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Multiple factors influence the care of patients with chronic conditions. As a Community Health Nurse, it is important that care given is prioritised based on both clinical and patient needs. Prioritisation of the patient needs for care is integral to daily nursing practice. This requires integrating different aspects of patient needs in order to maximise care activities and the effectiveness of nursing interventions.

This case study is designed to demonstrate the integration of various principles of managing care of patients with chronic conditions.

Students will be expected to identify and discuss two PRIORITIES OF CARE and apply the clinical reasoning cycle to these as a means of justification. Please refer to the unit outline and marking rubric when answering this question.

PLEASE CHOOSE ONE OF THE FOLLOWING SCENARIOS

The scenarios are your referral information and no additional information is available.

Scenario One: Peter Mitchell

Peter Mitchell is a 52-year-old male with type 2 diabetes who was admitted to the medical ward with poorly controlled diabetes, obesity ventilation syndrome and sleep apnoea. Peter was referred by his GP after he presented with symptoms of shakiness, diaphoresis, increased hunger, high BGL levels and difficulty breathing whilst sleeping. Peter has been a smoker for approximately 30 years and smokes approximately 20 cigarettes per day.

On his previous admission, Peter was seen by a dietician and commenced on low energy, high protein diet (LEHP) to assist with weight reduction. His GP had previously discussed weight loss with Peter, however, he had never wanted to do anything about it as it seemed ‘too hard’. Peter was also reviewed by the physiotherapist and was commenced on light exercises which he was to continue at home on discharge.

Peter has been discharged home with a referral to you as the community nurse for ongoing support and follow up, after four weeks in the medical ward to manage his weight and clinical comorbidities.

Social History

Peter is an unemployed male who receives government benefits. Peter lost his job three years ago as a fork lift driver at the Moranbah coal mine in far North Queensland. Peter states that he has always been a ’biggish guy’ with his ‘normal weight’ sitting at around 105kg but since starting insulin and losing his job he has gained a significant amount of weight.

Consequently, because of his weight issues, Peter has difficulty finding work due to fatigue and feeling generally ‘uncomfortable’ about his size. Peter is a divorcee who lives alone, his two sons live in the same state but live in different cities and rarely visit him. He has increasingly become socially isolated as he is embarrassed by his size. Peter is also finding it increasingly difficult to perform activities of daily living (ADLs). Peter realises that he is in the prime of his middle age life and is motivated to lose weight and quit smoking but isn’t sure where to start.

Medical History

Obesity - weight 145kgs

Type 2 diabetes (Diagnosed 9 years ago) Hypertension

Sleep apnoea

Gastro oesophageal disease reflux disease

Current Medications

insulin Novomix 30 B D (34 units mane & 28 units nocte) metformin 1000mg BD

lisinopril 10mg daily Nexium 20mg daily metoprolol 50mg BD pregabalin 50mg nocte

Case Study of Scenario of Peter Mitchell

The case analysis was for a patient with type 2 diabetes. The patient's name is Peter and he has been living in a hospital recently. Peter not only suffers from diabetes, but also suffers from diabetes ventilatory syndrome and sleep apnea, and is extremely obese. Currently, Peter has been discharged from the hospital through treatment, but given his health, the doctor advised him to go to a community nursing home to recuperate in order to continuously monitor his health problems. In addition, doctors suggested that Peter must go to the hospital to review his obesity and clinical conditions after 4 weeks. During the period of discharge, Peter needs careful care to recover as soon as possible. Unfortunately, Peter and his wife have been living alone since the divorce, and the children live far from him. In this case, Peter's physical recovery is worrying.

Between patients, Peter is usually a solitary and independent person. We prioritize two factors for him, namely usability and coordination. Because Peter has been lacking in enthusiasm at work and lacking the right exercise, there is a problem with health (Urden et al, 2017). Therefore, caregivers should first consider coordination and usability issues when they are caring for them to help him recover as soon as possible. If the caregiver can take care of Peter and coordinate his surroundings, he will be able to get the fastest recovery.

Previous case studies have demonstrated that the clinical reasoning cycle model requires the use of two prioritized care options to improve patient care (Dunkley et al., 2014). The clinical reasoning cycle model consists of eight steps. Below we will use Peter's case to analyze the priority care choices. First of all, we need to understand the actual situation of the patient Peter, mainly including the patient's medical history and living conditions. The caregiver can achieve this by meeting the patient often, talking to them, and gradually deepening their understanding (Urden et al, 2017). This step is relatively easy for the caregiver. By meeting regularly, the caregiver can easily collect information about the patient's medical history and understand the patient's living conditions (Dunkley et al, 2014). Not only that, but often communicate with patients can also psychologically close each other's distance, so that patients can open up to treat the caregiver, which further facilitates communication and communication between the two sides. In this case, Peter has been living alone since he divorced his wife, and the children are outside the distant city, and they are lonely and lonely. If the caregiver can often meet with him and comfort his loneliness, it is easy to gain Peter's trust and establish a good doctor-patient relationship. After that, caregivers need to introduce similar medical cases to patients, and encourage and educate patients with past experience to enhance the self-confidence of patients' recovery (Adam et al, 2017). At the same time, the relationship with patients is further developed. The caregiver spends the longest time with the patient and is the person who knows the health of the patient best (Keleher et al, 2017). Therefore, it is possible to restore the patient's guidance to the patient. Finally, the caregiver can set the stage goals for recovery based on Peter's treatment and then adjust it through daily monitoring, which is controlled by the caregiver. If the patient recovers well, the progress can be accelerated; if the patient feels uncomfortable during the recovery process, the recovery progress is correspondingly slowed down (Keleher et al, 2017). This process is primarily based on patient feedback on medications and treatments. Since the caregiver is often with the patient, it is easy to observe the patient's response. At the same time, due to the care of the caregiver every day, the patient itself will gradually deepen his understanding of his health problems, including what medicines to eat every day, what are the curative effects, what precautions and so on (Ackley et al, 2019). Between the patient Peter's life is a lonely person, but also lost his job due to illness, psychological pressure is huge, treating life is already full of negative attitude. Through the regular communication and encouragement of the caregiver, it is not only possible to keep abreast of Peter's treatment and feedback on the treatment, but also relieve Peter's psychological pressure. At the same time, this is also a process of learning and accumulating experience for the caregiver (Ackley et al, 2019). The patient's treatment recovery process can provide a better reference for taking care of the next patient, thus improving their service accuracy (Algoso et al, 2016). In this cycle, the caregiver's skills have also been greatly improved.

The coordination provided by professional caregivers for Peter can help him recover quickly. Patient Peter is obese, which makes him lose his family and work, so there must be some psychological problems in his heart. This requires the use of medical treatment, coordination of the caregiver's attitude, careful communication and communication, enhance Peter's confidence in life, improve enthusiasm, and then solve Peter's psychological problems (Algoso et al, 2016). For every diabetic patient, his diet must be strictly controlled. Caregivers need to develop dietary charts for patients from a professional perspective, and diabetics must also strictly follow the dietary habits of caregivers (Murdaugh et al, 2018). In normal life, the caregiver must strictly manage and control each meal of the patient, which is related to the health and life safety of the patient (Murdaugh et al, 2018). For Peter, the caregiver should provide him with a high nutritional value but low fat content, regardless of whether the patient likes it or not, should strictly follow the doctor's advice. At the same time, Peter is still a long-term smoker, which will lead to a greater increase in his future asthma. Therefore, the caregiver is not able to provide Peter with any food containing sensitizing substances. In addition, the caregiver must measure and monitor Peter's weight to help him maintain a strict diet chart. Among other coordination measures, it is necessary to let Peter take the initiative to think about whether the caregiver is the main character in his life. It should be noted that proper training is an important guarantee for maintaining good health (Currey et al, 2015). Caregivers should actively encourage Peter to carry out some hands-on training, from simple to complex, and gradually develop a good habit. This process has a positive impact on Peter's health and safety. The process of caring for a patient is originally a behavior that supports and helps the patient, and the body and mind of the patient are restored through care. In this process, the caregiver is not able to blame the patient's current status and past. Peter has lost his family and work because of obesity. He is mentally weak. If he is accused again, he will lose confidence in himself, be ashamed of his obesity and his illness, and eventually lead to psychological breakdown. The caregiver should not only focus on the outcome of the treatment, but also observe the psychological response of the patient through regular coordination (Giger, 2016). At the same time, Peter's attitude towards the caregiver should be as friendly as possible, mutual understanding and mutual respect, in order to establish a good doctor-patient relationship. In addition, medical facilities have a significant impact on the health and safety management of patients (Giger, 2016). The process of care is the process of managing the health and safety of patients. Patients need to recognize their situation, caregivers develop treatment plans for patients, and work together to get rid of the disease (Smith & Liehr, 2018). For the caregiver, managing the patient's weight is one of the biggest responsibilities to maintain the health and safety of the patient (Smith & Liehr, 2018). In addition, a diet chart suitable for him should be developed for the patient's condition.

The clinical reasoning cycle has become the most effective tool in the process of developing a recovery step for a patient. Being skilled in using this tool is very important for healthcare professionals (Smith & Liehr, 2018). According to the case, the first step is to communicate with the patient. Through communication, the nursing staff can get the best feedback during the treatment. Depending on the specific situation, the caregiver coordinates the patient to make it easier for both parties to communicate (Tobiano et al, 2016). Through the joint efforts of both parties, not only patients can enjoy better services, but also recover faster, and caregivers will improve their skills and experience in this process (Tobiano et al, 2016). In summary, caregivers can easily care for patients and help them recover by taking advantage of different care priorities.

Reference

Ackley, B. J., Ladwig, G. B., Msn, R. N., Makic, M. B. F., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care. Mosby.

Adam, S., Osborne, S., & Welch, J. (2017). Critical care nursing: science and practice. Oxford University Press.

Algoso, M., Peters, K., Ramjan, L., & East, L. (2016). Exploring undergraduate nursing students' perceptions of working in aged care settings: A review of the literature. Nurse Education Today, 36, 275-280.

Currey, J., Oldland, E., Considine, J., Glanville, D., & Story, I. (2015). Evaluation of postgraduate critical care nursing students’ attitudes to, and engagement with, Team-Based Learning: A descriptive study. Intensive and Critical Care Nursing, 31(1), 19-28.

Dunkley, A. J., Bodicoat, D. H., Greaves, C. J., Russell, C., Yates, T., Davies, M. J., & Khunti, K. (2014). Diabetes prevention in the real world: effectiveness of pragmatic lifestyle interventions for the prevention of type 2 diabetes and of the impact of adherence to guideline recommendations: a systematic review and meta-analysis. Diabetes care, 37(4), 922-933.

Giger, J. N. (2016). Transcultural nursing: Assessment and intervention. Elsevier Health Sciences.

Keleher, H., Parker, R., Abdulwadud, O., Francis, K., Segal, L., & Dalziel, K. (2017). Review of primary and community care nursing.

Murdaugh, C. L., Parsons, M. A., & Pender, N. J. (2018). Health promotion in nursing practice. Pearson Education Canada.

Smith, M. J., & Liehr, P. R. (2018). Middle range theory for nursing. Springer Publishing Company.

Tobiano, G., Bucknall, T., Marshall, A., Guinane, J., & Chaboyer, W. (2016). Patients’ perceptions of participation in nursing care on medical wards. Scandinavian Journal of Caring Sciences, 30(2), 260-270.

Urden, L. D., Stacy, K. M., & Lough, M. E. (2017). Critical care nursing: diagnosis and management. Elsevier Health Sciences.