Enhancing Patient Care through Comprehensive Nursing Strategies

Introduction

The delivery of high-quality nursing care is important because it helps the patients feel comfortable and hospitable in the care environment which promotes their ease of being healed from health issue. In this assignment, the case study of a patient suffering from erythrocytosis is to be discussed. For this purpose, initially the health assessment of the patient is to be made by following the NEWS2 approach. The GSF principles are to be mentioned to be followed by the nurses during the assessment and leadership styles followed by them is to be mentioned. Thereafter, the nursing intervention for the patient is to be discussed through person-centred care approach. Moreover, the way partnership working is to be successfully established to delivery care to the patients also to be explained.

Case Study

The NMC Code of Conduct mentions that no personal data of the patients are be shared by the nurses without their consent so that their privacy and confidentiality is maintained (NMC, 2018). Thus, in this study, the pseudonym Ms. H is to be used to indicate the patient so that her confidentiality and privacy is ensured. Ms H is a 25-year-old woman who was referred to the clinic for having flu-like symptoms such as headache, tiredness, muscle pain in the legs, difficulty in breathing and others. She was reported to have history of discolouration in her hands along with presence of chronic fatigue. She recalled being mentioned to have high haemoglobin level when she was 10 years old but ignored the condition out of lack of knolwdege. H expressed to have effective vision with no history of venous thrombosis. She is a non-smoker and mentioned there is no family history of blood disorder. She lives along with her mother who has type-2 diabetes and dementia. H is the sole carer of her mother and is currently managing her care along with executing the role of assistant chef in a nearby restaurant.

Health Status Assessment

The health assessment of patient is needed to identify the key problem of the patient. In this purpose, the NEWS2 approach is to be followed to determine the health problem of H. The NEWS2 is National Early Warning Sign which advocates the vital aspects to be assessed in a patient to determine their acute illness or health problem (Smith et al., 2019). The six key parameters focussed are respiration rate, oxygen saturation, systolic blood pressure, pulse rate, consciousness and body temperature (Fernando et al., 2019). However, before following the NEWS2 approach, H on being brought to the clinic was approved of executing a routine complete blood count examination. This is because complete blood count examination is the initial diagnosis for erythrocytosis that is increased presence of red blood cells in the body (Tremblay et al., 2021).

H has already mentioned previously experiencing high haemoglobin levels along with currently showing flu-like symptoms. Thus, to ensure if she is suffering from any other health issue or erythrocytosis, the assessment is been done. The result of the complete blood count for H mentioned her haemoglobin is 16.1 g/dL, platelets 197 × 109/L, erythropoietin 25 mIU/mL, Hematocrit 50.6% and Creatinine is 0.8 mg/dL. The normal values of haemoglobin is 11.6-15 g/dL, haematocrit is 35.5-44.9%, platelets 157-371× 109/L, erythropoietin is 2.6-18.5 mIU/mL and creatinine is 0.59-1.04 mg/dL (hematology.org, 2018). This indicates that the level of haemoglobin along with erythropoietin and haematocrit is high in H indicating she is suffering from erythrocytosis. This is because in erythrocytosis, the red blood cells level is increased which is clearly seen in case of H (Mithoowani et al., 2020).

According to NEWS2 assessment, the respiration rate of H is to be measured. This is because increased presence of red blood cells leads the blood to carry increased amount of oxygen to the tissues and organs making the blood become thicker than normal. It leads to create respiratory problem such as shortness of breath as increased thickness of blood supports hindered movement of oxygen, nutrients and hormones to the different parts of the body causing increased demand for oxygen leading to hindered breathing (Shi et al., 2021). The normal respiration of a healthy adult is 12-20 breaths/minute at rest (Mundo et al., 2021). The respiration rate of H is mentioned to be 26 breaths/min which is higher than normal. The NEWS2 mentions that measurement of oxygen saturation is another key parameter for health assessment of patient (Khani et al., 2021). In the case of H, the oxygen saturation is important to be measured because the presence of erythrocytosis causes thickening of blood that creates complication in effective saturation of oxygen in the blood leading to hindered organ functioning (Corante et al., 2018).

The oxygen saturation in blood is measured by using pulse oximetry and the normal oxygen saturation in blood is 95% (Sema Aylan et al., 2021). In case of H, the oxygen saturation in blood was 80% that is highly below the normal level. The arterial blood gas (ABG) test is to be performed for H. This is because ABG test informs about the acidity level of the blood along with the level of oxygen and carbon dioxide present in the blood realised from the artery (Koul et al., 2020). In case of erythrocytosis patients, the autosomal recessive disorder leads to cause cytochrome b5 reductase (cytb5r) deficiency. The cytb5r is seen to reduce expression of methaemoglobin that is responsible for keeping the number of red blood cells under control (Nagel, 2019). The formation of methaemoglobin occurs with the oxidisation of Fe3+ from heme Fe2+ which in erythrocytosis patients have lower ability to bind reversibly that causes cytb5r development in the methaemoglobin leading hinder flow of oxygen in the blood (Nagel, 2019). Thus, ABG test is to be performed to determine the extent to which the oxygen levels are present in hindered amount in the blood. The ABG test results of H mentioned she has PaO2 of 70 mmHg and PaCO2 of 45 mmHg with pH of the blood is 7.50 indicating her blood is slightly acidic in nature.

The blood pressure is measured in patients with erythrocytosis because the thicker blood concentration regarding increased pressure on the wall of the arteries to move which may eventually make them develop clots that creates adversity of cardiac diseases (Corante et al., 2018). Thus, blood pressure measure as mentioned in NEW2 is to be examined in case of H. The blood pressure of H is measured to be 125/88 mmHg which indicates that she is suffering from high blood pressure as the normal level is 120/90 mmHg in individuals (NHS, 2018). The normal pulse rate in a healthy adult is 60-100 beats/ min (NHS, 2018). In case of H, the pulse rate measured is 98 beats/min which indicates that her heart is working normally. The NEWS2 assessment mentions to determine the consciousness level of the patients (Mellhammar et al., 2019). In case of H, it is seen that she is gully conscious and aware of the actions been taken along with is showing proficiency in mentioning past along with present health history on her own.

The body temperature of H is recorded to be 36.5 ℃ which is considered as normal. The body temperature is measured in H to determine if she has fever which may indicate presence of infection in the body as the immune system when comes in contact with the foreign agents in the body fights back which results in raising the body temperature (Machin et al., 2021). The NEWS2 score recorded finally for H is 6 which indicate H is to be considered as slightly risk patients. This is because NEWS2 score of 0-4 indicates low risk whereas the score of 4-7 indicates low to moderate risk and above 7 indicates high risk (Mellhammar et al., 2019).

Leadership and Management in care

The nurses as leaders require to ensure enhanced quality care is delivered to the patients to improve their well-being (Conroy, 2018). In caring for Ms H, the nurses are going to use patient-centred leadership in leading care for the individual. The patient-centred leadership mentions the leaders to show value towards other frontline staff and support them to act collaboratively to ensure the focus of care remains on the patients so that their needs and demands are effectively fulfilled (Cardiff et al., 2018). Thus, according to the leadership style, the nurses caring for H are to be collaborative with other staff to ensure the focus of care remains on her to meet her specific needs and demands raised due to suffering from erythrocytosis. In person-centred leadership, the leaders are required to dynamic so that they can make changes in delivering care as per the changed needs and demands of the patients with their health progress (Lynch et al., 2018). Thus, to deliver care to H by following the person-centred leadership, the nurses acting as leader are to be dynamic to make any necessary changes in their care delivery as required by the patient with the progress or deterioration in health. In person-centred leadership, the leaders are required to be knowledgeable about the needs of the patients and require having time and resources arranged to deliver high-quality care to the patient (Hølge-Hazelton et al., 2021). Thus, nurses acting as leaders of care delivery for H are to be aware of her specific needs along with arrange resources and manage enough time to deliver the care without error and with high quality.

In order to manage care for H, the nurses are to follow GSF that is Gold Standards Framework developed to guide nurses, general practitioners and others regarding the way to recognise life threatening condition of the patients at the earliest to develop effective plan in improving their health condition (Park et al., 2017). The 7C’s in GSF are communication, coordination, symptom control, continuous care, continued learning, support for care and care for the dying (goldstandardsframework.org.uk, 2020). According to GSF, the nurses to manage care for the patients are to be involved in active communication with them to determine their health needs and demands (qni.org., 2018). It is evident as the study by Gutiérrez-Puertas et al., (2020) argued that lack of communication between patients and nurses leads to mismanagement of care delivery. This is because without interaction the nurses are unable to understand the needs of care of the patients and fail to explain the importance of the treatment been provided to the patient which creating hindered compliance from both leading to low-quality care support (MacLean et al., 2017). Therefore, to manage effective care for H, the nurses are to develop enhanced communication with her to understand her needs and explain to her the reason for care been provided to make her comply and accept the care.

The coordination by the nurses is to be maintained in care as it supports deliberate organisation of care active along with sharing of care information with patients and other members of multi-disciplinary team (MDT) to provide safe as well as more effective support to the patient (Roberts et al., 2019). Thus, coordinated care is to be provided to H by the nurses by collaborating with the multi-disciplinary team. The care to be delivered to H is to be managed by the nurses in such a way that the symptoms of the disease is effectively resolved to ensure enhanced quality health of the patient (Freeman et al., 2019). In care management, continuity in care is important to delivery care support with enhanced quality overtime through cooperation with the patients for reaching the share goal of high-quality and cost-effective care (Roberts et al., 2019). Thus, the nurses caring for H is to maintain continuity in care and change the care support as required for ensuring enhanced care management for her.

Person-centred care

The person-centred care (PCC) involves delivering care to patients by keeping them in the centre of the care plan and involving them in decision-making regarding their care (Haydon et al., 2018). Thus, to deliver PCC to H, the nurses are to ensure H is involved in making decision regarding the intervention to be provided to her to resolve her symptoms regarding erythrocytosis. This is because it would make her feel valued and support her dignity along with rights that are essential principle to be ensured in PCC (Boström et al., 2020). In delivering PCC to H, the nurses are to involve in teamwork with the multi-disciplinary team (MBT). This is because it would help the nurses to share expertise and knolwdege from the MDT to determine the best nature of multiple care to be delivered to H as a patient to resolve her complication with erythrocytosis at the earliest (Roberts et al., 2019). The nurses while working with the MDT develop conflict due to lack of effective agreement between different professionals in delivering care to the patients (Meng et al., 2020). The developed conflict is to be resolved because it would lead to duplication of care and non-cooperation of professionals that would delivery hindered care to the patients (Roberts, 2019). It is argued by McKibben (2017), conflict raised between nurses and members in MDT is able to be resolved through evidence-based discussion. Thus, the nurses caring for H to work with the MDT are to implement evidence-based discussion to avoid conflict being raised in care.

The members of MDT for H are required to include nurses, physicians, phlebotomists and pharmacist. Phlebotomist are professionals who perform the procedure of phlebotomy that is removal of some amount of blood from the body to lower the number of red blood cells in the body among erythrocytosis patients (Sandal et al., 2019). The pharmacist and physicians are to be involved in MDT caring for H because the physicians have enhanced knolwdege to prescribe effective medication for managing erythrocytosis which the nurses with the help of the pharmacist can follow to deliver enhanced care to H. The delegation of care is to be effective made by the nurses by consultation with the MDT so that professionals are able to involve in delivering enhanced care to the patient (Parasuraman et al., 2018). In delegation, the nurses are to mention in detail about the last health progress and treatment specification followed for the patient while delegating to other members of the MDT so that they are aware regarding the way to initiate care delivery to avoid duplication or error in care (Sandal et al., 2019). Thus, the nurses caring for H to delegate care responsibility such as phlebotomy to the phlebotomist is to mention in detail regarding the existing care progress and treatment of the patient so that they do not develop confusion regarding way further care to be delivered by them.

Working in Partnership

The future care to be followed for H is continuously monitoring her red blood cell count after certain interval of time to determine her level of well-being and the impact of the current care. The working in partnership with other professionals helps the nurses to develop improved information sharing regarding care of the patients to decide the best and cost-effective care for the patients to support their enhanced well-being in long-term manner (Yuan and Murphy, 2019). This is because different professionals share various expert knolwdege to be discussed to determine the best care support for the patient. However, it is argued by Moule et al., (2017), partnership working is time-consuming as various individuals are involved in making decision regarding care. Thus, partnership care is to be established for H so that best quality care can be delivered to her, but effective time management is to be made to ensure the care decision is made at the earliest by the team.

The study by Lazzari (2018) mentions that partnership working with professionals leads the nurses to avoid duplication of care and ensure enhanced understanding of team roles to be played by each other to ensure enhanced care contribution. This is because being in partnership leads the nurses and other professionals to discuss and determine the roles to be played by each other according to their expertise so that duplication of support is avoided, and best quality care is to be delivered to the patient. Thus, partnership working is to be continued to deliver enhanced care to H. However, it is criticised by Roxby (2018), partnership working in healthcare leads to misinterpretation of care process due to poor communication and raise conflict in care due to unique background of different team members. Thus, the nurses to establish effective partnership working for delivering care to H are required to develop enhanced communication with their partners to discuss in detail the care to be followed to avoid confusion and conflict.

Conclusion

The above discussion mentioned that Ms H is suffering from erythrocytosis which is evident from her complete blood count test. The NEWS2 assessment mentioned H to have score of 6 which indicates that she is moderate risk patient. The nurses caring for H are to use person-centred leadership in leading her care and would follow 7 C’s of GSF to delivery quality care. Moreover, partnership in care is to be established for supporting H by the nurses as it helps to enhance the quality of care along with avoid duplication and limit error in care.

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