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1.Provide an overview of what is strengths-based nursing synthesising the principles and values of SBN.

2.Demonstrate how strengths-based nursing could be implemented in Emma’s nursing care to address the healthcare needs raised in Emma’s case study .

3.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;

4.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,

5.Summarise the nursing care practices and client outcomes you would expect from implementing strengths-based nursing care complementing the medical model focus,

Strength based nursing care plan

Strength based nursing (SBN) refers to an approach that focuses on care of people, which encompasses eight core principles that guide the nursing profession, thus promoting self-efficacy, hope, and empowerment of the patients (Gottlieb 2014). Across different levels of care that range from primary care services for healthy patients, to critical and acute care services for patients who are unconscious, the domain of SBN primarily focuses on reaffirming the goals of a nurse for promoting the health and wellbeing of the patients, facilitating easy recovery and healing process, and alleviating all kinds of suffering.

This is principally achieved by development of an environment that strengthens the capacities of the patient for health and the associated mechanism self healing and recovery. According to DeNisco and Barker (2013) SBN is found to compliment medical care and also assists or supports by providing a language that facilitates easy communication, regarding the contribution of nurses to the health and healing of the patient, thereby empowering them to gain increased control over their quality of life (Moyle, Parker and Bramble 2014). The essay will focus on the case study of Emma Gee, an occupational therapist who had been admitted to the hospital following an episode of stroke. This will be followed by formulation of a strength based care plan during her transition journey.


Strength based nursing care plan- Despite increasing attention that  that is being paid to wellness prevention and patient centred care, the medical model that places an emphasis on the deficits of the patients, rather than their strengths, often remains the most commonly used practice model in clinical services (Tourangeau et al. 2016). Most nursing professionals have been trained to place a due focus on the problems that are faced by the patients, which in turn is facilitated by conducting an analysis of the concerns and thoughts of the patient. In the words of Ibrahim, Michail and Callaghan (2014) formulation of strength based nursing care plan will help in bringing a balance to the deficit based care plans and it will focus on gaining a deeper understanding of the problems within the holistic and broader context that will uncover the outer and inner strengths of the client Emma Gee.

Following Emma’s admission to the hospital where she is being delivered adequate care services in the Intensive Care Unit (ICU) and is gradually regaining consciousness, it is utmost necessary for the nursing professionals to provide her assistance in feeding activities. Stroke most often affects the way by which food moves around in the mouth and the swallowing capabilities of a person, thereby leading to a condition called dysphagia. This condition most often creates problems with drinking and eating and the food or drink might get inserted in a wrong way or inside the lungs (Rofes, Vilardell and Clavé 2013). Conduction of a swallowing assessment is essential to evaluate the oesophagus and its associated functions. The Fiberoptic Endoscopic Evaluation of Swallowing (FEES) might also be used to determine the functionality and anatomy of the swallowing apparatus and its associated reflexes. Dysphagia results in aspiration and some of the most common signs and symptoms include shortness of breath and wet sounding voice. Hence, assistance is also required from a speech pathologist for managing dysphagia (Wan et al. 2014).  A dietician will help in ensuring that Emma is being provided adequate nutrition and is taking proper nutritional supplements (Crary et al. 2013). Collaboration with a speech pathologist will also help in checking the muscles that are used for swallowing food. Videofluroscopy or modified barium swallow can also be used for the same purpose. This should be followed by supervision and/or assistance from speech pathologist such as, drinking thickened drinks, or eating smooth foods that are considered safe, besides suggesting movements that would make swallowing easier and safer (Edmiaston et al. 2014). Therefore, effective collaboration is required from the nurse in charge, the speech pathologist and dietician who will take all possible efforts to make Emma show compliance to a well formulated diet chart that will enhance her health status and help her tolerate certain drinks and food. Conduction of frequent pain assessments, making a regular note of her vital signs, managing integrity of the skin, and assessing the psychological functioning of the patient are also imperative in this case study. The patient should also be frequently repositioned, with the aim of promoting her optimal recovery, which will be achieved by modulating the muscle tone and preventing complications such as, respiratory problem, pain, contracture, and pressure sores.

Swallowing assessment and dysphagia management


The case study also hints at communication deficits in Emma that resulted in a failure of her family members and the nursing staff in interpreting what she intended to say. Although a white board has been brought by her sister, effective collaboration between the therapists and her family members will help in gaining a deeper understanding of the different strategies and communication techniques that should be employed in this scenario. Flynn et al. (2013) stated that several stroke patients report difficulties in their communication that commonly includes a history of dysarthria, apraxia, cognitive difficulties, and dysphonia. The speech pathologist will assess Emma’s reading, talking, listening, understanding, and writing and will work together with the family members for developing a rehabilitation program. Some of the commonly used resources that might prove beneficial in this context are presence of white boards, communication signals and pictures. Talking in a quiet place where there is no distraction, speaking in simple short sentences, obtaining feedbacks to make sure that the instructions have been correctly interpreted or understood, and using different gestures might prove helpful (O'Halloran, Worrall and Hickson 2015).

Emma’s family that comprises of her father, mother, and sister has been found to be extremely supportive in her recuperation journey. Hence, a family centred partnership approach should be taken in order to facilitate health care decision making process. Some of the basic principles that must be followed while are namely (1) information sharing in an objective, open and unbiased manner; (2) fostering a collaboration and partnership that will help in taking medically appropriate decisions best fits her strength values needs and ability; (3) negotiating the desired outcomes of the medical care plan; and (4) respecting and honouring the linguistic and cultural traditions diversity and their preferences of her family members (Coyne 2015). Some of the essential components of a therapeutic relationship that must be followed in this context include genuineness, empathy, and respect (Coyne, Hallström and Söderbäck 2016). The nursing professionals should have the ability to identify with, and understand the situation of the client for motives and feelings, thus establishing a personal connection. Features of genuineness must include being honest, open and sincere towards the patient, besides showing an absence of defensiveness, and traits of active listening skills (Kaakinen et al. 2018). Establishing respect by including the strengths and weaknesses of the client will also help Emma and her family members to feel at ease, and will increase the opportunity for awareness and valuable enquiry related to her health.

Communication deficits and rehabilitation

The Australian family Strengths Nursing Assessment (AFS) will also be followed where the eight qualities related to family strength will help in fostering conversation with the family, and taking into account their preferences and opinions, related to clinical decision making. This family based strength assessment model will build on different positive attributes that are essential for family functioning such as, affection and appreciation,  positive communication,  commitment,  spiritual well being,  coping with crisis and together time.


Rehabilitation admission- Rehabilitation services are specialised healthcare facilities that assist an individual regain mental, physical, and cognitive abilities, which get impaired or lost due to some injury, disease, or treatment (O'Sullivan, Schmitz and Fulk 2013). This admission to a stroke rehabilitation centre will play a crucial role in assisting Emma in her journey of recovery.  According to Laver et al. (2015) the primary goal of stroke rehabilitation is to provide assistance to be affected individuals in relearning the skills that have been lost when stroke affected a portion of their brain. Common physical activity that Emma must be assisted to perform is mobility training and use of mobility aids such as, wheelchairs, walkers and ankle brace (Winstein et al. 2016). Performing motor skill exercises will also help in improving the strength of muscles and its coordination, besides strengthening swallowing capabilities. Emma must also be convinced to undergo different occupational and speech therapies that will help her deal and cope up with lost cognitive abilities namely, processing memory, social skills, and problem solving (Mendis 2013). Speech therapy will also help in regaining the lost abilities of listening, writing, speaking, and comprehension. Efforts must be taken during the rehabilitation program to maintain her dignity and privacy, while setting up a proper regimen for toileting and grooming activities.

Discharge planning- The primary objective of discharge planning is to improve service coordination, following discharge of a patient from hospital by taking into consideration the needs of the client in the largest community (Poston, Dumas and Edlund 2014). The strength based approach should be completely utilised in order to enforce a discharge plan that promotes her health and wellbeing, while allowing her to live a meaningful and purposeful life after stroke. The strength based approach will place be grounded on the inherent strength of Emma, her family and communities, by deploying personal strength that will facilitate empowerment and recovery (Shepperd et al. 2013). Solution Focused Therapy (SFT) will form an essential aspect of discharge planning, which will elaborate on what she wants to achieve, rather than the problems that are making her seek help (Bond et al. 2013).  Encouraging Emma and her family to focus on determining their path to reach intended goals will accelerate the recovery process. Educating her family members on stroke and increasing their awareness on its management will also be crucial. Organising conferences, consultations and family meetings will help in focusing more on the role and responsibility of the family and its dynamics in Emma’s recovery journey.

Discharge planning

Safe accommodation forms an imperative part of discharge planning. Adequate recommendations must be given for making adjustments in her home such as, mobility equipment installation, and presence of mobility aids (New et al. 2013). Consultations with occupational therapists and home visit programs will also be an important component of discharge planning. Emma must also be recommended the referral of counsellors to discuss her concerns regarding sexual problems (if any). Referring her to different employment opportunities will help in eliminating feelings of hopelessness, and depression due to lack of employment.

Discussion- An analysis of Emma’s case suggested that there were some problems related to communication gaps, inclusion of family and absence of patient centred care. Providing care services that are respectful of and responsive to her preferences, values, and needs would have helped in ensuring that her values guided all the major clinical decisions that were taken. The case study also elaborated on lack of encouragement from the nursing staff and forceful feeding.  Absence of any emotional connection and therapeutic relationship with the healthcare professionals also made Emma isolated and depressed. Hence, involving the patient in decision making process and treating her with respect, dignity, while showing sensitivity towards her autonomy and cultural values, was needed. Anxiety and fear associated with illness are often as debilitating as the physical impact. Involving the friends and family of the patient in decision making process and supporting the family members of caregiver, besides recognising their strengths and needs was also essential in this regard.

Carman et al. (2013) opined that patient engagement has been recognised as a crucial strategy for achieving triple aim related to healthcare namely, improving patient experience, reducing costs, and advancing the population health. SBN focuses on active collaboration between patients and providers to manage design and accomplish possible health outcomes that will help in successfully achieving patient engagement in healthcare practices. The process of patient empowerment also assists people to gain control over their life, besides elevating their capacity to immediately act on different problems that they define as crucial. Some of the major aspects of patient empowerment include self-awareness, self-efficacy, coping skills, confidence, and health literacy. This will help the patient gain a sound understanding of the presenting complaints, access to healthcare services, and proposed treatment plans (Schulz and Nakamoto 2013). The SBN will also help nurses to deliver services that are culturally competent, by recognising the patient differences in beliefs, practices, demographics, norms, and desire related to clinical care, and taking the perspectives into account while proposing a care plan (Betancourt et al. 2016). Australia is a melting pot of different cultures and ethnicities, including the indigenous population. Conducting a cultural assessment will also be an essential step in the process of patient centred care that will help the nurses to formulate an appropriate treatment plant for each client, based on the information provided regarding the beliefs, values, and opinions of the client.

Family-centered care and Australian Family Strengths Nursing Assessment

Conclusion

To conclude it can be stated that, the strength based approach of nursing care as discussed in the essay that might help Emma in her recovery journey, after being affected by stroke. Some of the most essential attributes that should be taken into account are empowerment of the patient and family,  partnership and collaboration, establishment of therapeutic relationship, and application of strength based nursing to provide better quality of care services. True patient engagement not only relies on patient education of communication, but focuses on the skills, knowledge, willingness, and ability of patients to manage their own health.  Hence, SBN will make the nursing professionals increase their cultural competence based on three facets of attitude, skills, and knowledge. While caring for patients and their family members it is imperative for a nursing professional to focus on the outer and inner strength, besides taking into account the preferences and demands of the patients and families that will best assist them in dealing with their problems and minimising all deficits. Completely informing Emma about her prognosis and condition, besides providing emotional and physical comfort, would have also created a significant positive impact on her experience of hospitalization. Employing active listening skills to identify the concerns and problems of the patient, and adopting a non judgemental and unbiased approach will also make Emma feel valued and respected.

References

Betancourt, J.R., Green, A.R., Carrillo, J.E. and Owusu Ananeh-Firempong, I.I., 2016. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports.

Bond, C., Woods, K., Humphrey, N., Symes, W. and Green, L., 2013. Practitioner review: The effectiveness of solution focused brief therapy with children and families: A systematic and critical evaluation of the literature from 1990–2010. Journal of Child Psychology and Psychiatry, 54(7), pp.707-723.

Carman, K.L., Dardess, P., Maurer, M., Sofaer, S., Adams, K., Bechtel, C. and Sweeney, J., 2013. Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Affairs, 32(2), pp.223-231.

Coyne, I., 2015. Families and health?care professionals' perspectives and expectations of family?centred care: hidden expectations and unclear roles. Health expectations, 18(5), pp.796-808.

Coyne, I., Hallström, I. and Söderbäck, M., 2016. Reframing the focus from a family-centred to a child-centred care approach for children’s healthcare. Journal of Child Health Care, 20(4), pp.494-502.

Crary, M.A., Humphrey, J.L., Carnaby-Mann, G., Sambandam, R., Miller, L. and Silliman, S., 2013. Dysphagia, nutrition, and hydration in ischemic stroke patients at admission and discharge from acute care. Dysphagia, 28(1), pp.69-76.

Conclusion

DeNisco, S.M. and Barker, A.M., 2013. Advanced practice nursing: Evolving roles for the transformation of the profession.

Edmiaston, J., Connor, L.T., Steger-May, K. and Ford, A.L., 2014. A simple bedside stroke dysphagia screen, validated against videofluoroscopy, detects dysphagia and aspiration with high sensitivity. Journal of Stroke and Cerebrovascular diseases, 23(4), pp.712-716.

Flynn, D., Ford, G.A., Stobbart, L., Rodgers, H., Murtagh, M.J. and Thomson, R.G., 2013. A review of decision support, risk communication and patient information tools for thrombolytic treatment in acute stroke: lessons for tool developers. BMC health services research, 13(1), p.225.

Gottlieb, L.N., 2014. CE: Strengths-based nursing. AJN The American Journal of Nursing, 114(8), pp.24-32.

Ibrahim, N., Michail, M. and Callaghan, P., 2014. The strengths based approach as a service delivery model for severe mental illness: a meta-analysis of clinical trials. BMC psychiatry, 14(1), p.243.

Kaakinen, J.R., Coehlo, D.P., Steele, R. and Robinson, M., 2018. Family health care nursing: Theory, practice, and research. FA Davis.

Laver, K.E., George, S., Thomas, S., Deutsch, J.E. and Crotty, M., 2015. Virtual reality for stroke rehabilitation. Cochrane database of systematic reviews, (2).

Mendis, S., 2013. Stroke disability and rehabilitation of stroke: World Health Organization perspective. International Journal of stroke, 8(1), pp.3-4.

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

New, P.W., Jolley, D.J., Cameron, P.A., Olver, J.H. and Stoelwinder, J.U., 2013. A prospective multicentre study of barriers to discharge from inpatient rehabilitation. Med J Aust, 198(2), pp.104-108.

O'Halloran, R., Worrall, L. and Hickson, L., 2015. Environmental factors that influence communication between patients and their healthcare providers in acute hospital stroke units: an observational study. International journal of language & communication disorders, pp.1-18.

O'Sullivan, S.B., Schmitz, T.J. and Fulk, G., 2013. Physical rehabilitation. FA Davis.

Poston, K.M., Dumas, B.P. and Edlund, B.J., 2014. Outcomes of a quality improvement project implementing stroke discharge advocacy to reduce 30-day readmission rates. Journal of nursing care quality, 29(3), pp.237-244.

Rofes, L., Vilardell, N. and Clavé, P., 2013. Post?stroke dysphagia: progress at last. Neurogastroenterology & Motility, 25(4), pp.278-282.

Schulz, P.J. and Nakamoto, K., 2013. Health literacy and patient empowerment in health communication: the importance of separating conjoined twins. Patient education and counseling, 90(1), pp.4-11.

Shepperd, S., Lannin, N.A., Clemson, L.M., McCluskey, A., Cameron, I.D. and Barras, S.L., 2013. Discharge planning from hospital to home. Cochrane database of systematic reviews, (1).

Tourangeau, A.E., Giovannetti, P., Tu, J.V. and Wood, M., 2016. Nursing-related determinants of 30-day mortality for hospitalized patients. Canadian Journal of Nursing Research Archive, 33(4).

Wan, C.Y., Zheng, X., Marchina, S., Norton, A. and Schlaug, G., 2014. Intensive therapy induces contralateral white matter changes in chronic stroke patients with Broca’s aphasia. Brain and language, 136, pp.1-7.

Winstein, C.J., Stein, J., Arena, R., Bates, B., Cherney, L.R., Cramer, S.C., Deruyter, F., Eng, J.J., Fisher, B., Harvey, R.L. and Lang, C.E., 2016. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 47(6), pp.e98-e169.

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