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Interpersonal communication skills in nursing
Nursing case study, interpersonal skills
Person centred care concepts
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Introduction
The aim of this essay is to discuss Mary, a 75 year old retired teacher with a history of obesity and hypertension, who one month previously, suffered an Ischaemic stroke. In line with the Nursing and Midwifery Council (NMC) (2011) confidentiality guidelines, the identity of the service user has been kept anonymous by using the pseudonym ‘Mary’. In relation to Mary, the author will discuss the risk and resilience factors associated with stroke, the vulnerability impact of the disease, and the appropriate level of care which makes a difference to recovery.
The World Health Organisation (2013) explains that an Ischaemic stroke occurs as a result of a blood vessel becoming blocked by a clot, reducing the supply of oxygen to the brain and, therefore, damaging tissue. The rationale for selecting Mary for this discussion is; the author wishes to expand her evidenced based knowledge of stroke since it is the principal cause of disability and the third leading cause of mortality within the Scottish population (Scottish Intercollegiate Guidelines Network (SIGN), 2008) and, therefore, a national priority. In response to this priority, the Scottish Government (2009) produced their ‘Better Heart Disease and Stroke Care Action Plan’. Additionally, they have introduced a HEAT target to ensure 90% of stroke patients get transferred to a specialised stroke unit on the day of admission to hospital (Scottish Government, 2012).
Vulnerability, Risk and Resilience
Lloyd and Heller (2012) discuss how vulnerability relates to people, who for a period, may need help from health and social care services because they are unable to take care of themselves physically, mentally, and emotionally. Mary’s post stroke symptoms include right sided...
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...lnerable to further risks; however, a person’s resilience can affect how they cope with being put in a vulnerable position (Edward, 2013). Furthermore, the ability of the nurse to provide excellent person centred care, using suitable interpersonal skills while showing compassion, can have a major impact on recovery (Dewar, Pullin and Tocheris, 2011).
This module has enabled the author to understand the concept of vulnerability, risk and resilience in relation to stroke. Therefore, it will contribute to her professional development and lifelong learning (NES, 2012). Additionally, the author has gained evidence based knowledge of person-centred care, compassion and self-awareness; all of which can be used to inform future practice (Miller, 2008). Consequently, she will be able to provide the appropriate level of care that can make a difference to a person’s recovery.
Stroke survivors or anyone with chronic illness and health providers remain hopeful and “realistic” by counting on each other. The patients while being realistic about the outcome of their disease, stay hopeful that each of their health care providers will give them the appropriate care and will make sure that they can live with their disease in the best way possible.
Nobody is perfect. We all make mistakes. Some of the best lessons in life are learned from making a mistake. But in the healthcare world making mistakes means losing lives. This has started to happen so frequently there has been a term coined – Failure to Rescue or FTR. Failure to rescue is a situation in which a patient was starting to deteriorate and it wasn’t noticed or it wasn’t properly addressed and the patient dies. The idea is that doctors or nurses could’ve had the opportunity to save the life of the patient but because of a variety of reasons, didn’t. This paper discusses the concept of FTR, describes ways to prevent it from happening; especially in relation to strokes or cerebrovascular accidents, and discusses the nursing implications involved in all of these factors.
It is frequently expressed by stroke patients and caregivers that they have not been afforded the suitable information related to stroke, treatments, or post discharge management and recovery, and that the information conveyed is perceived as insufficient and complex. The problem is that there is a failure of healthcare professionals in identifying the learning needs of stroke patients associated with a deficiency in knowledge of just how to access and communicate this crucial information. Indeed, while patient education can be time consuming and nurses may not be properly trained in stroke education it is a nursing duty to provide these teachings to patients and caregivers prior to discharge. This paper will propose an educational plan intended to train, assist, and support nursing staff responsible for stroke patient education, in providing accurate, individualized, guideline based stroke education to patients and families prior to discharge. This plan
Cerebrovascular Accident a) Overview - definition and the effects of the stroke on the body A stroke is a serious, life-threatening medical condition that occurs when the blood supply to part of the brain is cut off. (http://www.nhs.uk/conditions/Stroke/Pages/Introduction.aspx) This condition is a common cause of death and disability, especially in older people. Some predisposing factors include: • hypertension • atheroma • cigarette smoking • diabetes mellitus It occurs when blood flow to the brain suddenly interrupted, causing hypoxia. The effects include paralysis of a limb or one side of the body and disturbances of speech and vision.
Life Support: Three Nurses on the Front Line, written by Suzanne Gordon, shows a considerable amount of points that are backed up with statistics and arguments about the deterioration in nursing care. Suzanne Gordon has been awarded for her outstanding journalist and author skills. Gordon broadly writes about health care in the medical field. Gordon goes through great measures to show how the health care system impacts each and every individual and their families and what they go through to do it. Gordon has many arguments throughout the book, but I will only analyze and evaluate three of the arguments made: medical profession neglecting the importance of physician-nurse relationships, the discipline between medicine and nurse, and the public and health policy issues.
Every person’s needs must be recognized, respected, and filled if he or she must attain wholeness. The environment must attuned to that wholeness for healing to occur. Healing must be total or holistic if health must be restored or maintained. And a nurse-patient relationship is the very foundation of nursing (Conway et al 2011; Johnson, 2011). The Theory recognizes a person’s needs above all. It sets up the conducive environment to healing. It addresses and works on the restoration and maintenance of total health rather than only specific parts or aspect of the patient’s body or personality. And these are possible only through a positive healing relationship between the patient and the nurse (Conway et al, Johnson).
Still, the previous advantages discussed should influence the nurse to improve in identifying patient vulnerability. This is evident by this patient where I utilized my interpersonal skills to communicate to this patient so that he/she is aware that he/she is not alone in this journey. Nurses need to utilize models and theories to guide nursing practice. For instance, McCormack’s framework focuses on patient-centered care which influences nurses to understand the patient as a whole and their values (Abley, 2012, p. 42). Being able to identify values will give nurses and myself a better comprehension about the patients resulting in worthiness and belonging expressed. As a result, informing nurses about patient’s subjective vulnerability because a trust and understanding relationship is established. This is supported in a clinical experience where a patient “felt understood and opened up for further interactions based on trust” through an honest, supportive relationship with a nurse (Gjengedal, 2013, p. 134). Nurses should provide patient-focused provision of service, and assist this patient in overcoming his/her obstacle as a way of encouragement. Furthermore, Sellman (2005) explains how encouragement may compromise human flourish (p. 7), it is dependent on the situation and it cannot be assumed all encouragement will lead to harm. This informs nurses to be aware of the consequences that prevent the
According to Kashyap, et al., (2014), resilience is a positive personal attribute buffers the impact of stress and helps maintain health. Research has identified personal characteristics of individuals that possess the capacity for resilience. During the hiring process, selecting candidates that possess the identified personal characteristics would increase the likelihood of successful acclamation to the ER environment. Resiliency characteristics include: creative thinking/or problem solving, decisive action, tenacity, interpersonal connectedness, honesty, self-control, and optimism (Tubbert, 2016). Resilience is the positive capacity of people to cope with stress (Kashyap et al., 2014). Resilient individuals have the ability to successfully cope during times of chronic stress (Kashyap, et al., 2014). Nursing in the ER is stressful, therefore teaching nurses how to manage the stress needs to be a priority for nursing administrations. The most important defense against stress is resilience (Kashyap, et al., 2014). Eliminating occupational stress from ER nursing is impossible, but resilience training can improve how nurses deal with the unavoidable stress. Resilience is an interaction between individual resources and current situational events (Goodman et al., 2017). Maintaining resilience requires diligence and continuous evaluation of the need for support. Resilience is not constant across time and context, rather it is dynamic in nature (Goodman et al., 2017). Resilience training will assist ER nurses in overcoming
It goes without saying that everyone’s health is important and should be taken care carefully. Everyone has heard of strokes before but many people do not really know its meaning, types, and the number of individuals of that dies due to this issue. According to Centers for Disease Control and Prevention (2015), strokes kills an average of 130,000 people a year and it is one of the most common deaths that happen in the United States. An average of 800,000 of people die from cardiovascular disease and strokes and it is also a reason of long-term disability (Centers of Disease Control and Prevention, 2015). Strokes, which can also be called cerebrovascular accident or CVA happen when the blood supply to the brain is interrupted or the blood vessel going towards the brain burst. Then part of the brain dies or become seriously injured because the brain cells do not receive oxygen and they eventually die. People’s lifestyle may also impact seriously on their health and increase the possibility of having a stroke. Some of the risk that can severely increase the cause of stroke would be high blood pressure, heart disease, diabetes, cigarette smoking, as well as strokes that
In less stressful environment, nurses able to incorporate caring relationship, improve interactions between patient and a nurse, and develop understanding of the other person’s perspective (Nicely, K, Sloane, D., Aiden, L., 2012).
“Vulnerability is at the core, the heart, the center, of meaningful human experiences” (Brown, 2014). Vulnerability can be regarded as a constant human experience that can be affected by physical, social and psychological dimensions (Scanlon & Lee, 2006; Malone, 2000) Deconstructing the concept of vulnerability and how it relates to client care is imperative for nurses due to their dynamic role in health care (Gjengedal et al.2013). In this paper I will provide a theoretical overview of the nursing concept vulnerability. I will explore how a thorough understanding of vulnerability informs the nursing concept of vulnerability and informs the nursing practice and the nursing profession. I will identify the gaps in the nursing
Stroke not only affect the life of the patient but also their significant others, especially the caregiver. Caregiver is identified as the “hidden patient” (Andolstek et al, 1988). Families maintain the primary care responsibility for elderly with chronic illness and disability (Montgomery et al, 1985). The effects of caregiving span across physical health (Grafstrom et al, 1992; Kiecolt-Glasier et al, 1991), mental well-being (Cochrane et al, 1997) and social life (Luterman, D. ,2008; Bakas et al, 2006).
Jean-Dominique Bauby revealed“…I would have to rely on myself if I wanted to prove that my IQ was still higher than a turnip” (Bauby 82). Bauby’s account has augmented my perception of those who endure and succumb to stroke. I now ascertain the struggles of trying to preserve independence and retain dignity whilst enduring the collapse of the body. Having a stroke can effect a person’s self-esteem, I could sense Bauby’s feelings of anger, apprehension, sadness, and fear in wavering points while reading. “My weekly bath plunges me into distress and happiness” (Bauby 17) demonstrates his frustration of having to be bedridden and reliant on caregivers. His memoir provided insight on how many patients with stroke cope with ambiguity, even Bauby
“Time is brain” is the repeated catch phrase when addressing the treatment and management of stroke (Saver, 2006). Access to prompt and appropriate medical care during the first few hours of stroke onset is critical to patient survival and outcomes. Recent changes in the guidelines for acute stroke care released by the American Heart Association (AHA) and the American Stroke Association (ASA) have improved patient access to treatment. Stroke treatment now follows the model of myocardial infarction treatment. Hospitals are categorized into four levels based on stroke treatment capability. The most specialized treatment is available in comprehensive stroke centers followed by primary stroke centers, acute stroke-ready hospitals, and community hospitals. The use of telemedicine now enables even community hospitals, with limited specialized capabilities, to care for stroke patients. Telemedicine puts emergency hospital personnel in contact with neurologists providing expertise in the evaluation of a stroke patient and determination of their eligibility for treatment with thrombolytic medication (Jefferey, 2013).
Stroke is a serious medical condition that affects people of all ages specifically older adults. People suffer from a stroke when there is decreased blood flow to the brain. Blood supply decreases due to a blockage or a rupture of a blood vessel which then leads to brain tissues dying. The two types of stroke are ischemic stroke and hemorrhagic stroke. An ischemic stroke is caused by a blood clot blocking the artery that brings oxygenated blood to the brain. On the other hand, a hemorrhagic stroke is when an artery in the brain leaks or ruptures (“About Stroke,” 2013). According to the Centers for Disease Control and Prevention (CDC), “Stroke is the fourth leading cause of death in the United States and is a major cause of adult disability” (“About Stroke,” 2013). Stroke causes a number of disabilities and also leads to decreased mobility in over half of the victims that are 65 and older. The CDC lists several risk factors of stroke such as heredity, age, gender and ethnicity as well as medical conditions such as high blood pressure, high cholesterol, diabetes and excessive weight gain that in...