Assessment

The current assignment focuses on the aspect of nursing for continuous care and management of the daily life activities of individuals. The assignment aims at designing a care plan for the urine incontinence treatment of a patient suffering from co-morbid conditions. The patient here had been suffering from Alzheimer’s which though has been in control. However, recently the patient had been suffering from a severe urine infection and had been admitted to the hospital with complaints or urine continence. Thus, the nurse working in the incontinence management team or the multidisciplinary hospital team looking after the overall health of the patient needs to work together in order to provide the patient with long term care goal. The current assignment uses the ASPIRE framework along with the Roper Logan and Tienary model (RLT) for the planning of the care. The ASPIRE model had been broken down into a number of components for the evaluation of the health issues suffered by the patient such as –Assessment, systematic nursing diagnosis, planning and implementation.

The nurses catering to the diverse clinical needs of the patients admitted in the hospitals play a crucial role in motivating good health behaviour and change within the target patient group. As commented by Sirls et al.  (2013, p.205), the role of the nurses is to design effective and holistic treatment care plans for the care support users. This could be ensured by the implementation of self-management programs within the hospital setup. As commented by Visser et al. (2015, p.213), educating the patient about their present health concerns ant and the effective self-managerial strategies can help in providing more autonomy to the support service users. Additionally, implementing linguistically and culturally sensitive practices within the hospital set up can helps in reducing the communication gaps. The nurse could use electronic health information systems for maintaining the patient records. The reports and the data generated can help in easy access to the vital information about the patient’s health condition.

In this context, the nurse could use the Ropert Logan and Tienary model in looking after the care needs of the patients admitted to the hospital. The model was developed in the 1980’s and has been accepted as the standard model of care assessment in UK based hospitals. The model stresses upon the societal needs of the patients and the importance as well as the impact of the daily set of activities upon the life of patients.  The various components of the model help in evaluating the effect an illness may have on the daily life activities of an individual.  As mentioned by Nelsonand Carey (2016, p.20), the RLT model inculcated as a necessary checklist within the hospital assessment parameters helps in the evaluation of the physical and the mental stability of an individual.

 

Figure1: RLT model

(Source: Heidenreich et al. 2012, p.125)

The nurses are liable to access the current health problems and situations of the patients from a closed end. Therefore, reporting and collection of authentic data records become a pre-requisite. As commented by Williams (2015, p.25), one of the sole features of the data collection process is the identification of the problems encountered by the Patient and maintain a clear record of all these data. However as mentioned by Tastan et al. (2014, p.1161), a number of potential barriers and challenges are faced by the nurse in looking after diverse care needs of the support users. In this context, one of the problems encountered by the nurse in looking after the patient was a gap in communication. The patient here was an 85-year-old woman suffering from dementia. Therefore she would often miss communicating the important details to the nurse or other health care professionals looking after her. The patient here named Julie had been a long term survivor of dementia and had been living with her husband. However, lately, she was admitted to the hospital with urine incontinence. Therefore, the patients need to be put under proper hygiene and cleanliness maintenance along with conducting a number of important tests of the patient such as ultrasonography and CT scan of the kidneys and the bladder.

Holistic Care Regimen

In this context, proper record keeping needs to be done such as the amount of liquid intake by the patient along with the amount and the frequency of urination. As mentioned by Liu et al.(2014, p.17), detailed record keeping might help in prioritising as well as looking after the patient needs. The SBAR tool of communication was used by the nurse to facilitate the exchange of information as well as promote easy and effective communication between the nurse and the support service users. The SBAR model could be used for effective data collection and recording of the health details of patients with communication gaps.  The lack of communication could be attributed to languages barriers along with cognitive impairment and lack of decision-making skills in the support service user(Faller et al. 2013, p.783). In this context, Julie was an 85-year-old lady suffering from dementia. Therefore, the SBAR tool used by the nurse could help in accessing and preserving the vital health details of the patient. The SBAR tool is based upon analysis of the situation, assessment of the background along with the provision of suitable recommendation for addressing the problem situation of the patient.

A number of care plans and strategies could be implemented by the practising nurse for looking after the condition of urine incontinence of the patient. As mentioned by Ghitza (2015, p.25), one of the effective practices which could be conducted over here is maintaining a record book. Additionally, monitoring the intake of fluids along with maintaining appropriate hydration regimen serves as well tested evidence based measure in looking after the care needs of patients with urine incontinence.

In this context, some of the care goals could be implemented for looking after the concerns of support users like Julie. The long terms care goals which could be exercised over here includes implementation of Pelvic floor muscle exercises (PFMEs). This would help the patient in retaining as well as controlling the frequent need to urinate. The results after the implementation of the process could be evaluated with the help of recording the voiding and the hydration details of the patient. Additionally, provision of toilet assistance and bladder training could be useful interventions(Ghitza, 2014, p.15).

To implement pelvic floor muscle exercises as a part of the care planning

Specific	· To identify the extent  of the infection · To evaluate the co-morbid conditions of the patient
Measurable	· To use the SBAR tool to analyse the problem situation of the patient · To evaluate the patient response to recovery through Roper Logan Tienary (RLT) model
Achievable	· Implementation of light exercises such as PFMEs for the patients with urine incontinence · To maintain a log book recording the daily health performance of the patient
Realistic	· Diagnosing the patient condition  through internal organ scanning · Report to the multidisciplinary team regarding  further surgical measures
Time –bound	· Implementing the PFMEs for a repetitive period of six months · Evaluation of the effect through  regular follow-up

Table: SMART tool

(Source: Author)

Both the nurse and the patient play a pivotal role in the planning and implementation of the SMART goals and objectives. The nurses can design the care plan using the SBAR tool which would help them analyse the detailed problem situation of the patient. As mentioned by Prodonovich et al. (2014, p.177), tailoring the care plan as per the requirements of the patients helps in addressing the diverse and the complex health requirements of the patients. The patients need to participate as well as show sufficient zeal in the evidence based program. This could be ascertained by providing the patients with transparent and communicative information.

The nurse needs to consider the patient preferences in planning and designing of effective care interventions and policies. As mentioned by Katigbak et al. (2015, p.25), the involvement of the patient in the designing of the treatment plan provides more autonomy to the patients. Additionally, tools such as SBAR and RLT used by the nurse could help in narrowing down to the problem statement faced by the patient.  The RLT assessment tool can be used by the nurse in accessing the daily activities of the patient and the impact of the same on the life of the patient (Dundar et al.2014, p.314). The RLT tool helps in analysing the basic set of activities undertaken by the patient daily and the impact of the same on the health conditions of the patient. One of the prerequisites of the RLT model is to maintain a safe and clean environment for the patient (Parwaiz, 2016, p.189). The same could aid in the recovery and healing of the patient. Similarly, some of the parameters such as the mobility, measuring the normal respiration rate of the patient along with sleeping pattern can give an idea about the overall health condition of the patient. Additionally, implementation of exercises such as the Pelvic floor muscle exercises can help in controlling the urine incontinence rates in the patient.

RLT Model used for Assessment of Patient Health

In this context, the nurse looking after the UI patient could also use her contact base resources where she is well connected with other health care professionals. As commented by Joffe et al. (2013, p.500), sharing of information across relevant expertise channels can help in the speedy attainment of the care and support services. Therefore, the nurse needs to keep a tab of the reports collected from the patient and discuss it over with the professional health experts or Urologists to design an effective care plan for patients such as Julie. However, a number of ethical and legal issues could be faced by the nurse in looking after the care needs of support users like Julie. The ethical issues may be faced with respect to the resistance offered in the implementation of effective exercises for relieving the aggrieved condition of the patient. As mentioned by De Meester et al.(2013, p.1193), the resistance could be offered due to lack of sufficient knowledge in the support users regarding the effectiveness of the implemented strategies. Additionally, lack of cognitive judgment and undertaking in the patient attributed to dementia could also be mentioned as a limiting factor over here. Additionally, failure in confidentiality of vital patient records as per the Data Protection Act, 1998 can call for legal action.

The nurse needs to constantly recheck the measures to evaluate the effectivity of the implemented goals. In the context of Julie, the nurse would conduct the RLT evaluation daily and compare the data over a week to analyse the improvement in the health of the patient. The evaluation becomes the last part of the ASPIRE framework after assessment, systematic diagnosis, planning and implementation. It is the final stage of the entire process where both the nurse and the patients could measure the success of the implementation of a plan. As commented by Dundar et al (2014, p.15), evaluation is the last and the most decisive stage of patient care.

Conclusion 

The assignment focuses on the importance of the implementation of a suitable framework for looking after admitted to the care concerns of the patient admitted to the hospital. In this context, the patient had been admitted to the hospital with issues related to urine incontinence. Additionally, the patient had been seen to possess co-morbid conditions such as dementia. Therefore, the presence of dementia made the process of assessment difficult for the nurse. In this respect, the RLT model had been used by the nurse in order to measure the improvement in health. The implementation of the model also helps the nurse in planning long term care goals. The assignment also focuses on the importance of the SBAR tool for designing of effective communication strategies for analysing the loopholes and the drawbacks suffered by the patient in the care and treatment. In this respect, a SMART tool had been designed in order to implement effective exercises and supportive framework for looking after the care needs as well as providing more autonomy to the support users.

References 

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