Asthma is a chronic inflammatory condition of the airways that causes fluctuating airflow bronchial blockage and may be treated appropriately or resolved on its own It is often characterized by intermittent bouts of wheezing, coughing, and shortness of breath The condition mostly affects adults and is a major public health concern for all individuals due to its high mortality and morbidity According to Holst et al. (2020), at least 400 million people across the globe have the condition, and the number is anticipated to rise by 200 million by 2024. As a result of its morbidity and mortality, the ministry of health of the United Kingdom has long recognized the need to control and prevent exacerbations of the condition This paper aims to discuss Sally that presented to the emergency rooms with severe cough, shortness of breath and wheezing, which upon examination, was found to have Asthmaю Therefore the paper will analyze the therapeutic relationship of placing Sally in her decision-making, the evidence-based requirement for care and support of Sally, health assessment strategies and principles of risk assessment and management In addition, the paper will discuss legal and ethical issues in the care and evaluation Sally.
Therapeutic Relationship That Placers Patients at the Centre of their Treatment
Patient Presenting Emotional State
As Sally Roberts entered the emergent department, fear and anxiety were all written on her face. The patient’s level of anxiety increased during every wheezing episode. In addition, she appeared so confused about what was happening to her to the extent that she could not speak This emotional state, therefore, called for the formation of a therapeutic alliance with the patient to help her overcome the dears and reduce the level of anxiety which worsened the patient’s condition.
Elements of TR that Encourages Patient to Take Part in Her Decision Making
A therapeutic interpersonal connection is one that patients view as being based in a safe environment during an often stressful time and exhibiting kind, helpful, and nonjudgmental behavior. These relationships either last a short while or last a very long time. This type of communication frequently demonstrates warmth, friendliness, genuine interest, empathy, and a desire to support and help. Therefore, therapeutic interpersonal connections foster interactions that promote effective communication (Bourdin et al., 2019). Those in the medical field who form therapeutic relationships with their patients report greater patient satisfaction, medication compliance, quality of life rates, decreased stress and desperation levels and lower healthcare costs. Through this interconnection, nurses can inform patients throughout all phases of care, whereby patients share their preferences and agree on the best choices. The therapeutic relationship, therefore, fosters patient involvement in decision-making.
Importance of Decision Making and NMC Code of Nurses
There are many advantages to involving patients in healthcare decision-making. Participating patients are more inclined to conform to surveillance, diagnosis and treatment, report a higher degree of satisfaction with their care, have broader knowledge about conditions, tests, and treatments, have more reasonable goals about benefits and risks, experience less decision- making conflict and anxiety, undergo fewer potentially diagnostic treatment and even achieve better health outcomes (Wu et al., 2021) Through patient participation in healthcare, nurses can achieve the principles of NMC code of practice which states that nurses must prioritize their patients, practice effectiveness in their practices, preserves patient safety and promote trust and professionalism.
What Nurses Can Do to Encourage Therapeutic Relationships
Nurses are required to establish and sustain relationships that are centered on optimal practice in order to foster therapeutic relationships within the emergency room. Developing therapeutic interpersonal connections requires self-evaluation and an awareness of how these affect relationships. This type of relationship can be achieved through therapeutic listening Therapeutic listening is a multisensory interpersonal communication process whereby the nurse pays close attention to the patient’s verbal and nonverbal cues in order to grasp better, synthesize, and interpret the client’s condition (Holst et al., 2020) Nurses can also achieve therapeutic relationship through responding to the unmet needs of patients and their emotions Furthermore, nurses can encourage a therapeutic relationship with the patient by providing patient-centered care which involves according to care based on patient’s preferences.
Therapeutic Relationship and Patient-Centered Theory
The philosophy of patient-centered care aids in highlighting the significance of the therapeutic connection. According to the Institute of Medicine, patient-centered care encompasses empathy, respect, and sensitivity to each patient’s needs and wants. It offers complete care and ensures that patient values guide physician decisions. Recall that person-centered care is more thorough and considers factors like context, family, close friends, prevention, and promotion. In their concept study, Bracelli et al. (2022) emphasized four aspects of person-centered care: comprehensive, customized, respectful, and empowering. They added that in person-centered care environments, leaders set the standard for planning and delivery of care in a collaborative manner. This theory thus shows the significance of forming a therapeutic relationship.
Behavior and Communication Skills Nurses Must Adopt
There are five behaviours and communication skills that are critical in achieving patient-centered care One of them is professional intimacy which is a firm core that nurses provide patients through activities such as helping them achieve activities of daily living and offering spiritual, psychological and social elements of care In addition, nurses must empathize to the patient by understanding their perspectives and validating and resonating with their meaning of the process (Harris, 2019) Respect is also another essential part of achieving therapeutic relationship byutr recognizing the unifies of the patient and their worth regardless of the patient’s socio-economic status Trust is also an essential part of developing therapeutic relationships and encourage freedom and unity among healthcare providers and the patient Furthermore, nurses can achieve therapeutic relationship by active listening and paying attention to clients’ needs hence creating a trusting and free environment where patient is free to talk about anything hence aiding in forming a therapeutic relationship.
Impact of Acute Environment on the Need to Build Therapeutic Relationships
The milieu of acute healthcare has been characterized as threatening, isolating, identity-distorting, and hopeless. In order to ensure high-quality care, patients need an advocate like a family member in the healthcare institution with them at all times, as findings show that these patients struggle to get medical staff to listen. Additionally, Dixon et al. (2021) discovered that poor communication was a common theme associated with staff being task-oriented, which caused patients to feel upset, and nurses’ poor communication skills were due to their hectic schedules. Therefore, given the threatening and challenging context of acute care, the therapeutic relationship is essential in alleviating anxiety levels and assuring them of their safety.
Evidenced Based Requirement for Care and Support of Adults with Acute Health Conditions and Health Assessment Strategies and Tools
Signs and Symptoms
Sally Roberts came to the emergency room presenting with signs and symptoms of shortness of breath, chest tightness, wheezing, and persistent cough, which she reports worsens at night or during exercise Based on her examination, it was determined that she was suffering from Asthma The major cause of Asthma is the inflammation of the airways This inflammation occurs from the production of inflammatory mediators such as histamine and leukotrienes that stems from a response to allergens, cold air, or exertion appears (Kane, 2022) These mediators are released by bronchial basophils, epithelial cells and alveolar macrophages These mediators causes a cute bronchoconstriction brought on by certain mediators known as the early-phase asthmatic response (Liu et al., 2022) The stimulation of neutrophils and eosinophils, as well as their movement to the airways, where they inflict damage, are likewise regulated by inflammatory mediators This so-called “late-phase asthmatic response” leads to epithelium damage, airway oedema, increased mucus production, and increased bronchial smooth muscle reactivity All these events lead to recurrent episodes of wheezing, dyspnea, tightness of the chest, and cough, as witnessed by Sally Roberts.
Points of Care and Assessment Strategies and Tools
The major points of care for Sally involve managing the presenting symptoms and evaluating the patient using different assessment tools and strategies. These points of care include:
Medication Management
The objectives of medication management are to stop or lessen the occurrence and severity of symptoms, stop recurring exacerbations, stop lung function from declining, and enhance the quality of life There are two types of asthma medications: those for long-term control and those for immediate relief (Kane, 2022) To obtain and keep chronic Asthma under control, daily long-term control drugs are used While short or quick-term medications are used in managing cute symptoms and exacerbations These medication therapies are chosen about patient’s severity, safety and optimum method of care delivery Therefore Sally will be administered with long terms control medication such as corticosteroid This medication is meant to reduce inflammations hence relieving the Sally Roberts from bronchospasm wheezing and shortness of breath (Bozigar et al., 2019) In addition, Sally will need the administration of short-acting beta agnisines, which aid in treating acute asthma symptoms This regimen involves the administration of inhalers to help the patient relive wheezing, shortness of breath and cough The use of these inhalers is regarded as the first line of treatment the patient as evidenced by several randomized controlled studies supporting this practice.
Patient Education
Another critical point of care is patient education Education on asthma management is essential and useful for achieving established health outcomes and better asthma control (Liu et al., 2022) Patients and their caregivers who get targeted Asthma education gain information about Asthma, skill sets for managing it at home, implementation plans for modifying asthma control, and empowerment Incorporating self-management instructional components into the patient and provider treatment decreases the need for emergency room visits and hospital stays, improves health status, diminishes activity limitations, enhances the quality of life and reported asthma control, and increases medication compliance At every point of interaction with the patient and their careers, it is crucial to reinforce the message of asthma self-management education Patients and their caregivers should receive education on the basic and important information on Asthma, which includes w hat constitutes Asthma under control, functions of drugs, how to use inhaler devices with proper method and self-monitoring based on symptoms or peak flow (Dixon et al., 2021) In addition, Sally will need to be educated on recognizing triggers and mitigation of environmental exposure as well as when to respond to asthma symptoms that are getting worse and how to do so, as well as where and when to get medical help The reason for this management strategy is that it is one of the proven methods for improving patient outcomes.
Monitoring the Patient
Another essential point of care for the patient is monitoring for control and follow up To acquire and maintain asthma control, a progressive therapy method is advised, where the dosage, amount of drugs, and regularity of intake are raised as required and reduced as appropriate (Liu et al., 2022) The need to independently take into account asthma’s ongoing influence on life quality and functional status, as well as the dangers Asthma provides for adverse occurrences in the future, is highlighted by the assessment of both the realms of damage and risk Due to the dynamic nature of Asthma, regular monitoring is necessary to keep the illness under control and determine the smallest step and dose of treatment The management of Asthma can be reviewed, and the effectiveness of treatment can be observed through appropriate monitoring The domains of asthma impairment and risk can be used to further segment asthma severity and control (Ray & Kelly, 2019) The surveillance process can use precise evaluation procedures, such as tracking asthma signs and symptoms, pulmonary function, missed days from work, school, or other obligations, quality of life, history of asthma exacerbations, compliance with and side effects of the patient in patient satisfaction.
Psychosocial Assessment of the Patient
Care for asthma patients may be negatively impacted by psychological stressors such as social position, caregiver knowledge, and the existence of emotional or mental illnesses in family members Adherence to an asthma treatment plan may also be impacted by cultural and ethnic beliefs or perceptions regarding asthma or other chronic illnesses Patients who suffer from depression or other psychiatric disorders frequently describe deficits that are more severe In addition to symptom management, social or mental health treatments may enhance patients’ perceptions of symptom control The NHLBI guidelines from 2007 have increased the significance of delivering asthma care that is sensitive to the patient’s and caregiver’s ethnicity and culture while also taking into account their educational background (Kane, 2022) The home environment may affect asthma treatment and adherence to therapy, according to the literature asthmatic patients have been discovered to be more susceptible to behavioural problems including depression and others that call for psychiatric treatment.
Assessment Strategies and Tools
Assessment of the patient is another critical point of care One of the assessment strategies used in the assessment of lung functions Lung function tests for asthma patients often comprise several routine evaluations These include spirometer measurements of airflow restriction and evaluations of bronchodilator response Lung spirometer measurement is a test that analyzes the air that is exhaled and inspired objectively This assessment method help in confirming a restriction in airflow (Otani et al., 2022) In addition, it determines whether airflow restriction may be reversed after taking a short-acting bronchodilator The advantage of this method is that it is reproducible and non-invasive One disadvantage of the method are that spirometers might not be available right away in some medical settings In addition, given the low sensitivity of bronchodilator reversibility, care must be used when interpreting the results Furthermore, the costs of instruction and equipment are high Another lung function test is carbon monoxide diffusion capacity This method determines the lungs’ capacity to move gas and assesses any problems with gas transfer (Bozigar et al., 2019) The technique helps in determining the diagnosis of emphysema Some of the advantages of the method are that it is reproducible and also less invasive However, results are susceptible to physiological variance, testing methodology, mistakes in gas analysis, and computer algorithm faults.
Bio makers assessment is also another effective strategy of assessment Biomarkers are observable traits that can be quantitatively assessed to determine if a biological process is normal or pathological Four primary functions comprise the clinical utility of biomarkers One of them is that it plays a major role in diagnosis of the condition In addition, it helps in illness staging and continuous monitoring of disease development Furthermore, the technique aids in the evaluation of treatment effectiveness This assessment method thus helps in determining the method of biomarker investigation hence enabling the identification of new targets for innovative therapeutics in addition to providing clinicians with a full grasp of the underlying biological mechanisms behind illness development Serum immunoglobulin-E, peripheral blood eosinophil, sputum eosinophil counts, and exhaled fraction of nitric oxide are employed in practice as airway inflammatory indicators (Olatunji et al., n.d) However, there are restrictions on biomarkers that prevent their use in clinical practice such as their expensive nature.
Applying the Principles of Risk Assessment and Management Reflecting Positive Risk Taking
Principles of Risk Assessment and Management
Risk assessment and management in healthcare refers to systematic processes used by healthcare practitioners to detect, monitor, assess, mitigate and prevent unforeseen circumstances. Healthcare providers that use risk assessment and mitigation proactively and methodically protect patient safety as well as their resources, customer base, certification, levels of reimbursement and reputation in the community (Wu et al., 2021) These risk assessment and management is important for Sally Robert’s condition as it helps in ensuring she receives full health care services Based on the definition of risk assessment and management, three principles of risk assessment and management can be applied to Sally Roberts case These aspects include preventative factors that are categorized into primary, secondary and tertiary prevention methods Primary prevention is lowering or removing risk factors that can predispose the patient to asthmatic attack These activities include lowering factors such as the elimination of allergens like house dust, mite antigen, smoking and irritants that can trigger asthmatic attack in the patient Secondary prevention, on the other has, includes detecting and managing the patient of the condition through conducting screening activities through conducting comprehensive history taking, and testing the pulmonary functions to determine the presence of hyper-responsiveness or sensitizations Moreover, primary prevention involves conducting an in-depth investigation to determine the triggers of asthmatic detection in the patient Tertiary prevention, on the other hand, involves activities meant to lower disease morbidity in the patient following the diagnosis of her condition (Bozigar et al., 2019) A case of tertiary prevention is the constant use of anti-inflammatory drugs to prevent inflammation or the elimination of the origins of antigen Examples include removing causes of antigen triggers such as replacing isocyanides-containing spray paints at the workplace in case she is sensitive to isocyanides.
Points of Positive Risk-Taking and Risk Management and Assessment
Positive risk-taking is a tactic that places more emphasis on what people can do than just their constraints. The first step in taking beneficial risks is identifying potential rewards or harm. It is preferred that people take positive risks in order to foster personal development or growth. (Otani and others, 2021) Taking the time to plan an activity with their caregiver and think through the risks and what-ifs. These steps are essential in assisting Sally in regaining her confidence in her independence and ability to move around. One of the examples of positive risk-taking in managing Sally is the use of corticosteroid inhalers to relieve inflammations of airways While this measure is the best point of care in managing Sally, there is a risk that taking the medication can cause weight gain to the patient due to its effects of increasing appetite In addition, long-term management with corticosteroids predisposes the patient to developing pneumonia which is another serious respiratory problem that can make the condition worse In such occasions, risk assessment and management can help in reducing the likelihood of these unforeseen events from occurring (Olatunji et al., n.d) Risk assessment and management include conducting weight monitoring activities of Sally Roberts during follow-up visits to measure their weight and determine if there is any unprecedented weight gain In addition, monitoring vital signs is another risk assessment strategy to determine if she is improving or she is developing pneumonia to change the medication if she is developing signs and symptoms of pneumonia.
Another positive risk-taking is lung function testing, one of the points of care. These are tests meant to determine the presence of asthma diagnoses or determine if the prescribed medications are working. While this assessment strategy is critical in asthma care, there are risks associated with some of these tests. One of them is provocation tests, a lung function test. This test can trigger a fatal asthmatic attack in the patient (Wu et al., 2021). Therefore, risk assessment and management are necessary to avoid such events by first using other lung function tests Like a spirometer or availing all the resuscitation medication in case the patient has an asthmatic attack during the test.
Legal and Ethical Issues in Delivering and Evaluating Care of Adults with Health Difficulties
The integrity of the nursing profession depends on adherence to ethical and legal codes, which serve as a framework for ensuring that patients receive optimum care. Due to the emerging issues facing healthcare each day, nurses are encouraged to ensure adherence to the ethical and legal conundrums. The core of many of these scenarios is protecting patients’ rights, having adequate staff, making wise decisions, and providing high-quality patient care (Liu et al., 2019). Given the rise in the number of new nurses entering the profession, many require additional practice in navigating ethical and legal challenges in the nursing industry. To address these issues, skilled nurse managers and CNOs are vital to the healthcare team.
Examples of Legal Issues
In the context of Sally Roberts’s case, various legal issues may arise in the course of her management For example, the nurse, unaware of the patient allergy gives her a medication which triggers an allergic reaction making the patient go into coma or give the patient a medication overdose due to prescription errors by the physician These actions are examples are legal issues of healthcare system malpractices (Wu et al., 2021) These legal issues are one of the major cause of medical errors that adversely impacts the quality of healthcare outcomes Such errors can lead to worsen that patient condition putting their safety at stake As a result, healthcare providers are encouraged to adhere to the Nursing and Midwifery Council codes of practice which call for providers to ensure evidenced-based decision making and judgment in executing their activities In addition, the NMC code of practices uphold that health care providers should collaborate with others during the care process to ensure high quality care.
Examples of Ethical Issues
Numerous ethical issues can arise in the care of Sally. One example is the issue of informed consent that may arise in the care of Sally. A problem could develop if there is concern that patients and their families have not been informed of or do not understand the treatments used on a patient. Because they might need to comprehend the implications of their therapy fully, patients occasionally may feel uncomfortable asking questions or giving consent. Patients who feel supported and confident in their doctors and nurses are more likely to adhere to a treatment plan and achieve greater results. To prevent ethical issues, nurses should ensure that patients understand every facet of their therapeutic interventions. 2019 (Bourdin et al.) Among the most important things to know are all the risks, the intricacies of how an operation will be performed, and how particular medications and therapies operate. If not, hospitals could face high costs and patient safety risks. Nurses must make every effort to ensure that their client is aware of the treatment plan to obtain informed consent. Additionally, nurses must tell patients about their diseases, treatment options, and whether those options have FDA approval or not. To safeguard patients from potential harm, the doctor should use caution when considering the benefits and drawbacks of a medication that has not yet been approved for use (Liu et al., 2019). They ought to take advantage of the most recent and best data accessible. Patients with long-term or chronic diseases, such as Asthma, should be evaluated by the prescriber for any potential risk factors, such as susceptibility triggers.
Another ethical issue is patient privacy and confidentiality. For instance, Sally may not disclose her diagnosis to a family member. However, their knowledge about her condition is essential to ensure she can effectively manage the conditions. This issue is a major challenge that, if not done correctly, can lead to legal ramifications and consequences for nurses. In addition, failure to ensure confidentiality can impact patients’ trust in nurses, which will impact this communication and formation of the therapeutic relationship, which is key to achieving high-quality care (Holst et al., 2020). Therefore, nurses must respect patient autonomy and clients’ rights and operate in their best interests. All healthcare professionals should be aware of patient autonomy, which refers to a patient’s right to independently make decisions about their care based on their personal or cultural beliefs. When patients are autonomous, they can refuse treatments, medications, or surgeries. Regardless of whether it goes against the advice of doctors and other healthcare professionals, the nursing staff must respect this decision and implement it.
Factors that Can Increase Potential for the Risks
The most frequent causes of legal and ethical issues are communication problems. These problems can happen between doctors and nurses of the patient. Legal and ethical are typically the outcome of poor communication. Another cause is human problems. Human issues arise when the quality of practice, policies, protocols, or processes need to be correctly and effectively followed. Examples include specimen labeling and inadequate documentation (Bourdin et al., 2019). When people lack the knowledge to give the necessary care at the appropriate time, knowledge-based errors also happen. Furthermore, the lack of adequate healthcare workers causes a high workload to the healthcare workers, making them unable to provide maximum such as adequate communication leading to legal and ethical issues.
Conclusion
The above discussion provides an in-depth discussion of Sally Roberts’s diagnosis of Asthma. This condition is caused by information of the bronchial wall leading to wheezing, coughing, shortness of breath and dyspnea. The condition can be diagnosed through conducting lung function tests as one of the assessment strategies Management of the condition involves the use of medications such as corticosteroids, education of the patient about how to manage themselves and prevention of the triggers. During the management of the condition, healthcare providers are urged to be vigilant to prevent ethical and legal issues, such as informed, confidentiality, and privacy issues. These issues lead to poor healthcare outcomes and reduced patient satisfaction. Therefore, it is important to adhere to a professional code of practice to prevent any form of malpractice from occurring.
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