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Managing Care.

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South Bank University Diploma in Higher Education 0500 (Adult) Student Number: 9905890 Managing Care. Unit 7a. Unit Co-ordinator: Allan Gopal Personal Tutor: Alma Ramnauth Word Count: 2,133 ( Unit 7a ( Managing Care. CONTENTS TITLE PAGE 2 CONTENTS 3 ASSIGNMENT ESSAY 4 APPENDIX ONE 13 APPENDIX TWO 14 APPENDIX THREE 15 APPENDIX FOUR 16 REFERENCE 17 BIBLIOGRAPHY 20 DECLARATION OF AUTHENTICITY 22 Word count (excluding references, appendices and charts) 2,133 In this assignment I will look at the role of the nurse in managing the care of stroke patients in the rehabilitation setting. By looking at the needs of dysphasic stroke patients of both sexes with ages ranging between 55 to 82years old on a 19 bed Stroke Unit I will demonstrate how their specific needs are being met by current nursing practice and how local and national policies are being implemented to improve stroke care nationally. Many studies have looked at the role of the nurse; some from a management perspective and others focusing on rehabilitation, the findings differ only in the way they are expressed. The Royal College of Nursing identifies eight categories, others have identified between four and fourteen key roles [see appendix one] {RCN as cited in Edwards A. 2002:40}. All the studies recognise the roles as being inter-linked and all identify the following within the categories, co-ordination of care, educator, provider of clinical skills, emotional/psychological support and assessment/evaluation of needs. This assignment will focus on the nurse as the co-ordinator of care within the multidisciplinary team and as an educator of both patients and colleagues. The importance of these roles to nursing is highlighted in the National Clinical Guidelines (NCG) for Stroke {as cited in Irwin P. 2000:28}. Stroke is an umbrella term for a range of conditions principally of the blood vessels that cause, "an insult to the central nervous system"{Kelley R. as cited in Weiner W. ...read more.


Salvage J. 1990:47}. The NMC and DoH papers OHN and Making a Difference restate this and require all nurses to be active in health promotion {NMC 2002:1.2,2.4, DoH 1999a:11.25, DoH 1999b:10.6}. Health promotion is multidimensional, and nurses must participate in all areas, in primary care to prevent disease and ill health, in education to empower people and with legislation to protect communities [see Appendix Three]{Tannahill as cited in Pike S, Forester D. 1995: 40}. Education is always included in the role of the nurse; either as a heading other integrated it into other roles [see Appendix One]. Peplau considers education under two roles first the nurse as "resource person" able to answer patients direct questions and provide information. Then also as a "teacher" creating the learning environment and individual teaching programme by establishing what the patient needs to learn and how much they already know {as cited in Simpson H. 1991:23}. The goal of health education is to promote independence by encouraging the patients to take responsibility for their own health. Following a stroke patients can feel helpless and that they have no control over their lives, providing health information and promoting healthier lifestyles empowers patients "...to increase control over and to improve their health" {Miller L. 2002:46, Davis S. O'Connor S. 1999:208, WHO1984 as cited in Able-Smith B. 1994:42}. Studies have shown that when patients understand their condition and treatment they are more satisfied with their care, more compliant with treatment and they experience lower levels of depression and anxiety {Reynolds M.1978. Ley P.1988, Morrison V. et al.1998 as cited in Barton J. 2002:34}. Health education is very effective at preventing further strokes {IWPS as cited in Irwin P. 2000:30}. The management of hypertension is one of the health education priorities in of stroke patients, as around 50% of patients will have been diagnosed with hypertension prior to their first stroke {Warlow C. ...read more.


The Teaching-Coaching Function 3. The Diagnostic & patient-Monitoring Function 4. Effective Management of Rapidly Changing Situations 5. Administering & Monitoring Therapeutic Interventions & Regimens 6. Monitoring & Ensuring the Quality of Health Care Practices 7. Organizational & Work-Role Competencies The Roper Logan and Tierney 12 Activities of Living. 1. 1. Maintaining a safe environment 2. Communicating 3. Breathing 4. Eating and drinking 5. Eliminating 6. Personal cleansing and dressing 7. Controlling body temperature 8. Mobilising 9. Working and playing 10. Expressing sexuality 11. Sleeping 12. Dying Lifespan, Dependence - Independence, Factors Biological Psychological Sociocultural Environmental Politicoeconomic Roper N. Logan W. Tierney A. 1985 Health Promotion Tannahill's overlapping spheres illustrate the multidimensions of health promotion. The prevention sphere attempts to protect good health by screening for, immunising against and providing help for known health risks. The education sphere focuses on empowering communities and individuals to take control of there own health needs. The health protection sphere concentrates on legal and financial aspects to shape the environment in which communities live {as cited in Pike S, Forester D. 1995: 40}. [Source: Downie et al cited in Naidoo J, Wills J. 2000: 107] [source: Ewles L, Simnett I. 1999: 264] The process can be though of as a 'revolving door'; patient's will only enter when they know were it leads. Once in, it may take several turns to negotiate the exit successfully. Pre-contemplation: Smoking, poor diet, obesity, stress, and lack of exercise. Contemplation: made aware of the risks they have entered the 'door'; they may still choose to ignore or reject the risks. Commitment: when they have accepted the risks and the need to change they progress, Action: active changes in behaviour and attitudes. Maintenance: peers may support or sabotage the new behaviour, at this stage there are two outcomes exit or relapse, Exit: if the individual is encouraged to maintain the new safer lifestyle they exit the cycle. Relapse: this may occur for a variety of reasons, social pressure, emotional state or lack of access to services; the 'door' continues round and hopefully by the next turn they will be able to exit. ...read more.

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