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Professional Nursing Practice : Concepts And Perspectives

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Professional Nursing Practice : Concepts And Perspectives

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Professional Nursing Practice : Concepts And Perspectives

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Discuss about the Professional Nursing Practice for Concepts and Perspectives.

Nursing is a profession, where there professionals ate accountable for assessing, monitoring as well as evaluating the outcomes of the patient. Being a key member of multidisciplinary team, nurses need to identify the key health needs and treatment priority of the patient, on the basis of patient assessment (George, 2011). In this context, several theories and models has been developed, for guiding the nursing care process and identifying the key nursing care priorities. In this essay, the key focus is the 89 years old Australian immigrant patient Mrs. Barbara Green, who has recently diagnosed with some additional health and well being issues along with her past medical history. In this context, to identify the key nursing priorities through a systematic process, Levett-Jones’ clinical reasoning cycle has been used (Levett-Jones, 2013). In addition to this theoretical framework, Miller’s functional consequences theory has also been used to identify impact of Mrs. Green’s age upon her physical, mental, social and emotional health and wellbeing.
The patient Mrs. Green is an 89 years old German immigrant, who is living in Australia since last 40 years. She is a retired school teacher. She was married to Henry, who died 2 years ago. Her son Dominik lives in Germany and visit her regularly, whereas Tracy, her daughter also lives throughout Australia, visit her regularly. Mrs. Green can speak both English and German. She started to participate in local Catholic Church and organize fundraising activities. She is respectful to their catholic culture and unwilling to leave her home and return back to Germany.
Key age related changes observed in Mrs. Green is macular degeneration, for which she stopped driving, became unable to leave her house due to altered mobility. Isolation is another age related change; she lost physical contact with her friends and members of German Association. Other recently diagnosed age related changes diagnosed for Mrs. Green are constipation, weight loss, limited joint movement, occasional dizziness and painful joints. From her previous history, other age related deterioration of Mrs. Green’s health status has been identified, which were rheumatoid arthritis and osteoarthritis.
Risk factors identified for Mrs. Green include living alone in a single storey house, without any support. Another risk factor is gradual deterioration of her vision and mobility. Hyperthyroidism is another health risk associated with negative health consequences (Nieswiadomy, 2011). It has also revealed that her house is unusually unkempt and she has minimal amount of food. Therefore, risk for malnutrition, risk physical, chemical hazard as well as risk of fall has been identified. Isolation and reduced independence is increasing her risk of stress and depression.
Negative functional consequences include reduced vision, mobility and isolation, i.e. she is unable go out from her home and join her German association. In addition, due to impaired mobility and vision, she is being unable to perform ADLs (Hunter, 2016).  
Mrs. Green has recently been identified with several age related negative functional consequences, which are identified as the age related changes, according to Miller’s functional consequences theory. For instance, osteoarthritis, reduced vision, reduced mobility, reduced ability to drive and perform her ADLs. It has also been identified that she has a wide social network, but due to these changes in her functionality, she is unable keep her commitments, making her isolated (Blais, 2015). She lives alone, in an unsupported condition. She refused to live her house and live with her son or daughter. However, her reduced functionality is making her worried for her further life.
While processing the information gained from Mrs. Green’s case study, it has been revealed that her reduced mobility and reduced vision are two key negative consequences of her aging process. These problems are contributing to the development of her third key concern, i.e. social isolation. Recently she has been diagnosed with severe symptoms of rheumatoid arthritis, macular degeneration as well as hypothyroidism. For instance, limited joint movement, pain and stiffness are the consequences of progressive rheumatoid arthritis and osteoarthritis, whereas reduced vision is the consequence of dry macular degeneration; on the other hand, non-significant weight loss is the consequence of hypothyroidism as well as malnutrition (Nieswiadomy, 2011).
Analyzing the case of Mrs. Green, three key problems have been identified, based on which the nursing care priorities would be decided, goals will be established and care plan will be developed.  The first key issue for Mrs. Green is her reduced mobility and gradually reducing vision. These two problems are reducing her ability to perform ADLs, ability to be connected with the German association or drive. In addition, she is also suffering from several severe consequences of arthritis and macular degeneration. The next problem identified for Mrs. Green is her non-significant weight loss and malnutrition. It has been identified that she is not eating properly, losing her weight significantly, along with occasional dizziness and memory impairment (Chitty & Black, 2011). Thus, these problems are contributing significantly in her overall deterioration in health functioning. In addition, the third problem identified for Mrs. Green is her social isolation and loss of independence. From her case study, it has been revealed that she is highly connected with the social network, but due to her mobility and vision issues, she is no longer able to go out from her home and join her German association (Wold, 2013). It is making her isolated, socially excluded, which have a significant impact upon her mental health. In addition, she lives alone at her home. Thus, this problem should also be prioritized.
After identifying three key problems for Mrs. Green, it is important to set goals for each problem, as it helps to develop appropriate care plan for the improvement of her heath and well being. The following table represents the goals set for each heath problem of Mrs. Green.

Nursing care priority/ key problem


1. Reduced mobility and gradually reducing vision

1. To improve physical movement
2. To improve visual function
3. To reduce risk of fall
4. To improve her ability to perform ADLs

2. Non-significant weight loss and malnutrition

1. To encourage healthy eating
2. To facilitate weight gain

3. Social isolation and loss of independence

1. To improve her social engagement
2. Improve her self-esteem and autonomy          

According the above mentioned goals, the next table will demonstrate appropriate care plan for Mrs. Green’s health issue.

Nursing care priority/ key problem

Nursing intervention

1. Reduced mobility and gradually reducing vision

1. Physical exercise training- Mrs. Green can be referred to a physical therapist who can help her to guide through some joint movement exercise, for reducing joint stiffness, physiotherapy is also recommended for improving muscle flexibility and strength building. A physical exercise session including cardiovascular exercise would be helpful for muscle strengthening and improving her daily functioning (Reuben & Tinetti, 2012)
2. Assistive technology- An advanced technology cane or walker can be provided with object detector. Her driving vehicle can be modified along with an advance driving training to improve her driving mobility. Her kitchen and other parts of house can be modified with assistive technologies to improve her daily performance (Gillespie et al., 2012). For improved vision, along with glasses, screen readers, screen enlargement application are recommended
3. hazard analysis- Hazard analysis should be done for reducing the risk of fall

2. Non-significant weight loss and malnutrition

1. Diet plan- A dietician can be appointed, who will make a diet chart for her, including protein intake, for weight gain and reducing of risk associated with hypothyroidism and malnutrition.
2. Health promotion and regular check up- A health promotion is required for enhancing her awareness towards her health status and importance of healthy diet. In this session, she will also be discussed about her risk of living alone at her home (Hall et al., 2011). She would be advice to appoint a care attendant, who can assist her in her daily functions. In addition, she would be motivated for visit her GP regularly and check her vital signs including thyroid hormone level.

3. Social isolation and loss of independence

1. Use assistive technology to meet German society- With the use of cane, wheelchair or modified vehicle, Mrs. Green can attend her German association, which will improve her mental status. In addition, with video conference tool, she can also be connected with her German society. It would eliminate the feelings of being isolated (Fairhall et al., 2012).
2. Appointing a care attendant- A care attendant can be appointed, who will assist her to perform her daily functioning and improve her physical and mental health, by reducing isolation, enhancing independence and reducing the risk of fall through elimination of any kinds of hazardous substances (Cameron et al., 2013).
3. Palliative care- As she has been isolated and being stressed, social support and palliative care is needed for helping Mrs. Green to cope with her age related changes and consequences. In this context, her cultural aspects would ne prioritized, to make her feel valued (Levett-Jones, 2013).

Evaluating the entire procedure, i.e. identifying care priority, assessing and establishing goals for each priority and developing care plan, it has been revealed that each goals has critically linked with the care plans, aligning with three key nursing problems (Levett-Jones, 2013).
Integrating these interventions in the nursing care plan will help achieve goals successfully.
While dealing with Mrs. Green’s care planning, I have learned how to identify actual nursing are priorities and develop appropriate care plan for individual patient, with the help of step by step process of clinical reasoning cycle.
In addition, assessing the case study I have also revealed the importance of understanding and analyzing age related consequences, while dealing with an aged patient, with the help of Miller’s functional consequences theory.
In this essay, the key focus was to review the process of client focused care plan development through the step by step process of clinical reasoning cycle. The case study in this essay has focused upon 89 years old women Mrs. Green, who is subjected to several age related health issues. These health consequences have been analyzed with the help of Miller’s functional consequences theory. Then, with the help of Levett Jones’ clinical reasoning cycle, the care priority of the patient has been identified and then according to these priorities goals has been established, which in turn helped in generating appropriate care plan for Mrs. Green’s health and wellbeing.
Reference List
Blais, K. (2015). Professional nursing practice: Concepts and perspectives. Pearson.
Cameron, I. D., Fairhall, N., Langron, C., Lockwood, K., Monaghan, N., Aggar, C., … & Kurrle, S. E. (2013). A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial. BMC medicine, 11(1), 65.
Chitty, K. K., & Black, B. P. (2011). Professional nursing: concepts & challenges.
Fairhall, N., Sherrington, C., Kurrle, S. E., Lord, S. R., Lockwood, K., & Cameron, I. D. (2012). Effect of a multifactorial interdisciplinary intervention on mobility-related disability in frail older people: randomised controlled trial. BMC medicine, 10(1), 120.
George, J. B. (2011). Nursing Theories: The Base for Professional Nursing Practice, 6/e. Pearson Education India.
Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Sherrington, C., Gates, S., Clemson, L. M., & Lamb, S. E. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev, 9(11).
Hall, S., Kolliakou, A., Petkova, H., Froggatt, K., & Higginson, I. J. (2011). Interventions for improving palliative care for older people living in nursing care homes. The Cochrane Library.
Hunter, S. (Ed). (2016). Miller’s nursing for wellness in older adults (2 nd Australia and New Zealand ed.) North Ryde, NSW: Lippincott, Williams and Wilkins.
Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Frenchs Forest, NSW: Pearson.
Nieswiadomy, R. M. (2011). Foundations in nursing research. Pearson Higher Ed.
Reuben, D. B., & Tinetti, M. E. (2012). Goal-oriented patient care—an alternative health outcomes paradigm. New England Journal of Medicine, 366(9), 777-779.
Wold, G. H. (2013). Basic geriatric nursing. Elsevier Health Sciences.

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