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Introduction - Nursing Care Plan for a Haemophilia Patient
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The study aims to present a supporting care plan with rationale of a haemophilia patient with joint bleed. It constitutes a critical analysis of the patient and my direct contribution that have been identified over the observation period. The study discusses the Roper.Logan Tierncy model and demonstrate how it is different from the Vergina Henderson model. Moreover, the study give its critical insights on the API model.
The patient jack (pseudo name) was 12 year old, was admitted into the hospital due to having complain of pain and swelling in joints. The boy was having severe fever for around 14 days. Patient’s name was changed to maintain patient’s identity and confidentiality.
Evolution of (priority 1 & priority 2)
The swelling started from his left elbow which all of a sudden started and was dull and aching in nature. On moments that occur in a sudden range, the swelling and pain exacerbated. After, 7 days a similar swelling and pain started in his right elbow joint which was followed by left knee joint and right shoulder. The patient showed no any trauma to his joints. The patient experienced high grade fever with intermittency, frequently happening 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 felled relieved. The boy had a history of non-traumatic incidents of skin brushing and epistaxis since his birth. The patient’s past history demonstrated difficulty in blood clotting post circumcision, which required medical attention.
The patient history demonstrated his vaccinations were up to date according to EPI. Since, the patient was a result of consanguineous marriage where his younger brother, a 7 years old male demonstrated similar traits to the patient.
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.
Range of Movement
Swelling and Tenderness
A large swelling area (10*10 cm) spread from mid to fore arm. On palpation it felt tender and warm.
Flexion limited to 450 and extension up to 1500.
Limited swelling (5*5 cm) upto joint. On palpation it felt tender and warm.
Limited abduction up to 900
No tenderness and swelling
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. 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 the nursing theories serve primarily in improving the overall nursing practice to put a positive influence on the patient’s health and improvisation of the quality of life. The nursing theories are ought to define the patient care and to guide the nursing practice and to provide a foundation that lay the basis of clinical decision making.
Critically looking at nursing models
A critical analysis of the nursing models demonstrate 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 was ought to be used extensively for the proper guidance of nurses in nursing. Nursing models are basically prototype models that are used in every scientific discipline before the launch of any new technology. Similarly, in nursing models serve as primary models were developed to provide guidance for 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 were to provide a shared goal among the theorists and perform various researches to test their theories and models. Moreover, nursing models synchronously describe and analyse the core concepts of nursing which holds importance in nursing practice. Such a concept can be seen when the concept of care (Leininger, 1988) was critically analysed.
After in 1970’s, when nursing as a 4-stage model was introduced to assist in the delivery care. Since, the time these models were adopted for to be use broadly over masses, they were also criticised. The nursing models faced criticism because of the complex terminologies and jargon (lumen, 2021). The criticism of the nursing models holds an equal importance as development of these models since it did not only helped in simplification of these models but also adaptation of these models in worldwide nursing practice. These criticism evacuated the voids in the nursing practice and thus enhanced the overall nursing practice.
Why nursing theory is preferred
Nursing theory aims to determine, predict and explain the nursing phenomenon, 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 the 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 the practical nursing since, the theories are to be followed for enhancing knowledge and education for the nurses. Nursing theories guide a nurse about future course of action that is recommended for enhanced patient care.
In practice, nursing theories are preferred to evaluate the care provided, help in assessment, involvement and evaluation of care that is to be provided by the nurses. Nursing theories helps nurses to predict, report and explain their experiences. Nursing theory in practices helps nurses to accumulate data, and a patient’s health status. These data is further utilized in the decision making and implementation. Most importantly, the nursing theories defines the anatomy of nursing as a separate discipline with its 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-Tierncy model also abbreviated as ADLs or often ALs served the purpose of assessing the patient care. The model became widespread in the United Kingdom specifically in the public sector. The model is diiferent from a checklist where assessment of the patient care on various basis are done. The Roper-Logan-Tierncy model is used for purposes such as assessing the patient’s illness, level of injury and changes that had happen to his life due to illness. Nevertheless, the model supported the nusing 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 lead to easier interventions which helps supporting the patient’s independence.
The model helps nurses to 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 their role in providing maximum independence for the patient (ecpiuniversity, 2021).
Roper model should be considered a cognitive approach for the assessment of patient care where it does mean to be entirely different from a checklist where a nurse access and intervene the necessary care for patient’s complete independence. It should not be considered as a checklist (Petiprin, 2020).
Vergina Henderson model
Vergina Henderson model was derived by Virginia Henderson from her experience and education. She aimed at providing a unique set to focus in nursing practice that evolved as a theory. The Vergina Henderson model emphases on increasing patient’s independence for enhanced progress after a patient is brought to the hospital. The model was centralized along basic human needs as its main focus. In 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 for day and night.
- A nurse should possess both science and arts knowledge.
As indicated by Henderson, people have fundamental requirements that are segments of wellbeing. They may expect help to accomplish wellbeing and autonomy, or help to accomplish a quiet demise. For the individual, brain and body are indivisible and interrelated, and the individual considers the organic, mental, sociological, and profound parts. This hypothesis presents the patient as an amount of 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 for living. Every single outside condition and impacts that influence life and improvement. The climate likewise remembers people for 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-Tierncy, the activities of daily living model consists of the below listed activities:-
- Maintaining a safe environment
- Eating and drinking
- Washing and dressing
- Controlling temperature
- Working and playing
The activities of daily living model also includes sexuality and death which are activities in daily living but these two are often discarded.
As per the model, there are five factors that impact the exercises 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 with respect to 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 discussing explicit parts, they expect the patients are, as well. This prompts the clinical overseers attributing the shortfall of assessment to the patient's tendency, when as a general rule, the patient's tendencies were not tended to (Petiprin, 2020).
In 1958, Ida Jean Orlando started the nursing process that really oversees nursing care today. Described as a systematic method to manage care using the urgent principles of fundamental thinking, client centered approaches to manage treatment, target organized tasks, evidence based practice (EDP) ideas, and nursing intuition. Sweeping and consistent estimates are joined to give the reason to tolerant, quality-based vehicle.
The nursing as a process is having similar functions which serve as a systematic guide to care focused on patient with 5 sequential steps. These 5 sequential steps correspond to assessment, diagnosing, planning, implementation and evaluation.
Assessment is the very first step that incorporates the data collection together with its critical analysis. The data collected is both objective and subjective in nature. The subjective collection of information involves the records of verbal statement given by the patient or the care assistant. However, the objective collection of information tends to contain the tangible records which are measurable such as patient’s intake, output, vital signs, weight and height. These information may be collected form the patient directly or by his family members, friends or the primary care providers. For assessment critical analysing skills are vital hence, concept based course cannot be fit and need to change.
Implication of care support with literature critically analyse
Implication of care support is the progression which includes activity or doing and the real completing of nursing mediations illustrated in the arrangement of care. This stage requires nursing mediations, for example, applying a heart screen or oxygen, immediate or circuitous consideration, medicine organization, standard treatment conventions and EDP norms (Contributor and Contributor, 2021).
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 condition. The arrangement of care might be adjusted dependent on new evaluation information (Wayne, 2021).
SBAR is the accurate way to communicate medical information for prevention of dangerous errors. SBAR is abbreviation used for situation, background, assessment and recommendations. SBAR was first endorsed by the joint commission for exchange of complete messages between a nurse and a doctor regarding the patent’s condition. SBAR could be written or could be given in oral. SBAR could be explained as follows:
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 a nurse identification, the unit identification and patient’s identification.
This consists of a concise overview about 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.
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.
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 wellbeing 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 wellbeing (Toney-Butler and Thayer, 2021).
This report focuses on my assessment of the haemophilia patient with 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.
Two nursing priorities
Pain is often dreaded yet general inside. Early pain hypotheses zeroed in on finding neurological torment filaments. Nonetheless, when careful mediations neglected to control the agony, different clarifications are to be looked for. The transaction among training and examination has progressed our arrangement and the board of torment. Current agony speculations clarify torment as a physical, mental and social experience. Nursing intercessions that are multidimensional will have a superior possibility at improving a patient's torment.
Mobility is required particularly if an individual is to keep up autonomous living. Restricted development influences the presentation of most ADLs. The human body is intended for movement; henceforth, any limitation of development will negatively affect each major anatomic framework subsequently bringing about debilitated actual versatility.
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.
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].
Torment deteriorating with grasping exercises restricted to average part of elbow (prevailing arm in 75% of cases) is because of average epicondylitis, otherwise called 'golf player's elbow'.
History of rehashed pressure and injury ought to be investigated.
Elbow solidness is related with joint pain or injury. Solidness limiting flexion is really impairing then limitation of expansion
Neurological side effects like deadness and shivering ought to be evaluated. Ulnar nerve radiculopathy is regular in average epicondylitis, osteoarthritis (half of patients), and provocative joint inflammation
When feeling for the joint, attempt to evoke the mark of delicacy, feel for any dubious mass and note any adjustments in temperature or surface.
Delicacy anteriorly in risk cubital fossa can be because of biceps tendonitis. Delicacy to palpation only foremost to average epicondyle implies average epicondylitis. Ulnar nerve delicacy (Tinel's sign) can be evoked only back to average epicondyle, showing ulnar neuropathy.
Blood tests (full blood tally, erythrocyte sedimentation rate, rheumatoid factor, and autoantibodies) ought to be done if fiery joint pain is suspected. Plain radiographs are generally typical in tendinopathies and are not indicated.
Ultrasound filtering (USS) requires an accomplished administrator and has variable affectability and specificity.1 Magnetic reverberation imaging (MRI) is best used to analyze tendon wounds; USS and MRI are valuable in optional consideration settings
Direct delicacy front toward parallel epicondyle is indicative of sidelong epicondylitis.
Alluded torment from neck or shoulder can present as elbow torment. Evaluation of cervical spine is especially significant in presumed rheumatoid joint pain
Likewise feel for any snap or crepitus in these regions to avoid spiral head break, joint pain, or free body.
Delicacy restricted to territory distal to outspread head is demonstrative of back interosseous nerve (PIN) pressure, a differential finding of parallel elbow torment (concurrent with horizontal epicondylitis in 5% of cases).1 Posteriorly, pathology in rear arm muscles muscle, olecranon interaction, and its bursa can offer ascent to delicacy.
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