Importance of Case Studies in Nursing

Introduction

The case study development regarding a patient in nursing is important as it enforces the nurses to develop reflection regarding the patient’s condition which ranges obtaining essential health information to the diagnosis and treatment of the medical condition. The case study analysis helps the nurses to get exposed to real life situation that offers them effective information regarding the way to care for the patient. In the assignment, a case study is being developed regarding a patient who is suffering from a type of urinary tract infection to understand the way the present health situation has impacted on the individual's body system. The activities of living that would be altered by the condition are also discussed. Further, the health and social care agenda and the health promotion activities related to the patient’s condition are explained, alongside the resources available for healthcare dissertation help, which provide valuable insights into managing such cases effectively.

Client Profile

The case study is related to the client named Patient J who is suffering from Pyelonephritis which is a type of urinary tract infection (UTI). Pyelonephritis is referred to the nature of urinary tract infection in which the kidney is infected with the initiation of the infection in the bladder or urethra of the patient (Hu et al. 2016). The client is 77 years female who lives with her husband aged 83 years suffering from arthritis. Her son visits them on weekly basis as he has to stay away for studies. Patient J’s husband is responsible to take care of her and there is no other person in the family to help them. The mentioned patient lives in a separate household within the city outskirts. She is also seen to be suffering from interstitial cystitis for the past ten years and has recently become dependent on using indwelling catheter due to her urgent urination needs. Interstitial cystitis is referred as a disease which affects the urinary bladder of the individuals making them face pain while the bladder gets filled up. This situation leads patients to face urgency of elimination as they often lack control over their bladder due to pain (Homma et al. 2016). Patient J faces similar condition and this has mainly rendered her to use indwelling catheter for elimination. Patient J is admitted to the Elderly Ward of the hospital as she reported getting high fever, continuous vomiting, frequent urinating, burning sensation while urinating and feeling of abdominal pain. Pyelonephritis includes symptoms such as vomiting, abdominal pain, high fever, back chills, burning sensation while eliminating, pus in urine and others (Johnson & Russo, 2018). Thus, the primary investigation informed to confirm that Patient J is suffering from pyelonephritis as she is showing most of the symptoms related to the disease. The nurse mentor responsible for taking care of Patient J in this situation is named as Nurse B. The anonymity of the patient is maintained by not disclosing her name or identity to ensure confidentiality. As per the NMC Code of Conduct (2015), the "Prioritise people" section informs that the nurses are to respect and maintain services to protect the right of confidentiality and privacy of the patients (NMC, 2015). Thus, according to the Code, confidentiality is maintained. Moreover, the patient is informed regarding the way her personal information is to be used and prior consent has been taken from him to ensure confidentiality and privacy as per NMC guidelines.

Body System

The normal function of the urinary system which has been affected by the pyelonephritis and Interstitial cystitis condition of Patient J is to remove urea and wastes from the body in the form of urine. This is required to maintain proper balance of salts and other substances present in the blood to ensure homeostasis (Thévenot et al. 2015). The urinary system includes two kidneys and ureter with a single bladder and urethra. The kidney is present at the initial point of the urinary tract that has the key function in normal individuals to filter out urea and other wastes in the blood. The filtered impurities are then travelled to the ureters which are connected from the kidney to the bladder. The urinary bladder is a triangle-shaped hollow structure located at the lower abdomen that holds the urine. The urethra is the tube through which the urine from the bladder is eliminated outside the body and the sphincter muscles control the bladder from leaking out urine (Sherwood, 2015). However, the presence of pyelonephritis has resulted Patient J to face disruption in the normal functioning of the urinary system.

The presence of pyelonephritis affects the kidneys to become swollen due to the presence of bacteria. This causes the patients suffering from the condition to experience abdominal pain and leads the kidneys to face issues with proper filtering of the wastes of the body. This is because the infection may damage the kidney cells making them non-functional. The improper filtering of wastes results in building-up of toxins in the blood which makes the patient experience high fever and vomit (Lee et al. 2017). This may be the reason behind Patient J experiencing the symptoms as due to infection the kidney cannot properly filter out toxins from the body. The bacteria present in case of pyelonephritis are able to make the ureters to spam (Becknell et al. 2015). This condition causes irritation in the lining of the ureter making individuals like Patient J suffering from the disease feel uncomfortable. The bladder and urethra are also infected by the bacteria in pyelonephritis that result the structures to face inflammation causing the individual feel frequency of urinating as they feel their bladder is not emptied. The infection causes damage to the lining of the urinary tract that creates a burning sensation while urinating (Becknell et al. 2015). Thus, Patient J may have faced frequency to urinate more lately and experience burning sensation due to the presence of bacteria and its impact on the urinary tract that is not usually faced by normal individuals. The exact way interstitial cystitis causes pain in the bladder and affects the urinary system is not properly disclosed (Sathya et al. 2019).

Activities of Living

According to Roper-Logan-Tierney model of nursing, there are twelve key activities of living that the nurses require to keep in mind while providing care to the patients so that effective care can be provided to the patients to make them satisfied. The twelve activities of living are breathing, communicating, maintaining safe environment, eating and drinking, washing, controlling body temperature, mobilisation, expressing sexuality, death, eliminating, working and sleeping (Holland & Jenkins, 2019). In case of Patient J, the three key activities of living that would be affected due to pyelonephritis are elimination, controlling body temperature and eating as well as drinking. The pyelonephritis would affect the eating and drinking habit of Patient J as the condition leads her to vomit and feel nausea. The vomiting in pyelonephritis leads the individuals to get dehydrated due to loss of water from the body (Baby et al. 2018). This alters the drinking habits of the patients like Patient J to feel thirsty all the time making them drink more water. Since vomiting is unpleasant, it makes the patients suffering from pyelonephritis to avoid taking up of meals as they feel of throwing up (Aggarwal et al. 2017). As a result of pyelonephritis, patients feel burning sensation in the urethra while urinating. This is because the bacteria present in the urine cause inflammation and damages of the lining of the urinary tract. Since the urine is acidic in nature while coming in contact with the damaged lining makes the person feel burning sensation (Tsai et al. 2016). Thus, eliminating activity of the Patient J would be altered to make her feel uncomfortable and pain while urinating. The pyelonephritis results the kidney to get damaged that makes them unable to properly filter out toxins from the blood to be thrown outside the body. This results the blood to retain many toxins within the body which is detected as threat by the white blood cells present in the body causing rise of body temperature in response (Keenan, O'rourke & Courtney, 2017). Thus, the lack of proper filtration of the blood as a result of pyelonephritis in Patient J is leading her to face fever. (Refer to Appendix 1)

As per the scenario, proper catheter care initiative is to be taken for Patient J so that she to able to maintain hygienic condition of the catheter while using it on compulsory basis for elimination. As mentioned by Sampathkumar et al. (2016), improper management of catheter by patients results in urinary tract infection (UTI). This is because the microorganism causing UTI are present at the opening of the catheter which enters the urinary system of human through the bladder followed by ureter to the kidney. In order to ensure proper elimination by Patient J without getting affected by UTI, she requires ensuring the catheter is disinfected each time when it is to be used for elimination. This is because without washing the catheter before use may result the microorganism which are present at the catheter from the external environment to enter the body of the patient causing urinary tract infection (Kumar et al. 2018). She also needs to make sure that no urine is clogged in the catheter and require changing and washing it every day. This is because clogged catheter with urine creates proper environment for the build up of microorganisms that cause UTI (Vigil & Hickling, 2016). The indwelling catheters are to be discarded after 30 days of use so as to avoid UTI (AlKhawaja et al. 2017).

According to the bio-psycho-social-environmental model, the biological, social environment and psychological factors are seen to interfere with the individuals health makes them develop disease which alters their daily activities (Puente & Bragazzi, 2012). The biological factors such as physical health, disability, genetic variations and others are considered to interfere with the health with the individual that makes them face altered activities of living (Gonzalo, Skochelak & Wolpaw, 2016). In respect to physical health, it is seen that Patient J is suffering from interstitial cystitis that has resulted her to become dependent on using indwelling urinary catheter that has altered her normal process of urinating. This is because the condition has rendered her feel urgency to urinate as the diseases has resulted him to lose control over the bladder. Moreover, the urinary tract infection in the form of pyelonephritis has also made her physically ill as she feels urgency to urinate which can be considered responsible for changing the eliminating pattern. This is because the condition has made Patient J to feel uneasy to urinate and fear of pain due to burning sensation. Moreover, it is seen that UTI is commonly seen in women as a result of their anatomy which shows that the ureter is shorter compared to men that are connected with the bladder to eliminate urine. This results the travelling if the infection from the ureter to the upper urinary tract in easier way making female prone to the face urinary tract infection (UTI) such as pyelonephritis (Kajbaf et al. 2015). Thus, the female anatomy is also required to be considered that poses hindrance for Patient J to get exposed to infection in the urinary tract while eliminating. The psychological factors such as self-esteem, social skills, coping skills and others are seen to be considered in disrupting one’s health and daily activity. The coping skills are referred to the behaviour and emotions that are used for getting adjusted to the changes which occur in life (Martínková, 2017). In case of Patient J, it can be considered that the vomiting caused due to pyelonephritis is going to act in disrupting her coping skills to drink and eat properly. This is because she would develop fear of throwing up while eating making her feel uneasy to eat properly. Moreover, her co-morbid condition of having pyelonephritis along with interstitial cystitis would make her feel depressed to adopt proper coping skills to eat and drink effectively. This is evident as the co-morbid condition and long-time suffering from diseases makes the patients lose hope of living normally making them unable to develop coping skills to deal with the changes required for healthy living (Peng & How, 2017).

The social factors include family circumstances, peer relationship, trauma and others that are seen to affect the development and management of disease (Derevensky & Gilbeau, 2015). As mentioned by Brown et al. (2015), the patients who do not get proper support from the family feel neglected and lack self-value. This is because they feel they are being a burden of care on the family and there is none to understand their situation. In case of Patient J, it is seen that her husband is also old and suffering from arthritis that makes him feel issues with making increased mobility. Moreover, Patient J is also suffering from interstitial cystitis that makes her being unable to take her own care as she feel uneasy. Thus, this condition would interfere with proper assistance required by Patient J to eliminate. Further, Patient J's biological condition of having high fever as a result of pyelonephritis would make him feel uneasy. This consideration can be attached to eating and drinking as due to uneasy feeling he may avoid taking in food.

Health and Social Care Agenda

The aim of the Health and Social Care Delivery Plan (2016) is to offer early intervention to the patients and support them for self-management (www.gov.scot, 2016). This is required as early intervention for the disease results to reduce deterioration of the health issues. Moreover, self-management to control and prevent diseases is required so that proper personal attributes and activities are abided by to avoid getting infected by the disease. The other aim of the Plan is to offer day-case treatment to the patients as well as develop the norm to execute day surgery for all form of patients (www.gov.scot, 2016). This is required so that proper care can be given to the patients on urgent basis.

The Plan has the aim to offer care of highest standard to the people in all situations by making the patient remain in the centre of all the decision-making process (www.gov.scot, 2016). This is because by keeping the patient at the centre of the care the person’s personal needs and demands of care services can be fulfilled to offer them satisfactory care. The Plan also has the aim to rehabilitate people back to their community and homes as early as possible in such a way so that they have minimal risk of readmission to the hospital (www.gov.scot, 2016). This is required to lower medical cost as well as humiliation of the patients and to ensure that the patients are provided high-quality care as determined to avoid relapse to the disease which causes readmission.

Discuss how the content of the Health and Social Care Delivery Plan (2016) could be applied to the client

The given client named Patient J is seen to be suffering from Pyelonephritis along with having interstitial cystitis as a long-term condition. According to the Health and Social Care Delivery Plan (2016) the Patient, J is to offered early intervention to help her cope with Pyelonephritis (www.gov.scot, 2016). In relation to this, the Nurse B is to arrange services at the earliest for the diagnosis of the disease followed by effective treatment for the health issue for Patient J. The urinalysis and urine culture is the process used to diagnose Pyelonephritis. The diagnosis of the disease at the earliest is important so that the extent of complications due to the health issue in the patient’s body can be determined to identify the nature of treatment to be offered (Edelstein, 2016). The Plan also indicates that the patient is to be able to self-manage their condition (www.gov.scot, 2016). Thus, in relation to this, the Nurse B is to share details and educate about the way to manage catheter hygiene to the Patient J to ensure her proper recovery through self-management and avoid reappearance of the health issue. According to the content of the Plan, Patient J is to be provided day-case treatment and any surgery if required is to be executed in the day. The application of the Plan also indicates that Patient J is to be provided highest standard of care and her opinion is to be taken while offering any nature of care services as well she is to be involved in taking decision for her care services. As mentioned by Johnson et al. (2016), offering highest standards of care to the patients ensure their easy and early recovery as well as offer them satisfaction with care. The delivery of highest standards of care is to be accomplished for Patient J by Nurse B by using all her skills and knowledge and following legislation and policy guidelines mentioned to establish such nature of care. As argued by Edvardsson, Watt & Pearce (2017), lack of involvement of the patients in taking care decision makes them feel disrespected. Thus, to avoid such consequences and to apply the Plan effectively for Patient J the Nurse B is required to have informed consent for the patients regarding whatever care being offered to her in relation to resolve Pyelonephritis.

According to the aim of the Plan, Patient J is to be rehabilitated properly in society so that she is sufficiently able to manage her own life and there is less chance of readmission. The readmission of the patients occurs in case they are provided proper care intervention and support to avoid relapse of the disease while treatment in the hospital (Ackley et al. 2019). Thus, to avoid readmission and effective rehabilitation of Patient J the Nurse B is to ensure that while releasing from the hospital the patient is educated and is able to maintain proper hygiene of her catheter to avoid further infection in the urinary tract of any nature. Moreover, it is to be ensured by Nurse B that Patient J during the release from the hospital is totally cured of her condition regarding Pyelonephritis and proper supportive medications, as well as services, are arranged to avoid its relapse.

Health Promotion Activities

The client named Patient J is seen to be suffering from urinary tract infection as result of using catheter on a daily basis. In this respect, the client could take advantage and develop health literacy from the health promotion services offered by the Health Innovation Network (HIN) during their Catheter Care Awareness Week every year. The HIN during the Catheter Care Awareness Week provides information to the patients as well as health professionals regarding the strategies to be developed to improve knowledge and awareness of catheter use. This is executed with the intention to empower patients to self-care (healthinnovationnetwork.com, 2018). Patient J by availing this service would be benefited to develop proper knowledge regarding the way to manage her indwelling catheter use without anyone’s help so that infection can be prevented. In this program, the patients are asked to develop catheter passport as it offers information to the patient as well as others regarding the way to care for the catheter to avoid spreading of infection to the urinary tract (healthinnovationnetwork.com, 2018). The adoption of this method is beneficial for Patient J as she would be able to ensure that the Nurse B or her husband has proper knowledge regarding the way to help her manage her catheter to avoid infection.

The HIN during the Catheter Care Awareness Week provides educational materials and videos to the service users and the healthcare professionals to educate and train them effectively regarding the way to manage catheter so as to avoid infection (healthinnovationnetwork.com, 2018). These materials are beneficial for Patient J to develop proper health literacy regarding the way to manage her own catheter so that urinary tract infection can be prevented at the present and future. During the Catheter Care Awareness Week, the patients are provided pledge cards to motivate them to have self-goals of care that are to be fulfilled within certain amount of time to ensure better health condition (healthinnovationnetwork.com, 2018). Patient J would be beneficial by using pledge cards in the sense that she would be able to develop self-care goals to be fulfilled to have better health condition and effectively control urinary tract infection. The "No Catheter- No catheter-associated urinary tract infection" programme developed by the Nurse Consultant at Newcastle upon Tyne Hospitals NHS Foundation Trust provides information regarding the way to improve care of urinary catheter and reduce urinary tract infection. Under the programme, a new catheter care plan is developed on the basis of evidence-based guidelines to deliver personalised patient catheter care (www.england.nhs.uk, 2018). The adoption of this service would be beneficial for Patient J to develop care strategy based on her personal health condition to control and prevent urinary tract infection while using indwelling catheter. The programme offers better health education and training program to the healthcare staffs to develop efficiency in executing proper catheter management (www.england.nhs.uk, 2018). The service would be beneficial for Patient J to be assured that Nurse B under the program would be properly educated and trained in helping her to resolve infection with proper catheter management.

Continue your exploration of Importance of Collaboration in Healthcare with our related content.

The programme allows new integration of work approaches to be embedded together to create effective collaboration between infection prevention and control team, nurses from the local Clinical Commission Group, the continence team and others (www.england.nhs.uk, 2018). This is beneficial for Patient J to have high-quality services from the healthcare staffs within the hospital who would offer her better care to resolve her urinary catheter infection within minimum time as a result of the programme. The programme allows the development of a new and innovative catheter application (www.england.nhs.uk, 2018). As a result of these services, Patient J would be benefited to have personal care services to help her manage her indwelling catheter in a proper way to avoid future infection. The programme also has the intention to establish patient or carer focus group in relation to catheter care for helping to inform and guide any development regarding the use of catheter to prevent infection (www.england.nhs.uk, 2018). This service would be beneficial for Patient J to remain updated regarding the way to use her catheter to avoid spread of infection. The programme also allows the nurses and healthcare staffs to be aware of different options available to avoid catheter use (www.england.nhs.uk, 2018). This service would benefit Patient J to develop knowledge regarding the alternative modes to be used instead of indwelling catheter for urination to avoid spread of infection.

Conclusion

The above discussion informs that Patient J is suffering from urinary catheter infection that pyelonephritis as a result of catheter use due to interstitial cystitis that has rendered her to feel urgency and lack of control over her bladder to urinate. As a result of the pyelonephritis, Patient J faces burning sensation and pain while eliminating along with high temperature and vomiting. The condition has resulted her to face issues with three key activities of life that are elimination, controlling pg body temperature and eating as well as drinking. The bio-psychosocial-environmental model informs that Patient J being female is prone to getting urinary tract infection as a result of their anatomical features. Patient J is deemed to be benefited by availing services offered by "No Catheter- No catheter-associated urinary tract infection" programme and Catheter Care Awareness Week organised by HIN as they ensure better health literacy and awareness regarding the way to control CAUTI.