SKILLS FOR NURSING PRACTISE

Introduction

The skills for effective nursing practise include providing attention to details in care, professionalism, critical thinking, time management, effective communication establishment and others. In care, these skills are important as helps the nurses to provide a standard care with quality care satisfaction to the patients which enhance their health and well-being. In this study, the care regarding a patient suffering from cystic fibrosis and epilepsy is to be discussed. For this purpose, the way SBAR communication tool and holistic need assessment of the patient are to be determined by nurses is to be explained. Moreover, the person-centred nursing decision to execute healthcare intervention for the patient to help the individual have enhanced health is to be discussed.

Case Study

The case study is regarding two patient named G who is a female of 18 years old with diagnosed cystic fibrosis past 10 years and her mother D who is suffering from epilepsy for the past 6 years. The NMC Code of Conduct mentions the duty to the nurses to record and manage patient data in such a way so that it remains confidential and the privacy of the patient is maintained (NMC, 2018). Thus, the anonym G and D is used to indicate the patients so that their real identity and facts remain confidential. G is currently hospitalised due to persistent cough and shortness of breath and D due to uncontrolled jerking movements of the legs and arms along with loss of consciousness after few minutes on hospitalisation. G and her mother D live together with their father who is found to be employed and provides all nature of support to them.

Identifying holistic needs of the patient

The holistic needs assessment of the patients is required to be executed by the physician and nurses so that the person-centred care needs can be identified to deliver specific and holistic to the patient (Clarke et al., 2020). The holistic needs assessment of the patients includes identifying the needs of the patient regarding physical, psychological, spiritual and social aspects of life (Tointon and Hunt, 2016). In order to determine physical needs of D, different diagnostic test is to be performed so that the health condition and related needs of care for her can be identified by the nurses and physician. On initial health analysis of D, the physician involved in providing initial care to her informed the nurse to immediately perform epilepsy blood test within 10-20 min of the seizure and Complete Blood Count (CBC) test for D. In cystic fibrosis, thickened and sticky mucus is produced by the body that blocks the airways leading the patient to experience coughing and shortness of breath (Emiroglu et al., 2017). In this purpose, to detect the extent of lung functioning of G who has cystic fibrosis and reports of breathlessness, the spirometry test and chest X-rays are asked to be performed.

The epilepsy blood test is be executed within 10-20 minutes of the seizure or loss of consciousness because prolactin levels gets peaked after the seizures helping the physician to determine whether the seizure is caused by epilepsy or any other condition (Nass et al., 2017). The normal prolactin level of non-pregnant women is 25ng/mL and in men it is less than 20 ng/mL (Grupe et al., 2020). In D’s case, it is seen that her prolactin level has raised to 36 ng/ml after the seizure indicating it is epileptic seizure for which she needs care. The CBC test in epilepsy is executed to determine the presence of any abnormalities or infection in the patient that may influence the choice of use of anticonvulsant medications for the patient which are generally used for managing seizures (Emiroglu et al., 2017). In the CBC test, D expressed no present of abnormal infections to be present that influence the administration of medication. The spirometry test for G indicated that percentage of FVC/FEV1 ratio in the patient is 65% which indicates that G is suffering from moderately abnormal lung functioning. This is evident as percentage of FVC/FEV1 in spirometry test 80% or above is considered as normal but percentage of 60-69 is considered as moderately abnormal lung functioning in patient (König et al., 2018).

The chest X-ray is performed for cystic fibrosis with lung manifestation as the radiographic images helps to detect bronchial thickening and dilation, mucoid impaction, hyperinflation and others which are causing breathing issues for the patient (Murrie et al., 2020). In G’s case, the chest X-ray revealed that her bronchioles have thickened along with thickening of the airways due to increased sputum formation making the patient develop shortness of breath and extensive coughing. Thus, the physical health diagnosis of G and D informs that D needs support with seizures and G needs enhancement of her breathing condition. In order to determine the psychological needs of G and D, the Beck Depression Inventory (BDI) tool is been used. This is because BDI tool helps to allow determining the severity of depression among children and adolescent (Smith et al., 2020). In patients with cystic fibrosis, clinical depression is commonly found due to increased health complication faced by patients related to their physical health and social life as a result of the disease (Havermans and Willem, 2019). In case of G, it is found that the GDI score is 25 and in case of D the score was 11 which indicates that G has moderate depression while D as mild depression as the score between 19-29 in GDI scale is mentioned to be moderate depression 10-16 is mild depression (Smith et al., 2020). Thus, the psychological need of G is to help her cope with clinical depression that may have been raised out of the physical and social issues experienced due to cystic fibrosis and epileptic state. Since the depression of D is minimal, thus no current active assistance is required by her.

The social needs analysis of G mentions that she faces issues with stomach problem due to which she has to strictly maintain a diet and is unable to eat on her own wish. This has led G to face problem in maintaining proper diet as her mother suffer from epilepsy and father being working, they fail at time to provide her adequate meals. She is not allowed to cook due to which she also experiences problem with having diet causing her to have low BMI rate. This is evident as her BMI rate is found to be 16 which is indicates she is underweight as normal BMI rate of healthy person ranges from 18-25 (Harindhanavudhi et al., 2020). She reports being facing problem with performing extensive task due to cystic fibrosis that requires increased energy due to which she is often mocked to be weak by her friends. Moreover, D’s epileptic condition leads her to visit restricted places as sudden incidence of seizure may lead her in fatal condition in risky places. Thus, D cannot always support G’s social independence in meeting people, visiting places and others as she cannot be able to take effective care to resolve problems if raised by G’s social independence as a result of her health condition. G and are found to be catholic but expressed no spiritual needs to be fulfilled.

Comprehensive person-centred nursing assessment of the patient

In order to execute person-centred nursing assessment for G and D, the nurses are to involve in effective communication with the patient and physicians. This is because it would help the nurses decide the vitality of the present situation faced by G and D along with discuss the recommended action to be taken for G and D with the physicians to ensure enhancing her health condition. For this purpose, the SBAR communication tool is to be used as a nurse for caring for G and D. This is because SBAR communication tool include standardised prompt questions to be asked to ensure the healthcare staffs can share focussed and concise information regarding the patient. It also allows the nurses to interact assertively and lower ned of repetition of facts that is time-consuming often causing delay in care towards the patient (Kostoff et al., 2016). The SBAR communication tool includes situation, background, assessment and recommendation steps (Shahid and Thomas, 2018).

The situation in SBAR tool includes making the nurses clearly and briefly describe the present situation regarding the patient to the physician (Shahid and Thomas, 2018). In this phase, as a nurse caring for G and D, the detailed description of the current health condition faced by the patients is to be briefly informed to the responsible physician involved to be caring for G and D. The current situation is that the patient G who has cystic fibrosis is suffering from shortness of breath and extensive persistent cough and D who has epilepsy is suffering from episodes of jerking and seizure is to be informed to the respective physicians. The background informs the nurses to communicate relevant background data regarding the patient to help physician detect the severity of the condition (Panesar et al., 2016). The background information of G and D as a nurse caring for them to be provided to physician is that G’s FVC/FEV1 percentage is 65% and D’s prolactin score detected from 15 minutes of seizure is 25 ng/mL, G has thickened bronchioles and airways and her BDI score is 25. D has lost consciousness and faced seizure immediately after admission to the hospital but regained after 45 minutes with reporting aware of the condition. Moreover, D reports of increased breathlessness and persistent coughing with sputum.

The assessment informs the nurses to mention any diagnosis made by them regarding the patient based on the diagnostic reports (Shahid and Thomas, 2018). As a nurse caring for G and D, it is assessed that D may be facing seizures out of increased epileptic progress and G facing breathlessness along with coughing due to locked airways caused by thick mucus build-up in the lung due to cystic fibrosis state. The recommendation is the immediate action determined to be taken for the patient by the nurse to be informed to the physician (Shahid and Thomas, 2018). The recommendation for G is that she is to be provided additional oxygen support immediately to her overcome breathlessness and D is to be provided Carbamazepine as anticonvulsant medication for avoiding further epileptic seizures.

Interventions for the patient

The NMC Code of Conduct mentions that nurses are to work in partnership with other health professionals to develop expert ideas and skills in delivering quality care to the patients (NMC, 2018). In G’s case, the nurse is to form partnership with pulmonologist to determine the specific medication and intervention to be executed to help her overcome breathlessness and persistent coughing due to cystic fibrosis. According to NICE guidelines, the medication such as dornae alfa and hypertonic saline is to be provided to cystic fibrosis patients in thinning the mucus in the lungs to be coughed up for enhancing breathing efficiency of patients (NICE, 2017). The NHS mention that use of bronchodilators are effective in cystic fibrosis patient as it helps to increase the diameter of the bronchioles to allow enhanced breathing and use of medicine such as Kalydeco is to be used for reducing mucus development in the airways that interferes with the breathing (NHS, 2020). The dose of medication to be provided to G for helping her develop enhanced breathing and overcome mucus blocked airways is to be determined by the nurse in consultation and partnership with pulmonologist. The effective partnership by the nurse is to be maintained by developing trust towards one another and developing enhanced interaction to delineate roles to be played in the care to avoid argument and duplication in care delivery (Bull et al., 2017).

The nurse to arrange care for D to help her cope with seizers due to epilepsy is to work in consultation with the neurologist. This is because the neurologists are expert in managing and deciding care for epileptic patient as it is mainly a nervous disorder (Szaflarski et al., 2017). The medication such as carbamazepine is to be provided to D by the nurse in consultation with the neurologist as it acts to avoid further seizures. However, it is mentioned that withdrawal seizures is faced by patients on ending to take carbamazepine (NHS, 2020a). In this condition, the nurses are to develop instructions from the neurologist regarding the way gradually the medication dose of carbamazepine is to be lowered for D so that after stopping to take the medication the person does not face withdrawal seizures. The nurse is to provide information about the side-effects apart from benefits to be faced by D on taking carbamazepine such as nausea, vomiting and others (NHS, 2020a). This is to allow maintaining their professional value of integrity in care which dictates them to remain honest (NMC, 2018). A dietician is to be involved in supporting the nurse develop effective dietary chart for G so that her BMI rate can be improved which is currently lowered. Moreover, the diet would help G to take nutritional value that allows better control of pulmonary condition in cystic fibrosis to lead an enhanced social life where breathlessness may not be faced with extensive work as faced previously by G.

The NMC Code of Conduct mentions that the nurses are to act in best interest of the patient and develop discussion with them in deciding specific care (NMC, 2018). The nurses are to act in selfless way towards the patients to show altruistic value (Timmins et al., 2018). In this relation, the nurse would develop discussion with G to determine the way the person wish to access CBT that is either through offline or online services in helping her cope depression. This is because it would help the nurses arrange the CBT care accordingly as per personal preference of the patient, in turn, ensuring establishing person-centred where the demands and needs of the patients are kept in the centre for deciding care. The Cognitive Behaviour Therapy (CBT) is an effective therapy in allowing people overcome depression. This is because it helps people to understand the way their current thoughts and behaviour are influencing them emotionally which are to be changed to lead a better emotional life (Quittner et al., 2020, NHS, 2020). Thus, use of CBT for helping G overcome depression is effective leading action in providing care in her best interest as she is reported to be depressed out of her current condition.

Follow-up care of the patient

The follow-up care for G and D to be managed by the nurses is maintaining health-check each month for their cystic fibrosis affecting G’s lungs and breathing ability and seizure condition for epilepsy affecting D. This is because regular heal-check ensures the nurses to determine any changes in health and actions can be taken at the early stage to manage the change to ensure better health of the patient (Zhang et al., 2017). The nurse is to contact the father of G on her discharge to inform him the importance of maintaining healthy diet for G and the way he can manage it with D that is not currently fulfilled with consultation of the dietician. The nurses are to ask parents of G and D to report each week for the first 3 months about their health progress to establish effective monitoring of their health. A physiologist is to be involved in follow-up of care for G by the nurses to ensure that enhanced physical exercise is performed by her to manage her physical and mental health condition out the complication of the diseases. On discharge, the use of assistive technology such as bracelets and others are to be informed to D to be provided to her so that she can detect any further seizure and ensure her safety.

Conclusion

The above discussion mentions that G is suffering from cystic fibrosis and D has epilepsy which has rendered G to currently face breathlessness and extensive cough and D to face pre-seizures with jerking of hands ad leg as current emergency health condition. The physical needs of G identified are supporting for breathlessness and D is to avoid seizures whereas the psychological need of G is to help her cope depression developed due to suffering from the disease. The social need of G is being able to be independent in living life. The nurse formed partnership with neurologist and pulmonologist is providing pharmacological care such as dornae alfa to G for resolving breathlessness in cystic fibrosis and carbamazepine for preventing further seizure in case of D. The dietician is involved along with CBT is provided to G for enhancing his diet and emotional condition which are not issues faced by D.

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