Analysis of Nurses' Role in Health Care for Developing a Personal and Centred Care Plan with the Aid of A. P. I. E. Framework

The essay`s primary objective is to analyse nurses` role in health care for developing a personal and centred care plan with the aid of A.P.I.E. framework. The use of A.P.I.E. will enable the evaluation of different stages in nursing process including assessment, care planning, care implementation, and evaluation, which will be evaluated efficiently according to a case study example of Ryan, a 25-year-old Diabetes patient. The nursing and midwifery Council code (NMC 2015) indicates that nurses need to have a responsibility that will guide them in ensuring adequate care for all patients (Carter 2015). The care plan developed for Ryan will be assessed as to whether it reflects the NMC code and how it had impacted the overall well being of the patient.

Diabetes

Diabetes is a chronic condition that affects how a person`s body uses energy from food in the form of blood sugar or glucose. People living with diabetes usually have high glucose content in their blood as a result of the production of too little insulin or the body not accepting or using the produced insulin, or both circumstances (American Diabetes Association 2015). Many effects of diabetes are associated with high blood pressure, a lack of blood glucose control, and high cholesterol levels (American Diabetes Association 2014). The kidneys are also at high risk of damage due to diabetes and the risk increases if the diabetes is poorly controlled, and the individual has high blood pressure and cholesterol (Alonso et al. 2015). Besides, nerves can also be affected by diabetes, and it can be severe since the nerves are involved in many bodily functions, from digestion and movement through to reproduction (American Diabetes Association 2016). However, it is possible for people with diabetes to control their blood sugar levels through physical activity, diet, and in some cases, a combination of insulin injections and medication (Hamman et al. 2015). Persons with diabetes are required to maintain their blood sugar levels within a stable and healthy range (American Diabetes Association 2014).

The study presents a case of Ryan, a 25-year-old man who was diagnosed in 2016 with symptoms that indicated hyperglycemia one year before diagnosis. Ryan also remembered past periods of nocturia associated with large Italian pastries and pasta meals. At present, Ryan presents with suboptimal diabetes control, foot pain, and weight gain. He is now nervous when it comes to making commitments that he is not sure he can keep. It is one reason why Ryan is currently on long-term sick leave from work. He also has emotional difficulties as he finds the loss of his career and previous lifestyle hard to come to terms with and is frequently treated for depression.

Diabetes is among the most prevalent chronic conditions that require legal accountability management emphasised in the Nursing and Midwifery Code (NMC 2015). The Code presents a good guideline as it sets out professional standards for nurses and midwives to uphold for them to be registered to practice. NMC 2015 covers the core standards of performance, conduct, and ethics and provides the guidance needed in improving safety and quality of care. NMC 2015 also defines what makes a professional as it guides every nurse and midwife reflecting on their professional approach, daily practice, and values (Glasper 2015; Dix 2015).

Similar to other chronic conditions, diabetes influences both the individual and the family. The disease is characterised with a lot of emotions at play for the diagnosed individual such as anxiety and depression since their previous life is all gone, and now they have to watch over everything they eat as they adopt new behaviours and habits (Westermann, Kozak, Harling, and Nienhaus 2014). For family and friends, anxiety and stress are common emotions. Besides, they may also be confused as they may not understand the new roles that they should assume. To victims, families, and friends, diabetes can drain their pockets. Diabetes is a lifelong condition that comes with increasing costs, and the younger a person is diagnosed with it, the more expensive his/her lifetime medical expense will be (Lara-Smalling and Cakiner-Egilmez 2014). Different kinds of help and advice are available to persons who believe their condition is negatively affecting their family and friends. Besides, people with diabetic family members can also receive social support and help.

Nursing Models

Nursing care models present nurses with the appropriate infrastructure for organisation and delivery of care to both patients and their families. Different models of nursing have waned over the decades. A nursing model provides nurses with a theory about people, their health, environment, and their roles as nurses (Arora 2015). The nursing models can contribute to an increased sense of autonomy and job control. Nursing has a variety of models that have different approaches to such issues. For instance, Slatyer, Coventry, Twigg & Davis (2016) explain Roper`s emphasise on the 12 living activities needed to be carried out by all people, while Dobrowolska et al. (2015) mention Orem`s model that was developed around the self-care concept. The variety of models allows nurses and other practitioners to apply the model that can best reflect their client group and area of work. The models may also play different roles as nurses move through their careers. The models can provide a “novice” nurse with a model that can offer them real guidance at their care planning process. Experienced nurses are also able to make use of the models to develop their eclectic models, based on elements described by the theories that suit their context of care and approach. The models also provide nurse leaders with a theoretical foundation for developing a care philosophy and documentation that relates to their work. In this case, a structured care planning process used A.P.I.E, a problem-solving process that directs nurses to solve medical problems in a systematic approach, using Assess, Planning, Implement and Evaluation. The framework was used in this case since it provides a holistic look at the illness as well as the patient, to ensure sufficient caregiving.

Client Assessment

Based on the concerns presented in the case of Ryan, the assessment would begin with a nurse carrying out a focused evaluation providing data that relates to his health, glucose levels, and nutritional status. A considerable part of the data is collected in the morning, patient observation is done at mealtime, and nurses interact with patients throughout their shifts as professional exchanges take place with other health care team members. During the assessment process, data was gathered into two, quantitative information and qualitative information. Quantitative information consisted of Ryan`s weight, height, pulse, temperature, and blood pressure. On the other hand, qualitative data was in connection with the client`s family status, social background, mental state, and likes and dislikes. The client`s data was collected by various means as nurses made use of observations, interviews, measurements, coping strategies, past and present medical history, and also how he perceives his health patterns. Besides, the nurse consistently validated the data with Ryan ensuring that the interpretation was both accurate and complete. Still, during Ryan`s assessment, there was a need to address specific considerations which included his physical state, stress levels, and hormones. Due to the prevalence of his attacks, and his undesired body weight Ryan was stressed most of the time. His psychological state, cultural and social backgrounds were also considered. Data obtained for Ryan came from a deployed multidisciplinary team as well as his family.

After undergoing blood tests, heart and lung check-up, urinalysis, and chest x-ray, Ryan was diagnosed with type 2 diabetes. The GP and nurses talked to him and explained how he could successfully manage his new condition through self-monitoring, lifestyle changes, and insulin medication, which he was given. The data formed the baseline of the nursing process as it offered measurements and descriptions allowing the nursing team to discover that Ryan was making progress. The deliberation was taken from Ryan`s medical diagnosis and the effects of the consequences on his everyday lives. The nurses looked beyond medical diagnosis and took into account the psychological, social, physical, and spiritual issues related to his illness. As Nieuwlaat et al. (2014) advocates, the information was then compared to observed standards and norms, organised to align with a programme structure and interpreted yielding strengths and limitations from which a list of problems is created. Further to problems identification, there will be a formulation of appropriate interventions which also be implemented and undergo a continuous evaluation and revision to assist Ryan to achieve and maintain optimal health despite his diabetes.

Care Planning

Sherifali, Bai, Kenny, Warren, and Ali (2015) argue that patient planning care needs to consider their lifestyle; personal preference, values, and economics as they influence their goals. The nurses carried out a complete assessing stage to smoothly progress through the planning. The plans were also made in a way that they can be able to change at any time according to the response of the patient to his new treatment. The nurse documented Ryan`s reactions to the set goals and the planning of care, which apart from being a legal document, it is accountable to nursing practice. The goals set for Ryan was keeping track of blood sugar levels, regularly taking medicines, stop smoking, and flossing and brushing teeth daily to help keep the mouth healthy (Munshi et al. 2016). The planning stage was directive with a baseline of the patient`s progress about his condition after nursing care. The goals needed to be observable, measurable, and recordable so that the nurses could assess if the patient were making progress towards the goals (Pousinho, Morgado, Falcão, and Alves 2016). Both Ryan and the nursing team evaluated the goals, and the results were impressive since Ryan did all he could to maintain his blood sugar levels. The NP directed that the goals be both short and long-term depending on meeting the needs of the patients effectively.  However, we maintained more short-term goals since they are better for Ryan as he can be motivated for achieving the desired outcome. When the NP was deciding on the goals, she felt it was beneficial to consider the person that could meet the goals, which is either the patient or nurse, what was actually to be achieved, how they were to be attained and when they were to be achieved 2016). The goals were set using the MACROS criteria tool. Besides, they were done under the headings of PRODUCT that stands for (P) patient-centred, (R) recordable, (O) observable, (D) directive, (U) understandable, (C) credible and (T) time related about the available resources.

Implementation of Care

When both the nurses and patients have decided on the appropriate goals, it is important to implement them according to the nursing care needs so that the patient can also adjust to the needed changes (Quinn et al. 2016). Implementation primarily involves the plan of care action given to the patient. Implementation of care involves numerous factors that need to be taken into consideration, such as individual and cultural differences. A patient`s beliefs and values will influence the type of care given, how much the patient will want to do for him/herself and what he/she expects the nurse to do (Chapman et al. 2015; Kim et al. 2015). Usually, they are looked at in the planning stage to enable both the patient and nurse to know what medical guidelines and standards expect of them and when. When nurses implement care plans for patients with individual and cultural differences, it is essential for them to establish their expectations, the best way to care for their individual and cultural needs and how it may affect the care being provided (Faria et al. 2014).

Implementing care is facilitated through employing particular nursing interventions, a treatment given based on clinical judgment and knowledge to enhance positive patient outcome. Implementation of care may be done directly or indirectly and usually takes into account the physical, social, spiritual, and psychological support, which needs to be observed from a nursing team as well as a multidisciplinary team (Vann, Hawley, Wegner, Falk, Harward, and Kshirsagar 2015). When implementing patient-led care, and if the patient can take care of him/herself, nurses need to keep in mind that their patients need to feel support and more comfortable, this is part of the NMC standards. Besides, the caregiving process needs to be patient centred, individualised, safe, ethical, and legal (Davis, Wei, Meyers, Kilpatrick, and Pandya 2014). It is also essential for all the care to be researched, and evidence-based, and is within the limits of the available resources. When implementing nursing care, nurses need to remember to offer respect and dignity, which form part of the NMC code of conduct (Zhao, Suhonen, Koskinen, and Leino‐Kilpi 2017). Additionally, all care given must be well documented as demanded in the NMC guidelines. The records have to be comprehensive, accurate and include the views of the patient. The signing of the records is also significant since it shows the care process given and nurses need to be accountable for care provided to a patient (McGloin, Timmins, Coates, and Boore 2015).

In connection with the care plan developed for Ryan, all the necessary processes and steps that needed implementation for the fulfilment of his health needs were identified and discussed adeptly. In the care plan context, nurses are required to work in collaboration with other healthcare professionals  to provide Ryan who has been admitted with diabetes being a relatively young patient at 25 years, with the best health solution. As Shepherd (2017) recommends, nurses should refer such a patient to physiotherapists and psychologists who are capable of addressing the issue of stress and his sudden realisation of his condition through specific therapies and exercises. In Ryan`s case, it can be consistently said that the assessments on therapy prescription need to be conducted by a healthcare professional with high expertise and skills primarily in  to diabetes and efficient management of the condition.

As identified from Ryan`s care plan, nurses and other medical professionals considerably focused on discussing the newly diagnosed type 2 diabetes, the possibility of complications and management of the condition. The overall care plan focused upon suggesting ways to maintain his blood sugar levels and adopt a new way of life which can help Ryan to get over with his stress and current physical condition, which worsens his situation. Nurses and other healthcare professionals undertook various consultations before appropriately informing Ryan regarding the need to follow up with doctors appointment and maintaining his blood sugar levels to reduce chances of suffering complications such as blindness, nerve damage, and kidney failure (Hays, Finch, Saha, Marrero, and Ackermann 2014). He was also made aware of the benefits of breathing exercises and relaxation together with stress management exercise which are necessary for tackling with his current situation. Moreover, as per the discussions in the care plan, it can be identified that Ryan was prescribed proper medication.

Evaluation

Once the implementation stage is complete, the nursing care plan needs to be evaluated so that the NP, nursing team, and other medical professionals can determine whether the patient was given proper care (Hill 2015). At this stage, it is usually imperative to establish whether the care plan has led the patient in progressing towards the set goals or made him/her move away from the laid down targets. Practical implementation is realised when the patient is in line with the baselines discovered in the assessment and has achieved the laid down goals. The information in this step will allow nurses to ascertain the comprehensiveness and holistic nature of the assessment, and if it led to accurate diagnosis (Carolan-Olah 2016; Farrell 2015). Evaluation needs to consider whether the goals were relevant and realistic for the patient to achieve them. It could also consider whether the documented care plan was implemented to the later and by the right professionals. In the evaluation stage, considerations concerning the goals need to be taken as they are assessed to discover whether they have solved or alleviated the problem (Caro‐Bautista, Martín‐Santos, and Morales‐Asencio 2014).

In the context of this case and as Westermann, Kozak, Harling, and Nienhaus (2014) indicate, it can be established that there is a need to monitor and review care plans regularly to analyse and assess their efficiency and effectiveness in presenting best facilities and healthcare services to individuals like Ryan. It is the nurse` responsibility to assess and evaluate the patient`s status along with their general well being and health progress. It can be concluded that the nursing care plan implemented in the case of Ryan was highly successful in fulfilling or meeting his healthcare needs despite his young age and lack of previous treatment of the condition. The overall monitoring and revaluation of Ryan`s care plan have facilitated the assurance of providing best quality care for adhering to the patient`s overall healthcare needs along with enabling his continuous recovery.

Conclusion

As proven in Ryan`s case, care planning is an integral part of nursing. Consequently, it can be said that the care plans can significantly state or define the overall role of nurses and other healthcare practitioners. Nursing interventions in care plans can be referred to as specific ways of substantially recording and monitoring a respective client`s care plan. Usually, the care plans are individualised to serve particular patients base on their conditions, symptoms, values, and beliefs. The care plans can also be highly effective if documented to enable referrals needed to offer the highest medical services to patients. The essay has focused on assessing the general role of nurses and meaning of nursing intervention within the healthcare setting along with developing a specific care plan for Ryan a 25-year male patient admitted for diabetes.

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