Perform a patient case study

The aim of the assignment is to perform a patient case study that will focus on the appraisal of the nursing model used in practice, culturally specific components of care, health education and promotion, and the multidisciplinary approaches to care provision. All names in the case study have been changed to protect the patients’ identity, to conform with The Code (2008) and Data Protection Act (1998).

Edna is an 87 year old female, has a good quality of life and is busy socially. She lives alone and has been widowed for ten years, yet has plenty of family and friends close by. She is self sufficient, does her own cooking and cleaning, and drives to see her friends. Edna’s previous occupation was a dinner lady at the local school where she served for over 30 years. She is a devout Roman Catholic and goes to Church every Sunday.

Edna has previous medical history of hypertension, angina and arthritis, all of which are controlled with medication. More recently she had urinary problems and was suffering from incontinence. She was referred to the urology consultant and after tests, he discovered a blockage in her bladder that would require an operation for its removal. She was then seen by the specialist urology nurse who explained the procedure and went through the pre-operation checklist with her.

Edna was admitted onto the ward in good health as a planned surgery case to undergo a transuretheral resection of a bladder tumor. The ward is a mixed adult ward taking mainly planned surgical patients for urology and ear, nose and throat. The ward also had orthopaedic patients awaiting surgery, and any patients requiring surgery from accident and emergency. The admission process is done through a pack, which contains wristbands, waterlow score, nutritional score, bed rails assessment, Clexane assessment, drug board, patient notes, early warning score, Roper, Logan and Tierney model, and a disclaimer for property. This pack is used routinely for all patients and is to be filled in with patient present.

The nursing model used in the packs was the Roper, Logan and Tierney model of nursing. Newton (1991), states that the model seems practical, approachable and functional, and if used correctly enhances care. Roper (1976), explains that the complexity and specialization of nursing requires a simple frame work such as the Roper, Logan and Tierney, so that the elements of nursing are finally identified and understood. Hannah & Alimo (1989) discuss how this framework provides an explicit focus for nursing assessment and actions. They explain how emphasis is placed on independence and individual perception, and this encourages patient-centered care, stating that the model is useful, logical and holistic.

They state that the model is for “Real nurses nursing real patients”. I think that the model met most of Edna’s needs, but a nurse needs to use the model as a guideline and concentrate on the patient. For example Edna is an elderly lady who is used to respect and autonomy. She is quite set in her ways as to when she likes to eat her meals and what she will eat, and although this is included in the model cannot be changed in the hospital environment. While it has been identified that she likes to rise at 6.30am and have her breakfast, then go back to sleep before rising again at 9am to have a bath, this is not feasible in the ward environment. This is because hospital meals are only delivered to the ward after 8am, and the ward does not have a bath, only two shower rooms.

I will now consider Dorothea Orem’s model of nursing, also recognized as the ‘Self Care Model’. This model promotes specific goals of the autonomy and patient self care. The aspects of the model require input and control from the patient, so would be unsuitable for a patient that is not mentally able. The nurse or healthcare professional is to supplement any deficit in the patients care, therefore supporting them instead of controlling their care.

Deynes (1988) says that the model contains several propositions important to health promotion, and Orem (2001) states that adults in our modern society are expected to be self reliant and responsible for themselves. Therefore self help is a desirable activity and must be considered most important when caring for and teaching our patients. If we considered using this model for the patients care, we would allow Edna to define what activities of living she can perform without help, and then support her by filling in the ‘deficits’. As an independent lady, this model may help Edna herself identify any areas when she may require help or assistance and avoid any unnecessary doing from the nurse.

Taking into consideration the different styles and views of both models, I would find it hard to decide which would best suit the patient unless it was put into practice. I think that the Roper, Logan and Tierney model met Ednas needs for her stay at the hospital, as it was simple and helped the nurse to identify any particular requirements that Edna felt were necessary to her. I do however like the section of Dorothea Orems model that promotes normality. Normality is unique to us all, and so the promotion of normality would also be unique to the patient. As every nurses’ values, beliefs and opinions differ, so will the results of Edna’s care plan using either model.

As Ellson (2008) quite rightly tell us, personal observations of the nurse using the model show us the naivety of its use, many nurses unaware of the complex nature of the model and the conflicts that can arise. She says there could be many reasons for different observation and usage of any model, stating time constraints, and prioritizing the patients’ most urgent needs. However, as nurses we must view and assess a patient holistically, and take in all of their beliefs and values, regardless of our own. I think that each model of nursing would suit a certain patient perfectly, but as all the models differ, so do our patients. So to conclude we need to use a model of nursing that best fits the majority of our patients, and train the staff of its correct use, as too many models on one ward would be very confusing.

Edna cultural needs were based on her age and the way she was brought up. As an elderly lady she was very well spoken, and socially she was a popular person and a leader figure in her family. Fox (2004), wrote the book Watching the English, and many of the traits she wrote about were of Edna’s generation. Some of these are common courtesy for others and manners, being uncomfortable in strange social environments, such as the hospital and being private about family life. Edna’s social needs were to be around her family and friends, and culturally, she wished for her business to be kept private and not to be a burden on anyone else.

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