Miller’s Functional Consequences Theory
According to Hunter, (2012) the application of the concept of wellness has been around for almost fifty years which aims at addressing the issue of care planning for the older generation to improve their living standards and extend the life expectancy. The article analyzes the scenario of Mr Nguyen by applying the Millers Functional Consequences theory to build on the level of functionality as well as its impact on the care setting and development for older people who usually have conditions associated with old age. The article will also include the application of the Levett-Jones’ Clinical Reasoning Cycle to identify, evaluate and implement care for Mr Dinh Nguyen who has been used as a representative of the older generation that requires careful planning. These two theories show that dignity and cultural background of the elderly people is important and should be considered in care planning (Grol, Wensing, Bosch, Hulscher & Eccles, 2013). The article will then outline the care priorities that should be given to Mr Nguyen while considering him personally, collecting his information and processing the information to come up with the condition that requires medical intervention. The identification of his top priority will be done using the Clinical Reasoning Cycle, goals set, various intervention made and outcomes observed. The article will then include a reflection and finally, a conclusion on the important issues discussed.
This is one of the major theories on adult ageing and wellness. The theory explains the unique connection that exists among the concepts of individuality, nursing, health, culture and the environment in the context of promoting wellness among the older people (Ferrucci et al. 2016). This perspective can be used to determine the risk factors as well as come up with a care plan to manage the conditions of Mr Nguyen who is an elderly man of eighty-three years.
The risk factors that increase with age are not changeable and greatly influences the health of the elderly individuals. Using the scenario of Mr Dinh Nguyen, there are many risk factors that directly affects his health. These risk factors include living alone in a two storey building while he is having reduces functional capabilities and living alone whereas he is not able to carry out daily activities well. There is a risk of him falling as he tries to move around the vast building and he has no one to take care of such emergencies (Ambrose, Paul & Hausdorff, 2013). The chronic illness has also reduced his activeness so in case of an emergency he cannot be able to act swiftly. The Miller’s Functional Perspective encourages establishments of models that address the risks that are associated with chronic illnesses among the older generation and suggests structural, behavioural and lifestyle changes to reduce these risks among the elderly.
Risk Factors According To The Functional Consequences Theory
The Functional Consequences Theory states that there are age-related changes that occur due to the advancement of age (Seddon & Sobrin, 2013). These changes are considered progressive, inevitable, permanent and cannot be modified (Hunter, 2012). These changes that occur among the elderly generations are extrinsic and pathologic and are the risk factors for the development of many conditions and illnesses that are usually seen in the older generations. For instance, in our scenario, Mr Dinh Nguyen suffers from Multiple Sclerosis as well as osteoarthritis which are the two most common conditions that are associated with advanced age. These diseases mostly occur in the elderly persons due to reduced bone density and also as genetic degenerative disorders due to old age. It should be noted that age increases the risk of diseases hence leading to adverse and undesirable functional consequences among the aged individuals. The age-related changes should be detected early so that proper interventions can be provided to reduce the risk of occurrence of further damage to the body as well as reduce suffering hence leading to improved quality of life and extended life expectancy.
Hunter, (2012) states that the Functional Consequences Theory suggests that old age leads to numerous negative consequences that limit the capabilities of an individual. Therefore, the aged people may experience difficulties in performing basic daily activities. The reduced functional levels also affect other aspects of the individual such as socialization as it has many limitations hence leading to the isolation that can result in depression. In the case scenario, Mr Dinh Nguyen has multiple sclerosis and osteomyelitis which constitutes to the signs and symptoms that he experiences which limits his functional capabilities. Mr Dinh experiences a type of “an electric shock” that makes him not to be able to move his head, back and neck hence reducing his movement and worsens his gait.
The conditions that he has affects his eyesight hence he is not able to see properly as he experiences blurred vision. The loss of functional capabilities has reduced his abilities hence he is not able to perform basic daily activities such as showering, dressing or even cooking for himself. As we are informed from the case scenario, there is a possibility of Mr Dinh Nguyen developing social isolation that could lead to depression as the conditions are worsening such that he has not even been able to undertake his annual holiday. Inability to hold urine leading to his urinary incontinence is another form of functional consequence. Therefore, it can be noted that the comorbidities that result due to the complications of conditions brought about by old ae reduce the abilities of the individual hence leading to negative functional consequences.
Age-Related Factors According To The Functional Consequences Theory
The Levett-Jones’ Clinical Reasoning Cycle will be applied to identify the care priorities for Mr Nguyen. Levett-Jones’ Clinical Reasoning Cycle is a nursing tool established to identify, evaluate, assess and implement care through critical thinking and development of an effective decision-making process (Hunter & Arthur, 2016). The Clinical Reasoning cycle has eight steps which include; The consideration of the patient situation, the collection of information, synthesizing data, pointing out problems, establishing goals of management, taking action, evaluating results and outcomes and finally reflecting on the entire process (Levett-Jones, 2013). The cycle also promotes the consideration of the patient’s dignity as well as cultural background throughout the care process.
The patient in the case scenario is Mr Dinh Nguyen who is an 85 year old male an immigrant from Vietnam. Mr Dinh suffers from multiple sclerosis and osteoarthritis both of which have resulted in multiple signs and symptoms.
The signs and symptoms that he presents include; blurred vision, urinary incontinence, the numbness of the face, back pains and stiffness of the neck. Mr Dinh Nguyen has reduced motility and a severe gait. He is on medication which includes Panadol osteo, teriflunomide and prednisolone. The information provided shows that he strains to do basic daily activities. He resides alone in a story building and his illness has made him have minimal social interactions hence he is on the verge of depression (Schaie & Willis, 2010). He has financial problems as his wife died 12 months ago.
Processing Mr Dinh Nguyen’s Information
Panadol Osteo and Prednisolone – Both medications are used by Mr Dinh Nguyen for the management of osteoarthritis (Basedow, Runciman, March & Esterman, 2014; Abou-Raya, Abou-Raya, Khadrawi & Helmii, 2013).
Reduced Motility, blurred vision and numbness of the face – These are signs and symptoms of multiple sclerosis (Lublin et al. 2014).
Abnormal gait, back pain and Stiff neck – These are signs and symptoms of osteoarthritis (Hochman et al. 2013).
Osteoarthritis – This is as a result of Mr Nguyen old age and genetic predisposition.
Teriflunomide – He uses this medication to manage multiple sclerosis (Confavreux et al. 2014).
Living alone in a huge 2-story building – This increases the fall risk as he has many factors limiting his mobility and coordination.
Identification of Problems/Issues that can be termed as Mr Nguyen Top 3 Priorities
1) Reduced motility due to impaired coordination.
2) Eyesight problems leading to blurred vision.
3) Stiff neck and Back Pains.
Adverse Functional Consequences According To The Functional Consequences Theory
Mr Nguyen’s Top Priority Of Care
The top priority of care that needs urgent action is reduced motility due to impaired coordination. This has been selected since it is essential as it hinders Mr Nguyen from performing basic activities that are essential for survival and also it puts his life in danger as there are risks of falling due to lack of coordination.
The goals should be directed towards the top priority which is reduced motility
ü To enable Mr Nguyen to be able to perform daily basic activities as well as regain coordination and motility.
ü To ensure that Mr Nguyen has the necessary facilities and availability of caregiver in case of an emergency.
ü For Mr Nguyen to regain coordination, the underlying condition to be treated and then encouraged to do physical activity as well as exercise.
ü Avail care throughout by assigning Mr Nguyen a personal caregiver or a family member to help his daily activities as well as during emergencies.
ü Mr Nguyen is able to regain coordination and motility.
ü Mr Nguyen has a caregiver all through and in times of emergency
ü The Case Scenario of Mr Nguyen has made me realize that dignity and patient’s cultural background should be taken into consideration while planning for care.
ü I have come to understand that the two theories are important in developing a care plan for the patient as we have been able to determine the care priority of Mr Nguyen as well as formulate a care plan.
Conclusion
The nurses need to integrate the Levett-Jones’ Clinical Reasoning Cycle and Miller’s Functional Perspective in the care planning of the patient. These two perspectives have been integrated to come up with Mr Nguyen’s care plan. Miller’s Functional Consequence theory outlines the age-related changes that occur in old people, the adverse functional consequences and the health risk factors that face the elderly. Levett-Jones’ Clinical Reasoning Cycle has been applied in the identification, evaluation, assessment, establishment of goals and the action to be taken as well as the evaluation of Mr Nguyen hence making of effective decisions on the care planning. Therefore, the two perspectives need to be utilized together so that the best care plan can be determined hence leading to the wellness of the elderly generation by providing the right care (Satariano, Scharlach & Lindeman, 2014).
References
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Basedow, M., Runciman, W. B., March, L., & Esterman, A. (2014). Australians with osteoarthritis; the use of and beliefs about complementary and alternative medicines. Complementary therapies in clinical practice, 20(4), 237-242.
Confavreux, C., O’Connor, P., Comi, G., Freedman, M. S., Miller, A. E., Olsson, T. P., … & Truffinet, P. (2014). Oral teriflunomide for patients with relapsing multiple sclerosis (TOWER): a randomised, double-blind, placebo-controlled, phase 3 trial. The Lancet Neurology, 13(3), 247-256.
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Hochman, J. R., Davis, A. M., Elkayam, J., Gagliese, L., & Hawker, G. A. (2013). Neuropathic pain symptoms on the modified painDETECT correlate with signs of central sensitization in knee osteoarthritis. Osteoarthritis and Cartilage, 21(9), 1236-1242.
Hunter, S. (Ed). (2012). Miller’s nursing for wellness in older adults. Sydney: Wolters Kluwer/Lippincott, Williams and Wilkins.
Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement: Clinical educators’ perceptions. Nurse education in practice, 18, 73-79.
Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Frenchs Forest, NSW: Pearson.
Lublin, F. D., Reingold, S. C., Cohen, J. A., Cutter, G. R., Sørensen, P. S., Thompson, A. J., … & Bebo, B. (2014). Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology, 10-1212.
Satariano, W. A., Scharlach, A. E., & Lindeman, D. (2014). Aging, place, and technology: Toward improving access and wellness in older populations. Journal of aging and health, 26(8), 1373-1389.
Schaie, K. W., & Willis, S. L. (Eds.). (2010). Handbook of the psychology of aging. Academic Press.
Seddon, J. M., & Sobrin, L. (2013). Epidemiology and risk factors for age-related macular degeneration. In Retina (Fifth Edition) (pp. 1134-1144).
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