Promoting Health in Extended Care

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nIntroduction

nCaring elderly patients play a major role in facilitating better health outcome. The health of people deteriorates as they become older. Aging affects the way a body reacts to treatment and frequency of infections. Therefore, there is need to deliver specialized care for elderly patients. Due to physiological changes, elderly patients have a higher risk of falls and injuries (Prohaska, et al, 2012). Similarly, their risk of isolation due to bereavement is likely to cause depression and death to these patients. Since Amalie has cultural and linguistic differences, the nurse should consider nursing interventions that are linguistically and culturally sensitive (Stuart-Hamilton, 2010). The paper will discuss how to use Functional Consequences Theory and Critical Reasoning Model in nursing for a case study involving an elderly patient (Amalie).

nMillers Functional Consequences Theory of healthy ageing

nThe Functional Consequences Theory enables nurses to focus their care towards reducing infections and the risk factors for elderly patients. In this case, a nurse should concentrate on improving the quality of life and recovery of the patient (Miller, 2009). The Functional Consequences Theory involves five components, which are Functional Consequences, Negative Functional Consequences, Positive Functional Consequences, Age-Related Changes and Risk Factors. In the case of Amalie, the paper will discuss the care priorities using the Functional Consequences Theory (Moon & Galea, 2015). The care priorities for Amalie include increased rate of fall and injuries, and increased risk of social isolation. Amalie is from culturally and linguistically diverse community hence, there is need to provide special care.

nLinguistic and cultural diversity can be a source of relapse, trauma and depression to the elder patient. Due to this fact, the nurses need to have knowledge on how to prevent relapse within a cultural difference background. Research shows that elderly patients from CALD issues have a challenge in gaining access to services of mental health. In addition, these patients are reluctant to social event such as community health services (Stuart-Hamilton, 2010). These patients normally lack culturally appropriate and safe health services. Poor communication also acts as a major hindrance to access of health services.

nFunctional Consequences refers to detectible effects of risk factors. It also includes changes associated to elderly patients that can affect their quality of life in the daily life. Therefore, the nurse should initiate timely and effective nursing interventions to the elderly patient (Holland & Roberts, 2013).

nNegative Functional Consequences occur when factors disrupt the quality of life or health status of an elderly person. In addition, negative functional consequences are harmful to the patient because they raise the level of dependency (Holland & Roberts, 2013). In the case of Amalie, Negative Functional Consequences include loss of physical contact with her friends and members of the German association as well as loss of her husband (Stuart-Hamilton, 2010). Similarly, Amalie lives in a linguistically and culturally diverse environment. Ultimately, she develops a tendency of feeling guilty and lonely (Jeffreys, 2010).

nHowever, Positive Functional Consequences occur when factors reduce the level of dependency and improve the health status of the patient. They occur because of appropriate nursing interventions (Hindle & Coates, 2011). In the case of Amalie, the Positive Functional Consequences will include reduced instances of isolations, depressions and injuries as well as cultural sensitive nursing services.

nAge-Related Changes refers to irreversible and inevitable changes that take place to the elderly patient (Prohaska, et al, 2012). Amalie is suffering from bereavement because she has lost her husband and she is culturally and Linguistically Diverse (CALD) since she has a German background as opposed to Australian. Moreover, she is suffering from isolation because of loss of her spouse. Similarly, she is living alone in the home as her children live in different parts of the world/country (Goldman, et al, 2012). She also has challenges in language since she has a German origin. On the other hand, due to ageing, patients lose the ability to communicate effectively.

nDue to differences in culture and language and bereavement, she may be exposed to neuropsychological risk factors such as depression and delirium (Reed, et al, 2012). Differences in culture and language also act as risk factors. A nurse will address the risk factors through introduction of promotional interventions that will facilitate her recovery.

nLevett-Jones Clinical Reasoning Model

nClinical Reasoning Model explains a system by which health professionals such as nurses gather information regarding a patient. It also helps them to understand the problems and needs of the patient (Holland & Roberts, 2013). Critical reasoning model involves eight levels of nursing interventions. The interventions emphasize the need for reflection and evaluation (Clare & Woods, 2013). The cyclic stages of interventions are observing, gathering, processing, decisions, organizing, actions, evaluation and reflection.

nSteps of the clinical reasoning model

nPatient consideration

nAt the first stage, the nurse should meet the patient who needs care and starts to acquire initial needs. In this case, the nurse should visit Amalie after obtaining her health report or after completion of her medical examination (Reed, et al, 2012). Although the initial impression is very essential, it is affected by preconceptions and assumptions prior to its commencement. At this step, the nurse should attempt to understand the background information of Amalie and the history of care (Prohaska, et al, 2012). In this regard, a nurse must seek the medical history of her bereavement and culturally and linguistically diverse (CALD) nature. Therefore, in order to help Amalie, a nurse should design culturally sensitive community health services. Additionally, referrals and assessments should be culturally acceptable (Goldman, et al, 2012). Most importantly, a nurse should be guided by practices and principles that promote culturally sensitive community health services for Amalie.

nCollection of Information

nIn the second step, the nurse should start to collect appropriate information regarding Amalie. Therefore, he/she should appraise the available information through Amalies recorded history, clinical and medical notes and documents (Tabloski, 2010). He/she should also review the patients reports. Based on the collected data, the nurse should decide on the new kind of information needed (Levett-Jones, 2013). The new data can be related to the friends and family of Amalie. Most importantly, the nurse should seek to understand the concerns of Amalie. Finally, the nurse should utilize the collected information.

nInformation processing

nThe data collected should be analysed, and clustered to produce hypothesis and inferences. In the case of Amalie, the existing health conditions should be compared to the past. Consequently, the nurse should predict possible health results based on certain course of action (Holland & Roberts, 2013). In this case, the nurse must establish a repertoire related to clinical conditions of Amalie, which play a role in comparing the existing circumstances.

nProblems Identification

nThis stage involves information synthesis. With regard to Amalie, the nurse should synthesis information gathered and processed aiming to recognize issues or problems affecting her (Jeffreys, 2010). The stages play a crucial role because it helps in choosing the most suitable goals of actions and nursing care (Levett-Jones, 2013). The nurse will be able to identify issues related to increased risk of culturally and language diversity. Some of the identifiable effects of risk and age-related changes include more falls, social isolation, increased physical inactivity (Parnell, 2014).

nGoals establishment

nAt this stage of critical reasoning cycle, the nurse establishes goals based on the care priorities. In this respect, the goals will be based on how to manage risk associated with cultural and language diversity of Amalie. Similarly, the goals will also be set based on reducing risks of isolations (Hindle & Coates, 2011). The nurse must develop Specific, Measurable, Achievable, Realistic and Timely (SMART) goals. The goals should focus on reducing elderly patients isolation and lack of accessibility on healthcare facility. Therefore, the nurse should set goals to conduct multifactorial assessment of risks for Amalie in order to observe and identify effects of risks and age-related changes (Prohaska, et al, 2012).

nCourse of Action

nThe nurse should choose the most suitable action. Moreover, he/she should select the best person to conduct the nursing interventions aiming to help Amalie manage diseases (Levett-Jones, 2013). A nurse should implement nursing interventions to Amalie, which address the care priorities such as increased falls and injury risks, as well as increased risk of social isolation (CALD and bereavement).

nTherefore, interventions should not generalize the nursing care. Nursing services should recognize the similarities and differences between Amalies and local culture. In the process of helping Amalie recover it is important for a nurse to involve volunteers of similar cultural and linguistic background (Goldman, et al, 2012). The nurse will need to work with organizations that offer ethno-specific assistance in the process of nursing interventions. Most importantly, the staff working with Amalie should be having competencies in working with CALD (Prohaska, et al, 2012). In this regard, the staff should be aware of behaviours, skills and attitudes that helps them to provide appropriate care to patients from CALD backgrounds (Kersey-Matusiak, 2013). Furthermore, this type of care should be appropriate and respectful to these patients.

nEffective communication and information also play a key role in helping patients from CALD background. Therefore, effective communication helps to sustain nursing care for Amalie. This can be achieved by communicating and offering information in local language (Perry, 2014). In this case, a nurse should try to communicate in a language that Amalie is comfortable with (Holland & Roberts, 2013). Additionally, a German interpreter can be used when offering care. Furthermore, a nurse should engage social workers that have bi-lingual skills. The nursing interventions for Amalie can be improved by increasing her awareness. In this regard, the nurse should use translated information systems such as newspapers, and pamphlets (Moon & Galea, 2015). A nurse should also work with community and social leaders in Australia to help establish linkages between Amalie and service providers (Prohaska, et al, 2012). Amalies family should also be engaged in development of nursing program and planning.

nThe nurse should initiate modification of home environment aiming to eliminate environmental hazards in Amalies house (Holland & Roberts, 2013). On the other hand, due to weakening muscle strengths, the nurse should introduce exercise programs. The program will play a major role in reinforcing her muscles. Similarly, training on balance and gait should be initiated aiming to reduce gait and balance impairment (Prohaska, et al, 2012). The intervention should also include physician monitoring which can help in assessing progress of the patient.

nOutcome Evaluation

nThe cycle requires that the nurse should re-evaluate the information of Amalie. For instance, he/she should evaluate her medical status aiming to identify the most efficient nursing interventions to enhance improvement (Levett-Jones, 2013). In this regard, the nurse should assess the effectiveness of nursing interventions. Moreover, he/she should address the issues that hinder the effectiveness of interventions such as on culture and language sensitive nursing services (Jeffreys, 2010). Evaluation should be based on whether the intended outcomes are achieved. Outcome evaluation plays an important role in nursing interventions because it helps nurses to make corrective actions (Parnell, 2014).

nReflection

nThe last stages require the nurse to assess the nursing intervention in order to change, improve and refine. This step is important because it provides a chance for learning to the nurse (Clare & Woods, 2013). It permits the nurse to process the reasons why he/she conducted the interventions and outcome to Amalie.

nConclusion

nIt is evident that Functional Consequence Theory and Critical Reasoning Model have an important role to play in ensuring success of nursing interventions such as Amalies case. The nursing strategies are patient-centred which helps to pay close attention to her (Reed, et al, 2012). On the other hand, the approaches help the nurse to plan, implement and evaluate the nursing outcomes.

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nReferences

nClare, L., & Woods, R. (2013). Handbook of the clinical psychology of ageing (2nd ed.). Chichester, England: John Wiley & Sons.

nGoldman, M., Troisi, R., & Rexrode, K. (2012). Women and health. Oxford: Academic.

nHindle, A., & Coates, A. (2011). Nursing care of older people. Oxford: Oxford University Press.

nHolland, K., & Roberts, D. (2013). Nursing. Oxford: Oxford University Press.

nJeffreys, M. (2010). Teaching cultural competence in nursing and health care. New York: Springer Pub. Co.

nKersey-Matusiak, G. (2013). Delivering culturally competent nursing care. New York: Springer Pub. Co.

nLevett-Jones, T. (2013). Clinical reasoning. Frenchs Forest, N.S.W.: Pearson Australia.

nMiller, C. (2009). Nursing for wellness in older adults. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

nMoon, J., & Galea, M. (2015). Improving health management through clinical decision support systems. IGI Global.

nParnell, T. (2014). Health Literacy in Nursing: Providing Person-Centered Care. Springer Publishing Company.

nPerry, A. (2014). Clinical nursing skills & techniques. St. louis: Elsevier mosby.

nProhaska, T., Anderson, L., & Binstock, R. (2012). Public health for an aging society. Baltimore: Johns Hopkins University Press.

nReed, J., Clarke, C., & Macfarlane, A. (2012). Nursing older adults. Berkshire, England: Open University Press.

nStuart-Hamilton, I. (2010). The psychology of ageing. London: Jessica Kingsley Publishers.

nTabloski, P. (2010). Gerontological nursing. Upper Saddle River, N.J.: Pearson.