Anticipatory Approach To Nursing


A sick person is one who hardly succeeds alone to better his or her living conditions. Indeed, well-trained assistance and infrastructure need to intervene to improve patient’s health and wellbeing. In this essay, we are both determining and discussing the importance of anticipative supervisions and available approaches relative to health assistance when giving permanent supports to sick persons with a life-long condition. As such, our essay follows four main patches: the first patch analyses the use of self-management technics to consider symptom recognition, medical care, educational interventions, and self-monitoring in finding patients lifestyle betterments. The second patch reviews the steps, answers, and medications used by care providers as a response to worsening sick person’s conditions or end life care. The third patch, however, explores the function of digital and information technology in helping human beings/ families/carers in an era of healthcare contents as considered by the NHS 24, health apps social media. Lastly, we present the philosophy, theory and underpinning processes of anticipatory care in influencing health care delivery, and we explain how nursing models may support holistic assessment and care planning in anticipatory care.

Patient self-management strategiesPatient self-management has been used as an effective tool for managing chronic illness and while allowing the patients to be actively involved in improving their health conditions. According to Adjtya et al (2003), self-management refers to a patient’s ability to manage their treatment, symptoms, lifestyle changes, psychosocial and physical consequences that are brought about by chronic illnesses such as cancer and diabetes. The behavioural, cognitive and educational strategies are meant to help the individual address the health issue inherent in their personal and professional life after chronic illness diagnosis.

Education and symptom recognition

Because patients with chronic illness may experience health complications during their entire lives, self-management strategies are effective in ensuring that they live with these illnesses cheaply. Nonetheless, the first self-management strategy is cognitive symptom management, where the patient develops skills for identifying and responding to various symptoms related to their conditions. According to Arsand & Demiris (2008), it entails providing education to the patient about any signs and symptoms of the illness that may emerge and how to manage such symptoms. Patient education on symptom management is important in managing crucial chronic illnesses such as heart failure. For example, Basch et al (2005) assert patients with little knowledge about heart failure symptoms, how to recognize them and what to do when they worsen are more likely to seek hospital readmission. Therefore, cognitive symptom management, enabled by patient education, emerge to be effective self-management strategies for patients with chronic illnesses.


Lifestyle Modification

Another effective self-management strategy is lifestyle modification. According to most randomised control trials and epidemiological studies on some types and aspects of long-term illnesses such as lipids and blood pressure, managing various determinants of chronic illnesses through lifestyle and dietary modifications help reduce the associated risk factors and play a major role in preventing or reducing the escalation of chronic illness such as cancer and diabetes (Cash, 2003). These assertions corroborate with the words of Adjtya et al (2003) that obesity and overweight are associated with increased mortality of breast, kidney, and colon cancer among other sites. Thus, it is important for patients with chronic illness to keep a personal check on their weights, to prevent the escalation of their conditions especially when the illness is sensitive to poor weight (Arsand & Demiris, 2008). Other lifestyle modifications include engaging in regular physical exercises. In this regard, according to Basch et al (2005), physical exercises create an opportunity for the patient to spend more energy and pay an effective role in weight control, thereby reducing chances of developing more complications of the illness.


As part of self-management strategies, research reveals that self-monitoring is an effective strategy with several clinical benefits on persons with chronic illnesses. Considered by Creer (1997) a fundamental component of self-management, self-monitoring entails the performance of various activities such as self-interpretation of symptoms, self-identification, and measurements of various illness signs, self-awareness of one’s illness and self-adjustment to the prescribed medication.

Arsand & Demiris (2008) indicate that self-monitoring helps to deal with chronic illnesses by reducing high blood pressure, reducing adverse events and ultimately reducing the mortality rates of persons with chronic conditions. For instance, the National Institute for Health and Care Excellence (NICE, 2011) guidelines indicate that patients should practice self-monitoring of their blood pressure and vitamin K antagonist in high blood pressure and atrial fibrillation respectively. While Basch et al (2005) claim that the exact implications of self-monitoring are not well known, they also assert that self-monitoring is a strategy that helps patients with chronic illnesses to keep track of their health conditions and be aware of any symptom that may need medical attention. Nonetheless, more research is still required to identify the exact impact of self-monitoring on the patient’s well-being.

Responding To a Deteriorating Patient

Maintaining high healthcare standards entails the establishment of systems that help in recognizing and addressing deteriorating patient conditions, systems that are established and maintained by any healthcare service provider. According to Sharma et al (2016), maintaining these standards entails delivering effective healthcare services to all demographics including children, adolescents, adults and the old, as well as delivering to these demographics all types of care including mental health care, maternity, surgical care, and medical care services. However, in doing so, there are several activities and procedures that practitioners must undertake to ensure that these services are effective.

Rajiv et al (2014) argue that there must be rapid recognition and response systems meant to promote and enhance rapid response to all people with deteriorating health conditions. It involves the coordination of a range of practitioners such as clinicians, health service managers, and facility owners in establishing and maintaining rapid response deteriorating patients – in a manner that considers the patient’s local context.

Ideally, to paraphrase Borba et al (2017), these systems are meant to measure and document important observations made on the patient including the frequency and duration of important psychological observations as well as appropriately document the patient monitoring plan. Nonetheless, the care providers must be able to make psychological observations meant to assess and observe the mental status of the patient in order to detect any form of physiological deterioration in the patient. According to Mariam et al (2015), these observations may involve the patient’s respiratory rate, blood pressure, and temperature as well as oxygen saturation. In regards to mental assessment, it is important to assess the patient’s level of consciousness by evaluating their responsiveness or how alert they are.

The actions implemented by caregivers in response to patient deterioration vary with varying types of patients. For instance, in the case of paediatrics, caregivers use various early warning tools to respond to the health deterioration of children. More importantly, in most cases, these tools are applied under the guidance the advanced paediatric life support criteria (APLS) and they help practitioners to measure the child’s temperature, heart rate, oxygen requirements and other physiological observations (Sharma et al, 2016). Similarly, according to Ralph et al (2018), these tools are age specific to enable the practitioner to recognize any deterioration early enough for purposes of early escalation of care.

All in all, the observations made from these assessments can be recorded in the nominated observations records chart, which may have different specialties depending on the decisions made by hospital management executives (Mariam et al, 2015). Afterward, it is the responsibility of the rapid response team to respond to the patient at the established time. The response process should be systematic and adhere to the established guidelines. For instance, the patient should not be transferred intra-hospital or inter-hospital unless the transportation is conducted by a response team with high-level skills of patient life support (Borba et al, 2017). Equally, upon making the medical emergency call, the doctor responsible for handling the patient must be notified to be prepared. Correspondingly, Borba et al (2017) suggest that all the clinicians that are part of the response team must communicate with the doctor or among themselves in a systematic and structured way.

Health Digital information system

Technological advancement has enabled physicians to have a better, easier and more efficient diagnosis of patients, making the medical profession a lot easier. According to Bellazzi et al (2002), medical technology spans from information technology to innovative technological applications in biotechnology and pharmaceuticals. However, of interest herein is medical information technology.

Indeed, medical technology has transformed the way healthcare services are delivered within the UK and other countries that have embraced such technology. To paraphrase Chan et al (1999), elements of medical IT such as electronic medical records management systems, health mobile apps (e.g. NHS 24), and telehealth services has made it easier to patients, physicians, family member and carers to connect and coordinate for an easier delivery of healthcare.

A major role that healthcare information technology has played in the improvement of healthcare delivery is its ability to reduce medical errors. For example, studies by Geisler (2008) indicate that computer systems that help in physician order entry (i.e. CPOE) have played a major role in reducing medical errors by about 80% in the United States. Moreover, telehealth/Telemedicine has been a major medium of care delivery used by physicians to monitor the progress of patients with chronic illness without having to be physically in contact (Goossen, 2003). For instance, in the UK, the NHS 24, Scotland’s telecare service provider provides health care services to any caller who would like to have out-of-service-hours (i.e. during Fridays, weekends, and public holidays) healthcare services. Moreover, the telephone services allow members of the public to access health advice from practitioners when they cannot wait until normal official days to get such guidance. Similarly, according to Horner (2001), through telemedicine, patients can engage with their physicians from the comfort of their homes, thereby reducing costs while accessing quality healthcare.

With the proliferation of mobile technology, a major breakthrough achieved by healthcare practitioners is the development of mHealth Apps. According to Darkins et al (2008), Mhealth or mobile health apps are tools for delivering healthcare information through mobile phones and tablets. And have been useful in achieving various healthcare service improvement goals such a delivering healthcare consultation through SMS texts. Mhealth has also played a key role in the implementation of UK’s health and cares information strategy, an integrated platform within which the health records are stored and managed (Bellazzi et al, 2002). Indeed, nearly half of the UK population possess smartphones and with the increasing efficiency of health information systems, it is speculated that more and more people will be willing to use their smartphones for healthcare purposes (Darkins et al, 2008).

Advance Care planning

The interventions, responses, and actions initiated by care providers in response to patients who need end of life care, or those with deteriorating health conditions are also called Advance Care planning (ACP) or Anticipatory care planning, the interventions (Charles et al, 1999). Majorly, ACP is meant to improve the lives of such patients; even though Shucksmith et al (2012) indicated that by 2012, only 5% of the respondents in British Social Attitudes survey were under ACP.

Nonetheless, ACP is used by people with long-term illnesses who are aware that they may soon lose the mental capacity to make important decisions (Charles et al, 2003). Thus, it involves a coordinated and structured collaboration between the patients, carers/families, and the health practitioners to ensure that the patient’s preferences and wishes of how they would like to be clinically handled are known to everyone especially in situations where they may not be able to make important decisions. I doing so, the practitioners engage in practices and interventions such as opening discussions with the patient, exploring and identifying their wishes, communicating and recording these wishes.

In some countries such as the UK, there are documents such as the ‘power of attorney’ which is a legal document for recording a patient’s wish to allow someone else makes decisions on their behalf during terminal illness (Mason et al, 2015). Moreover, most people in the UK also use these documents to give orders regarding how they would like their financial assets and properties to be managed.

During terminal illness, practitioners can also give the patient to express their wishes about future medical interventions that may be needed when they are unable to make decisions regarding them for instance, in the UK, patients may be required to sign an Advance Decision to Refuse Treatment (ADRT) document, which highlights the patient’s wish not to undergo a specific type of treatment or medical i9ntervention in future (Thoonsen et al, 2016). For example, if the patient may not want to undergo resuscitation or take certain antibiotics, the practitioners may respond to this by making the patient sign the ADRT.

Whereas ACP has several benefits such as ensuring that patient care during terminal/long-term illness is personalized, Baker et al (2015) assert that initiating discussions about ACP is a difficult affair and this difficulty creates a barrier against ACP altogether. Similarly, while ACP helps in improving end of life healthcare by ensuring that the patient’s care preferences are identified in earlier stages of the disease, engaging in ACP at the wrong time may (i.e. in the later stages of the disease) render it less effective (Charles et al, 2003). Yet, it is impractical to engage in ACP early enough because it is an intervention that should not be initiated until death is imminent (Thoonsen et al, 2016).

Holistic Care

Holistic care is seen as a procedure where persons or patients are not only treated through physical symptoms or health conditions but also mentally, emotionally, spiritually, relationally and socially environmental (Royal College of Nursing, 2010). Lindsay (2012) asserts that nurses play a key role in promoting patient’s health by discussing with them about both their spiritual needs and views, in an open, non-judgemental and supportive environment. This provides a important framework for the patient’s to work through difficult decisions and confront difficult outcomes.

In addition, having a strong spiritual base and foundations for some patients and persons helps them to best face difficulties related to health conditions and shape their decision-making processes (Weber 2005). As such, nursing models and theories are used to identify, describe and explain a range of nursing concepts that promote patients in need. Holistic care also enables nurses to be aware of patient’s spiritual practices such as prayer or bible studies and how this might affect the daily nursing care routine. This promotes better communication and understanding between nurses and patients.

Moreover, Luxford (2012) says that a holistic assessment can be used to assess either individual or family health care needs depending on the circumstances. Nonetheless, studies on the role of different theories and models reveal that holistic care can be achieved through various models, each with specific issues and approaches. However, some of the most common models include Roper-Logan-Tierney model of nursing (Nursing Theory, 2016). This model is executed based on an assessment of the patient’s daily living activities enabling the nurse to offer holistic care and determine the interventions required to promote maximum patient independence. The other model is that of Orem’s self-care deficit theory (Nursing theory, 2016) which supports self-management of the patient’s condition through the re-enforcement of patients assistance and routine checks by the caregiver.

In conclusion, different aspects of anticipatory care have been identified in this assay. This has helped to learn more about self-management strategies, the actions and interventions that care providers must do while providing end of life care, as well as lifestyle changes that patients with chronic diseases such as diabetes must do in order to improve their well-being. The role of digital technology was also been explored together with its drawbacks especially on patient’s life. This paper has also attempted to illustrate the theory that underpins anticipatory care and its impact on health care delivery. Ultimately, the paper has highlighted how nursing models and theories may support holistic assessment and care planning in anticipatory care. Thus, it is important to consider these elements of anticipatory care in every patient especially those that are experiencing long-term illness.

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