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Nursing Case Study

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Introduction

Nursing Case Study Introduction This reflective case study will provide a written account of the care delivered to a client by myself. Its aim is to enhance the reader's knowledge of the importance of the nursing process and allow discussion to take place at each stage. It will firstly give a pen picture of the chosen client while offering a rationale for the choice. The care delivered will then be analysed using the elements of the nursing process as a structure while identifying any ethical considerations. The case study will make theoretical observations when required. It is hoped that the interrelation of each stage of the process will be identified and by undertaking this study that knowledge, skills and future practice can be improved. Pen Picture Carol is a 63-year-old lady known to the mental health services. She is retired and lives on her own in a one bed roomed flat, on the outskirts of a large city. She has a quiet disposition, and isolates herself socially. She has few friends and spends the majority of her time socializing with her daughter. Carol has suffered from mild depression since 1980 following the death of her mother. Her mother was diagnosed with cancer after admission for a hip replacement. In 1996 carols depression deepened, following her own admission for a hip replacement. At this time she had her first contact with the current mental health services. New symptoms such as a ringing in her head and anxiety and agitation were identified. She spent a four-month period on the acute ward, attempting suicide three times. Her reasons for this involved a primary goal of escaping the unbearable noises and voices in her head, which made her increasingly anxious and agitated. Treatments at this time included a course of ECT in combination with anti-depressants, with, Lorazepam 0.5mgs, qds available as PRN (as required) for agitation and anxiety. More recently she has had four separate admissions usually lasting about 3-4 months presenting each time with similar symptoms. ...read more.

Middle

It allowed progress to be at a faster pace in visually constructing what are the areas of most need. The depression was being controlled through an anti-depressant regime and the noises and voices were being treated with anti-psychotic medication. The assessment indicated several strengths and needs to assist clarification they will be listed below. To help clarify the main strengths and needs from the assessment I will list them below. 1. Anxiety (Moderate-Severe with Panic at times). 2. Relationship issues, regarding ability to form them. 3. Physical responses to anxiety, including blurred vision, dizziness, restlessness, abdominal discomfort, sleep disturbance and general aches and pains. It was decided collaboratively with nurse-patient and members of the multi disciplinary team (MDT) that the decision to focus on anxiety was an appropriate one. As the Nursing Assessment had indicated that anxiety was a key factor in carols current condition. This will be the focus of discussion when considering the planning of care. Planning Beck et al (1993) see care planning as a definite guide to nurse-client interactions. Dyer et al (1995) view it as a written plan of action designed to help deliver quality patient care. It is a natural progression from assessment and analysis yet its effectiveness relies heavily on the accuracy of the preceding assessments. Dyer et al (1995) suggest that its benefit includes continuity of care and communication between members of the team and the patient knows what current thinking is. Sentiments shared by Ritter (1989). As explained above the emphasis was on the symptoms of anxiety. Following the identification of a need or a problem, thoughts turned to a solution. As mentioned the planning/prioritising of care must be a collaborative decision. Within MDT meetings attended by the consultant, SHO, primary nurse, Carols CPN and myself. The directions of provisions were agreed. The way to use the provisions was a decision for the nursing team involved in Carols care. ...read more.

Conclusion

Dismissive attitudes toward carols complaint could be seen throughout the nursing team. A factor identified by O'Toole (1995) as being prevalent in these cases. Throughout nursing literature collaboration is named as a key factor in the accuracy of evaluation (Ward 1985, Ritter 1989, and Beck et al 1993). This aids the in the teaching and learning process within nursing care, allowing growth to occur in the individual as well as in the nurses own capacity to deliver effective care. Therefore both carol and myself evaluated the whole process, helpful in allowing a more critical appraisal of the intervention to take place, as it could be argued that my ability to criticise my own actions could be biased. This also created the perfect opportunity for collaborative re-assessment to take place. Conclusion The study allows the reader to observe the theoretical aspects of the nursing process and the practical implications of it. It shows that there is a need to assess the whole person in order to gain an understanding of their perceptual world. Family involvement was shown to be important as well as collaboration with the client and between all agencies and members of the MDT. It illustrates the need for student nurses and qualified staff alike to gain knowledge of effective tools that can be helpful in assessment and diagnosis. E.g. HIS and Beck's inventory tools. It moves on to suggest that a plan of care is dependent on the accuracy of the assessment. The more accurate the assessment, the more effective the plan of care is. It emphasises the need for ethical awareness. Allowing the nurse to predict problems. Interventions with anxiety related disorders vary but all seem to have elements of cognitive and behavioural theory within them. The self-help pack can be useful in respecting autonomy but the choice must be appropriate for client needs. Finally evaluation is seen as having four components. The care delivered must be assessed for adequacy, appropriateness, effectiveness and efficiency. Helping in the teaching and learning aspects of nurse-client relationships. ?? ?? ?? ?? 1 ...read more.

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