Case Study 1 2018. PDF

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FINAL % 68. Therefore, the first step of the Clinical reasoning cycle is considering patients situation, this allows the Nurse to gain an initial impression and the individual's own historicity (Levett-Jones, 2013). From the scenario, Amalie’s is facing difficulties with mobility as she lives alone and due to rheumatoid arthritis, osteoarthritis and the recent development of Dry Macular Disease. Hunter (2012) states decrease in independence, causes a negative functional consequence as this affects individual’s quality of life, this step emphasizes the importance of identifying and respecting older adults functioning and wellbeing (Levett-Jones, 2013) The second clinical reasoning process is collecting cues and information by reviewing current information, this allows the nurse to decide on new data that needs to be collected and allows focused assessments & elicitation of patients concerns (Levett-Jones, 2013). The first step in collecting cues and information is reviewing (Levett-Jones, 2013), this can be done by the referral letter from Amalie's GP, as it states concerning symptoms such as occasional dizziness, swollen feet and enlarged joints, constipation, painful and stiffness in joint, medical history and medication currently prescribed. This information allows the nurse to critically evaluate gathering new information (Levett-Jones, 2013), that allows person-centered care (Hunter, 2012). To gather new information this can be done by a physical examination, which allows the nurse to take height, weight, temperature, pulse, respirations, blood pressure and a falls risk assessment should be utilized during this time due to dizziness, swollen feet, and stiffness in joints, this comprehensive assessment will allow the nurse to identify any pain that has not been confirmed associated with movement, therefore this will allow the process of a pain assessment (Stubbs, Binnekade, Eggermont, Sepehry, Patchay & Schofield, 2014), which can be done with the 11 point-pain intensity word scale or the Wong-Baker FACES Rating Scale, this allows the nurse to follow onto the effects on activities of daily living and documenting outcomes (Berman, Snyder, Levett-Jones, Dwyer, Hales, Harvey, Stanley, 2014) as Amalie house is unkempt with bare cupboards of baked beans and tins of soup, this allows the nurse to understand the effects of daily living uniquely towards Amalie scenario as this focuses directly on bathing, dressing, grooming, mouth care, toileting, walking, climbing stairs and eating (Berman et al., 2014).

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FINAL % 68. The third step is processing information (Levett-Jones, 2013), as Amalie has stated that she is very connected with the community and has realized she may need help to continue to feel this way, this allows the nurse to reflect on Amalie’s problems with mobility from Rheumatoid Arthritis and Osteoarthrosis, as this affects her ability to allow physical performance, decreasing a sense of autonomy through daily living reducing her social aspect within the community (Portegijs, Rantakokko, Mikkola, Viljanen, & Rantanen 2014). Amalie’s also facing difficulties with constipation, this can reflect on her nutritional values in her daily living which can be causing non-significant recent weight loss, pain or from a pharmacology side effect on medications currently prescribed (Pilgrim, Robinson, Sayer, & Roberts, 2015), this allows the nurse to recognize information and reflect on information that may not have been noticed during the collection of cues and information and allows a mini nutritional assessment to be conducted as psychosocial factors contribute to nutritional values especially in the elderly who live alone (Berman et al., 2014). The most prominent effect on Amalie's independence and mobility is the recent development of Dry Macular Degeneration as this is a chronic, progressive eye disorder that in turn causes mild loss of vision, this causes certain risk factors that affect mental health due to the loss of independence, as human beings central vision is used for particular activities such as reading, driving, socialization & facial recognition (Yuzawa, Fujita, Tanaka, & Wang, 2013). Hunter (2012) states that the functional consequence theory has a holistic approach that considers older adults as a complex and unique individual whose functioning may be influenced by many internal and external factors. External factors such as poor nutrition may be a contribution from the loss of a spouse or illness by reducing mobility internally as depression contributes to lowered effects of eating, which in turn causes other health complications such as iron deficiency’s or anemia which may result in constipation & pain, although, as human beings age, nutritional needs change due to many biological changes (Berman et al., 2014). Step four of the clinical reasoning cycle is uniquely based on identifying problems, this allows the nurse to make a definitive diagnosis of the patient’s problem (Levett-Jones, 2013). Using Millers Functional Consequence theory (Hunter, 2012) to 2

FINAL % 68. evaluate the three nursing care priorities and develop a nursing care plan was viewed broadly in the decision based by a definition stating that the elderly have to sustain a healthy living to function at their highest capacity despite age-related changes and certain risk factors, additionally this theory incorporates psychosocial and physiological functions including the embracement of well-being and quality of life, therefore, the three age-related changes that decreased Amalie's quality of life are, mobility, isolation & nutrition. Unfortunately, the most prominent age-related change negatively influencing Amalie's quality of life is mobility due to rheumatoid arthritis, osteoarthritis & dry macular disease. Osteoarthritis & Rheumatoid arthritis cause significate pain and initially decreases mobility in elderly adults (Brown, Edwards, Seaton & Buckley, 2015), additionally, Sengupta, Nguyen, Van Landingham, Solomon, Do, Ferrucci & Ramulu, (2015) state that individuals suffering from dry macular disease do not participate in social activities and may become isolated due to decrease in independently. The fifth and sixth step of that clinical reasoning cycle is establishing goals and taking action (Levett-Jones, 2013), considering Amalie's age and dependency the community nurse needs to conduct goal-orientated care planning, multidimensional assessment, multi-disciplinary involvement, evidence-based generic interventions & time-limited programs (Benevolent Society, 2018). These assessments briefly include the promotion of independence, physical and cognitive domains, social & emotional support, setting realistic goals, introducing skilled practitioners, and programs focusing on mobility, personal care, activities of daily living, falls preventions & medication management, these assessments uniquely allow Hunter (2012) positive functional consequence outcome. Taking into consideration Amalie’s dignity and following the SMART goal management this will allow the nurse and Amalie to create goals by being specific, measurable, achievable, realistic & timely (Levett-Jones, 2013). Specifically, Amalie has expressed concerns she may need help in order to stay connected to her community. The specific goal is to increase mobility & correct nutritional needs as Amalie health has deteriorated, forcing her to withdraw from daily activities, this allows a systemic approach and a long-term goal of genuine independence, this can

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FINAL % 68. be measurable by increasing physical activity as (Plasqui, 2008) states that the role of long-term physical activity can help manage pain from rheumatoid arthritis, this can be measured by a pain assessment following the PQRST method (Levett-Jones, 2013) and a mini nutritional assessment. This goal should be achievable within months and is attainable by recommending an occupational therapist, physiotherapist, and care giver. Realistically Amalie won’t recover full independence, although this implementation should increase social behavior and decrease isolation and allow a basic range of motion for daily activities. Additionally, to establish the correct goals towards Amalie situation an occupational therapist can be recommended as discussed above, this will help to maximize mobility with home care assessments, this allows the occupational therapist to utilize Amalie’s home comfort within the community to increase her quality of life and realistically achieve a level of independence (Di Stefano, Stuckey, & Lovell, 2012), by helping to re-learn alternative methods and allow implementation of environmental modifications (Ryburn, Wells, & Foreman, 2009). Furthermore, a physiotherapist can be recommended as this improves mobility an physical functioning in the elderly patients suffering from disability & mobility problems as they assist in home exercises with long term goals of restoring strength, coordination, balance and flexibility (De Vries, Van Ravensberg, Hobbelen, Rikkert, Staal, & Nijhuis-van der Sanden, 2012) moreover under Amalie's circumstances living alone, a caregiver will provide assistance with physical and personal care and assistance with transport (Australian Homecare, 2018). Understanding the fifth and sixth goal on the clinical reasoning cycle, the seventh goal is to evaluate the outcome of Amalie’s situation, this can be done by understanding the difference between objective and subjective data (Levett-Jones, 2013). Through subjective data this can be done by the community nursing advising Amalie the benefits on exercising to help reduce pain and enhance of quality of life by increasing socialization & range of movement with the occupational therapist, physiotherapist & increasing home care needs with the care giver (De Vries et al., 2012), this will allow Amalie to express subjective data such as pain and her individual feeling of wellbeing and eating regime over the goals planned to the community nurse and allow future reflection and intervention (Levett-Jones, 2013).

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FINAL % 68. Therefore, objective data that can be collected by the nurse over time can be by assessing range of movement, and assistance in daily living (Berman et al., 2014), this will allow the nurse to reflect on Millers Functional Consequence theory by understanding age-related physiological changes and pathological conditions that decrease an individual’s ability to function through daily activities that were once stress-free (Hunter, 2012). As a result, reflecting on this scenario, I now realize that many psychological and psychosocial conditions influence elderly adults through their daily living. I now have more knowledge on the pathological influences of dry macular disease, rheumatoid arthritis and osteoarthritis and how they can decrease individual’s ability to function when friends and family are unavailable to assist in daily living necessities and how the influence of pain can affect nutritional and emotional needs to individuals (Plasquj, 2008). Next time, I would have expressed more concern for medication management with individuals suffering mobility and gone more into dept with contacting Amalie’s family for opinions and their assistance. In conclusion, this essay expresses the excessive concern towards the education on the Clinical Reasoning Cycle and being able to reflect on Millers Function Consequence Theory, this allows the nurses to promote a individuals dignity and identify and prioritize nursing care issues and the ability to customize a shared outcome with the patient to form a positive functional consequence and the capability to search different avenues in the multi-dimensional healthcare industry to increase an individual’s quality of life.

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