Person-Centred Care

The Vipul Patel scenario was chosen because it offers a good opportunity to demonstrate person-centred care. For Mr. Patel, patient-centred care is important since he is suffering from heart attack. As such, a great deal of care is likely to lean towards self-care that focuses on protective lifestyle behaviours, self-monitoring, and medical-treatment adherence (Morgan and Yoder, 2012). Cardiac infarction is normally a traumatic diagnosis, and a patient should expect to live with the condition for the rest of their life. Individual motivation and psychological health are, thus, essential aspects, and compassionate, responsive approaches to decision-making are vital in establishing trust between patients and healthcare providers (Morgan and Yoder, 2012).

The coordination of care is essential as well. It includes regular medical check-ups and the continuous management, because it is a flawless transition across healthcare settings, for instance during discharge from the hospital (Morgan and Yoder, 2012; Edwards and Staniszewska, 2000). This paper purposes to address the problem of chest pain, shortness of breath, and cardiac health. It is, however, important to note that a care plan for self-care to enhance cardiac health will be developed. Patient confidentiality will be maintained as well. Therefore, all the information Mr. Patel provides during the process of care will be protected, and the information will not be released to third parties without his consent.

Overview of the Person- Centred Care Framework and Its Relevance to the Care Planning

The person-centred care (PCC) framework was created with the aim of being utilized in the intervention phase of a huge quasi-experimental project that focuses on measuring the efficiency of the execution of person-centred nursing in a tertiary hospital setting (McCormack and McCance, 2006). The framework offers a distinctive standpoint for nursing that theoretically connects caring and person-centredness. The PCC framework consists of 4 constructs. i.e., requirements, which focus on nurse characteristics, the care environment, where accent is made on the background in which care is offered, person-centred processes, which focus on offering care via a range of activities, and expected outcomes, which are the consequences of efficient person-centred nursing (McCormack and McCance, 2006; Coyle and Williams, 2001). The PCC framework is relevant to the care planning for this patient because it provides a guideline to offering care which increases the patient’s quality of life. It is achieved by enhancing patient self-care, mental and physical status, patient dignity, and treatment. The framework serves to reduce hospital stay, improve self-efficacy and the burden of cardiac infarction symptoms. The framework advances the dissemination of suitable information and support to the patient, i.e., therapeutic education that ensures the patient stays out of hospital (Leplege et al., 2007).

Care Plan

Assessment

The PCC framework is used in the assessment of Mr. Patel. As such, the assessment will include taking the patient’s history and conducting a complete head-to-toe assessment (Clarke, 2014). Taking the history of the patient will involve gathering information about the presenting complaint. This basically entails asking the patient questions regarding his current symptoms. Information about the history of the presenting complaint will also be gathered, encompassing examinations, treatment, and referrals already organized and offered. The patient will be asked about his past medical history as well, including considerable past illnesses, surgery encompassing complications, and trauma. Mr. Vipul’s drug history will also be taken into consideration. As such, he will be required to provide specific details about drugs he has taken in the past and the ones he is currently taking. The patient is expected to inform if he has any allergies. The patient’s family history is also essential, particularly about his marriage status, children, and common illnesses in his familial lineage. Mr. Vipul will be required to give information about his social history. This will include information on accommodation and living arrangements, smoking, drug abuse, alcohol consumption, occupation, and baseline functioning.

The next step entails checking the patient’s respiratory rate, oxygen saturations, pulse rate, and blood pressure. The latter will be measured in the brachial artery, utilizing a cuff around the patient’s upper arm. Notably, a big cuff will be used in this patient since he is obese. Utilizing a small cuff will cause his blood pressure to be overestimated. This will be followed by the head-to-toe assessment. Checking the patient’s eyes for drainage may reveal the latter to be a sign of allergy or injury. The eyes will also be checked to establish how the pupils react to light. A slow reaction to light may be an indication of neurological impairment. The skin of the patient for warmth, colour, and moisture will be also checked (Clarke, 2014). Redness of the skin may be an indication of chronic arterial insufficiency. Periphery cyanosis may result in a bluish discoloration to the patient’s lips and extremities. As such, the oral mucous membranes will be examined for cyanosis that may not be readily evident on the skin. The symptoms of peripheral cyanosis will be inspected beneath the tongue, inside the cheeks and the nail beds. The nails will be examined for capillary refill. Also, fingers will be checked for nicotine staining.

The neck will be checked next. In this case, the neck’s blood vessels will be examined. This will aim at determining the pulsation of the internal jugular veins and the carotid artery. The internal jugular veins will offer information about the patient’s blood volume and pressure in the right side of the heart. This will also help in determining the efficiency of the patient’s heart. Auscultating the carotid artery helps to determine if a bruit is present. For instance, the swishing or blowing sound is indicative of turbulent blood flow. The chest will be auscultated for apical heart rate. Palpations of the chest will be conducted. In particular, the patient’s chest will be palpated to find the apical pulse (Clarke, 2014). A normal pulsation is gentle in an area approximately 1.5-2cm in diameter. Any other pulsation is perceived to be abnormal. The abdomen will be inspected for distension and asymmetry. A distended abdomen may be an indication of ascites related to a condition such as heart failure. Еhe patient’s extremities will be examined, i.e. the legs and arms for malformation, pain, and edema (Clarke 2014).  The patient’s arms and legs will also be palpated. Asymmetry may be indicative of cardiovascular diseases. The colour, movements, warmth, and the sensation of the hands and legs will be checked and comparisons made to establish sufficiency of perfusion.

The ISBAR tool will also be incorporated in the assessment so as to enhance communication. The tool will allow for the application of the 6C’s of nursing. As such, the nurse will seek to establish rapport first. This will be attained by the nurse introducing him/herself to the patient by stating their name and the role they play in the hospital. The patient will then be welcomed and requested to state his name or his preferred name as well as state his age. Open-ended questions will follow, and they will be aimed at collecting information about Mr. Patel’s present status of health and reason for consultation. Establishing rapport gives the nurse the opportunity to demonstrate care, communication, and compassion (Clarke, 2014). The next step will entail determining the background of the patient, i.e., past medical history, allergies, and drugs. This step will allow for the nurse to apply communication. Assessment is the step that follows. In this case, the head-to-toe assessment is selected, and it purposes to examine the patient’s body systems to establish what causes pain to the patient. This assessment serves to demonstrate the nurse’s competence. The last step is recommendation where the nurse develops a plan of care and treatment for the patient. This stage allows for the demonstration of courage and commitment.

Documentation will follow. This will serve to demonstrate what has occurred during the assessment, while the clinical reasoning will also be applied. Using a structured patient assessment framework in some clinical environment enhances the wholeness and quality of clinical documentation (Munroe et al., 2013). In this case, the PCC framework will be used, and by doing so the documentation of the assessment will be improved.

Problem Identification

The patient complains of a crushing pain in his chest. This symptom may be attributable to tissue ischemia, i.e., occlusion of the coronary artery.

The patient complains of shortness of breath. This is indicative of myocardial infarction, failure of the heart to pump blood sufficiently.

Poor cardiac health as evidenced by the heart attack.

Goal Statement

The patient understands the lifestyle changes he should adopt by communicating the types of foods he is advised to consume, the type of exercises he can engage in, and the strategies he can apply to quit smoking within the next 24hrs.

Nursing Interventions/ Implementation

The care plan for this patient will focus on patient education and counselling, which will mainly entail encouraging Mr. Patel to make some lifestyle changes so as to enhance his cardiac health. According to Mr. Patel’s medical history, he does not exercise often, and this can be attributed to the fact that he regularly works late. He also loves to sit at home and watch the television after work. The patient will be advised to change this habit. Therefore, the best recommendation for him is to make an effort to engage in regular physical exercise. Even though his busy schedule can prevent him from engaging in exercise, he should attempt to set aside at least 15-20 minutes a day to exercise (Michie, Miles & Weinman, 2003). For instance, he can develop a habit of walking more often, swimming, or even biking. After some time, he can even start to engage in light jogging prior to going to work. In fact, jogging will enhance his cardiac health. Notably, Mr. Patel will be advised to start exercising in a slow, step-by-step manner, aiming to increase his capacity of activity. For this reason, he should begin at a level that he is comfortable with and increase the length and intensity of activity as he gains fitness.

The patient admits that he is a smoker, and he smokes about 30-40 cigarettes daily. This is not good for his cardiac health and overall well-being. In this case, he is advised to cease smoking. Motivational interviewing will be applied. Lai et al. (2010) argue that motivational interviewing is a proven style of counselling that assists patients with chronic conditions move toward giving up tobacco. Most healthcare providers are used to educate the patients on the types of steps they need to adopt to quit smoking. Still, simply asking patients to stop the behaviour does not often lead to a change (Cahill, Stevens, Perera & Lancaster, 2013; Sherrie, 2007). Motivational interviewing aims to underline inconsistencies between the goals of this patient and his present behaviour. As such, open ended questions will be used. For instance, Mr. Patel will be requested to provide reasons as to why he believes he should stop the smoking habit, articulate his understanding of the risks associated with tobacco use, the anticipated benefits of quitting, and any possible barriers to quitting.

Use of affirmations will be applied as well. The latter is aimed at reminding the patient that he is in control of his own choices, and that the nurse supports him. Statements are positive and purpose to encourage the patient to promote a compassionate relationship with patients who have possibly been judged by others for using tobacco (Carr and Higginson, 2001; Standing, 2017). Examples of statements that will be used in this case are: “It appears that you have spent a significant amount of time thinking about the changes you want to make” and ”Your dedication to your wife and daughter is a strength that will assist you when you decide to quit.” Noting the changes that Mr. Patel can make will serve to enhance his self-confidence to move towards living a life that is tobacco-free.

It is also important to apply listening. Communicative behaviours, like listening and closeness are strongly associated with satisfaction with the health care offered (Brownie and Nancarrow, 2013; Wanzer et al., 2004). As such, the nurse will listen carefully to what Mr. Patel says and reflect back his intentions. This will illustrate the nurse’s comprehension of the challenges associated with being a nicotine addict. For instance, the nurse can say: ”You are saying that cigarettes help you to cope with stress?” Reflective statements can also be utilized to efficiently underline Mr. Patel’s own words about his interest and dedication to quitting. An example of such a statement is: ”it appears that you are willing to stop smoking so that you can have an easier time breathing and chasing your daughter around the house.” This counselling session will end by summarizing decisions made. Making a summary gives the nurse the opportunity to direct the conversation toward the next steps the patient needs to take (McCance, McKenna & Boore, 2001).

Another nursing intervention will focus on modifying the patient’s diet. The patient-centred care framework encourages sufficient nutrition (Watterson, 2013). This is what informs this nursing intervention. Mr. Patel has adopted a poor dietary habit of consuming fast foods. Obesity and high cholesterol levels are yet more indications that the patient has a poor dietary habit. In this case, he will be advised to adopt a Mediterranean-style diet, which comprises of more fruits and vegetables, whole grains, and less red meat. Consumption of oily fish is also recommended. In order to reduce Mr. Patel’s cholesterol level, he will be recommended to decrease the consumption of saturated fats which can be found in whole milk, meat pies, and cakes. As such, these foods should be kept to a minimum in his diet. Sodium intake should be minimized as well. Also, instead of utilizing butter and cheese, Mr. Patel is advised to use oils, such as olive and canola oils, which are healthy for the heart. Obesity increases the patient’s risk of having another heart attack in the future (Wong et al., 2015). For this reason, it is important for Mr. Patel to lose weight. This can be achieved through adherence to a healthy diet and engaging in physical exercise.

Discharge Plan

The patient will be advised to take the medication as prescribed by the physician. In case the prescribed drugs fail to improve the symptoms or they make the patient experience severe side effects, he is advised to contact the caregiver. This will allow the healthcare provider to prescribe drugs that are more effective and having minimal side effects (Radwin and Fawcett, 2002). Mr. Patel will be advised to rest for at least 1-2 months so as to give his heart time to recover. The nurse will ensure that he/she discusses with Mr. Patel the best time to return to his normal activity based on his condition during discharge.

The healthcare provider will recommend Mr. Patel to join a heart rehabilitation program. This program is aimed at assisting the patient to strengthen his lungs and heart. Importantly, the healthcare professional will ensure that he/she asks the patient about his opinions regarding the suggestion. The nurse will then explain what the program entails and its benefits. Then, Mr. Patel will be given the opportunity to decide whether to join the program or not. Mr. Patel will be taught on how to monitor his heart rate and blood pressure and, hence, check these parameters daily and record the readings. He should contact the hospital immediately when the readings are not normal. The patient will also be reminded to adopt a healthy lifestyle that entails consuming healthy diets, engaging in physical exercise, and quitting smoking (Durkin, Brennan & Wakefield, 2012). This lifestyle change will improve the overall well-being of the patient and improve his cardiac health (Bennett, Perry & Lawrence, 2009; Lai et al., 2010).

How the Planning Process Meets the Concepts of the Valuing People’s Framework

Clarke (2013) notes that treating the patient with respect and dignity entails caring for them, showing them compassion, and being courteous. Mr. Patel will be shown care and compassion during the care process. This is demonstrated when the nurse empathises with his addiction to tobacco use. He/she tries to understand why Mr. Patel has developed this habit and attempts to help him to come with a solution to quit it.

Autonomy is also demonstrated in the intervention plan when the nurse presents the patient with recommendations about the lifestyle changes he should adopt. In this case, the patient is not forced to adhere to them. He is allowed to independently decide if the recommendations suit him. Life experience is one of the attributes the nurse has, and as such, it serves to illustrate his/her knowledge, skills, and competency (Gulanick and Myers, 2011). The intervention demonstrates that the nurse is competent as he/she has been able to use information gathered from patient history and assessment to develop a care plan that fits this heart patient. The environment of care in this case fosters shared decision making. This is illustrated when the nurse listens to Mr. Patel’s opinions about smoking, and together, they attempt to decide the strategy he will use to quit the addiction. Evidently, there is a relationship existing between the patient and the nurse. The nurse supports Mr. Patel’s motivations and understanding by encouraging a 2-way communication.

Legal and ethical considerations are respected. The information regarding patient’s health is kept confidential and protected from the access of third parties (Dimond, 2015). All interventions are performed upon patient’s consent.

Evaluation

Goal is met when Mr. Patel takes less than 30 cigarettes over the past 24 hrs. This is a great step towards quitting smoking since it is an indication that he will to try to quit the habit.

Goal is met when the patient consumes a heart healthy meal in the last 24 hrs. This is indicated by incorporation of vegetables and fruits in his diet and the avoidance of fast foods.

Goal is met when the patient engages in some form of exercise in the last 12 hrs. The exercise may be in form of walking around the hospital with the aid of a health professional or family member.

Conclusion

Obviously, this assignment turned to be very helpful. For instance, it has revealed the importance of person centred care as it serves to enhance patient satisfaction. By doing this assignment, I was also able to practice using the person-centred framework to conduct patient assessment, develop care goals for a patient, and come up with a care plan. I must say that the assignment has equipped me with the necessary skills and knowledge that will help me to offer effective care to my patients as an adult nurse in the future.

References

Bennett, C., Perry, J. and Lawrence, Z., 2009. Health Promotion in Primary Care.

          Nursing Standard, 23(47), pp.48-56.

Brownie, S. and Nancarrow, S., 2013. Effects of person-centered care on residents

          and staff in aged-care facilities: a systematic review. Clinical interventions in        Aging, 8, p.1.

Cahill, K., Stevens, S., Perera, R., & Lancaster, T. (2013). Pharmacological interventions for smoking cessation: an overview of reviews. Cochrane database of systematic reviews, (5).

Carr, A.J. and Higginson, I.J., 2001. Measuring quality of life: Are quality of life

          measures patient centred?. BMJ: British Medical Journal, 322(7298), p.1357.

Clarke, C., 2014. Promoting the 6Cs of nursing in patient assessment. Nursing           Standard, 28, 44, 52-59.

Clarke, J., 2013. Spiritual care in everyday nursing practice: A new approach.

          Macmillan International Higher Education.

Coyle, J. and Williams, B., 2001. Valuing people as individuals: development of an

          instrument through a survey of person‐centredness in secondary care.           Journal of Advanced Nursing, 36(3), pp.450-459.

Dimond, B. (2015). Legal Aspects of Nursing. Pearson Higher Ed.

Durkin, S., Brennan, E., & Wakefield, M. (2012). Mass media campaigns to promote smoking cessation among adults: an integrative review. Tobacco control, 21(2), 127-138.

Edwards, C. and Staniszewska, S., 2000. Accessing the user’s perspective. Health &

          Social Care in the Community, 8(6), pp.417-424.

Gulanick, M. and Myers, J.L., 2011. Nursing care plans: diagnoses, interventions,

          and outcomes. Elsevier Health Sciences.

Lai, D.T., Cahill, K., Qin, Y. and Tang, J.L., 2010. Motivational interviewing for

          smoking cessation. Cochrane database of systematic reviews, (1).

Leplege, A., Gzil, F., Cammelli, M., Lefeve, C., Pachoud, B. and Ville, I., 2007.          

          Person-centredness: conceptual and historical perspectives. Disability and     rehabilitation, 29(20-21), pp.1555-1565.

McCance, T.V., McKenna, H.P. and Boore, J.R., 2001. Exploring caring using

          narrative methodology: an analysis of the approach. Journal of Advanced     Nursing, 33(3), pp.350-356.

McCormack, B. and McCance, T.V., 2006. Development of a framework for

          person‐centred nursing. Journal of advanced Nursing, 56(5), pp.472-479.

Michie, S., Miles, J. and Weinman, J., 2003. Patient-centredness in chronic illness:

          what is it and does it matter?. Patient education and counseling, 51(3),           pp.197-206.

Morgan, S. and Yoder, L.H., 2012. A concept analysis of person-centered care.

          Journal of holistic nursing, 30(1), pp.6-15.

Munroe, B., Curtis, K., Considine, J. and Buckley, T., 2013. The impact structured

          patient assessment frameworks have on patient care: an integrative review.          Journal of Clinical Nursing, 22(21-22), pp.2991-3005.

Radwin, L. and Fawcett, J., 2002. A conceptual model‐based programme of nursing

          research: retrospective and prospective applications. Journal of Advanced     Nursing, 40(3), pp.355-360.

Sherrie, S., 2007. Initiating person-centered care practices in long-term care

          facilities. Journal of Gerontological Nursing, 33(11), p.47.

Standing, M., 2017. Clinical Judgement and Decision Making in Nursing. Learning

          Matters.

Wanzer, M.B., Booth-Butterfield, M. and Gruber, K., 2004. Perceptions of health care

          providers’ communication: relationships between patient-centered           communication and satisfaction. Health communication, 16(3), pp.363-384.

Watterson, L. (2013). 6Cs + principles = care. Nursing Standard, 27(46), 24-5.

Wong, C.X., Sullivan, T., Sun, M.T., Mahajan, R., Pathak, R.K., Middeldorp, M.,

          Twomey, D., Ganesan, A.N., Rangnekar, G., Roberts-Thomson, K.C. and     Lau, D.H., 2015. Obesity and the risk of incident, post-operative, and post-   ablation atrial fibrillation: a meta-analysis of 626,603 individuals in 51 studies.         JACC: Clinical Electrophysiology, 1(3), pp.139-152.