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Introduction - Nursing Care Plan Strategies for Hemophilia Patients
The study aims to present a supporting care plan with the rationale of a hemophilia patient with joint bleed. It constitutes a critical analysis of the patient and my direct contribution that has been identified over the observation period. The study discusses the Roper. Logan Tierncy's model demonstrates how it is different from the Vergina Henderson model. Moreover, the study gives critical insights into the API model.
Patients History
The patient was 12 years old and was admitted to the hospital due to having complained of pain and swelling in joints. The boy was having a severe fever for around 14 days. The swelling started from his left elbow which all of a sudden started and was dull and aching in nature. In moments that occur in a sudden rage, the swelling and pain are exacerbated. After, 7 days a similar swelling and pain started in his right elbow joint which was followed by the left knee joint and right shoulder. The patient showed no trauma to his joints. The patient experienced high-grade fever with intermittency, and frequently severe joint pain that was relieved by consumption of oral antipyretics.
The patient has been experiencing similar episodes of swelling and joint pain occasionally since the time of his birth. On injecting the FVIII and blood transfusion, the patient felt relieved. The boy had a history of non-traumatic incidents of skin brushing and epistaxis since his birth. The patient's history demonstrated difficulty in blood clotting post-circumcision, which required medical attention.
The patient's history demonstrated his vaccinations were up to date according to EPI. Since, the patient was a result of consanguineous marriage his younger brother, a 7 years old male demonstrated similar traits to the patient.
Pathophysiology
O/E, the patient had an average body height and lean shape oriented to time, place, and person with a GCS of 15/15. HR measured was 88 beats/min, BP - 110/80, RR - 20 breaths/min, BP -110/80 mmHg, and temperature - 102 0F. Upon examining the locomotor, restricted moment and swelling (with/without tenderness) were noted. Other systems of the patient were found unremarkable.
Findings:-
Joints
Range of Movement
Swelling and Tenderness
Left Elbow
Semi-flexed
A large swelling area (10*10 cm) spread from mid to forearm. On palpation, it felt tender and warm.
Right Elbow
Flexion is limited to 450 and extension up to 1500.
Limited swelling (5*5 cm) up to the joint. On palpation, it felt tender and warm.
Right Shoulder
Limited abduction up to 900
No tenderness or swelling
Left Knee
Fixed in about 900 of flexion
Locally swelled joint (not tender)
Overview of nursing theory
Nursing theories are the organized frameworks that define and identify nursing as a separate discipline. Nursing theories define the intended purpose of guidance to the nursing practice. Nursing since as a profession is recognized by an unparalleled body of vital knowledge called nursing science is meant to guide a specific and concrete level of nursing. The first nursing theory was introduced by Florence Nightingale in 1860 in which she introduced the world to nursing through her environmental theory. Florence Nightingale mentioned, "Nursing as an act of utilizing the patient's environment to assist them in their recovery" (Wayne, 2021). The purpose of nursing theories is to improve the overall nursing practice to have a positive influence on the patient's health and improvisation of the quality of life. The nursing theories ought to define patient care to guide the nursing practice and provide a foundation that lays the basis of clinical decision-making.
Critically looking at nursing models
A critical analysis of the nursing models demonstrates that the nursing models initially were in widespread use in the practice of British nursing between the 1980s and 1990s. These models especially such as activities of the living models and self-care model ought to be used extensively for the proper guidance of nurses in nursing. Nursing models are prototype models that are used in every scientific discipline before the launch of any new technology. Similarly, nursing models serve as primary models that were developed to guide the nursing practice. These models were used by early theorists and model developers to conjugate nursing practice with the scientific approach. The benefit of using these models was to provide a shared goal among the theorists and perform various research to test their theories and models. Moreover, nursing models synchronously describe and analyze the core concepts of nursing that hold importance in nursing practice. Such a concept can be seen when the concept of care (Leininger, 1988) is critically analyzed.
After the 1970s, nursing as a 4-stage model was introduced to assist in the delivery of care. Since, the time these models were adopted to be used broadly over masses, they were also criticized. The nursing models faced criticism because of the complex terminologies and jargon(Lumen, 2021). The criticism of the nursing models holds equal importance as the development of these models since it did not only help in simplification of these models but also the adaptation of these models in worldwide nursing practice. This criticism evacuated the voids in the nursing practice and thus enhanced the overall nursing practice.
Why nursing theory is preferred
The nursing theory aims to determine, predict, and explain the nursing phenomenon and helps in distinguishing the basis of nursing practice. Nursing theories are the definite set of defined theory that is used for enhanced patient care and communication among nurses working at various locations. This helps in improving the professional status of nursing as a separate discipline. Since care is a qualitative term and it cannot be quantified, there is a need to implement the theories to assess and evaluate the level of care. Moreover, the nursing theories serve as guidance to the nurses in practice worldwide. Furthermore, the nursing theories serve as a backbone of practical nursing since the theories are to be followed to enhance knowledge and education for the nurses. Nursing theories guide a nurse about the future course of action that is recommended for enhanced patient care.
In practice, nursing theories are preferred to evaluate the care provided and help in the assessment, involvement, and evaluation of care that is to be provided by the nurses. Nursing theories help nurses to predict, report, and explain their experiences. Nursing theory in practice helps nurses accumulate data and a patient's health status. This data is further utilized in the decision-making and implementation. Most importantly, nursing theories define the anatomy of nursing as a separate discipline with an independent function.
Nursing process (Roper. Logan Tierncy Model)
The Activity of daily living model for nursing was jointly discovered by Nancy Roper, Winifred W. Logan, and Alison J Tierney was inspired by the Virginia Henderson model. The Roper-Logan-Tierncymodel also abbreviated as ADLs or often ALs served the purpose of assessing patient care. The model became widespread in the United Kingdom specifically in the public sector. The model is different from a checklist where the assessment of patient care on various bases is done. The Roper-Logan-Tierncy model is used for purposes such as assessing the patient's illness, level of injury, and changes that had to happen to his life due to illness. Nevertheless, the model supported the nursing discipline in accessing and making the quality of life of the patients better.
The Roper-Logan-Tierncy model defines the means of living. This model allowed categorizing the findings into living activities for a thorough and complete assessment of the patients. The implementation of this model leads to easier interventions that help to support the patient's independence.
The model helps nurses assess the patient's relative vs. potential independence. This assessment helps in ranging the patient's independence across complete vs. incomplete independence. The assessment is further used by the nurses to determine and intervene in their role in providing maximum independence for the patient(ECPI University, 2021).
Roper model should be considered as a cognitive approach for the assessment of patient care which is entirely different from a checklist where nurses access and intervene the necessary care for patients' complete independence. It should not be considered a checklist (Petiprin, 2020).
Vergina Henderson model
Vergina Henderson's model was derived by Virginia Henderson from her experience and education. She aimed to provide a unique set to focus on nursing practice that evolved as a theory. The Vergina Henderson model emphasizes increasing patient's independence for enhanced progress after a patient is brought to the hospital. The model was centralized along with basic human needs as its main focus. In the Henderson model, the major assumptions made by Vergina Henderson were:-
Nursing care should be provided until a patient is fit to help himself.
Nurses should be devoted to patient care day and night.
A nurse should possess both science and art knowledge.
As indicated by Henderson, people have fundamental requirements that are segments of well-being. They may expect help to accomplish wellbeing and autonomy, or help to accomplish a quiet demise. For the individual, the brain and body are indivisible and interrelated, and the individual considers the organic, mental, sociological, and profound parts. This hypothesis presents the patient as several parts with biophysical needs instead of as a sort of customer or buyer(Lumen, 2021).
The climate is comprised of settings in which an individual learns one-of-a-kind examples of living. Every single outside condition and the impact that influences life and improvement. The climate likewise remembers people for their connection to families. The hypothesis insignificantly examines the effect of the local area on the individual and family. Fundamental nursing care includes giving conditions in which the patient can freely play out the fourteen segments clarified in the model(Petiprin, 2020).
Activities of daily living model
As listed by Roper-Logan-Tierney, the activities of the daily living model consist of the below-listed activities:-
Maintaining a safe environment
Communication
Breathing
Eating and drinking
Elimination
Washing and dressing
Controlling temperature
Mobilization
Working and playing
Sleeping
The activities of the daily living model also include sexuality and death which are activities in daily living but these two are often discarded.
As per the model, five factors impact the exercise of living. The consolidation of these elements into the hypothesis of nursing makes it a comprehensive model. On the off chance that they aren't thought of, the subsequent evaluation is deficient and defective. The elements are utilized to decide the individual patient's general freedom concerning the exercises of day-by-day living(Petiprin, 2020).
Roper protests her model being used as a basic agenda. She communicates that if specialists are abnormal in discussing explicit parts, they expect the patients to be, as well. This prompts the clinical overseers to attribute the shortfall of assessment to the patient's tendency when as a general rule, the patient's tendencies were not tended to(Petiprin, 2020).
Nursing Process
In 1958, Ida Jean Orlando started the nursing process that oversees nursing care today. Described as a systematic method to manage care using the urgent principles of fundamental thinking, client-centered approaches to managing treatment, target organized tasks, evidence-based practice (EDP) ideas, and nursing intuition. Sweeping and consistent estimates are joined to give the reason for tolerant, quality-based vehicles.
Nursing as a process has similar functions which serve as a systematic guide to care focused on the patient with 5 sequential steps. These 5 sequential steps correspond to assessment, diagnosing, planning, implementation, and evaluation.
Assessment
Assessment is the very first step that incorporates the data collection together with its critical analysis. The data collected is both objective and subjective. The subjective collection of information involves the records of the verbal statement given by the patient or the care assistant. However, the objective collection of information tends to contain tangible records that are measurable such as patient's intake, output, vital signs, weight, and height. This information may be collected from the patient directly or by his family members, friends, or primary care providers. For assessment, critical analyzing skills are vital hence, the concept-based course cannot be fit and needs to change.
The implication of care support with literature critically analyze
The implication of care support is the progression which includes an activity or doing and the real completion of nursing mediations illustrated in the arrangement of care. This stage requires nursing mediation, for example, applying a heart screen or oxygen, immediate or circuitous consideration, medicine organization, standard treatment conventions, and EDP norms(Contributor and Contributor, 2021).
Evaluation
This last advance of the nursing interaction is fundamental to a positive patient result. At whatever point a medical care supplier intercedes or executes care, they should reconsider or assess to guarantee the ideal result has been met. Reassessment may often be required relying on generally quiet conditions. The arrangement of care might be adjusted depending on new evaluation information(Wayne, 2021).
Recommendation
SBAR is an accurate way to communicate medical information for the prevention of dangerous errors. SBAR is an abbreviation used for situation, background, assessment, and recommendations. SBAR was first endorsed by the Joint Commission for the exchange of complete messages between a nurse and a doctor regarding the patient's condition. SBAR could be written or could be given orally. SBAR could be explained as follows:
Situation:
This contains a brief statement of the problem where brief is the key term. The main purpose of this brief is to remove irrelevant information. The unit consists of nurse identification, unit identification, and patient identification.
Background:
This consists of a concise overview of the patient's situation, including the diagnosis and the medical history, with dates and medication info or names of the physicians involved. Moreover, this may contain any relevant information.
Assessment:
This consists of the assessment that is to be considered by a nurse as the summation of the phenomenon considering the patient's laboratory report.
Recommendations
While making recommendations, a nurse could use simple communication with the doctor as a direct message or suggest actions to be taken in a timeframe.
The subsequent articles examined for SBAR. Audit of the unit brought about the accompanying topics: the SBAR instrument makes a typical language for correspondence, expands the certainty of clients, brings about more viable and proficient correspondence, improves patient security results, and advances a culture of patient well-being in medical care associations. The advantages of SBAR can be partitioned into essential and auxiliary advantages. Essential advantages result from qualities exceptional to the SBAR instrument, while optional advantages result from the normalization interaction of correspondence. The essential advantages may make SBAR more invaluable than other normalized specialized apparatuses. Correspondence mistakes are a foundational issue in medical care, frequently bringing about quiet damage. Proof of this audit demonstrates SBAR as a basic and powerful mediation for improving correspondence and patient well-being (Toney-Butler and Thayer, 2021).
Conclusion
This report focuses on my assessment of the hemophilia patient with a joint bleed as the major. In this report, I have described and simplified my understanding of the nursing models, theories, and practical implementation on the patient. This assessment consists of developing an SBAR for the above-mentioned patient.
References
Contributor, N. and Contributor, N., 2021. Nursing models and contemporary nursing 1: their development, uses and limitations | Nursing Times. [online] Nursing Times. Available at: <https://www.nursingtimes.net/roles/nurse-educators/nursing-models-and-contemporary-nursing-1-their-development-uses-and-limitations-15-06-2010/> [Accessed 17 March 2010].
ecpiuniversity, 2021. Why Does Nursing Need Theory as Well as Practical Application? [online] Ecpi.edu. Available at: <https://www.ecpi.edu/blog/why-does-nursing-need-theory-as-well-as-practical-application> [Accessed 4 March 2021].
lumen, 2021. The Medical History. [online] Lumen.luc.edu. Available at: <http://www.lumen.luc.edu/lumen/meded/ipm/ipm1/homepage/MedHistory_Example.pdf> [Accessed 8 March 2021].
Petiprin, A., 2020. Henderson's Nursing Need Theory - Nursing Theory. [online] Nursing Theory. Available at: <https://nursing-theory.org/theories-and-models/henderson-need-theory.php> [Accessed 5 March 2021].
Petiprin, A., 2020. Roper-Logan-Tierney's Model for Nursing Based on a Model of Living - Nursing Theory. [online] Nursing Theory. Available at: <https://nursing-theory.org/theories-and-models/roper-model-for-nursing-based-on-a-model-of-living.php> [Accessed 5 March 2021].
Toney-Butler, T. and Thayer, J., 2021. Nursing Process. [online] Ncbi.nlm.nih.gov. Available at: <https://www.ncbi.nlm.nih.gov/books/NBK499937> [Accessed 7 March 2021].
Wayne, G., 2021. Nursing Theories and Theorists: An Ultimate Guide for Nurses. [online] Nurseslabs. Available at: <https://nurseslabs.com/nursing-theories/> [Accessed 1 March 2021]
