Miller’s Functional Consequence theory
Care planning for the elderly is a major issue for the management and caring for the older generation since these old folks are faced with disorders that are associated with old age through nursing care prioritization. This article will analyze the scenario of Mr Dinh Nguyen by using Millers Functional Consequences Perspective so as to come up with the level of function and the influences that impact on the care given to the elderly (McMahon & Fleury, 2012). Levett-Jones’ Clinical Reasoning Cycle is used as a tool to recognize, assess, implement and evaluate the care given to the elderly (Dalton, Gee & Levett-Jones, 2015). These two perspectives show that the dignity of the elderly persons and their cultural background are important aspects to consider while providing care for the older generation (Wrosch, Scheier & Miller, 2013). This paper identifies three care priorities for Mr Dinh Nguyen through considering the patient, collecting patient’s information and eventually processing the data collected. Top priority care will be identified by the use of the first four steps of Levett-Jones’ Clinical Reasoning Cycle for which goals will be set, action taken, outcomes observed and a reflection made. A conclusion that outlines the important information gained regarding the care plan for the elderly is provided.
This theory provides a framework for evaluating age-related changes that should be taken into consideration, wellness outcomes, nursing intervention and finally the risk factors that should be addressed when giving care to the elderly. This perspective provides the base in which the healthcare providers are able to identify health risk factors and address them accordingly through taking into account the concepts of nursing, health, elderly person and the environment (Hunter, 2012). This theory can be applied to the evaluation of the care given to Mr Dinh Nguyen who is elderly since he is 83 years old. He has increased risk as he lives alone in a two storey building and the fact that he suffers from multiple sclerosis. He also has negative functional consequences as he is not able to perform daily activities and is at a risk of social isolation and depression (Currais & Maher, 2013).
The age-related changes that occur in the elderly like in the case of Mr Nguyen are inevitable, not modifiable, irreversible and progressive changes that occur to the older generation. These changes that occur to the elderly are not dependent on the pathologic and extrinsic conditions (Kraft, 2012). Mr Nguyen is diagnosed with Multiple Sclerosis and Osteoarthritis which are associated with old age due to degenerate disorders and decreased bone density. Therefore, age increases disease occurrence risk in old persons hence there are negative functional consequences with advanced age. The healthcare provider should be able to identify these age-related changes so that he or she can be able to provide the required medical intervention. Through these interventions, the role of the nurse is brought out as enhancement of health, functioning and improving the lives of the older persons.
Identifying Impaired Coordination as a Priority
According to Miller’s Functional Consequence theory, hazard influences are changeable factors that influence the health of an individual (World Health Organization, 2014). For instance, Mr Nguyen risk factor includes living alone in a two storey building with functional decline as he is not able to do daily activities, chronic diseases and geriatric syndromes that he exhibits. The perspective advocate for the creation of models and strategies that address chronic disease management, lifestyle changes and behavioural risks to ensure wellness and the promotion of health among the elderly generation.
Miller’s Functional Consequence perspective state that old age results into adverse functional consequences that lead to difficulty in performing day to day activities and increased risk of social isolation and depression (Bonder & Dal Bello-Haas, 2017). Mr Nguyen has blurred vision and experiences an electric shock feeling that makes it impossible for him to move his head, neck and back hence reducing his mobility and making his gait severe. Due to these functional consequences, Mr Dinh finds it difficult to carry out daily activities such as dressing, cooking and showering. Another functional consequence that he faces is the inability to hold urine which has made him experience urinary incontinence. Mr Dinh faces the risk of social isolation and depression since he lives alone and this year he has not been able to go for his annual holiday due to his deteriorating health.
The next section of this article will involve the use of the first four steps of the Clinical Reasoning Cycle to identify Mr Dinh’s three nursing care priorities. The three steps that are used for Mr. Dinh includes; Nurse’s consideration of Mr. Nguyen, collecting information about him and processing the information. From these three priorities and use of Miller’s Functional Consequences theory, the most important care priority will be determined for further discussion.
The patient is Mr Dinh Nguyen who is an immigrant from Vietnam. He has Multiple Sclerosis, osteoarthritis, urinary incontinence, blurred vision, face numbness, stiff neck and back pain hence he is not able to carry out daily activities such as dressing, cooking and showering. He has reduced motility and has a severe gait. He is a widower and lives alone in a two-story building. His wife died twelve months ago. His complications have denied him the opportunity to go his annual holiday get-away and he is getting worried due to the undesirable course of his illness and wonders if he will be able to manage it in future. Mr Dinh has no family members living with him and he experiences financial problems. He is currently under the following medications; Panadol Osteo, Prednisolone and Teriflunomide.
Levett-Jones’ Clinical Reasoning Cycle
Mr Dinh Nguyen is an elderly managed 83 years. He was diagnosed with Multiple Sclerosis 6 years ago and two years he was found to be having osteoarthritis which currently being managed by medications. He has the following signs and symptoms; urinary incontinence, blurred vision, face numbness, stiff neck and back pain, reduced motility and abnormal gait. Due to his condition, he is unable to perform basic activities such as showering, tying shoelaces, cooking and dressing. He lives alone in a two storey building and has financial problems.
Blurred vision – This is a symptom of Multiple sclerosis (Browne et al. 2014).
Back Pain – Caused by Multiple Sclerosis or can be a symptom of osteoarthritis
Impaired Coordination (reduced motility), numbness of the face – Results due to the pathogenesis of MS.
Abnormal gait and Stiff neck – Related to osteoarthritis (Pirker & Katzenschlager, 2017).
Osteoarthritis – May have resulted due to Mr Nguyen advanced age and due to multiple sclerosis because MS increases the incidence of osteoarthritis (Berenbaum, 2013).
Prednisolone – Used for management of osteoarthritis as it is a corticosteroid which is used for managing degenerative inflammatory diseases.
Teriflunomide – This is a medication used to control Mr Dinh Nguyen Multiple Sclerosis.
Panadol Osteo – Is used by Mr Nguyen to relieve the pain caused by osteoarthritis.
Living in a two storey building – Increases the risk of falling and hurting himself since he has symptoms that make him weak hence proper care should be given to him and be given a caregiver and the facility made safe.
Identifying Problems/Issues (3 Main Priorities)
- Impaired Coordination that leads to reduced motility and makes the basic task like cooking, dressing, showering and tying shoelaces impossible.
- Blurred Vision
- Back pain and stiff neck
Top Priority of Care (Understanding And Utilizing A Clinical Decision Making Framework To Come Up With The Top Care Needed)
By use of the Miller’s Functional Consequence theory, there needs to be an effective clinical decision making framework to determine the top care priority for Mr Dinh impaired coordination which has reduced his mobility and has made performing basic activities hard (Levett-Jones, 2013). The discussion below focuses on the framework which constitutes; establishing care goals, action to be taken, an evaluation of the outcomes and a reflection on care given to manage impaired coordination (Edlin & Golanty, 2012).
The goals for managing impaired coordination would be;
Ø To ensure Mr Dinh can perform tasks like cooking, showering and dressing.
Ø To ensure that Mr Dinh can walk properly.
Ø Mr Dinh to get a caregiver to watch him all the time due to his impaired coordination to avoid accidents.
Goals for Managing Impaired Coordination
Ø Falls’ risk assessment and management – The possibility of Mr Dinh falling due to impaired coordination and reduced motility should be accessed and management actions are taken such as providing him with a walking stick.
Ø Avail Emergency mechanisms – The include having someone to watch over Mr Dinh to help him in case of a fall.
Ø Exercises and Physical activity (Lox, Ginis & Petruzzello, 2017). – Mr Dinh to do exercises to ensure that his bones and joints are adapted to activities.
Ø Occupational Therapy and Surgery – This will help him recuperate from his illness
Ø Mr Dihn is able to perform basic tasks such as cooking, showering and dressing.
Ø Mr Dinh is able to walk properly.
Ø He has a caregiver who watches him and helps him in exercising and physical activities and is there in case of an emergency.
Ø By going through the case study and the two theories, I now understand that impaired coordination is the major issue that faces people with multiple sclerosis and osteoarthritis.
Ø I now understand that to make sound decisions about the care given to the elderly, one has to look at the risks, age changes and the loss of function.
Ø From the above discussion and case study, it is evident that care should be given while observing the dignity of the patient as well as the cultural background.
Conclusion
Miller’s Functional Consequence theory deals with age-related changes, health risk factors for the older generation and outlines the negative functional consequences that are experienced by the elderly people. Nurses can apply this model to all the situations that have the ultimate goal of promoting wellness and healthy lives for the older individuals (Rodin, 2014).Levett-Jones’ Clinical Reasoning Cycle has been used to identify, evaluate, assess, implement, establish goals, take action, evaluate the outcomes of the care given to Mr Dihn through critical thinking and development of an effective decision-making process. Amalgamation of Miller’s Functional Consequence theory and Levett-Jones’ Medical Reasoning Sequence provides a framework that promotes wellness for the older people by providing evidence-based information.
References
Berenbaum, F. (2013). Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!). A Australian Journal of Osteoarthritis and Cartilage, 21(1), 16-21.
Bonder, B. R., & Dal Bello-Haas, V. (2017). Functional performance in older adults. FA Davis.
Browne, P., Chandraratna, D., Angood, C., Tremlett, H., Baker, C., Taylor, B. V., & Thompson, A. J. (2014). Atlas of multiple sclerosis 2013: a growing global problem with widespread inequity. Neurology, 83(11), 1022-1024.
Currais, A., & Maher, P. (2013). Functional consequences of age-dependent changes in glutathione status in the brain. Antioxidants & redox signaling, 19(8), 813-822.
Dalton, L., Gee, T., & Levett-Jones, T. (2015). Using clinical reasoning and simulation-based education to’flip’the Enrolled Nurse curriculum. Australian Journal of Advanced Nursing, The, 33(2), 29.
Edlin, G., & Golanty, E. (2012). Health and wellness. Jones & Bartlett Publishers.
Hunter, S. (Ed). (2012). Miller’s nursing for wellness in older adults. Sydney: Wolters Kluwer/Lippincott, Williams and Wilkins.
Kraft, E. (2012). Cognitive function, physical activity, and aging: possible biological links and implications for multimodal interventions. Aging, Neuropsychology, and Cognition, 19(1-2), 248-263.
Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Frenchs Forest, NSW: Pearson.
Lox, C. L., Ginis, K. A. M., & Petruzzello, S. J. (2017). The psychology of exercise: Integrating theory and practice. Taylor & Francis.
McMahon, S., & Fleury, J. (2012, January). Wellness in older adults: A concept analysis. In Nursing forum (Vol. 47, No. 1, pp. 39-51). Malden, USA: Blackwell Publishing Inc.
Pirker, W., & Katzenschlager, R. (2017). Gait disorders in adults and the elderly. Wiener Klinische Wochenschrift, 129(3-4), 81-95.
Rodin, J. (2014). Health, control, and aging. The psychology of control and aging, 139-165.
World Health Organization. (2014). Social determinants of mental health. World Health Organization.
Wrosch, C., Scheier, M. F., & Miller, G. E. (2013). Goal adjustment capacities, subjective well?being, and physical health. Social and Personality Psychology Compass, 7(12), 847-860.
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