This of patient with confidentiality by ensuring all

This essay will firstly explain about what person centred care is
about. Then, it will focus on a scenario of a fictitious patient named Mr.
Vipul Patel and it will mainly talk about his care plan.

Person centred care was firstly introduced by psychologist Carl
Rogers (1951) in relation to humanistic psychotherapy (The Health Foundation,
2014). “Person-centeredness is an approach to practice established through the
formation and fostering of healthful relationships between all care providers,
service users and others significant to them in their lives. It is underpinned
by values of respect for persons (personhood), individual right to self-determination,
mutual respect and understanding. It is enabled by cultures of empowerment that
foster continuous approaches to practice development” (McCance T and McCormack B,
2011). Health Innovation Network South London explains that person centred care
considers health and social care service users as equal partners of the
professionals in terms of planning, observing and developing the care in order
to ensure it meets according to their needs. Therefore, person centred care is
actually about seeing people as an individual and tackling the problem together
to develop a solution rather than just doing things for them (Health Innovation
Network South London).

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Mental Capacity Act (MCA), 2017 explains that we can ensure our
care plan of being person centred by involving opinions, knowledge and ideas in
the care plan of people using the service or their carers can give a better view
on how to best achieve their required needs for care and support. Meaningful
involvement of service users in their care plan means:

Ø  Having a conversation
between two parties where power is equally shared and one party helping the
other to make a decision about their care.

Ø  The plan should only be
shared or implemented by others with the consent of the person.

Ø  The person should have the
full control on how they would prefer the care and support to be provided
(Mental Capacity Act, 2017)

It is also important for professionals to handle the care plan of
patient with confidentiality by ensuring all records are kept safely and
securely. Professionals should make sure that they share patient’s reports with
others with only the consent of patient (Nursing and Midwifery Council).

Nursing process:

Historically, there was only medical model used in the healthcare
system where typically doctors used to diagnose the patient and the care was
delivered according to patient’s physical symptoms only. This model clearly
ignored the holistic care and needs of a patient such as emotional and mental
concerns, their family, their lifestyle and physical and practical concerns.
Therefore, in order to provide more of a problem solving focus to patient care
‘nursing process’ was developed in 1967 (Stonehouse D, 2017). “Nursing process
promotes health, prevention of illnesses, safe environment, advocacy and care
of disabled and dying people”, (Bartz CC, 2010). Nursing process consists of
five stages- assessment, nursing diagnosis, planning, implementation and
evaluation; these stages helps to ensure that quality care is delivered to
patient in a holistic way (Stonehouse D, 2017). 

Assessment:

Assessment is the initial step of the
nursing process. At this stage, the nurse gathers patient’s information on
their psychological, physiological, sociological and spiritual status.
This information’s0 can be gathered through different ways such as- nurses can
carry out nursing interview or physical examinations, they can also obtain patient’s
past medical history or family history and observation can also be used to
assess a patient, for example: by observing patient interaction (Yildirim B and Özkahraman S, 2011) In Vipul’s scenario, the first
assessment that will be used is mini (initial assessment). This is a quick snapshot
assessment of the patient where their ABC (airway, breathing and circulation),
mental status, appearance, level of consciousness and vital signs are assessed
according to the National Early Warning Score (NEWS).

Linking this to the scenario: nurses
must initially check Vipul’s airway if its clear or not, see for any airway
obstruction and assess for any bleeding or vomit. Secondly, nurses need to
check if Vipul is breathing on room air or administered under oxygen. Nurses
must observe and count Vipul’s respiratory rate and listen if the patient is
wheezing or grunting. Then, nurses must check for patient’s pulse and blood
pressure, observe the patient’s appearance if they are sweating excessively or
their lips have turned blue. Nurses must also look for any external or internal
bleeding (Watson D, 2006). During the assessment Vipul was suffering from
shortness of breath and this was found through his initial assessment where
Vipul’s saturation level and respiratory rate were low. Vipul also complained
about this matter during the nursing interview as he wanted to give the best
overview of his health problems to the professionals as he had the
understanding of providing a better overview of his health situation would
result in him getting the right care (McCance T and
McCormack B, 2011). Through the nursing interview, it was
also found out that Vipul eats only takeaway or ready meals mainly due to lack
of time as he often works late. Moreover, he does not exercise regularly.

 

Nursing Diagnosis:

Nursing diagnosis is about analysing
the data that have been obtained from the assessment and making conclusion and
assessing if they are any risks for safety or infection, any signs and symptoms
that needs immediate evaluation by more specialist professional, actual and
potential health problems (McCance T and
McCormack B, 2011). Problem= Obesity   

Cause= Eating Takeaway and no
exercise                   
                       

Evidence= BMI and Breathlessness

 

In Vipul’s case, he’s diagnosed with
obesity by the professionals. This diagnosis is based from the assessment which
was carried out in the first phase. One of the guideline of NHS UK showed the
symptoms of obesity was shortness of breath. According to Schwartzstei R, 2016 obesity
can cause shortness of breath as excess amount of fats around the belly area
might result in difficulty in breathing as it makes it harder to push on the
diaphragm and chest wall, resulting in difficulty for the lungs to be filled
with air. It was recorded in the assessment that Vipul suffered from shortness
of breath on exertion and he was also suffering from shortness of breath prior
to his collapse. In addition, during the assessment it was also recorded that
Vipul had BMI of 43.1 which clearly classes him as an obese according to NHS as
he mostly depends on takeaway or ready meal and he hardly exercises as he
doesn’t has enough time to do so.

 

 Plan

A plan was created to help Vipul with
his health problems caused by obesity. The SMART target that was set for Vipul
was to lose his weight by 93 kg in next 12 months. So, he will have to lose at
least 3 kg in a month in next 12 months in order to achieve this target. Vipul
can achieve this target ultimately by starting to pre-prepare his meals on his off
day which could last him for few days in a week for next 12 months and he can
review this target in every 2 months. Firstly, this target is specific as it
solely focuses on Vipul’s diet and this way he can at least consume healthy
home cooked food every day. Secondly, it is measurable as Vipul will be
reviewing his weight in every 2 months to check if he’s actually losing weight
by 3 kg every month or not. This target is also attainable and realistic as the
time period to achieve this goal is in 12 months’ time so every month Mr. Patel
should be losing 3 kg and the fact that the time period to achieve this goal is
time consuming as Vipul is losing his weight healthily by only eating more
home-cooked food.

 

Implementation:

 

Vipul can implement his intervention
effectively by visiting his local GP every 2 months to review his case, if he’s
losing his weight or not as planned. In case, if Vipul has not been meeting his
goal effectively then, perhaps the GP can help him to tackle his problem as to
why Vipul is not meeting his SMART goal. Furthermore, Vipul could also meet
with dietitians who could help him with advises on healthy foods which are low
in fats. Vipul can also weigh himself regularly so that he will be aware if
he’s on the right track in achieving his goal. If Vipul has been losing his
weight more significantly then, perhaps he’s GP could introduce him ideas of
working out which can help him to achieve his goal quicker.

 

Evaluation:

 

The target goal that was set for Vipul
was met as Mr. Patel managed to lose his weight by 42 kg in 12 months’ time and
has been classed as overweight from being obese previously. Although, Mr. Patel
successfully achieved his target goal of losing weight however, maybe in the
planning section professionals could have also recommended him to
physiotherapist so that Vipul could have perhaps lost his weight sooner in
around 6-8 months’ time instead of 12 months.

Furthermore,
losing weight will also help the chances of Vipul suffering from another
potential heart attack in the future.

The second problem that Vipul faces is chest pain
which is due to myocardial infarction and this is evidenced by Vipul-himself
complaining about his chest pain.

 

Assessment:

 An
assessment was carried out for Vipul in order to gather information in relation to his chest pain problem. A nursing assessment was
carried out for Mr. Patel where he told the nurse about his chest pain and that
he smokes 30-40 cigarettes a day as now Vipul had the understanding of by
giving a good overview of his health to the professionals would benefit him to
get the right treatment. This is supported by McCance T
and McCormack B (2011) where it explains that building a
mutual trust and understanding between patient and professional relationship
will result in better engagement of patient in their own care. Furthermore,
Vipul also had physical assessment through where nurses became aware of his
hypotension due to administration of isosorbide mononitrate 30mg. This is
supported by Myers J and Gulanick M, (2011) where it states that pain causes
tachycardia and increased in BP however hypotension is seen if nitrate is
administered. Through looking at Vipul’s past medical notes, nurses were also
aware of his myocardial infarction and high blood cholesterol level.

 

Nursing Diagnosis:

From the knowledge of assessment, it
was found out that Vipul was experiencing severe chest pain due to myocardial
infarction. Health professionals used the myocardial infarction symptoms of
British Heart Foundation guideline to analyse Vipul’s symptoms. One of the
symptom from the guideline is chest pain and it was previously recorded in the
assessment that Vipul had severe chest pain prior to his collapse from
myocardial infarction whilst having dinner with family (British Heart Foundation).Another
symptom which was recorded in assessment was Vipul suffering from shortness of
breath and he had high blood cholesterol level.

  

Planning

After the nursing diagnosis phase, a plan was
created for Vipul’s chest pain. The plan for his chest pain was that his pain
scale needs to be less than 5 in 1-10 pain scale within 24 hours. Analgesia
should be administered depending on his level of pain. His chest pain and
response to medication should be continuously reassessed and if there is no
sign of relief even after taking optimal dose of medication then it should be
immediately reported to the physician (Myers J and Gulanick M, 2011).

 

Implementation

 

Vipul’s intervention can be effectively
implemented by firstly, explaining him the Numerical Pain Rating Scale which is
1-10, 10 being the worst pain ever and 1 being the least pain. Kitwood, 1997 states that
good communication is a key goal of person centred care thus, communicating
with Vipul effectively by asking about his pain scale every 2 hourly for next
24 hours to record his accurate pain scale will help nurses to closely observe
his chest pain. In addition, to closely monitor his chest pain nurses could
monitor his heart rhythm through ECG immediately during pain for next 24 hours
to compare it with his previous ECG report upon admission so that, if Vipul’s
current ECG result showed high risk of getting another myocardial infarction
then, nurses could send him for emergency coronary artery bypass graft.
Furthermore, it is also important to ensure 5R’s are carefully followed by
nurses in order to avoid any drug errors whilst administering analgesia for
Vipul. The five rights ensures that the drug is given to the right patient, the
right drug is being given at the right time prescribed, the right dose ensures
that the correct amount of drug is given to patient and the right route ensures
that the drug is given to the patient through correct route (Olin J, 2012).

 

Evaluation:

The goal was achieved at the end as
Vipul scored his pain level as 4 from the scale of 1-10 within the 24 hours of
time.

 

3rd PROBLEM= VIPUL IS
SCARED AND SUBDUED

Assessment

 A comprehensive (full) assessment
was undertaken for Vipul. This assessment focuses on depth regarding patient’s
physical examination, risk factors, psychological and social aspects of
patient’s health (Gladstone N, 2017). Through this assessment, the nurse
observed the physical appearance of Vipul and found that Vipul seemed very
subdued, scared and mentally stressed. After assessing the nature of Mr.
Patel’s fear, it was found out that he was worried and stressed over financial
issue because he was the main source of income of the family and he had to
support his wife and 11 year old daughter as he stated in the nursing
interview, “how will I provide my wife and daughter and who will pay the bills?”
(Gulanick M and Myers J, 2011).

 

 

Nursing Diagnosis

From the assessment, it is found that
Vipul suffers from mental stress, fear and depression due to his financial
issue. The NHS guideline on symptoms of depression was used to analyse Vipul’s
situation. Some of the symptoms in the guideline showed feeling of continuous
low mood, sadness, anxious and being worried. It was recorded in the assessment
that Vipul appeared to be in low-spirit, fear and anxious regularly due to his
family situation.

Actual: Vipul is depressed

Risk: He’s in risk of having panick
attack or mental breakdown which could potentially lead to suicidal thoughts.

Wellnesses: Family coping

Planning:

The
plan for Vipul’s psychological wellbeing is to help him express his fears by
careful, thoughtful questioning and active listening. Also by referring him to
a psychologist where he will be assessed every month on his wellbeing self-assessment
with a goal of scoring 40-59 points within 24 months. Also before his
dischargement from the hospital, a social-worker should be involved who could
possibly help him regarding his financial issue by helping his family to apply
for housing and benefits from the local council. Vipul and his wife should also
be referred to counselling sessions every month for 6 months where not only
Vipul but his wife could also discuss about their family worries so that they
can still be better parents for their daughter.

 

Implementation:

 The professionals can implement the
plan for Vipul by interacting with him calmly and expressing care and concern
whilst talking to him or questioning him about his fears. This is supported by
Gulanick M and Myers LJ pg971, where it states that when patients are sharing their
real feelings, they do not want false reassurances thus, it is important for
professionals to express care and concern. The goal for Vipul is to score 40-59
points within 24 months on his wellbeing self-assessment. To achieve this goal,
Vipul has to make sure that he visits his referred psychologist every month;
the professionals could also send a letter by post prior to Vipul’s appointment
with psychologist so that he wont forget about his scheduled test. Furthermore,
regarding his financial issue, the social worker must explain Vipul and his
wife about the housing benefits to provide them with reassurance.

 

Evaluation:

Vipul’s goal has been met as he managed
to score 50 in his wellbeing self-assessment. The appointment letters helped
him to not forget about his tests which was scheduled for every month. Through
the help from council, Vipul didn’t had to worry much about paying his rent as
the council helped him

 

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