Learning Outcomes
The most significant priority of healthcare models is to improve and enhance the quality of care among adults. The role of the advanced practice nursing (APN) is to take this immediate priority and maximize their specialized skills in nursing knowledge to handle the customers’ needs within their sphere. Older people in the society are faced with various chronic conditions and different functionality problems. With this, The society turns to adult nursing as the main solution to such dilemmas. The paper is focused on analyzing the role of the adult nurse in a variety of settings and insight into adults’ experiences of ill health.
According to (Castledine and Close, 2009), adult nursing is a health practice that is carried out across all institutional settings as named above. Adult nursing is a broad term that that simply refers to the general nursing care except for children care. Also, it has a particular grouping that deals with older people (geriatric nursing) (Adams, 2010). However, where care for senior adults focuses primarily on physical health and well-being, such nursing care would fall within the responsibilities of adult nurses. On the other hand, where attention falls towards mental health conditions of an adult, the same would fall within the scope of mental health. For instance, the care for patients of dementia falls within adult nursing even though the deteriorated cases sometimes have much to do with mental problem.
One of the main areas or ill-health in adult nursing includes taking care of patients of dementia. Given the high and still rising cases of dementia, there demands to apply relevant models of care that help in identifying specific patient’s needs. The main role of adult nurse involves assessing the patient’s conditions by the application of methods that are explained in the nursing theories (Potter et al., 2016). These methods allow the nurse to identify the exact patient needs and demonstrate effective communication that aids in the interaction between the nurse and the patient (Cherry and Jacob, 2013, p.81). Nurses are expected to apply the appropriate theory that would cater for the patient needs. The theory applied is expected to the provide a solution for the recognized patient’s problems and assess how level in which the procedure would be successful. One of these theories is the Orem’s Self-Care Deficit theory that was suggested by Dorothy (Hartweg, 1991).
The self-care deficit theory suggested by Orem features three theories. These are the self-care, self-care deficit and the nursing systems. In the self-care theory, (Hartweg, 1991) explains these are the activities the patient undertakes to maintain his health. In this theory, self-care agency is one’s assimilated ability to execute self-care needs which also depends with the condition’s factors i.e gender, age, family, healthcare, etc. Therapeutic self-care needs are the totality of the self-care measures needed. The better performance of self-care determines the fulfillment of the self-care requisites (Katherine Renpenning and Susan Gebhardt Taylor, 2003, p.104). There three types of self-care requisites are the universal, developmental and health deviation (Katherine Renpenning and Susan Gebhardt Taylor, 2003, p.218).
Health Needs and Services for Adults
The deficit theory involves the nurse role in patient assessment to identify the needs. Once they are identified, the nurse next step is to choose the appropriate nursing systems of care (Katherine Renpenning and Susan Gebhardt Taylor, 2003, p.218). The care is provided as per the level of the patient deficits. After identifying the care, procedures and the system, the last part involves evaluating the care to find out whether it met the specific needs. Thus, this theory was the one successful for our practice in assisting our patient.
The case I encountered was for a male adult patient, 75 years old suffering from dementia. For the sake of patient’s confidentiality, this paper will refer to the patient as Mr. White, and the caregiver (daughter) Ms. X. Mr. White came was presented to the orthopaedic emergency ward department in pain from a broken fractured Neck of Femur (NOF) which he had sustain from a fall. Mr. White was accompanied by her daughter X who also acted as his caregiver. Ms. X stated that Mr. White was 75 years old and he lived with him together with the rest of the family members. Mr. White is a retired teacher and had a good memory before his retirement. Ms. X presented a clinical note from a district nurse (DN) revealing the diagnosis of Mr. White with Alzheimer, a common type of dementia. The note showed that he had been diagnosed with the disease for five years ago. Ms. X and other family members have been taking care of him ever since. Mr. White wife had passed 20 years ago.
In applying the orem’s theory, we started with filling the patient profile, then we moved to data collection where we collected the basic information regarding the condition. I.e. age, gender, female, health state, development state, sociocultural orientation, health care system, family system, patterns of living .etc. We then collected information regarding the patient universal selfcare prerequisites such as the how he was breathing, fluid intake, food, elimination, activities (pain/rest) bone fracture and deformity, social interaction, communicates etc. We also assessed the developmental self-care requisites and health deviation self-care requisites such as cooperation with medical regime, adjustment to health changes, perception of the physical therapy approaches etc.
In overall, the areas that needs assistance were food and nutrition interventions, education for the disease management was required, life style to include medical regimen, hazard prevention such as falls, maintenance of health status, maintain a developmental environment, adherence to the medical regimen, solitude/ Interaction, Activities and rest, supportive educative, preoperative education, surgery, and post-operative education.
Role of Adult Nurse in Partnership with People and Professionals
On examination, Mr. White had sustained a non-ST-segment elevation myocardial infarction (NSTEMI) which was also linked to his fall. An anesthetic review showed that he was at another risk of unstable cardiac, which also suggested high chances of an intraoperative mortality. There was a recommendation for a delay of anesthetic from 24 to 72 to allow operative fixation. The purpose of this approach was to monitor optimize cardiac status if need be. In addition, there was a palliative care which was highly monitored for controlling his pain, which at some point it was necessary to use a continuous intravenous infusion of fentanyl. After about 3 days, Mr. White got a transthoracic echocardiogram which showed that his left ventricular had a normal size and was functioning well. After another anesthetic review, the patient was found fit to undergo a surgery though there still remained a high anesthetic risk. Since the daughter was supporting the idea of operation, she was just given the consent form which she signed, and the dynamic hip screw was inserted. There were no problems with the postoperative recovery. The patient just moved well except for a time when there was and pneumonia and anemia complications. All of them were taken care of and the conditions improved. Due to the few perioperative symptomatic conditions of delirium and some pain, the palliative care was ongoing for the management of those symptoms, and the move facilitated successful recovery by the 7th day of his admission.
Nutritionists and Dieticians
While identifying the therapeutic selfcare demands of Mr. White’s deficient areas under Orem’s model, the nursing diagnosis showed that the patient had inabilities to maintain an ideal nutrition or inadequate food intake. The two professionals were to focus on assessing Mr. White’s diets and nutrition during the palliative care. Besides, it has been noted that this problem of diets and nutrition is common among dementia patients as they hardly maintain steady body weight and regularly have feeding-related challenges (Jansen et al., 2015). For instance, Mr. White’s had a body mass index (BMI) of 14.9. Their role of nutritionists and dieticians in Mr. White’s case was to develop nutritional care approaches to prevent cases that can complicate Mr. White’s condition due to underweight. From the study of (Ye et al., 2016), underweight can cause deterioration of dementia.
Orthopaedic Surgeon
The role of this professional in Mr.White’s case was to perform the operation. According to (Riemen and Hutchison, 2016), a multidisciplinary hip fracture approach is composed of seven components. These are the orthogeriatric assessment, the rapid optimization in the preparation for the surgery, early identification the patient’s goals regarding multidisciplinary rehabilitation, continuous, coordination of orthogeriatric and multidisciplinary analysis, liaising with other health services, governance structure in all the stages and involvement in the palliative care. For the case of Mr.White, the Orthopaedic Surgeon recognized these as his roles and also followed up with the palliative care to ensure that the fracture did not trigger another problem.
Healthcare Models for Adults with Dementia
Anesthetist
The role of anesthetist was to perform Mr. White’s assessments of his health to advise on his status regarding anesthesia. The anesthetist also looked after him during the surgery. For instance, the anesthetist carried out an assessment that showed that Mr. White was at a risk of unstable cardiac, which also suggested high chances of an intraoperative mortality. According to (Vanderweyde et al., 2010), dementia patients develop a decline in cognitive ability as a post-operative outcome with most researchers suspecting that it is caused by anesthesia. Therefore, with the presence of anesthetist, such risks are reduced.
Orthogeriatric Team
The work of (De Rui et al., 2013) has enough evidence that the role of orthogeriatric team go beyond the hospital settings especially to provide the services of integral geriatric care. In our case, this team conducted weekly analysis to ensure that the previous functional situations were improving hence signifying Mr. White’s maximum recovery.
Medical Doctor
This was a ward-based doctor who kept reviewing Mr. White’s daily basis. According to (Hum et al., 2014), the management of cases of dementia falls within the role of the doctors who provide primary care for different medical conditions. In Mr. White, the doctor helped in care coordination and the understanding of Mr. White social and family background.
Neurologist
This is a physician with a specialty in the management and diagnosis of diseases that affect the nervous system. In the cases of dementia, neurologists also advised on the use of medications (Larner, 2014). In the case of Mr. White, the neurologist helped in examining and interpreting algorithms that allowed an efficient and accurate identification of neurodegenerative in addition to the vascular dementia. He guided in the determination of the dementia and preventing the development of Alzheimer’s disease.
The OT helped Mr.White to achieve independence in the performance of his daily tasks such as meal preparation. According to (Gulanick and Myers, 2014), the OT ‘s roles are to conduct assessments of functional capacity of a patient to care for himself. In Mr.White, these assessments included the capacity to work on daily routines and use of assistive equipment. OT also worked with the family members to provide trainings for maximizing safety at home and patient independence.
Physiotherapist
The role of physiotherapist in Mr. White’s case was to assess him after the surgery to enable him to recover his mobility. Th physiotherapist provided him with the most suitable walking aids and provided a training to the carer in addition to the required exercises. According to (Handley et al., 2017) physiotherapist help people affected by dementia with advises regarding exercise and assistive equipment especially if they have a history or risks of fall that has impaired their mobility. Therefore, our physiotherapist was highly beneficial to Mr.White.
Orem’s Self-Care Deficit Theory
Nursing and other Health Care staff
The roles of nurses in Mr. White were to take care of all his general needs and care. These included training family member on medical regime, coping skills, follow up with environmental care, etc. The roles of registered nurses are unlimited. According to (Adams, 2010) the nurses assist in the assessment, care plan, provision and evaluation of preventative and curative measures. Their wide range of operation also includes rehabilitative care and coordination of care plan ordered by other professionals.
Social Worker
Mr. White was also provided with the assistance of a social workers. Their roles were to organise any assistance needed during his discharge from hospital. Like the nurses, they also take a range of roles. For instance, the work of (Allen et al., 2012) states that they provide support to consumers especially at stressing moments, during a change, time of grief, adjustment, and counseling.
Conclusion
In a nursing career, adult nurses are nurse specialists whose aim is to help communities in promoting health, preventing ill-health and enabling the society to improve and maintain both their physical and mental health. In this role, an adult nurse professional treats, offers support, and empowers families to care for their health by practicing healthy life behaviors. This paper aimed to explore the scope of adult nursing. The paper has covered different major areas like the roles of adult nursing and its relationship with other nursing specialties. Finally, the paper has also looked at the insights of adult nursing and ill-health.
References
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Ye, B. S. et al. (2016) Unstable Body Mass Index and Progression to Probable Alzheimer’s Disease Dementia in Patients with Amnestic Mild Cognitive Impairment. Journal of Alzheimer’s disease: JAD. [Online] 49 (2), 483–491.
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