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Question:

The aim of this assignment is for students to demonstrate an understanding of culturally safe health promotion strategies, including education strategies that address the needs of clients with chronic diseases that empowers them to self-manage their condition. The provision of education to enable people to make decisions and to take actions in relation to their health is part of the role of the Registered Nurse (Nursing & Midwifery Board of Australia, 2016). Additionally, culturally safe and respectful practice requires having knowledge of how a nurses own culture, values, attitudes assumptions and beliefs influence their interaction with people and families, the community and colleagues (Nursing & Midwifery Board of Australia, Code of Conduct 2018)

This assignment addresses the following course learning outcomes:

  • Apply health promotion and illness prevention practices in a culturally safe manner to support people diagnosed with chronic illness;
  • Analyse primary health care and health promotion strategies that address the needs of those with chronic diseases.
Answer:
Introduction

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes the obstructed the airflow from the lungs. Signs and symptoms may include breathing difficulty, coughing, mucus production and wheezing in patient (Ponikowski et al., 2016). This case study presents one such health condition of the patient, Mr Georgeo Polaris who is2 years of Italian man admitted to the hospital with shortness of breath and coughing. After admission to the ward for chest infection treatment, he went through a series of respiratory examinations and diagnosis report suggested that chronic obstructive pulmonary disease. Moreover, he had the history of gastro-oesophagal reflux disease. He was prescribed with intravenous antibiotics, type four therapy and bronchodilators for managing the situation. After admission to the hospital, his shortness of breath worsens, and he had lost several kilos. The purpose of the study is to manage the situation of the patient and provide care to the patient. Therefore, the paper will illustrate the potential health concerns for the client, two appropriate education topics for client education,  two strategies for educating clients to manage situation and reflection on how own cultural believes and values influence the interaction with the patient in following paragraphs.

 
Major health concern of the patient:

COPD is defined as a type of progressive lung disease that causes the permanent damage to the tissues in the lungs and making it hard for the patient to breath. In this case study, the patient who was a 62years Old Italian man admitted to the hospital due to shortness of the breath and coughing. After admission to the hospital, he was diagnosed with COPD. In this situation, the potential health concern is shortness of breathing. The chest tightness, coughing and wheezing that observed in COPD are generally due to the airway obstruction which manifested as the decreased airway flow rate over the entire vital capacity of lungs (Atherton et al., 2016). Consequently, forced expiratory volume diminishes in 1 second. Therefore, this airway obstruction resulted in predominantly from smooth muscle spasm. COPD usually become becomes symptomatic with the shortness of breathing in individuals older than 45 years of age and frequently, associated with active or passive smoking, air pollution and occupational exposure as observed in this case study (Bartunek et al., 2015). George stated that he was a smoker since he was 14 years old and he was working in the construction industry. Smoking has a massive effect on the COPD and accounts for as many as 8 to 10 COPD related death in Australia (Cadrin-Tourigny et al.,2015). Smoking during the childhood and teenager slows down the growth and development lungs and consequently, increases the risk of COPD in adulthood. He was admitted to the hospital with productive coughing and fever. In productive coughing, the mucous has been produced in the chest give rise to the feeling of congestion and tight chest (Bartunek et al., 2015). Moreover, being a labor of construction industry has the massive contribution in the development of COPD. The prime reason behind this is that cement has sensitising, pneumoconiosis properties and enters into the body through the respiratory tract. Therefore, it gives rise to bronchoconstrictor response to inhaled stimuli. He was prescribed with salbutamol, tiotropium and esomeprazole magnesium.

The two topics for client education:

From the case study, it is evident that the patient was diagnosed with the COPD after admitted to the hospital with shortness of breath. As observed in this case study, the patient stated that he worked in the construction industry and he was smoker since 14 years old. These two factors majorly contributed to the development of the COPD. In such situation, the first factor for client education would be how smoking has the massive impact on the progression of COPD and quitting smoking has immediate and substantial health benefits on a patient (Daskalopoulou et al., 2015). Recent studies suggest that despite the nature of COPD is wide spreading; cessation of smoking has remarkable health benefits to a smoker suffering from the disease. In the slow progression of the disease, quit smoking leads to the improvement in symptoms such as productive coughing and wheezing. In severe cases, quitting smoking slowly stabilizes the shortness of breath in the patient and rapidly reduces the frequency of coughing(Carthon, Lasater, Sloane & Kutney-Lee, 2015).  Smoking cessations slow down the decline in the forced expiratory volume of air expelled in one second and reduce the risk of bacterial colonisation by improving the natural defence mechanism of the body (Jiménez-Ruiz et al., 2015). Therefore, to improve the health conditions, clients need to have an appropriate education about the disease. In this case, study, since the patient was working on the construction industry, how occupational hazard influence the progression of conditions should be another topic for client education. Occupational exposure has been shown to associated with COPD. However, it is not possible to quite a job to slow down the progression of the disease. Hence, the use of a simple face mask can slows down the disease progression since it prevents the entry of fine cement dust into the respiratory tract (Harris et al., 2017). The use of nebulised salbutamol in working place can slow down the progression of the disease. Moreover, washing hands, avoiding the crowded area and staying hydrated significantly reduced the COPD.

 


Quitting smoking gradually slows down the progression of COPD by stabilizing the shortness of the breathing.After gaining the sound knowledge about the quitting smoking and its health benefits, the patient would be able to manage the disease (Riley, 2015). During the education, nurses should take in to account the importance of the motivation. Therefore, the patient would be motivated to quit smoking and subsequently, smoking cessation reduces the shortness of breathing. The patient would be more disadvantage of tobacco. He will use chewing gum instead of a smoking cigarette, he will participate in the social activities and will do exercise on a daily basis. He will be more cautious about taking medicines in proper time to reduce the effect of the disease. Moreover, education about controlling the occupational hazard has a remarkable impact on the client since it will help the patient to slow down the progression of the disease. The patient will be more aware of using the mask in his working field in order to avoid the cement dust. He will be more aware of washing hands for decreasing the further risk of infection. He will clean his equipment required for the work in order to avoid further infection. He will be more cautious about living the healthy lifestyle.

Education strategy for educating patient:

Patients are amenable to receiving published health information that made available for patients while they are in clinical areas. Making use of clinical materials sometimes help both end of the clinical system. It allows nurses in providing information relevant to the disease and options for alternative therapies. The recent findings suggested that access to the health-related information in the clinical setting can improve the patient satisfaction and patient can take care of themselves without seeking clinical help (Abed, Himmel, Vormfelde & Koschack,  2014). In this case study, the patient, George diagnosed with COPD after admitted to the hospital and requires education about the quitting smoking along with occupational hazard for self-management of the diseases. Recent healthcare reforms in the United States including Affordable Care Act and Health Information Technology for Economic and Clinical Health (HITECH) Act stated that it should be mandatory to use technology for educating and promoting health literacy to the patient. Few findings suggested that use of multimedia technology in teaching patients and family members have the positive impact on the improvement of the health of patients. Therefore, Clinical expertise should educate the George and his wife about quitting smoking with the help of powerpoint audio-video tutorial to static PDF presented by using tablets or projectors (Campbell,  & Daley,2017). The presentation should contain the benefits of quitting smoking, how it related to the progression of the disease, what are the alternative ways that help in smoking cessation and strategies to live a disease free life. Patients express more satisfaction if they receive the information through audiovisual and patient more easily retains the information obtained from watching the video presentation. Moreover, the written report in sheet should be used for further information. This procedure provides an additional opportunity to the clinicians to build a healthy relationship with the patient through effective communication and address the area of concern.

Since the patient work in the construction industry, the education about the occupational hazard is needed to prevent the further progression of the disease. The verbal and non-verbal demonstration can be the method to educate the patient and his wife so that they can apply the knowledge in their practical life. Registered nurses should demonstrate the way of wearing a mask through physical activity or performing the act to describe the procedure of wearing the mask (Robinson, Williams, Bridle & Jones, 2017). The use of nebulised salbutamol can be explained through demonstration. The patient can retain the information that they visualise. The advantage of the demonstrating procedure is that sometimes patients lack the literacy of understanding the medical terms. Therefore, visualizing the act helps the patient to retain the information in the patient, and they are able to apply the knowledge in practical life.

 
Reflection on cultural believe influences the patient interaction:

Effective communication is essential in developing the communication with the patient. Since many countries become culturally diverse, communication without hurting the culture and ethnicity of the patients is required. In this case study, the patient who admitted to the hospital due to COPD is belonging to Italy. As an Australian nurse, my culture will have a substantial effect on the session of interaction with the patient. According to the trompenaars cultural dimensions’ model, Italy and Australia have fundamental cultural differences that influence the healthcare settings (Frank, Trompenaars, & Vasishth, 2016). In Italy, the individuals are more formal in the way they talk to approaching the stranger. On the hands, Australian are tends to form casual conversation in the first meeting. The casual conversation can affect believes of the patients (Crawford,  Candlin & Roger, 2017). He might feel offended due to casual conversation.Moreover, Australians are more prone to use blunt humour to diffuse tension, and it can offend the patient. Moreover, Italians are more introverts as compared to Australians which further influence the interactions of the patient. Therefore, the ways of thinking also have the massive effect on clinical setting since Italians are assumed to be more prone to stick to their cultural believes(Crawford,  Candlin & Roger, 2017). On the other hands, Australians are more open-minded towards others culture than Italians. Therefore, my ways of thinking and providing care will influence the patient. Therefore in order to give to the patient accurate care, I will be more concern about cultural believes during giving the care. I will be more empathetic towards him while providing the care and I will show sympathy to the patient while showing the care to the patient.

 
Conclusion:

From the analysis of the case study, it can be concluded that COPD is one of the leading cause of death around the globe. In this case study, In this case study, the patient who was a 62years Old Italian man admitted to the hospital due to shortness of the breath and coughing. After admission to the hospital, he was diagnosed with COPD. He had the history of the Gastroesophageal reflux disease. In such conditions, the primary health concern is shortness of breath, and the patient requires the educations related to the quit smoking and occupational hazard. Quit smoking has the enormous effect on disease since it slows down the progression of the disease. Moreover, using the mask in the workplace also reduced the occupational hazard of the disease.  Therefore,  methods of educating patients can be powerpoint audio-video tutorial to static PDF presented by using tablets or projectors. Patients express more satisfaction if they receive the information through audiovisual and patient more easily retains the information obtained by watching the video presentation. The verbal and non-verbal demonstration can be the method to educate the patient and his wife for wearing the mask in workplaces. Moreover, the paper also reflects on how cultural beliefs influence the interaction between nurse and patient during the episode of providing care.

 
References:

Abed, M. A., Himmel, W., Vormfelde, S., & Koschack, J. (2014). Video-assisted patient education to modify behavior: A systematic review. Patient education and counseling, 97(1), 16-22. Retrieved from : https://dx.doi.org/10.1016/j.pec.2014.06.015

Atherton, J. J., Sindone, A., De Pasquale, C. G., Driscoll, A., MacDonald, P. S., Hopper, I., ... & Thomas, L. (2018). National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of heart failure 2018. The Medical Journal of Australia, 209(10), 1.Retrived from:  https://doi.org/ 10.1016/j.hlc.2018.06.1042.

Bartunek, J., Davison, B., Sherman, W., Povsic, T., Henry, T. D., Gersh, B., ... & Homsy, C. (2016). Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART?1) trial design. European journal of heart failure, 18(2), 160-168. doi:10.1002/ejhf.434

Cadrin-Tourigny, J., Shohoudi, A., Roy, D., Talajic, M., Tadros, R., Mondésert, B., ... & Guerra, P. G. (2017). Decreased mortality with beta-blockers in patients with heart failure and coexisting atrial fibrillation: an AF-CHF substudy. JACC: Heart Failure, 5(2), 99-106. Retrive from: https://doi.org/10.1016/j.jchf.2016.10.015

Campbell, S. H., & Daley, K. (2017). Simulation scenarios for nursing educators: Making it real. Springer Publishing Company. Retrived from : https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.583.6501&rep=rep1&type=pdf

 Carthon, J. M. B., Lasater, K. B., Sloane, D. M., & Kutney-Lee, A. (2015). The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: a cross-sectional study of US hospitals. BMJ Qual Saf, 24(4), 255-263. Retrived from : https://dx.doi.org/10.1136/bmjqs-2014-003346

Crawford, T., Candlin, S., & Roger, P. (2017). New perspectives on understanding cultural diversity in nurse–patient communication. Collegian, 24(1), 63-69. Doi: 10.1186/s12872-016-0208-4

Daskalopoulou, S. S., Rabi, D. M., Zarnke, K. B., Dasgupta, K., Nerenberg, K., Cloutier, L., ... & McKay, D. W. (2015). The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Canadian Journal of Cardiology, 31(5), 549-568. Retrived from : https://doi.org/10.1016/j.cjca.2015.02.016

Frank, S. L., Trompenaars, T., & Vasishth, S. (2016). Cross?linguistic differences in processing double?embedded relative clauses: Working?memory constraints or language statistics?. Cognitive Science, 40(3), 554-578. DOI: 10.1111/cogs.12247

Harris, E. C., D’Angelo, S., Palmer, K. T., Cox, V., Darnton, A., & Coggon, D. (2017). 0270 Mortality from lung cancer in occupations with exposure to asbestos among men in england and wales (1979–2010). Retrieved from : https://oem.bmj.com/content/oemed/74/Suppl_1/A84.1.full.pdf

Jiménez-Ruiz, C. A., Andreas, S., Lewis, K. E., Tonnesen, P., Van Schayck, C. P., Hajek, P., ... & Powell, P. (2015). Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit. European respiratory journal, 46(1), 61-79. Retrived from : https://erj.ersjournals.com/content/erj/46/1/61.full.pdf.

McFarland, M. R., & Wehbe-Alamah, H. B. (2014). Leininger's culture care diversity and universality. Jones & Bartlett Publishers. Retrieved from : https://www.jblearning.com/catalog/9781284026627/

Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G., Coats, A. J., ... & Jessup, M. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European journal of heart failure, 18(8), 891-975. Retrieve from: (https://creativecommons.org/licenses/by-nc-nd/4.0/ ) .

Riley, J.B., 2015. Communication in nursing. Elsevier Health Sciences.retrived from : https://books.google.co.in/books?hl=en&lr=&id=SwndCwAAQBAJ&oi=fnd&pg=PP1&dq=Riley,+J.B.,+2015.%C2%A0Communication+in+nursing.+Elsevier+Health+Sciences.&ots=YZpo-4xkwC&sig=w-EvGUqGp2KlwMC9PvmVFKP1KS0#v=onepage&q=Riley%2C%20J.B.%2C%202015.%C2%A0Communication%20in%20nursing.%20Elsevier%20Health%20Sciences.&f=false

Robinson, H., Williams, V., Bridle, C., & Jones, A. (2017). What are the patient reported facilitators and barriers to physical activity following pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD)? A systematic review of qualitative research.

Spadaro, S., Stripoli, T., Volta, C. A., Trerotoli, P., Pierucci, P., Staffieri, F., ... & Grasso, S. (2018). High-flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and work of breathing in patients with chronic obstructive pulmonary disease. Critical Care, 22(1), 180. Retrived from : https://doi.org/10.1186/s13054-018-2107-9

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