The aim of this assignment is to create a care plan using the person-centred care (PCC) approach to assist, support and help reach the needs of a patient to have better caring outcome. Providing the needs and care of a patient is fundamental in PCC because it ensures the participation of the person in their healthcare, being in equal partnership with the health practitioners in making informed decisions of their care (RCN, 2019). The rationale for the chosen scenario is to know about how falls impact the quality of life and health in older people.
The quality of life as defined by the World Health Organisation (WHO, 2012), is an individual’s recognition of his or her living circumstance, understood in a cultural event, value system and in relation to the objectives, presumption and standards of a given society. In view of this, the quality of the patient in relation to health includes physical, psychological, personal relationships, level of independence, natural environment and not forgetting beliefs and social support.
To maintain confidentiality, a pseudonym is used in line with the Nursing and Midwifery Council (NMC) requirement Code of Conduct 5.5 (NMC,2015). Information about patient must be treated confidentially always and should only be used for the purpose for which they are given. Following the patient’s initial treatment, the assessment and care plan will involve himself (David), in collaboration with his wife Annie. This will contain the details of his individualised care plan using the Nursing Process frame work (A.P.I.E) with implementation to prevent complications, promote healing, recovery and adaptation in his home environment. The Roper, Logan and Tierney model of nursing (ADL) will be discussed and furthermore, goals that are SMART will be put in place. The assessment will also evaluate the care given to David and the tool used in assessing him will explored. All ethical and legal issues will be noted and demonstrate my ability and understanding of the Nursing care plan used in practice.David is a 70 years old retired labourer who lives with his wife Annie 65 years old and happens to be his carer. The scenario will identify three problems considered to be life threatening to David which are: David’s difficulty to mobilise which is evidence as his arthritis and pain are getting worse hence, using a stick to mobilise and having a wound, a large cut on his head and leg as he tried to go upstairs to bed. The second identified problem is his inability to cater for himself which is also evidence as self-neglect as his personal hygiene level has become poor and on the other hand becoming very forgetful. The third identified problem is because of his excessive drinking habit he suffers with frequent episode of gout. However, the chosen problem of focus to set up a care plan for David will be on falls prevention as he is using a stick as aid to help him mobilise around the house. An effective communication skill will be used to establish a therapeutic relationship to deliver a holistic care. Moreover, David and his wife will be empowered to make them feel they have the right of autonomy. According to Laschinger (2010), patient empowerment is to give patient the power of choice to make their own decisions over their lives. One of the safety risk of adult is falls. Falls can be defined as an unplanned event that causes a patient to lose balance and rest on the floor and can require the support of another. It is common and reoccurs often with elderly people because of their age, medical issues, frailty, and cognitive impairments. It happens in all age groups and usually instigated by various factors. As evidenced by the Centres for Disease Control and Prevention (CDC) about one in three adults who are over the age of 65 years’ experience a fall each year (Gulanick and Myers, 2013). . More so, according to the (CDC) the leading cause of death among the elderly is more than 15000 and more than 1.8 million emergency rooms were recorded in 2006. For hospitalisation over 43,300 were because for falls. The rate of falls among the elderly may cause destructive health issues ranging from mild to severe such as soft tissue, hip fracture or head injury which can lead to a prolonged hospitalisation (Gulanick and Myers, 2013). However, psychological pain can also be attributed to fall and for those that survive a fall their quality of life is seriously affected after a fall-related incident. A study by Tousignant et al. (2013) found that older adult who have fallen have 50% chance to fall in the future, hence, affecting their quality of life in the long run. When this situation happens, some older adult begins to compromise and withdraw from most of their social activities.There are three main types of fall which are accidental falls which involves slipping, tripping or when a patient has a mishap to fall generally caused by environmental factors such as having no grab bars in the interior of the home, slippery floor because of spillage and poor lighting, bed being so high and obstruction in walkways such as rough carpet edges. The second identified type is the anticipated physiological fall. This is when an adult is seen to be at risk of falls base on physical and physiological problems known as extrinsic and intrinsic factors. These risk factors are recognised through multifactorial fall risk assessment. To treat and remodel these risk factors the intervention of the multidisciplinary team will reduce the rate of fall. This type of falls amount to 78% of all fall and foreseeable factors include a previous fall, several diagnosis, impaired gait and lack of confidence of self-assessment on ability to go to the bathroom unaided (Quigley 2015).Lastly the third identified type of fall is the unanticipated physiological fall which occurs suddenly because of unidentified medical illness such as heart attacks, seizure and lack of vitamin D osteoporosis that could not be predicted but if it happens interventions are put in place to avoid any further injury. A care plan as defined by (Gulanick and Myers, 2013) is a written reflection of the nursing process between the healthcare professionals and the patient about their health conditions, the impact, how it is affecting their lives, and how they can be supported, as well as what should be put in place for interventions and implementation and not forgetting their desired outcome. To carry out this systematic approach as a healthcare professional, using all available resources as well as to distinguish and establish potential needs or existing issues by addressing the planning of individualised care and evaluating the effectiveness of the care is the fundamental root for excellence in nursing practice (Gulanick and Myers, 2013). Therefore, an accurate and a good plan of care is important as it empowers the healthcare professionals to make evidence-based decision on care from the assessment. As highlighted by (Barrett, Wilson and Woollands 2012a) inaccurate care plan can be a challenge when not done correctly. Therefore, every nurse has a professional responsibility to cater for their patient as an inaccurate input of data can be detrimental to a patient’s life and however, can also affect her colleagues in giving a continuous quality care.The nursing process which is a systemic process of providing an individualised care, which involves a sequence of activities in organising, recognising and managing the health issues of a patient. The process ensures the provision of high quality care by nurses using fundamental key of critical thinking skills, evidence-base practice, attainable goals and nursing intuition to give holistic care to their patient. However, the process enables nurses in planning and evaluating the care they provide in a scientific and orderly way (Kain, Marcantonio, & Iorio, 2014). In connection to David, it is evidence that the nursing process is based on the provision of care and regulate why and how this care should be given. The nursing process has been categorised into four stages which are assessment, planning, implementation and evaluation (A.P.I.E) based on the needs of the patient (Doenges and Morhouse, 2010).The first critical frame work of the nursing process is the assessment. The underlying aspect of the assessment is for the nurse to gather subjective and objective details of the patient using a holistic approach to help identify the problems (Barrett, Wilson and Woollands, 2012). As stated by Holland (2008) the assessment frame work helps to know the needs and preferences of the patient as it is an ongoing process. Therefore, as an assessment is extremely vital, it was necessary for us to establish a trusting and therapeutic communications with David and Annie to encourage great level of comfort to create an open-ended question to help gather information ( ). An assessment consists of subjective and objective information. Objective data is measurable and subjective is not as it is mostly the experiences acquired from the patient (Doughherty and Lister,2011). On visiting David and his wife Annie at their residence with my mentor to redress his wound and assess him of other support he might need, we introduced ourselves and David was informed of what was going to happen and verbal consent was gained prior to processing the nursing assessment (NMC, 2015). To have a good assessment carried out effectively and tailored to David’s needs we checked his notes and read his history of complaints and comments. David was asked if it was okay with Annie being there, and both agreed as she was his carer too. This was done to promote autonomy of the patient and avert deprivation of liberty conferring with NMC code (2015) and the trust policy. The nursing team communicated with both David and Annie using both verbal and non-verbal skills in a holistic way to help prioritise the needs and handle any immediate concerns effectively with adherence to the (NMC, 2015). It was routinely checked with David to ensure our interpretation of the data collected was accurate and nevertheless, some form of consideration was taken such as David’s physical state in relation to his stress levels, tiredness and hormones (Barette, Wilson, Woollands 2009). as he had a history of forgetfulness to help with various questions to enable me toThe objective data was gained by assessing David’s medical history, using a holistic approach which includes the collection of vital signs using the national early warning score (news score) to identify normal and abnormal life-threatening conditions to prioritize interventions and care. The subjective was known as he verbalised that, he was not happy with how he was treating his wife because of his alcohol problem and that he needed support although he has refused an assistance before. I was able to observe David by checking the colour of his skin, his eyes, his breathing pattern and document on the odour on him due to his personal hygiene issue. The Roper, Logan and Tierney model of nursing based on the activities of living was used to help gather any baseline information about him. The model emphasise that every individual carries out a daily activity that are fundamental to functioning normal and that the philosophy of care is placed on living and not illness. This model is built on the basic needs of a patient and therefore, can be used to measure an assessment ( ). As suggested by Barrett, Wilson and Woollands (2009) information regarding activities of living should focus within two areas: the usual and current routines of the patient as these will help in knowing about the habit of the patient when planning care and setting goals. However, on redressing David’s wound it was imperative to ensure there was no sign of infection, foul smell and the appropriate wound dressing being used to promote healing and all other activities in relation to his wound well documented in his file (NMC, 2009b). Although David has got a lot of on-going issues, the care plan is to prevent David from having another fall and to ensure his safety. David was assessed using the Morse Fall Scale (MFS) as it is reliable and a valid assessment tool. This assessment tool is used by majority of nurses and about 82.9% are in favour of it has it is easy to use and helps with falls prevention ( ). With David’s issues, this tool does focus on most of his problems regarding his mental status, history of falls, ambulatory aid, secondary diagnosis and gait. A score of 25 is indicated using this scale if a patient has a history of fall which happens to be the situation of David.15 measured as having more than one secondary diagnosis which is evident from his records and another 15 for any form of ambulatory aid which in David’s case mobilising with the aid of a stick. His mental state of forgetfulness is also scoring him 15 which in total adds up to 70. This tool helps with the identification of risk factors for falls in patient but however, to predict a future fall the sum of the total score may be used. If a patient is scoring over 50 on the fall scale they are at high risk of having other fall hence, planning, implementation and evaluation needed for the patient to resolve the problem which happens to be in the case of David.The second nursing process which is the planning is where David’s positive outcomes are formulated using the SMART goal. The SMART stands for specific, measurable, attainable, realistic and time frame. A short-term goal was set with David. As mentioned earlier, this will help with implementation and evaluate the care given ( ). The application was tailored to David’s needs to ensure safe mobilisation within his home environment with his ambulatory aid to prevent a fall for a period of four weeks exercising 20 minutes every day to support his balance and carry on with his daily activities.It is the responsibility of all healthcare providers to identify patient who are at risk of falls to prevent it and promote patient safety. Hence, the importance of implementation action needed to help with prevention. To help David achieve his plan of goal to mobilise effectively to prevent a future fall in his home environment, David will be equipped with the appropriate aid to promote visual and auditory orientation to the environment as an improper use of a stick can be harmful to him. Evidence however, suggest that people who are involved in regular exercise and perform other various activities helps strengthen their bones as patient with musculoskeletal problems are at increased to fall (Gulanick and Myers, 2013).Conversely, David will need a referral of the physiotherapist with his physical activities as mobility is the ability to move easily and freely in the environment which is a fundamental part of living, (Berman, et al., 2008). The purpose of the physiotherapist is to restore and help better the functional ability of David as he will use different techniques to reduce his pain, help manage his arthritis and avert having a disability. Collaborating with other healthcare team is necessary as it promote person-centred care. Consequently, another healthcare professional whose input is also vital in making sure David’s safety is ensured is the occupational therapist hence, another referral will be made by my mentor and me. The occupational therapist will help assist with issues that are of concerns to David about his activities of daily living. The purpose is to help David partake these activities by modifying the environment to support him. This will be carried out by checking out on any recognised hazard in his home environment that limit his ability to mobilise effectively, such as David wearing the appropriate non-skid footwear when ambulating at his home and helping him to familiarise himself to the layout of his room as well as his home environment and to check appropriate room lighting is put in place. Furthermore, the placement of any objects or equipment’s that limit or blocks a clear and straight path will be addressed. To help David in order not to experience another fall, we will educate him and his wife Annie about fall prevention such as the use of mobility assistive device. A reassessment on his other health issues will be carried out by the multidisciplinary team and any medication that he might be taking that could have contributed to his fall will be examined (…) and the multidisciplinary team needed for his care will be informed for him to be seen within his preferred time frame. Evaluation is an important part of care plan as it supports the approach of evidence ” base practise in delivering care (Moule et al 2017). Rcn. From the case study of David, my understanding of a care plan was achieved using both subjective and objection to collect data. In planning David’s care I have come to gain knowledge in knowing the importance of addressing the patient needs which are necessary as they are the experts who are at the centre of their care (Department of Health, 2012, NMC, 2008) and therefore knows what is best as great satisfaction is gained by them to assist in recovery to achieve a common goal (RCN, 2014). My communication skills were good as I used both verbal and non-verbal ways in delivery holistic care. It has also demonstrated the importance of the multidisciplinary team in collaborating with each other to the betterment of David in meeting his goals. The model of activities of daily living was implemented to help with needs. However, if David’s situation should change, and as suggested by the NICE (2014) guidelines a reassessment will be done to meet his needs. All documentations were recorded accurately in his file.In conclusion, the aim of the assignment was to create a care plan using the person-centred care approach to examine a case study. The rational of the case study was identified and although there were other enthralling issues concerned, I highlighted on the three problems that I did find alarming to the patient health. The nursing process framework was utilised which brought to light the importance of assessing a patient hence being able to diagnose, implement and evaluate the care given. Details of the chosen problem was explored as well as how it does affect other nursing issues. Short term goals were put in place to help with the effectiveness of intervention. All other healthcare professionals whose role were significant to the patient health was discussed. The (NMC) code of conduct was also implemented. In all, this assignment has enabled me to understand the importance of person-centred care which is understanding the concept of the individual.