Nursing Care for Chronically Ill
A Report on the Development of a Nursing Care Plan for Angela, Who Is a Chronically Ill Patient
Introduction
This report`s title overtly highlights its central essence. It seeks to provide a systematic, extensive, concise, and satisfactory development of a nursing care plan for Angela, who suffers from a chronic condition. To do this, the report will comprehensively discuss several aspects pertaining to chronic conditions. The report is structured into four sections, namely: a discussion of the guiding principles in planning nursing care for chronically ill patients, the development of a nursing care plan( will include three nursing interventions supported by relevant rationale), an analysis of three collaboration ways between the registered nurse and another interdisciplinary team to provide wholesome care and a conclusion.
A discussion of the guiding principles in planning nursing care for chronically ill patients
There is an increasing reliance on guiding principles regarding self-management and empowerment for patients with chronic conditions globally (McCorkle et al., 2011). Essentially, it includes both the patient and the family. Self-management enables the patient and the family to collaboratively perform caring tasks for the patient with little aid from the registered nurse and other interdisciplinary teams.
On the other hand, patient empowerment depicts the ability of the patient to positively influence his or her health (Mitchell et al., 2012). It involves enhancing the patient`s knowledge about their condition and motivating them to influence their health positively. This gives rise to well-informed patients who can immensely take responsibility for their health. This remarkably leads to improved quality of life and a lowered need for external assistance.
The relevant guiding principles in a chronic and complex illnesses context are listed below:
- Establish a treatment partnership with the patient and involve other staff
- Employ the five A`s (assess, advice, agree, assist, and arrange)
- Organizing proactive follow-up
- Assure of care continuity
Each of these is concisely discussed in the context below.
- Establish a treatment partnership with the patient
It is indispensable to initiate a treatment partnership with chronically sick patients in order to facilitate their progressive, positive recovery. This partnership normally involves creating ties with the patient and his or her family (Nuno, Coleman, Bengoa, & Sauto, 2012). This is meant to establish a collaborative element among these involved parties: the registered nurse, other relevant support staff, the patient and the family. It chiefly brings about synergy among these parties. For instance, Angela will need a partnership involving her, her daughters, the registered nurse, and other relevant support staff. This will hasten her holistic recovery.
- Employ the five A`s (assess, advice, agree, assist, and arrange)
These A`s capture the paramount patient aspects. Assessing involves evaluating the patient`s consultation goals, identifying suitable treatment risk factors, and assessing the patient`s beliefs, knowledge, concerns, and daily conduct related to his or her chronic condition. Advising includes completing the existing gaps in the patient`s understanding of his or her illness. This requires the use of non-judgemental and neutral language (Parekh, Goodman, Gordon, Koh, & Conditions, 2011). Agreeing is also essential. It involves agreeing upon goals that reflect the patient`s priorities. Assisting captures providing treatment, particularly regarding self-management. Arranging involves follow-ups to monitor treatment progress and stresses key messages. For example, Angela`s GP admitted her to the hospital for oral prednisolone and IV antibiotics, salbutamol, Atrovent nebulisers, and oxygen therapy to keep her SO2 above 92%. This will aid in treating her condition.
- Organizing proactive follow-ups
Proactive active follow-ups depict monitoring that is conducted on the patient before he or she has completed the treatment. It may be executed at agreed-upon periodic intervals (Tinetti, Fried, & Boyd, 2012). Such proactive follow-ups are precisely necessary since they enable the registered nurse, in collaboration with other relevant interdisciplinary teams, to closely note the patient`s response to treatment and recovery progress. For example, prior follow-ups will be indispensable for Angela since she has not been diligent in taking her medication before. Resultantly, this aids the registered nurse in monitoring her progress prudently.
- Assure of care continuity
This involves concretely promising the patient that the present care will go on even after discharge from the hospital and or after treatment to avert any likelihood of relapse. For instance, Angela`s GP needs to assure her of continued care even after her discharge from the hospital. This will help in quite remarkably stabilizing her chronic condition alongside assisting her to perpetually positively influence her healing process.
Development of a nursing care plan which involves three nursing interventions supported by relevant rationale
Care plans should enable and empower patients to care for themselves in their preferred way (Tinetti, Fried, & Boyd, 2012). This implies that the partnerships in self-management care facilitate the patients and their families to attain their care goals their way. As such, Angela`s chronic obstructive pulmonary disease (COPD) requires immensely diligent nursing interventions. She will need nursing care both at the inpatient and outpatient (Ludman et al., 2013).
The desired outcomes of the nursing interventions include steady airway patency, exhibiting behaviors to enhance airway clearance, for instance, expectorate secretions, demonstrating enhanced ventilation and enough oxygenation of tissues within the patient`s normal range, and being relieved from respiratory distress symptoms and taking part in treatment regimen accordingly (Kujipers, Groen, Aaronson, & Harten, 2013).
Nursing Intervention one
Note the presence and degree of dyspnoea based on observation of her “air hunger“ and respiratory distress. Employ a 0-10 scale Grade of Breathlessness Scale to rate her breathing difficulty (Morton, Fontain, Hudak, & Gallo, 2017). Verify precipitating issues when possible and distinguish acute episodes from chronic dyspnoea exacerbation.
Rationale
There is variability of respiratory dysfunction based on the underlying process like an allergic reaction, infection and the level of chronicity in a patient with established COPD (Katon J., 2011). Essentially, employing a 0-10 scale to rate dyspnoea helps to quantify and monitor respiratory distress changes. This rationale aids in upholding the guiding principles. For example the use of the five A`s (assess, advice, agree, assist and arrange). Since respiratory dysfunction is variant among patients, this principle is vividly addressed in that the five A`s are used in handling the rationale, like assessing variability and advising on chronicity level, among others. Similarly, the rationale assists in creating the necessary treatment partnership.
Nursing intervention two
Spur the expectoration of sputum when saturation or retention is exhibited (Bridges et al., 2013). This involves encouraging the patient to spit the sputum the more it is produced.
Rationale
Increased, thick, relentless, stained, copious secretions are a chief origin of impaired gas exchange in tiny airways. Deep suctioning can be needed when a cough is ineffective for secretions expectoration (Weissman & Meier, 2011). This implies that it is imperative to encourage deep spitting of the produced sputum to clear the patient’s airways and consequently ease the breathing difficulty. This is especially true when the sputum production is stained and of a monstrous amount, like Angela’s case (Katon et al., 2012). This particular rationale supports the present best practices and the guiding principles mentioned above in that the employment of the five A`s is evident in this rationale, particularly advising and assisting the patient to spit the sputum continuously. Additionally, the other guiding principles are also addressed here for instance, this rationale helps in establishing the decisive treatment collaboration with the patient, family, and other support staff.
Nursing intervention three
Uplift the top end or the `head` of the bed, and help the patient take a position to ease breathing. Incorporate intervals of time-prone position as allowed. Psych up pursed-lip or deep-slow breathing as individually required or allowed (Barry & Edgman, 2012).
Rationale
Oxygen delivery can be enhanced by breathing exercises and an upright position, lower airway collapse, work of breathing, and dyspnoea (Riegel, Jaarsma, & Stromberg, 2012). Recent research backs the employment of prone positions to upsurge SaO2 and PaO2. This rationale addresses the above-mentioned principles in several ways. For example, to organize proactive follow-ups. Here, the positive effects of oxygen therapy can be observed to monitor earlier treatment as the therapy continues. Similarly, this rationale can be used to assure care continuity in that the therapy will continue even in the outpatient.
An analysis of three collaboration ways between the registered nurse and other interdisciplinary teams to provide wholesome care and a conclusion
Nurses collaborate with other nurses and healthcare providers to resolve patient care challenges and offer the optimal quality degree of care to the patient or group of patients (Bender, Connelly, & Brown, 2013). This overtly implies that the partnership of these nursing professionals provides wholesome nursing care for patients. The interdisciplinary team is inevitably useful. The following is a precise and adequate analysis of three ways of such collaboration.
The registered nurse can collaborate with nursing assistants in the facility. These are the unlicensed assistive personnel who aid the nurses in the provision of both indirect and direct care, normally directly supervised by the nurse. They help perform nonsterile functions such as providing and helping with the patient`s daily living activities, aiding the patient with exercises, and measuring and documenting the patient’s health, just to mention a few. These assistive activities are critical in the patient’s recovery, particularly those chronically ill. For instance, the nursing assistants will help Angela do her daily chores (e.g., caring for her granddaughters) at the outpatient following her discharge, help her in oxygen therapy, and record her response to treatment.
Collaboration with respiratory therapists is another vital way. They precisely help in resolving healthcare problems associated with the respiratory system. These professionals administer respiratory medications, chest physiotherapy, and intubate patients. For example, Angela needs the above-mentioned special services for her treatment to be effective and successful. The prescriptions for her which include oral prednisolone and IV antibiotics, salbutamol, and Atrovent nebulisers, require a respiratory therapist to be appropriately administered. This is especially true after her confession that she had not been diligent in taking her prescription medicine before based on some speculator reasons. Similarly, the oxygen therapy as prescribed by her GP requires the immense assistance of the respiratory therapist. The therapist will take her through the relevant chest physiotherapy, which will, in turn, contribute to proper oxygenation in her body and consequently maintain her SpO2 above 92%.
The registered nurse may partner with a social worker. They have very diverse roles in the healthcare setting. The social worker usually offers psychological support and counsels patients (Hughes & Fitzpatrick, 2011). As such, they are necessary, particularly for patients with chronic conditions like Angela’s case. Most importantly, they provide long-term care for patients even after their discharge from the hospital. Angela needs regular, adequate, and continuous psychological support, particularly regarding her being upset about her admission at the hospital as she feels that it is likely to inconvenience her family and hence leave her daughters striving for childcare. This is because her daughters rely on her to take care of their children.
Consequently, the psychological aid will enable her to understand the pressing demands of her present condition and that her grandchildren will be well taken care of despite her being away from them for the time being. This will enable her to positively influence her health and continue her normal life even after being discharged. Counsel will also be provided for her accordingly to enable her to avoid or handle such stressful issues and worries.
Conclusion
Guiding principles form an indispensable pillar in planning nursing care for patients with chronic conditions. Care plans should serve to facilitate self-management and empowerment of the patient through collaborative efforts of the patient, family, registered nurse, and other interdisciplinary team. Nursing interventions should be relevant and supported by rationale. Registered nurses can effectively collaborate with other interdisciplinary team to holistically care for chronically ill patients.
References
Barry, J., & Edgman, S. (2012). Shared decision-making—the pinnacle of patient-centered care. New England Journal of Medicine, 780-781.
Bender, M., Connelly, D., & Brown, C. (2013). Interdisciplinary collaboration: The role of the clinical nurse leader. Journal of Nursing Management, 165-174.
Bridges, J., Nicholson, C., Maben, J., Pope, C., Flatley, M., Wilkinson, C., & Tziggili, M. (2013). Capacity for care: meta‐ethnography of acute care nurses’ experiences of the nurse‐patient relationship. Journal of Advanced Nursing, 760-772.
Hughes, B., & Fitzpatrick, J. (2011). Nurse-physician collaboration in an acute care community hospital. Journal of Interprofessional Care, 625-632.
Katon, J. (2011). Epidemiology and treatment of depression in patients with the chronic medical illness. Dialogues in clinical neuroscience, 7.
Katon, W., Russo, J., Lin, H., Schmittdiel, J., Ciechawonski, P., Ludman, E., & Von, M. (2012). Cost-effectiveness of a multicondition collaborative care intervention: a randomized controlled trial. Archives of General Psychiatry, 506-514.
Kujipers, W., Groen, G., Aaronson, K., & Harten, H. (2013). A systematic review of web-based interventions for patient empowerment and physical activity in chronic diseases: relevance for cancer survivors. Journal of medical internet research.
Ludman, J., Peterson, D., Katon, J., Lin, H., Von, M., Ciechanowski, P., & Gensichen, J. (2013). Improving confidence for self-care in patients with depression and chronic illnesses. Behavioural medicine, 1-6.
McCorkle, R., Ercolano, E., Lazenby, M., Schulman, D., Schlling, S., Lorin, K., & Wagner, H. (2011). Self‐management: Enabling and empowering patients living with cancer as a chronic illness. A cancer journal for clinicians, 50-62.
Mitchell, P., Wynia, M., Golden, R., McNellis, B., Okun, S., Webb, E., & Von, I. (2012). Core principles & values of effective team-based health care. Washington, DC: Institute of Medicine.
Morton, G., Fontain, D., Hudak, M., & Gallo, M. (2017). Critical care nursing: a holistic approach. Lippincott Williams & Wilkins.
Nuno, R., Coleman, K., Bengoa, R., & Sauto, R. (2012). Integrated care for chronic conditions: the contribution of the ICCC framework. Health policy, 55-64.
Parekh, K., Goodman, A., Gordon, C., Koh, K., & Conditions, H. I. (2011). Managing multiple chronic conditions: a strategic framework for improving health outcomes and quality of life. Public health reports, 460-471.
Riegel, B., Jaarsma, T., & Stromberg, A. (2012). A middle-range theory of self-care of chronic illness. Advances in Nursing Science, 194-204.
Tinetti, E., Fried, R., & Boyd, M. (2012). Designing health care for the most common chronic condition—multimorbidity. Jama, 2493-2494.
Weissman, E., & Meier, E. (2011). Identifying patients in need of a palliative care assessment in the hospital setting a consensus report from the Center to Advance Palliative Care. Journal of palliative medicine, 17-23.