INTRODUCTION:
The Nursing Process
The nursing process refers to a systematic technique of providing care that includes the essential concepts of “critical thinking,” “goal-oriented tasks,” “patient-centered approaches to medical care,” and “evidence-based practice” (EBP) principles. The inclusivity of integrative and scientific views establishes the foundation for compassionate and quality-based care (Lilley et al. 2022). The five steps of the nursing process, including assessment, diagnosis, planning, implementation, and evaluation, serve as a well-organized guide for providing patient-centric care. The assessment stage of the nursing process is the initial step and requires the use of critical thinking abilities alongside gathering objective and subjective data. The patient’s or the attendant’s verbal comments are subjective data. Objective data types that can be assessed and observable include symptoms and physical measurements such as body mass index, height, weight, and intake and output. Personal data refers to information provided orally by study participants, individuals, or administrators. The primary caregiver or data administrator may also supply some or all of the information, and they may or may not be related to the involved close relatives (McCuistion et al. 2021). Colleagues could take shifts serving on different spots in the disc row while describing the client’s condition. Electronic healthcare records are another source of information that could help with the assessment. A concept-based curriculum must be adjusted because critical thinking abilities are essential for assessment.
Additionally, establishing a nursing diagnosis through clinical logic also helps with planning and executing patient care. Conceptual changes to the curriculum are necessary because diagnosis is a crucial part of the evaluation process. According to McCuistion et al. 2021, nursing diagnosis is the clinical evaluation of a patient’s, family’s, or the community’s responses to actual or impending health crises. Using information and views from experts, a nurse can make a diagnosis and develop a care plan. So long as the technological norms are established, the goals and outcomes associated with treatment can be specified. Fundamental physiological needs and wants must be satisfied before more significant needs and aims, such as self-worth and self-awareness, may be achieved. Safety and physiological requirements serve as guidance for nursing care and nursing interventions.
According to EBP guidelines, objectives and results that directly affect patient care are established at the planning stage. Accomplishing these patient-centered objectives contributes to a successful outcome (Kuipers et al. 2021). The probability of a successful outcome increases if these unique goals are established for every patient and achieved. The use of nursing care approaches is crucial during this goal-setting phase. Care plans offer a guide for delivering individualized care catered to the individual’s needs. The overall illness and concomitant diseases influence the development of a care plan. The potential of the medical system to organize care, maintain records, collect payments, and offer longevity of care is improved through care plans. The implementation level involves performing or participating in and implementing the nursing procedures outlined in the care plan. Applying cardiac monitoring, delivering care, giving medications following defined care guidelines, and complying with EBP recommendations are all essential nursing actions during this stage (Lilley et al. 2022). A successful patient outcome is dependent on the evaluation stage. Whenever a medical professional gets involved or administers care, they must reexamine or reassess to ensure that the intended result has been reached. Depending on the patient’s overall state, reassessment may be necessary frequently. Medical practitioners should always double-check the facts or contrast the outcomes with previous findings while assuring the best outcomes from any intervention or care (Bucknall et al., 2019). A client’s overall well-being should be considered when determining how regularly they should have their condition evaluated.
Model of Living
The Model of Living by Roper, Logan, and Tierney is an approach to nursing care based on the activities of daily living (ADLs). According to Holland 2019, the model serves as an assessment used in the patient’s care and determining the patient’s needs. After an in-depth evaluation, the discoveries are divided into daily living activities, leading to nursing measures that improve autonomy in circumstances where clients might find it challenging to perform tasks independently. The client’s highest possible degree of independence is encouraged through evaluations and interventions. Nurses apply the framework to assess the patient’s overall self-sufficiency and ability for independence in daily life obligations (Holland and Jenkins 2019). The nurse can determine the actions that will boost autonomy combined with continuous support required to combat latent dependency by evaluating the patient’s independence from entirely dependent to totally independent (Holland 2019). Independence and dependence should be evaluated for the patient during hospitalization and throughout the treatment plan and evaluation. The professional nurse can determine whether or not the individual’s condition is improving by watching shifts in the dependence-independence continuum and altering the treatment given according to the evidence offered.
Additionally, the model also identifies five elements that have an impact on daily activities. Every patient’s level of relative self-reliance concerning ADLs is evaluated using the nursing theory. Physical, psychological, socio-cultural, environmental, and economic aspects are among these elements (Holland and Jenkins 2019). The client’s overall health, any recent ailments or injuries, and even the frequency of their pharmacological and anatomical conditions are all taken into account in the physical component. The psychological component discusses the functions that emotions, spiritual beliefs, rationality, and comprehension all play. The element’s primary constituents are thinking, sensation, wishing, and believing. The socio-cultural factor is examined regarding the client’s unique social and cultural factors. The patient’s individual beliefs, desires, and goals regarding independence and their capacity to engage in ADLs and those of other individuals are all part of this component. It includes aspirations and values influenced by one’s status in society, class, and culture. Based on the environmental element, the model discusses how everyday actions have an impact on the surroundings and how ADLs have an impact on the environment. The economic component also includes how politics, economics, and government initiatives affect day-to-day operations.
Aims and Objectives
The main objective of this project is to explore the care needs of a patientient with chronic obstructive pulmonary disease (COPD) regarding his activities of daily living using the Model of Living. Also, the project aims to tackle factors influencing the client’s quality of life and dependency level. Regarding the client’s needs, the project will assess his needs under each living activity, identify actual and potential problems, and provide interventions and evaluations.
CLIENT PROFILE:
The patient for this project was a male, Mr. Sam Thompson, aged 68. He was a family man, married with three children: a boy and two girls. His weight was 78 kg, and his height of 1.75 m. He was hypertensive, and he did not appear to be uncomfortable or bothered by his condition. Mr. Sam Thompson is a retired professional teacher and a bachelor’s degree graduate. The client has had chronic obstructive pulmonary disease (COPD) since he was 22. He started smoking when he was 28 years old (he smoked for 30 years, three times per day), but when he was diagnosed with COPD 10 years ago, he quit smoking with the assistance of his spouse and a medical professional. The client, who routinely used medicines and visited the doctor’s controls, complained of chest pain, bruises, respiratory discomfort, coughing up mucus, and coughing up blood for seven days consecutively before he was presented to the healthcare facility. The patient upped his medication dosage to help him get through these symptoms. He was eventually brought to the hospital due to his persistent complaints. Mr. Sam Thompson, fighting COPD, was hospitalized for care and monitoring. Upon admission, it was realized that he had five years of hypertension. The physical examination results conducted on the patient revealed that blood pressure was 130/80 mmHg, heart rate was 87/min, body temperature was 38.7°C, and respiration rate was 27/min. The treatment plan included medications such as Avelox, Delix, Clexane, Duphalac, Lasix, and Atrovent.
MODEL OF LIVING: (Applied to the client)
According to the Roper-Logan-Tierney Model of Nursing, a treatment plan for a client must be developed after evaluating the client’s capacities in every activity during their lifespan, their level of dependency, and any relevant conditions. The care plan identifies problems and potential fixes, sets goals, describes the nurse’s responsibilities, and encourages patient-driven care to evaluate the effectiveness of nursing (Holland and Jenkins 2019). It offers a structure for conducting a thorough patient assessment and developing a treatment plan. The model of living based on activities of daily living has five significant parts that are connected and impact one another (Binay et al. 2022). These elements include the following: lifespan, activities of daily living (ADLs), factors affecting ADLs, the continuum of dependency and independence, and individualized nursing care.
Lifespan
The concept of lifespan, which is one of the components of the model of living, is represented by a continuum of time. Nevertheless, unlike the continuum from independence to dependency, the pointer only points in a single direction to signify that life only continues forward until coming to an end. Every person requires nursing care at some point during their life span, which encompasses the entire process from conception to death (Binay et al. 2022). The dangerous infection known as chronic obstructive pulmonary disease affects people of practically all ages. However, it primarily affects older people. The client is in the period adulthood stage of the lifespan.
Dependence/Independence Level
The client’s degree of performance is indicated to show how dependent or autonomous they are on other people on a line, with indications that point in reverse directions. The continuum, which spans the range from total dependence to total independence, exists for all activities of daily living throughout an individual’s lifespan. It changes as a person ages and when an occurrence, a health problem, or other situations call for a temporary or permanent adjustment (Holland and Jenkins 2019). When the client could not complete his daily tasks independently because of COPD-related issues, he received assistance from nurses. The nurses, together with the help of family members, ensured that the client took medications as prescribed.
Factors Affecting Activities of Living
Factors affecting the client’s quality of life/dependency level include:
Physical
The patient’s overall health and current chronic obstructive pulmonary disease condition might impact his quality of life and level of dependence (Kar and Zengin 2020). He complained of chest pain, bruises, respiratory discomfort, coughing up mucus, and coughing up blood, necessitating his dependence on others in his daily activities. The client needs somebody to keep a close eye on him and to ensure he takes his medications accordingly.
Psychological
Since the psychological aspect makes the client more dependent on other people, it has an impact on his quality of life. Due to his health and the effects of the damage to his respiratory system, he might be unable to comprehend some things because he is emotionally overwhelmed. So that he may manage his illness, the client needs someone who can be by his side. He benefits from his family’s continued support by assisting with daily life activities.
Socio-cultural
The client’s experience with society and culture may impact his quality of life and degree of dependence on other people. Mr. Sam Thompson cannot stay alone because of his health state and the higher societal consideration that older people receive. He will require assistance from others to carry out his regular tasks.
Environmental
The environmental component could impact the patient’s quality of life, activities of daily living, and level of dependency. Mr. Sam Thompson lives with his family; thus, he counts on them to assist him with his daily activities.
Economic
Mr. Sam Thompson qualifies for a federal pension as a retired professional teacher and additional health care benefits. The client is also eligible for federal and state assistance programs to help older adults fulfill their daily obligations.
ACTIVITIES OF LIVING:
The activities of daily living (ADLs) refer to a person’s typical daily activities, including eating, showering, dressing, cleaning, working, housekeeping, and leisure pursuits. These self-care activities are necessary ones that people independently carry out to maintain and enhance their general well-being (NHS Lanarkshire n.d.). Determining how each ADL impacts an individual’s capability to take care of oneself to decide assistance with ADLs is necessary. ADLs are the main focus of the R-L-T Nursing Model. The model’s application to patient evaluation is encouraged through these activities. Regarding different activities of daily life, the client has varied needs.
1. Maintaining a Safe Environment
After being admitted to the hospital, it is crucial to establish and keep up a safe environment so that the patient can go about their daily activities healthily (Binay et al. 2022). Because of the patient’s advanced age, poor ventilation, ignorance of infection signs, and deteriorating pulmonary functioning, there is a danger of infections. It poses a significant risk for the client, considering hospital admission is a constant source of infection for clients (Voidazan et al. 2020). Invasive procedures are also performed on the patient. According to Mr. Sam Thompson, the care plan is complicated, and responding to the personal or family’s obsessive expectations might be challenging. Also, it is challenging to apply the tool since the patient has a chronic illness that requires long-term medication and oxygen. Some of the nursing interventions included the appropriate application of an aseptic technique, nurses hand washing after contact with every patient, changing the water used to moisten the oxygen, coughing exercises, and the use of antibiotics (Avelox tb 1*1 08 PO) prescribed by the clinician. The evaluation revealed that the client had no signs of infection during his period in the hospital.
2. Communication
Mr. Sam Thompson makes use of dentures, but this circumstance does not hinder his ability to communicate. Sensory organs are not a concern for the patient since they are not affected. The patient claimed that communication was not constrained and could communicate with his environment comfortably.
3. Breathing
The patient was taken to the hospital after complaining of chest pain, bruises, respiratory distress, coughing up mucus, and coughing blood. The client’s dyspnea has recently become worse. He also complains of a persistent cough and mucus production; he had a failure to sustain airway patency. Therapeutic interventions included help in performing cough and breathing exercises, use of pillow when coughing, correct sitting position with his bedside raised 50 degrees, and use of prescribed drugs (Atrovent inh and Avelox tb). The evaluation showed that the respiration rate minimized the mucus amount. The client also learned breathing (deep) and coughing exercises.
4. Eating and Drinking
Due to his hypertension condition, the client consumes a salt-free meal. It is suitable for the hospital context and a person’s home diet. There is no meal he dislikes. He claimed he could consume a specific type of food. Nevertheless, the client claimed that he had dropped 4 kilograms as a result of a decreased appetite brought on by weariness and breathing problems. There was bias in the patient’s nutrition than his body required. When ingesting oxygen, the client’s lips could get dry, but he had no problems with swallowing. Therapeutic interventions included consultation with a nutritionist to offer nutritional support, and the patient was consulted on the food he would like brought from home. The evaluation revealed that the client’s appetite increased and weight gain of 2kg.
5. Elimination
Sam Thompson is capable of meeting the discharge criterion by himself. The client, who defecates daily while living at home, claimed that he went 3–4 days without satisfying his need to empty. He claimed he experienced abdominal aches and difficulties excreting; he experienced constipation. Individual confinement is an option. Nursing interventions included fluid intake to improve intestinal excretion, fiber foods, taking freshly squeezed juice and dry fruits, and regular physical activity. The evaluation showed that constipation was resolved, and he defecated daily.
6. Washing and Dressing
Dyspnea has made the client partially dependent on this activity. He gets personal hygiene assistance from his wife. The patient is wearing clean jumpers. He claimed his wife could not take care of him due to breathing problems and lack of individualized care. Therapeutic interventions included encouraging patient independence, resting before performing daily activities, and using non-zipped clothing. The evaluation revealed that the patient half-depended his wife for dressing.
7. Controlling Temperature
The body’s temperature is at 38.7°C. The clothes worn by the client were appropriate for the temperature of the surroundings.
8. Mobility
Mr. Sam Thompson suffers from cyanosis, inefficient breathing, and difficulties with breathing. When making movements, dyspnea is evident. Whenever he moves around, he relies on his wife; he has mobility intolerance. Nursing interventions encompassed encouraging the client to rest well before exercise and meals, to do regular exercises, and to have whatever he needed to be placed next to him. As a result, the intolerance was minimized, although not eliminated.
9. Working and Playing
The client is a retired professional teacher. In his free time, he reads books, worships, devotes time to his children and grandchildren, and watches television.
10. Sleeping
Mr. Sam Thompson frequently woke up at night complaining that he was having trouble sleeping because he experienced dyspnea at night. The man claimed that three pillows were sufficient for him to sleep comfortably. The client was spotted producing sweets over the day. Therapeutic interventions included encouraging the client to avoid severe foods and smoking stimulants, to avoid excessive fluid intake before sleeping, increase daytime activities, avoid exhaustive activities, provide a conducive environment for the client to sleep, and the client was encouraged to have a relaxing activity, including reading, calm music before sleeping. As a result, the client could sleep more comfortably since dyspnea diminished.
11. Sexuality
Mr. Sam Thompson behaved appropriately for his gender and age. His speech pattern, vocal tone, attire, and conduct were all distinctive to his type.
12. Death
The client could pass away peacefully, and there is no aversion to dying. Religious beliefs positively impact the ability to cope with illnesses.
Conclusion
A nursing process is a systematic approach to providing patient-centered care. It contains five steps, namely assessment, diagnosis, planning, implementation, and evaluation, guiding healthcare professionals in providing individualized patient care. The process may be altered when nurses do not get the relevant data from the client, family, or carer. As a result, the care plan of such a patient will not be effective and appropriate. The model of living helps in the assessment of clients’ needs concerning their activities of daily living. The model also helps determine the patient’s lifespan, quality of care, and level of dependence. Sometimes it is challenging to determine the client’s needs using this model, especially when the caregiver is only sometimes with the patient. The care interventions provided to the client, Mr. Sam Thompson, were effective since they improved his COPD condition.
References
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Kar, S. and Zengin, N., 2020. The relation between self‐efficacy in patients with chronic obstructive pulmonary disease and caregiver burden. Scandinavian journal of caring sciences, 34(3), pp.754-761.
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NHS Lanarkshire, n.d. Activities Of Daily Living. NHS choices. https://www.nhslanarkshire.scot.nhs.uk/services/occupational-therapy/learning-disability/activities-of-daily-living/
Voidazan, S., Albu, S., Toth, R., Grigorescu, B., Rachita, A. and Moldovan, I., 2020. Healthcare associated infections—a new pathology in medical practice?. International journal of environmental research and public health, 17(3), p.760.
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