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Asthma Management in the Medical Ward: A Holistic Approach to Care and Ethical Considerations

  • 07 Pages
  • Published On: 06-11-2023
Essay

Introduction

In the medical ward, which is specific for respiratory and its associated problem Mr. H, who is 72 years old, get admitted with a chronic illness of asthma. The patient has a long term medical history of chronic respiratory problems associated with asthma. Asthma is a severe medical condition where the airways get swelled and excess mucus secretion takes place, due to which problems in breathing occur. When this persists for long time severe medical problems will arise. (Kudo, et al, 2013) The patient was chosen due to his chronic illness history which should be treated with proper intervention of registered nurse by following proper ethical guidelines and principle of holistic care. At the same time the reflective outcome can also help to grow expertise in this particular area of care giving by using proper reflective analysis. The patient is suffering from long term illness and therefore his physical and psychological balance has been shifted fur from normal condition due to prolonged illness. A collaborative approach towards improvement of breathing problems, communication difficulties can be useful for the overall wellbeing of the patient. Moreover, in this essay the ethical and legal points will be also addressed to cover the aspect of holistic care towards the patient’s wellbeing (NMC Code, 2018).

Ethical and professional role of Registered Nurse (RN)

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During the course of practice with asthma patient the ethical issues regarding consent seeking is a very important issue for Registered Nurse (RN). As asthma bring forward problems related to breathing. Sometimes this problems leads to severe conditions like nebulization and steroid injection insertion (Edmonds, et al, 2012). These preventive measures should always be done with proper consent received from the patient. If the patient is not in good condition of providing consent, his family is asked to give the consent for proper treatment (Thomas, et al, 2012; James et al, 2011). In case of Mr. H, the illness is a prolonged one and his mental stability sometimes goes down due to pathopsychological problems associated with asthma. Therefore, psychological interventions from the integrated healthcare system becomes sometimes necessity, which is again another job which needs consent from the patients family (NMC Code, 2018). The medical history and regular accountability of improvement or deterioration is another important ethical issue, which is encountered for Mr. H. Noting down the regular physical parameters, therefore becomes a liability of RN (NMC Code, 2018). The pathological condition of the patient does not permit him to properly communicate sometimes. Newcomb et al. discussed the barriers related to communication with patient suffering from asthma (Newcomb, et al, 2010). Therefore, enough stress must be given to the communication for effective communication with Mr. H.

Pathological changes of the condition on the patients’ health and wellbeing

As stated earlier asthma is a chronic problem of inflammation in the airways. Therefore, prolonged conditions of asthma has severe effects such as hyper responsiveness is airways , limitations in airflow as well as other respiratory problems. In case of Mr. H due to chronic illness some other problems like, structural changes in airway also happened along with the above stated problems. This in turn makes long term physical effects like, continuous coughing for a certain period of time, shortness in breath, trouble in daily work, unrestful even during ideal time, fatigue, pale and sweaty skin along with laziness in behaviour. For Mr. H these difficulties led to severe impairment in overall wellbeing as he could not take proper rest during night time. (Ritz, et al, 2010; Mancuso, et al, 2013)

The psychological impact of asthma depends on several things like, amount of severity, limitation of movement, social support, family support, length of suffering as well as proper awareness about the disease (Judd, et al, 2014). Though children and younger adult can retain day to day activity even with the asthmatic problems, but for vulnerable adults it is a bit difficult. According to Fernandes et al. seventy percent of the patients are found to have anxiety as a side effect of asthma which intern affects the wellbeing of the patient (Fernandes, et al, 2010). These problems in turn triggered the feeling of depression, sick role, lower self-esteem as well as lower cognitive ability. For aged and vulnerable patients these may have severe impact and by proper behavioural therapy these should be treated in an integrated health care model. Moreover, some panic attack and emotional problem restrict ability of self-management during asthma. The steroid and other drugs had side effect on the patient and in case of Mr. H the asthma was steroid dependent in nature. Therefore, some other problems due to steroidal side effect was encountered.

Principles of collaborative, holistic assessment to identify the core needs of the patient

The patients suffering from chronic asthma can grow several complications related to metal and physical parameters. Therefore, proper intervention is always necessary using a holistic manner of combating the illness. Activity of living is an important point which need’s focus in this regard. Activities that are related to daily life like, breathing, bathing, keeping personal hygiene, communicating with the environment, physical movement and many others, are termed collectively as activities of living or activities of daily living. For asthma mobility of a person can low down due to severe problems like dyspnea, exacerbation and chronic respiratory problems (Miravitlles, et al, 2013). However, the most problematic part of the asthma is, painful breathing condition. This problem mostly hamper the quality of living of the aged persons like, Mr. H. The aging brings several chronic problem to a person, and asthma makes it worst. Jones et al. discussed that, if the asthma of elderly persons are left untreated, it may lead to severe consequences related to breathing problems (Jones, et al, 2011). This is perhaps most severe problem related to activity of living ever encountered for asthma patients. The RN commonly encounter this problem and need to check its status from time to time. Moreover, several co-morbid factors influence this condition, like gastrointestinal reflux and the nurse need to take care of these side factors as well during the care giving. Moreover, the external environment like, dust and pollen can instantly trigger the breathing problems. RN needs to take care this matters constantly using proper equipment and medicinal supports. (Markus, et al, 2012) Collaborative approach to identify the patient’s need:In spite of the apparently visible problem related to breathing, the reason behind the trigger may be difficult to understand. Triggers may be present at home, at the nursing home, at the household chemicals. The assessment of the problem can only be done upon intervention of a collaborative team. The person is the best judge of the ailment, however due to the age related loose of cognitive skills the patient may not be able to recognize these. In that case the necessary help can come from the family members and the carers. The family members can provide the patient constant support for growing awareness about his problem. They can build pragmatic approach inside the patient’s mind regarding self-management. The change in behavioural issues can lower down the frequency of asthmatic attack and hyperventilation. Regular habit of taking medicine and inhalers can allow an asthma patient to lead healthy regular life. The carer can look for the core needs of the patients like, the use of inhaler, true timing of onset of the breathing problems and use of certain objects which trigger the problem. Social factors can also contribute in this way. A perfectly aware environment can limit the use of asthma triggering fumes or vapours to meet the proper needs of the patient. Recently, social workers are much involved in this business of asthma care (Liechty, 2011). Grammatopoulou et al. have recently discussed how holistic care can increase life expectancy of asthma patients (Grammatopoulou, et al, 2017).

Self-effective and patient cantered care

Healthcare with an approach of patient education, self-effectiveness and meaningful targeted education can improve the life style and wellbeing of an asthma patient to a huge extent. The management of factors that trigger asthma can allow the patient to achieve the normal behavioural traits that the missed due to pathophysiological outcome of asthma. Moreover, learning the proper way of eating, reducing stress and regular maintain of hygienic behaviours improves overall wellbeing of the patient by reducing several comorbid factors as discussed earlier. For older adults however, due to decrease in cognitive skills self-effective care becomes difficult, but regular intervention of different specialist can improve self-care to achieve proper wellbeing. Lahmann et al. have discussed the role of relaxation in improvement of older asthmatics (Lahmann, et al, 2010). Regular medication monitoring daily condition of breathing using peak flow meters can be an effective way of self-care for asthma patients. Following key points can be set as goal for registered nurses to enhance self-care education:

For asthma patient it’s a mandatory condition that he/she must get personalised advised from clinician.

Plans can be retain or can be delivered as a tabulated form.

Regular intervention is needed with the help of integrated team whether the patient is improving in terms of skilfulness.

Any kind of perturbation or behavioural flaws that trigger the asthma should be effectively understood by the patient.

The patient cantered care on the other hand emphasise on the protection of patient. The key point of a patient centred care is the patient is the core point of making decision and clinicians carers and the family constantly support them by information, advise and requisitions, but patient is the ultimate person to decide the final course of action. The way of patient centred practice also deals with evidence base practice, which integrates the expertise of different clinicians by using research evidences. For asthma patients the challenges are sometime become very high. For older adult like Mr. H the education self-care and evidence based practice sometimes need high degree of decisiveness among the registered nurses (NMC Code, 2018). Communication, continuity in care and concordance are three Cs, which is generally followed during patient centred interventions. (Uamar, et al, 2010)

Importance of reflection in linking theory to practice

Acute asthma management deals with a few steps in which proper assessment of the disease and the amount of severity should assessed from the involvement of multidisciplinary team. RN has played a pivotal role in coordinating the team and delivering the care in most effective manner. Along with asthmatic problem the patient has comorbid factors associated with old ages. Moreover, his cognitive behaviour are not strong enough to deliver self-care. In this regard RN has introduced several important tricks by using the theory of patient centred care (NMC Code, 2018). In spite of problematic comorbid factors and lower amount of cognitive efficiency of the patient the involvement of evidence-based practice by the registered nurse improved the wellbeing of the patient. (NMC Code, 2018)

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Conclusion

For long-term chronic disease patient it is necessary identify the extent of illness and the factors that hamper the overall wellbeing of the patient. Involvement of registered nurse is very important to make a proper approach towards the cure of patient. In this regard the collaborative, holistic care can significantly improve the overall wellbeing of the patient by effective introduction of self-care education and patient centred care approach. The two processes can reinforce each other in a symbiotic way to get high professionalism in care giving.

References

Edmonds, M.L., Milan, S.J., Brenner, B.E., Camargo Jr, C.A. and Rowe, B.H., 2012. Inhaled steroids for acute asthma following emergency department discharge. Cochrane Database of Systematic Reviews, (12).

Fernandes, L., Fonseca, J., Martins, S., Delgado, L., Pereira, A.C., Vaz, M. and Branco, G., 2010. Association of anxiety with asthma: subjective and objective outcome measures. Psychosomatics, 51(1), pp.39-46.

Grammatopoulou, E., Skordilis, E.K., Haniotou, A., John, Z. and Athanasopoulos, S., 2017. The effect of a holistic self-management plan on asthma control. Physiotherapy theory and practice, 33(8), pp.622-633.

James, J., Cottle, E. and Hodge, R.D., 2011. Registered nurse and health care chaplains experiences of providing the family support person role during family witnessed resuscitation. Intensive and Critical Care Nursing, 27(1), pp.19-26.

Jones, S.C., Iverson, D., Burns, P., Evers, U., Caputi, P. and Morgan, S., 2011. Asthma and ageing: an end user's perspective‐the perception and problems with the management of asthma in the elderly. Clinical & Experimental Allergy, 41(4), pp.471-481.

Judd, L.L., Schettler, P.J., Brown, E.S., Wolkowitz, O.M., Sternberg, E.M., Bender, B.G., Bulloch, K., Cidlowski, J.A., Ronald de Kloet, E., Fardet, L. and Joëls, M., 2014. Adverse consequences of glucocorticoid medication: psychological, cognitive, and behavioral effects. American Journal of Psychiatry, 171(10), pp.1045-1051.

Kudo, M., Ishigatsubo, Y. and Aoki, I., 2013. Pathology of asthma. Frontiers in microbiology, 4, p.263.

Lahmann, C., Henningsen, P., Schulz, C., Schuster, T., Sauer, N., Noll-Hussong, M., Ronel, J., Tritt, K. and Loew, T., 2010. Effects of functional relaxation and guided imagery on IgE in dust-mite allergic adult asthmatics: a randomized, controlled clinical trial. The Journal of nervous and mental disease, 198(2), pp.125-130.

Liechty, J.M., 2011. Health literacy: Critical opportunities for social work leadership in health care and research. Health & social work, 36(2), pp.99-107.

Mancuso, C.A., Choi, T.N., Westermann, H., Wenderoth, S., Wells, M.T. and Charlson, M.E., 2013. Improvement in asthma quality of life in patients enrolled in a prospective study to increase lifestyle physical activity. Journal of Asthma, 50(1), pp.103-107.

Merkus, P.J., Stocks, J., Beydon, N., Lombardi, E., Jones, M., McKenzie, S.A., Kivastik, J., Arets, B.G. and Stanojevic, S., 2010. Reference ranges for interrupter resistance technique: the Asthma UK Initiative. European Respiratory Journal, 36(1), pp.157-163.

Miravitlles, M., Soriano, J.B., Ancochea, J., Munoz, L., Duran-Tauleria, E., Sánchez, G., Sobradillo, V. and García-Río, F., 2013. Characterisation of the overlap COPD–asthma phenotype. Focus on physical activity and health status. Respiratory medicine, 107(7), pp.1053-1060.

Newcomb, P.A., McGrath, K.W., Covington, J.K., Lazarus, S.C. and Janson, S.L., 2010. Barriers to patient-clinician collaboration in asthma management: the patient experience. Journal of Asthma, 47(2), pp.192-197.

Nursing & Midwifery Council, 2018. The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates.

Qamar, N., Pappalardo, A.A., Arora, V.M. and Press, V.G., 2011. Patient-centered care and its effect on outcomes in the treatment of asthma. Patient related outcome measures, 2, p.81.

Ritz, T., Rosenfield, D. and Steptoe, A., 2010. Physical activity, lung function, and shortness of breath in the daily life of individuals with asthma. Chest, 138(4), pp.913-918.

Thomas, C.M., Bertram, E. and Allen, R.L., 2012. The transition from student to new registered nurse in professional practice. Journal for Nurses in Professional Development, 28(5), pp.243-249.


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