As a condition that impairs cognitive judgment, dementia impairs an individual’s ability to understand and take care of themselves and in the context of diabetes, it becomes worse coupled with increased risk of falls. Therefore, it is apparent that a multidisciplinary team is required for effective management of the condition. Such is the case of Mary, who is the main subject and forms the basis for this narrative. She is a widow aged 80 years, living alone in a flat and presented to the hospital with a fall. However, as an adult nurse, it is vital to carry out a holistic review of the patient to provide relevant and effective care to address her health needs. The nurse is able to carry out this responsibility as dictated by the nursing professional standards and code of ethics through effective communication.
The practice of nursing is engrained in various theories and among them is the Roper-Logan-Tierney’s model that guides nurses to provide care to patients based on their activities of daily living (Petiprin 2016). Mary has dementia, which is deemed to impair most activities of body function and daily living; hence, it was a relevant model for use in this context. The nurse is an imperative figure in the delivery of patient-centered care because unlike a physician, the nurse is guided by a set of standards and competencies that require him or her to identify and address varied patient needs as patients’ advocates (Smith 2019). Physicians are trained to provide medical care while a nurse is trained to provide holistic care by adopting the role of a health promotion agent (Kemppainen, Tossavainen, and Turunen 2013 and Salmond and Echevarria 2017). The fact that Mary is elderly, a stage in one’s lifespan that is deemed to be linked to various bodily dysfunctions, it was important to assess her daily activities to understand the extent to which dementia had affected her quality of life.
Effective communication is imperative in enabling nurses to perform their transformed role as health promotion agents and advocates. Thereby, effective communication was required between Mary and the attending nurse so she could extract as much information as possible pertaining to Mary’s needs (Sibiya 2018). Individuals with dementia have been found to have reduced mobility compared to those who do not have dementia. Immobility among individuals with diabetes tends to further aggravate the condition because exercise has a positive effect on insulin mechanism and muscle power (Colberg et al. 2016 and Orr et al. 2006). While applying effective communication skills, the nurse developed a good relationship with Mary through which she can extracted vital information for the planning of Mary’s nursing care. Mary had presented with a fall, alone, and given her medical history, it prompted the nurse to carry out an extensive evaluation as part of executing her role as a health promotion agent. The evaluation was purposeful as it helped to identify other health needs that affect Mary’s daily living and aided in the inclusion of relevant professionals to be part of the MDT.
Holistic nursing has brought a new perspective to nursing because nursing is no longer about following a list of rules. Instead, it has become a field that aims to explore the social, physical, psychological, and spiritual patient needs (Eriksson et al. 2018). Thereby, in reference to the Roper-Logan-Tierney model, the constituent 12 factors helped to explore various needs that aided in referring Mary to the relevant specialists and upheld a multidisciplinary team care process (Roper, Logan, and Tierney 1985). First, it was important to ensure that Mary was able to maintain a safe environment by analyzing her visual, audio, mobility, sense of smell, cognitive ability, and sense of touch. In view of the fact that dementia is among the mental illnesses that reduce an individual ability to recognize the essence of attaining a safe environment to prevent creating more problems, it was important to communicate the reason and need for admission to Mary because her inability to maintain a safe environment would result in more health problems.
Whereas the importance of effective communication is evident in healthcare, an individual with dementia tends to have difficulties communicating effectively. Effective communication skills are required to engage a patient in a deep conversation to obtain the required information needed to help identify his or her needs (Sibiya 2018). The Alzheimer Association outlines a sequence of steps that healthcare professionals could use to initiate a conversation with a dementia patient (Alzheimer Association 2019). As the nurse caring for Mary, it was important to engage her in a one-on-one conversation in a space free of distractions to help build trust and confidentiality. Communication was done slowly to give Mary the time to comprehend and react to whatever was being said to her. Maintaining eye contact and reassuring her motivated her to express her thoughts. Probing for information was guided by direct and simple questions requiring yes or no answers. When Mary began to speak, the nurse did not interfere; instead, she encouraged her talk more by nodding as it was through this talk that the nurse extracted important information for use in the management of comorbidities in order of priority. Even if there was discordance with Mary’s discourse, the nurse did not argue. Instead, the nurse developed simple and clear instructions that were reinforced by demonstrations. Also, notes were used to clarify confusing statements.
When effective communication is initiated, it is easy for a nurse to engage the client in subsequent assessments (Vermeir et al. 2015). After a thorough engagement with Mary, it was time to assess her vital signs to ensure that the individual’s respiratory system was fine and chronic diseases were identified. Nutrition is paramount; hence, Mary’s eating and drinking abilities were determined as they served as the basis for subsequent dietary intervention for diabetes. Optimal body functioning allows for the efficient elimination of waste (Roper, Logan, and Tierney 1985). Mary’s ability to maintain cleanliness and body hygiene was paramount, failure to which suggested a need for a social service provider. The other elements to be considered were temperature which is affected by both physical and biological elements. Whereas the biological elements warranted the attention of a physician, others required social or familial support. Mary lived alone, and this justified the need for an admission so that the MDT could help her meet all her daily living needs before her arm got better. In view of the fact that Mary had limited mobility, the hospital was an ideal place because with the help of occupational therapists, she would get assistance in initiating and maintain movement. Mary is elderly and not working, and through effective communication, the nurse learned about her socioeconomic status and hobbies that Mary could engage in when at home. Also, the nurse ensured that the hobbies were ideal for her based on her condition. Mary is window; hence, sexuality was not a priority for her but grooming well was essential. Mary’s sleeping patterns were assessed as well as her health status at the time to ensure that she was not in pain and distress due to her condition and comorbidities (Roper, Logan, and Tierney 1985).
In reference to the Roper-Logan-Tierney model for assessment as indicated above, it is evident that a multidisciplinary team was warranted because the holistic approach to nursing involves different specialists to help meet the varied needs of the patients (Eriksson et al. 2018). The identified needs entailed maintaining a safe environment, communication, eating and drinking, mobility, and personal cleansing and dressing. In the current case, it was important to work with a psychiatrist, physician, dietitian, occupational therapist, social worker, and community health worker to help Mary during her stay in hospital and later when she transitioned to return to her resident. The physician was important to help in managing her medical conditions while the psychiatrist helped to determine the extent of the dementia and provides supportive therapy to prevent deterioration, especially now that Mary would be admitted in a new environment that was likely to result in the onset of anxiety.
Communication is the governing activity as it through effective communication that the nurse is able to provide effective holistic care when Mary expresses all her concerns. While incorporating the MDT, it was essential to ensure that the social and cultural needs of the patient were met (O’Daniel and Rosenstein 2008). Dealing with a dementia patient is a sensitive process as it requires the nurse to motivate and encourage them to take part in the care process through a patient-centered approach. Mary had diabetes and was at risk of experiencing difficulties managing the condition because dementia tends to cause memory problems that can result in forgetfulness about diet control and scheduled medication intake. The fact that Mary lived alone was an issue of concern that warranted the intervention of a social worker to help track her family and involve them in her health management programme (Jenkins, Keenan, and Ginesi 2016). There was need to have someone help Mary after being discharged from the hospital to continue with the care plan so she could live a quality life.
Effective communication between the MDT in the hospital entails the use of communication tools/checklists that begin with goal setting. The use of electronic tools is deemed to foster effective communication and monitoring of a patient especially when working in a MDT (Panesar et al. 2014). Evidence suggests that a goal setting sheet should be included in the bedside notes and should highlight the task to be accomplished, care plan as well as the communication plan (Wang et al. 2018). This strategy was used to increase the MDT’s understanding of the treatment goals because every individual who was part of the MDT caring for Mary had to tailor his or her actions to the treatment goals delineated on the sheet. Daily interventions and status of the patients were continually noted on the bedside sheet through which the MDT read back and wrote down suggestions and planned course of care. Also, mobile devices were used to get wind of Mary’s condition even when an individual in the MDT was outside the facility. The nurse ensured that the MDT interacted on the basis of trust and respect even during times of stress
The narrative indicated that the adult nurse has an important role to play in leading an MDT, which determined the team’s success in the care process. The nurse spends more time with a patient than any other healthcare provider as they are deemed to be health promotion agents. Also, the transition of nursing to holistic nursing requires a nurse to spend substantial time with a patient as seen in the case of Mary. The nurse identifies the different healthcare providers who will be involve in the multidisciplinary care process. Thereby, after identifying that some of Mary’s activities of daily living were interfered with, it was necessary to admit her and engage a physician, psychiatrist, social worker, dietitian, community health worker, and occupational therapist to help improve her overall body functioning and quality of life until she got better. During discharge, it was essential to coordinate her care to ensure that she continued to receive monitoring and assistance while still at home.
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