outcomes. My further learning would involve researching evidence-based practices for managing respiratory conditions.
I learned the importance of accessing and planning patient care by minding their unconscious bias. Unconscious bias allows people to reason logically and make accurate decisions. According to Oxtoby (2020), unconscious bias can lead to false assumptions about the patient’s condition, resulting in adverse outcomes. I will apply this in my practice by understanding the patient’s culture. My further learning would involve researching strategies for avoiding patient prejudice and stereotypes.
Conclusion
Graham requires a person-centered approach to improve outcomes. This involves collecting information about him holistically by considering his physical, social, and psychological needs. The appropriate care plan based on his needs will involve interventions such as educating Graham on COPD and encouraging them to use sustained deep breathing. These interventions can be implemented by creating awareness of the importance of deep breathing using visual aids and an incentive spirometer. This experience has enabled me to gain diverse skills and competencies. However, it has exposed areas I need to work on to improve my competency through further research.
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