Miller’s Functional Consequences Theory
Discuss about the Nursing for Hypothyroidism and Macular Degeneration.
The assignment deals with the case study of Amalie Jones. The patient has medical history of arthritis, hypothyroidism and macular degeneration. The aim of the case study analysis is to identify and prioritise the most important nursing care issues for a client. Two theoretical framework underpins the assignment including the Miller’s Functional Consequences Theory and Levett-Jones’ Clinical Reasoning Cycle. The former is used to identify the influences impacting on the older person and the later is used as the tool to drive the process of identifying and assessing, implementing and evaluating care (Dalton, Gee & Levett-Jones, 2015; Bonder & Dal Bello-Haas, 2017). Geriatric nursing care is complex process and hence, there is a need to take systematic approach to give integrated care (Goodwin, Dixon, Anderson & Wodchis, 2014)). The assignment uses the “Levett-Jones Clinical Reasoning Cycle” as the framework to identify the three nursing care priorities for the patient. Using the Miller’s Functional Consequences Theory, the most important care priority would be identified to establish the nursing care goals, appropriate action plan for the patient’s well being. The nursing interventions will be evaluated for their outcomes. Lastly the essay will present the reflection on overall care process and conclude the discussion.
As per the Miller’s “functional consequences theory”, a person’s health and wellbeing is associated with the body-mind-spirit interconnectedness of each other. It means the health of the elderly people is more than just fulfilling the physiological needs. It also requires fulfilment of the emotional, spiritual and psychological health needs. As per the theory the there are several risk factors affecting the older adults although age related changes are inevitable. These changes and risk factors are associated with the positive and negative functional consequences. Most of these consequences are negative and needs interventions to modify the risk factors. It will promote wellness and result in the positive functional consequences and reducing the negative ones (Hunter, 2016).
Amalie Jones’s case can be related with this theory as she has factors to improve her quality of life as well as factors that can decrease the quality of living. Amalie Jones, 89 year old woman. She migrated to Australia from Germany with her husband and now lives alone after his demise. She is living in place which is totally different from her own cultural background. In case of the patient age is the physiologic stressors and the death of her husband and different cultural norms is the psychological stressors as per the Miller’s functional theory (Hunter, 2016).
Applying the Clinical Reasoning Cycle
Applying the clinical reasoning cycle for the patent’s assessment, her situation will be considered followed by collection of information, its processing, problem identification, establishment of goals, and lastly take action plan (Dalton, Gee & Levett-Jones, 2015). Amalie lives alone in her house and heer health are deteriorating and it is difficult for her to carry her activities of daily living. As per her medical history, she has arthritis, hypothyroidism and macular degeneration. Rheumatoid and osteoarthritis may be the cause of mobility restrictions and driving restrictions. It eventually resulted in social isolation. On further assessment it was found that the patient is losing weight, worried and not eating properly. She is also found with hyperthyroidism. The information from referral letter from her GP shows patient having symptoms of constipation, vision deficit, joint stiffness, painful joints, swollen feet, limited joint movement, and forgetfulness in taking medications. Currently she is taking medicines for her existing clinical symptoms including Ibuprofen, Hydroxychloroquine, Paracetamol, and Thyroxine.
While processing the patient’s health information it was found that the age related changes and isolation are main contributing factors for physiologic and psychological issues in patients, which is also in alignment with the Miller’s functioning theory. Sorting through literature review for further processing of information collected in above two steps, it was found that rheumatoid arthritis or osteoarthritis and macular degeneration are common chronic illness prevalent in older adults and progress with ageing (Busija, Tan, & Sanders, 2017). Macular degeneration is due to ageing which leads to thinning and break down of the cells and blood vessels under Macula. It leads to vision problem and is common occurrence at the age of 65 and above (Luu & Palczewski, 2018). It creates difficulty in reading and writing. It may be the cause for patient to have poor vision and avoid driving. Rheumatoid arthritis is the chronic autoimmune disease leading to attack of joints and bones by body’s own immune system. It results in damage of the lining of joints and bone erosion. It is manifested as pain, swelling of joints and joint stiffness. It is different from osteoarthritis which is simple wear and tear of joints (Loeser, Goldring, Scanzello & Goldring, 2012). This pathophysiology relates to Amalie’s restricted joint movement, and mobility issues. Also dizziness and constipation can related with the autoimmune dysfunction that manifests as dizziness and fatigue (Franceschi et al., 2018). Autoimmune diseases affect various body systems such as thyroid and altogether may cause constipation, a condition characterised by hardened faeces (Fairchild, Haws & Mead, 2017).
Priority Nursing Care Needs for the Patient
Applying the next step of clinical reasoning, the problem identified by analysing the Amalie’s clinical condition are mainly vision deficit, joint stiffness and limited mobility. These are priority care needs of the patients as they are associated with the risk of fall and injury. The third priority is the dizziness, which is also safety risk as it may affect her activities of daily living and increasing the risk of fall (Stubbs et al., 2014). These needs demand immediate attention as patient lives alone and isolated. Therefore, all the three areas are priority needs as it influences the patient’s functional independence.
There are many ageing related aspects and it is difficult to characterise all of them. Eventually elders will experience some factors. Limited mobility due to pain and swelling of joints is considered as top priority of nursing care. Amalie may be benefitted with the wellness outcome plan and holistic nursing care addressing the body-mind-spirit interconnection as per Miller’s functioning theory (Hunter, 2016). According to this theory the nursing attitude towards ageing enormously influences the patient (Hunter, 2016). Therefore, the SMART goal of nursing is to reduce the risk of fall and injury by improving mobility. The rationale is to support patient in retaining her functional independence. The second goal is to create patent’s awareness of safety measures to improve performance in daily living activities. The outcomes may be achieved in one month time and implies designing appropriate nursing actions as fifth step of clinical reasoning cycle.
The first nursing intervention for the patient is engagement in resistance training exercises using weight, step training along with muscle exercises and ROM exercises to improve strength and balance. The exercises may involve hopping on foot, standing, walking, and bending of knees. It will improve gait, build stamina and reduce the risk of fall. Arthritis impairs the gait and balance. ROM exercises to full extremities are beneficial in reducing the stiffness of joint and pain. Step training helps in executing well directed steps despite pain and joint stiffness. It improves joint functioning and mobility. It plays a vital role in fall prevention (Okubo, Schoene & Lord, 2016).
The second intervention is the patient education on safety measures and ways to avoid risk of fall. The patient will be educated on keeping safe environment at house such as use of bed ails, adequate lightning at night, lowering the position of bed and removing useless furniture to prevent clogging of the walking pathway. It will reduce the risk of fall due to hurdles and poor vision. Further, the patient will be trained to use assistive devices like walkers in case of emergency (Yost et al., 2015). Amalie will be instructed about the right angle to perform the recommended exercise to avoid preventable injuries due to incorrect posture and over exertion. It will help prevent muscle or joint damage and pain. Inadequate exercise may also lad to joint stiffening (Brach et al., 2017). The patient will be allowed to set routine with small goals as per her choice. It includes timing and duration of exercises. It will help maintain the patient’s respect and dignity. Goal directed behaviour will improve patient’s self confidence (Tzeng & Yin, 2014). Altogether the above interventions will patient archive functional independence and perform activities of daily living with low risk of fall and injury.
Nursing Interventions
Applying the clinical reasoning cycle, the nursing interventions will be evaluated as it helps measure the efficacy of outcomes and actions (Dalton, Gee & Levett-Jones, 2015). The patient will be assessed of her functional dependence using scale of 0-4. The ability of the patient to perform activities of daily living is indicated by 0 that is complete functional independence. Using checklist and brief open ended interview the patient’s knowledge on progressive activity, recovery, safety measures, and use assistive devices will be assessed (Moorhead, Johnson, Maas & Swanson, 2014). The patient may demonstrate using selective prevention measures. The success of intervention is evident from the enhanced mobility and increase in patient’s confidence to perform activities of daily living while avoiding an obstacle.
Refection is the last and important step of clinical reasoning cycle to contemplate the learning from the process (Dalton, Gee & Levett-Jones, 2015). Overall the Miller’s functional consequences theory has been useful to identify the factors decreasing the quality of life and develop appropriate interventions to reduce risk factors. Clinical reasoning cycle has been helpful in making care choices based on various contributing and predisposing factors. I felt I should educate the patient on pain medication and side effects as there are opiates and some tranquilisers that affect blood pressure and consciousness, increasing fall risks. Upon further reflection I felt the need to consider the assessment for monitoring the joint inflammation and pain as it determines the level of exercise needed by patient. However it may be included in next nursing plan after evaluation. This learning may be helpful in my future practice.
Conclusion
It can be concluded that clinical reasoning cycle is an effective tool. It helps to identify the needs of the patients to proceed with goal driven care by prioritising care needs. Using the framework of the Miller’s Functional Consequences Theory, I have gained the concept of the wellness in geriatric care and the wholistic perspective. It includes defining characteristics of building upon individual’s strength and optimising the potential. The case study analysis helped to understand the way to maintain their dignity during the assessment and care process. It gave deep insights into problem solving and nursing care provision. Both the frameworks used in the assignment has helped to identify the risk factors and priority needs. The top priority care need was identified to be limited mobility of the patient as it increases is of fall and injury. Interventions include physical activity or exercises and safety education to reduce risk of fall. The use of clinical knowledge and critical thinking may better help solve patient problem in future practice.
Patient Education
References
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Brach, J. S., Perera, S., Gilmore, S., Vanswearingen, J. M., Brodine, D., Nadkarni, N. K., & Ricci, E. (2017). Effectiveness of a timing and coordination group exercise program to improve mobility in community-dwelling older adults: a randomized clinical trial. JAMA internal medicine, 177(10), 1437-1444. DOI: 10.1001/jamainternmed.2017.3609
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