Nursing Care Plan: Mobility and Continuing Term Paper

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NURSING CARE PLAN: MOBILITY & CONTINUING CARE

This client is a 67-year-old single male employed as a job laborer who suffered a stroke and remains at a community hospital for the last six months. This client, Mr. Baker, has been scheduled to return home due to improvements in his mobility status however, requiring assistance in the form of a walker and wheelchair. This client resides with his older brother and hi brother's family as well as his elderly mother who all live in an executive flat with four bedrooms on the second floor. The primary caregiver of the client's elderly mother is Mr. Baker's sister-in-law leaving only his nieces and nephews who are unwilling to care for this client in order that he is enabled to stay at home.

FOCUS QUESTIONS

Focus questions in this case study are those stated as follows:

Given the client's medical history and current illness, what are his problems?

What nursing interventions can you implement to address the client's problems?

What is your role as a home care nurse?

Are there any potential problems that you would anticipate while planning for his home care?

III. GOAL

The goal in this case study is to discuss how this client might organize his at-home activities in order that he is enabled to stay at home.

IV. BRIEF REVIEW of LITERATURE

The work of Grimmer, et al. (2006) entitled: "The Development of a Practical Patient-Centered Checklist" relates that planning for discharge of patients or 'discharge planning' "has been defined in the systematic identification and organization of services and supports to assist patients to manage in the community post-discharge." Staff that are involved in the patient process of discharge are capable of understanding and interpreting both patients and carer needs and from the perspectives of each of the two as well as within the "constraints of local post-discharge service organization and availability." (Grimmer, et al. 2006) Within the framework of this definition the assumption is present that "these hospital staffs appreciate patients' home environments and social supports, as well as patient's ability to recuperate once that have left hospital; and that they can match actual patient need with organization of available and appropriate community supports." Grimmer et al. (2006) notes the need of timing in service provision as the "first two weeks post-discharge have been highlighted in our work and others' as the time of greatest concern for many patients and their families."

The areas stated to be the focus of the most concern is the period of time when patients are considered to be "at their most vulnerable, learning new skills and adapting to significant physical and emotional changes." (Grimmer, et al. 2006) in a study conducted it was reported that "less than 20% of patients" in the study were given health and support services through formal means in the first two weeks after having been discharged." Grimmer et al. (2006) in fact the median period to waiting for services that are organized and formal in nature is stated at eight working days. Resulting was a need for patients to be resourceful and their creating their own strategies and this at a time when patients are the most vulnerable. Grimmer et al. (2006) further notes that there was only minimal patient 'ownership' in the formal service provision and further that patients did not communicate barriers and challenges to the hospitals. Grimmer et al. (2006) additionally reports that the performance measures failed to demonstrate that the service provision secured was reflective of the 'real life needs' of patients because the perspective of the patient had somehow becomes skewed when failing to take into account the patient and carers' viewpoint

The findings in this study state that various factors are often overlooked in the discharge plan prepared the Professional Nurse. Grimmer et al. (2006) first states that safe transport "from hospitals to home was often overlooked by hospital staff and patients. Fro instance the realities of independent mobility after alighting without assistance from a taxi or public transport at the front gate were a revelation to many patients, particularly if they were not in possession of the house keys." (2006) Secondly stated in the findings reported by Grimmer et al. (2006) are the difficulties experienced in obtaining and preparing food stated to "commonly raised in our interviews..."

The checklist proposed by Grimmer et al. (2006) is one of the main heading of 'common patient concerns' and then divided into two sections: (1) immediate post discharge concerns; and (2) Longer term post-discharge concerns. (Grimmer, et al. 2006) Listed as immediate post discharge concerns are considerations of: (1) Travel; (2) physical access to residence; (2) fresh food available; (4) able to prepare food; (5) with whom did the patient live; (6) ability to get to and from the bathroom safely; (7) mobility when sleeping and needing to go to the bathroom, take medications, feed their pet, and pay bills. Longer-term considerations upon post-discharge are those relating to: (1) shopping; (2) paying bills; (3) doctor appointments; (4) assistance with house/garden chores; (5) duration assistance will be needed; (6) is nursing home placement appropriate; as well as other considerations that must be accounted for in discharge of patients. The checklist used in this patient assessment has been modeled after the checklist presented in the work of Grimmer et al. (2006).

The checklist asks the patient the following questions in attempting to address the barriers that will present to the patients' safe return home after having been discharged. The questions that are relevant toward this end are those as follows: (1) Do you or your family have the keys to your home? (2) Does your home need cleaned before you return there? If yes, who can do this for you? (3) Are here fresh groceries at home in preparation for discharge? If no, who can do this for you? (4) Do you feel confident about preparing and eating food when you go home? (5) Pets: Have arrangements been made for your pets while in the hospital? When you go home? Is the home properly cooled or heated? Do you have anyone who can assist you should you be urgently needing to pay electricity, gas or telephone bills immediately prior to returning home or in the first few days after returning home? Can you manage your home and gardens? If no, who can help you do this? Questions are asked concerning proper illumination in homes as well as concerning the patient's ability to go to the bathroom alone. If assistance is needed it is critical at this stage in the discharge process that the need is identified and a solution implemented proactively in some cases it is necessary to ask the patient who they know that will call them daily in the first few days they are home from the hospital. There may be family members to notify that the patient is returning home and as well, family members who are agreeable to collaborative plans may be educated at this time in the methods most likely to effectuate the patient's successful return home upon having bee discharged. It is important to identify the expectations of the patient in regards to community health and support services. The carer, described as "someone who can assist" the patient with daily living. Medications are taken under review prior to patients' discharge home as is the aspect of equipment needs and confidence in using assists for mobility. Assessment of transportation is critical in the assessment and then in the solution identification process of the nursing plan.

Finally Grimmer et al. (2006) states that other important tasks to complete prior to discharge of the patient are those as follows: (1) speak to at least one hospital staff member about how long it might be before you will be feeling better and can expect to resume usual activities; (2) if your physical abilities are more limited due to your recent illness it is important to understand and to ask questions if they are present to clear up any possible confusion; (3) discuss the method that will be used in coping with feeling depressed, lonely, or anxious; (4) be sure the carer is confident in their assisting the patient before the patient returns home. There is presently "no standard approach in this process in identifying precise needs. There is a potential gap stated to exist "between formal health services provided post-discharge and genuine patient need, particularly relevant in the immediate post-discharge period." (Grimmer, et al. 2006) the contention of Grimmer et al. is that "for many elderly patents, the effectiveness of health and support services provided post-discharge could be improved by practical advice provided whilst in hospital, regarding effective methods of solving common problems that could compromise immediate post-discharge health and safety." (2006) the work of Cartier (2002) entitled: "From Home to Hospital and Back Again: Economic Restructuring, End of Lie, and the Gender Problem of Place-Switching Health Services" states:

Economic restructuring in the health services industry in the U.S.A. exemplifies general patterns of… [END OF PREVIEW]

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