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Using any of the resources available related to the Emma Gee case study.  Develop a discussion on how strengths-based nursing and healthcare could be implemented for Emma at any point of her healthcare journey, or across the whole of Emma’s journey (hypothetically as if Emma was to experience her healthcare journey again).

Your discussion should:

  • provide an overview of what is strengths-based nursing synthesising the principles and values of SBN
  • demonstrate how strengths-based nursing could be implemented in

Emma’s nursing care to address the healthcare needs raised in Emma’s case study (specifically identify which healthcare need you are addressing using evidence from one of the resources available to you presenting the Emma Gee case),

  • select one critical transition point in Emma’s journey (e.g. immediate post-surgical care while Emma was unconscious; nursing care following Emma regaining consciousness; admission to rehabilitation; discharge planning from rehabilitation; etc) and present a strengths-based nursing care plan for Emma that includes a holistic approach, a family focus and collaboration with Emma, her family and other healthcare professionals involved in Emma’s care,
  • summarise the nursing care practices and client outcomes you would expect from implementing strengths-based nursing care complementing the medical model focus,
  • offer your conclusion on how SBN can help achieve patient and family empowerment, health promotion and partnerships in healthcare in Australia.

Understanding Strength Based Nursing

Strength-based nursing is an approach to care that is driven by some values to bring about an environment of empowerment, self-efficacy, and hope (Gottlieb, 2014). When giving care and support to patients and their families, there are inner and outer strengths that nurses focus on especially what both parties like doing best as they are dealing with problems. SBN is all about summoning, exploiting and developing a patient’s strengths to enhance healing (Gottlieb L, Gottlieb B, and Shamian, 2012, Moyle, Parker, and Bramble, 2014). This essay will discuss the applicability of strength based nursing and healthcare for Emma (a survivor of stroke) across her healthcare journey. The study is outlined to first explain what SBN is while explaining its values and principles. Then the discussion will show how SBN is applicable to control Emma’s anxiety. How a holistic approach, family focus, and Emma’s collaboration can lead a successful SBN care will be explained when Emma is transiting to surgical care. Before concluding, the discussion will summarize the nursing care activities and results expected after an SBN is implemented.

Strength-based nursing is an attitude and value-driven methodology that can guide, educators, managers, researchers, and clinicians. It is grounded in principles of patient/family centered care, relational care, empowerment, and instinctive health and healing. SBN shuns the traditional way of focusing on problems and things that are not working. The SBN model does not just lay its concern on prevention, wellness and patient-centered care practices which are more affiliated to deficits of the patient and not strengths. However, SBN regards looking and understanding these deficits and challenges in broader and holistic contexts and uncovering inner and outer strengths. The goals of promotion of health, facilitation of healing and alleviation of suffering are reaffirmed in this type of care. These goals are achieved through the creation of a favorable environment that bolsters the patient’s capacities to enhance health and distinctive healing mechanisms (NursingCenter, 2018). An SBN care complements medical care, converses nursing contribution to the health of the patient and family and healing, plus it empowers the ailing to have a better control over the illness and healing processes (Gottlieb, 2014). Factors that influence the successful implementation of SBN are aligned to SBN values like acceptance of SBN, curiosity- courage-commitment during early adoption, a critical build of early adopters and a context relevant and specific SBN approach (Gottlieb L and Gottlieb B, 2017).

(a)  Health and Healing: these are the key objectives of nursing. Health supports the patient’s ability to adapt to changes in life and lead to a purposeful life. Healing, on the other hand, restores wholeness and it involves rediscovering and reestablishing self, back to a state of equilibrium. Actually, in the healing journey, a patient gains new skills that maintain and improve his health.

(b)  Holism and embodiment: Holism is the recognition of the interconnectedness of the parts and their relative impacts on each other in response to internal and external environments. In order to enhance or restore wholeness in innate healing, there must be symptom treatment and elimination of the cause of dysfunction (Iglehart, 2013).

Values and Principles of SBN (Gottlieb, 2014)

(c)  Uniqueness: SBN is aware that all people are uniquely different in terms of genetic definition and precise disposition. Uniqueness is defined by strengths and deficits and their effect on physical, interactive and relational responses and the formation of a person’s distinctiveness.

(d) Subjective reality and created meaning: SBN affirms that understanding of events and responses is shaped by perceptions, emotions, experiences, representations, and meanings because they all carry specific meanings. These factors create a narrative which is a significant integrative process that creates health and enhances healing.

(e)  Self-determination: The person’s values choice, self-determination as well as self-knowledge are all recognized by SBN. SBN values the inner thrill of individuals undergoing a healthcare process (Elder, ‎Evans, and ‎Nizette, 2011).

(f)  Learning, timing and readiness: Learning is an important and transformation aspect and it includes biological, physiological and social processes. Readiness to engage in learning new things is a precondition for learning. Timing in healthcare settings is harmonizing the anticipated outcomes and body aptitudes and the inclination of the mind. The three combined values determine healing and SBN recognizes that healing may occur even at the jaws of death.

(g) Person and environment are fundamental: Physical and social environments affect person and family. Under different environments, one's strengths or deficits may be exposed. The growth of people depends on the presence of “goodness of fit” within the environment they are in. Under this favorable environment, the patient is able to draw on his strengths and chances for growth, healing and flourishing (Gottlieb, 2014).

(h)  Collaborative Partnership: SBN prefers the relationship between a nurse, patient and family being collaborative. When these two parties bring together their experiences and competencies there is a likely success. The patient and family bring the knowledge about self and their circumstances while the nurse brings a formal and practical knowledge of health and healing. In this collaborative partnership, the nurse should be open, indulgent and with the drive to share power (Delaney, 2018). That way, the patient and family will submit to care as they have an assurance that they are valued and respected.

Patients like Emma are likely to have died had their condition not treated with the correct professionalism. There is a likelihood fear for fatal endings upon the discovery of illness for most patients (Wu et al., 2014). Emma explains that she experiences increased anxiety due to her cerebral angiogram before surgery. The anxiety is even said to have been developing prior to the insertion of the catheter for brain imaging. A cerebral angiogram is a complex test that requires right handling to prevent a stroke from occurring (Tavakol, Ashraf, and Brener, 2012). Emma’s anxiety increased from her lack of knowledge as she imagined things would turn the unexpected way. Strength based nursing acknowledges that knowledge is power and leadership should create a learning environment (Gottlieb L, Gottlieb B, and Shamian, 2012). During the cerebral angiogram, Emma is left alone in the room and she was thinking that she was being tortured, still an issue of proper engagement to help her understand. One way to intervene against Emma’s anxiety is using music. As earlier discussed, SBN involves a collaborative partnership with the patient’s interests as the central focus. Even after the diagnosis took place, Emma was not actively involved in the discussion of her treatment plan. From information deficit, Emma is kind of unaware or rather “ignorant” of the difficulties that would arise after her surgery. There is an element of hopelessness that can be seen as Emma is disillusioned. Disillusionment, as confirmed by Klonoff (2010), is likely to affect the recovery journey. Hope and empowerment are among the values of SBN that assistant in the promotion of health and healing (Gottlieb, 2012). It is not that the nurses did not give Emma hope. The nurses are seemingly concerned about her and even from statements like “Are you OK Emma?” show some level of concern. The implication on Emma is not as effective as the level of concern accorded to her seems insufficient. If a proper SBN practice was effected Emma would at least be hopeful and would not have thoughts such as “I am being tortured”. One principle of SBN states that reality is defined by the language used. So, in the case of Emma, her language of torture impacts her diagnosis journey as a torturous one. (Gottlieb, 2012).

SBN Intervention to reduce Emma’s Anxiety

The strength-based care for Emma ought to be one that incorporates the value of learning, timing, and readiness (Adams, 2010). SBN engages people actively in their acquirement of knowledge related to their illness, health, and healing seeks signals for readiness and also times the interventions based on the knowledge of the person and the situation (Dyess, 2013). The briefing of the cerebral angiogram was poorly timed. Emma clearly never knew that it would reach a time when she would be left in a room alone and receive commands via a microphone. She was briefed in haste and before she would consent the whole medical and nursing team was on the other side of the glass window. These were aspects of poor intervention considering the critical condition that a stroke would easily occur during or after the procedure. It is even sad that Emma was without knowledge that her neck was restrained and when she tried to turn to the direction of the voice she could not make it. From this situation, her developing anxiety engulfed her and even when she cried out of fear she was ignored. This is an indication there was a need for Emma to be downright ready and that would have quenched the anxiety. It is imperative that. Emma should have been introduced in details about the possible illness after diagnosis, the possible of lifestyle changes she would have to adopt as well as signals of deteriorating state. That way anxiety would have been curbed (Gottlieb, 2014).

Emma describes her transition to the rehab as a sudden shift from being a therapist to patient. She also described that her rehabilitation took her years. The first experiences in the Rehab 2 were overwhelming for Emma. Emma was tired but was embarrassed about her current presenting condition as she could not face a colleague (a social worker she had worked with). This is clear that Emma had not accepted her state of illness. The note left on Emma’s bed is a clear fact that there were no defined roles in the rehab from colleagues. Her anxiety and depression developed even more (Gee, 2016). 

Holism and embodiment should guide the administration of care during this critical moment from the many tiresome activities in diagnosis and treatment (Iglehart, 2013).

Emma being the center of care should be the priority for all. The role of the nurses in a holistic approach is to facilitate the achievement of goals of patients (Hansen, Walters, and Howes, 2016). The goal of Emma was getting rid of the illness and recovering to a state that she could live her life before the illness. It has been researched and confirmed that strengths (personal factors) within themselves that determine their recovery. Focusing on Emma’s strengths would impact her satisfaction with life and that way she will be responsive and submissive to care given during rehabilitation (Xie, 2013).

The rehabilitation for Emma should be approached collaboratively from the caregivers, Emma herself, family and even friends. There is a much value for collaborative partnership in the care plan for Emma because of the simple fact that every partnership benefits all participants to varying degrees (Gottlieb and Feeley and Dalton 2006, Zwarenstein, Goldman, and Reeves, 2009). Building on a partnership program that incorporates discussed goals, collective power, sincerity and respect ensures brings all parties involved in Emma’s care into easy agreements and minimal quarrels. Collaborative partnership is anchored to elements that involve inclusion of all people’s talents and expertise to meet goals and work in a meaningful way (Gottlieb L, Gottlieb B, and Shamian, 2012). This, for example, involves the facilitation and support of Emma’s great interest in writing in the rehabilitation program. That way, Emma is able to feel comfortable in her new environment. Under collaborative partnership there is finding of voice for all, defense of ones stand and consequently, the resulting decisions are sound and reasonable (Schmalenburg et al. 2005). Therefore, in Emma’s transition into rehabilitation, there should be mutual understanding and incorporation of all parties, especially during decision making.

Involving the family and the patient is key success factor to recovery as it makes them submit when the nurse explains formal knowledge of healing and health be motivation and encouraging Emma. That way Emma could be less anxious and less depressed and even have hope towards recovery (Gottlieb, 2012).

Emma’s transition from Dalcross Hospital to Royal Talbot Rehabilitation Centre was seemingly difficult (Gee, 2016). Dalcross was a prestigious hospital and the way this rehab Centre is explained seems like it is a boring place. The goals of recovery are achieved through the creation of a favorable environment that bolsters the patient’s capacities to enhance health and distinctive healing mechanisms (Tracy, and Wallace, 2016).The family should be bold and strong in the recovery process and as it seems, Emma’s family failed in that. Emma’s both parents are said to have been nervous instead of encouraging her even as they handle her to strangers. Emma required empowerment to believe in herself that she can go through the whole process and recover to her original stat (Gottlieb, 2014). The recovery of Emma should have been attached on to a strong therapeutic foundation that would elicit her strengths, enthusiasm and withstand performance (Jones-Smith, 2013). Emma’s collaboration is important in her plan of care especially from the fact that she cannot do many things by herself. An SBN approach would be successful if she stopped being embarrassed and submitted to help rendered on her like bathing, using the toilet and wearing clothes, among others. The SBN should encourage her to speak her will out like the clothes she prefers to dress in or in case something was done wrong like when her carer forgot to do up her bra and when her carer almost put her left foot on her right shoe. Self-determination is a key principle towards recovery (Antai-Otong, 2016). For Emma, her values should be respected and her choices upheld. Even though sometimes it cannot be done as her wishes, at least her interests should be prioritized when they really make sense. Aspects of life involve making choices in response to present conditions or specific circumstances and limitations. An SBN care plan should not one that dictates care but ones that accepts to share power and listening actively so as to make clarifications, elaborations, explanations, information and making suggestions. An SBN should take the role of an advocate for Emma and her family to enhance a sense of inclusion.

Nursing practices to promote resilience and achievement of Emma’s goals included in a holistic approach are;

  • Upholding all the values and principles of SBN
  • Encouraging Emma to persevere through the rigorous therapy and rehabilitation exercises and procedures.
  • Helping Emma to focus on overcoming the challenges rather than fearing them.
  • Involving Emma in decision making during therapy, the transition to rehabilitation and recovery
  • Involving Emma’s family in decision making-collaborative partnership
  • Sharing power and listening actively

The outcomes expected for Emma are her recovering to her original lifestyle, restoring independence, enhancing her mobility on her own limbs, preserving Emma’s dignity, promoting family satisfaction, reducing Emma’s anxiety and ensuring she regains hope and empowering her.

Conclusion

An SBN approach can lead to health and healing to patients sometimes even when the patient lacks hope of life. Survival, empowerment, and hope are important aspects towards a successful SBN and they require combined efforts from nurses, patients and their family. The approach to care should be holistic and collaborative in that it focuses on a patient and the family. Prioritizing on the patient as well as the family is important as it determines the submission to care and collaboration towards healing and recovery. The nurse takes the formal and practical role in ensuring that the fears, reservations, and questions of the family and the patient are controlled and answered.

References

Adams, R.J., 2010. Improving health outcomes with better patient understanding and education. Risk management and healthcare policy, 3, p.61 -72. doi: 10.2147/RMHP.S7500. Epub 2010 Oct 14.

Antai-Otong, D., 2016. Psychiatric Mental Health Nursing, An Issue of Nursing Clinics of North America, E-Book (Vol. 51, No. 2). Elsevier Health Sciences.

Delaney L.J., 2018. Patient-centered care as an approach to improving health care in Australia. Collegian. (25) 1 Pp. 119-123. doi: 10.1016/j.colegn.2017.02.005

Dyess, S.M., 2013, January. Gottlieb, L. (2013). Strengths?based nursing care: Health and healing for person and family. New York: Springer Publishing. In Nursing Forum (48) 1, pp. 2-2.

Elder R, ‎Evans K, and ‎Nizette D, 2011. Psychiatric & Mental Health Nursing. 2 ed. Pp. 11-21 Elsevier Health Sciences.

Gee, E. 2016. Reinventing Emma. The inspirational story of a young stroke survivor.

Gottlieb, L.N. and Gottlieb, B., 2017. Strengths-Based Nursing: A Process for Implementing a Philosophy into Practice. Journal of family nursing, 23(3), pp.319-340. doi: 10.1177/1074840717717731

Gottlieb, L.N., 2012. Strengths-based nursing care: Health and healing for person and family. Springer Publishing Company.

Gottlieb, L.N., 2014. CE: Strengths-based nursing. AJN The American Journal of Nursing, 114(8), pp.24-32. doi: 10.1097/01.NAJ.0000453039.70629.e2.

Gottlieb, L.N., Feeley, N. and Dalton, C., 2006. The collaborative partnership approach to care: A delicate balance. Elsevier Health Sciences.

Gottlieb, L.N., Gottlieb, B. and Shamian, J., 2012. Principles of strengths-based nursing leadership for strengths-based nursing care: A new paradigm for nursing and healthcare for the 21st century. Nursing Leadership, 25(2). doi:10.12927/cjnl.2012.22960

Hammond, W., 2010. Principles of strength-based practice. Calgary: Resiliency Initiatives. Available at https://www.ayscbc.org/Principles%20of%20Strength-2.pdf [Accessed 13 Oct. 2018].

Hansen, E., Walters, J. and Howes, F., 2016. Whole person care, patient-centered care and clinical practice guidelines in general practice. Health Sociology Review, 25(2), pp.157-170. doi:10.1080/14461242.2016.1170625

Iglehart, J.K., 2013. Expanding the role of advanced nurse practitioners—risks and rewards. New England Journal of Medicine (368) 20 pp. 1935-41 doi: 10.1056/NEJMhpr1301084

Jones-Smith, E., 2013. Strengths-based therapy: Connecting theory, practice and skills. Sage Publications.

Klonoff, P.S., 2010. Psychotherapy after brain injury: Principles and techniques. Guilford Press.

Moyle, W., Parker, D. and Bramble, M., 2014. Care of older adults: A strengths-based approach. Cambridge University Press.

NursingCenter (2018). Strengths-Based Nursing. [Online] Available at: https://www.nursingcenter.com/cearticle?an=00000446-201408000-00024&Journal_ID=54030&Issue_ID=2532773 [Accessed 13 Oct. 2018].

Schmalenberg, C., Kramer, M., King, C.R., Krugman, M., Lund, C., Poduska, D. and Rapp, D., 2005. Excellence through evidence: securing collegial/collaborative nurse-physician relationships, part 2. Journal of Nursing Administration, 35(11), pp.507-514.

Slade, M., Amering, M., Farkas, M., Hamilton, B., O'Hagan, M., Panther, G., Perkins, R., Shepherd, G., Tse, S. and Whitley, R., 2014. Uses and abuses of recovery: implementing recovery?oriented practices in mental health systems. World Psychiatry, 13(1), pp.12-20. doi:10.1002/wps.20084

Tavakol, M., Ashraf, S. and Brener, S.J., 2012. Risks and complications of coronary angiography: a comprehensive review. Global journal of health science, 4(1), p.65. doi:  10.5539/gjhs.v4n1p65

Tracy, K. and Wallace, S.P., 2016. Benefits of peer support groups in the treatment of addiction. Substance abuse and rehabilitation, 7, p.143. doi:  10.2147/SAR.S81535

Wu, H., Gong, W., Pan, J., Fei, F., Wang, H., Hu, R. and Yu, M., 2014. Survival rate and risk factors of mortality among first-ever stroke patients. Zhonghua liu xing bing xue za zhi= Zhonghua liuxingbingxue zazhi, 35(7), pp.812-816. Available at https://www.ncbi.nlm.nih.gov/pubmed/25294073 [Accessed 16 Oct. 2018].

Xie, H., 2013. Strengths-based approach for mental health recovery. Iranian journal of psychiatry and behavioral sciences, 7(2), p.5. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939995/ [Accessed 16 Oct. 2018].

Zwarenstein, M., Goldman, J. and Reeves, S., 2009. Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database Syst Rev, 3(3), p.CD000072.

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