Integrated Nursing Care of the Adult Patient

Introduction

Integrated care in nursing is organising care delivery process for the patient to achieve improved care for the patients through enhanced coordination of support provided to the patient (Song and Tang, 2019). In this assignment, the integrated nursing care for Hayley is to be discussed. The case study of Hayley is fictional which ensure that no breach in confidentiality is faced in real situation which has led to meet the way privacy and confidentiality of the patients to be controlled as mentioned by NMC (NMC, 2018). For students working on similar topics, seeking nursing dissertation help can be invaluable in structuring and presenting these complex concepts. In explaining the integrated care, the communication strategy, psychological response and holistic role of the nurses in caring for Kayley is to be discussed. Continue your exploration of Therapeutic Communication in Mental Health Nursing with our related content.

Communication Strategy

In nursing, good communication between the patients and nurses contributes the nurses to develop enhanced ability in delivering individuals satisfactory carte to the patients. This is because through interact the nurses are able to understand the key needs and demands of the patients along with assuring them safety and show empathy to make them develop confidence and satisfaction to avail the care (Azevedo et al., 2017). In order to communicate for Hayley, she is to be asked closed questions in verbally manner to be replied by her in a non-verbal way to understand her current health condition. This is because Hayley is currently facing breathlessness due to which she is incapable to form full sentences which is important for establishing effective verbal communication. However, in non-verbal communication, patients are able to use their body language, gestures, facial expression and others to inform their needs effectively (O’Connor and Carey, 2017). As argued by O'Connell et al. (2021), objectives responses are gathered through non-verbal communication from the patients. This acts as barrier for the nurses to identify in detail regarding the exact needs and demands of the patients through communication. Thus, it indicates that patient symptoms such as breathlessness as seen in Hayley is one of the barriers towards development of enhanced communication with patients by the nurses as it is leading them interact objectively rather than in detail to understand and delivery her care.

In order to communicate with Hayley to identify her current health condition and needs, active listening along with verbal responses that express compassion and empathy towards her are to be used by the nurses. This is because active listening makes the patients feel valued and understood by the nurses and assist nurses determine the patient’s health condition and need to manage effective care (Grant and Goodman, 2018). Moreover, compassion and empathetic communication by the nurses makes the patients develop trust, calmness and avoid anxiety out of the belief that their pain is effectively understood by the nurses who are trying to provide best care for them (Hunter et al., 2017). Thus, for Hayley, active listening, compassion and empathetic communication skills would be used by nurses to assure her to be helped immediately with care to calm and reduce her worries regarding when to receive care as she is single mother and a newborn is present at home. The Linear communication model is to be used as a strategy for Hayley to improve communication with her and enhance her well-being. The Linear communication model ensures one-way delivery of information from the receiver to the sender (Wittenberg et al., 2019). The strategy is appropriate for Hayley because currently she is unable to communicate properly due to breathlessness and in this condition, nurses can only direct her to follow the instruction in care to immediately improve her breathlessness condition faced due to asthma attack. The advantage of using the model is that it allows straightforward delivery of inform directly to the patients, but the limitation is that feedback regarding the care message delivered is unable to be received by the nurses (Wittenberg et al., 2019).

Psychological Response

The case study of Hayley informs she already has asthma which may have exacerbated that is leading her to face breathlessness as it is the key symptom of the disease. The current symptom of breathlessness has indirectly led her to show anxiety as major psychological response. This is because increased breathlessness has led her to visit hospital to access care which is otherwise not possible. She is a single mother and reports being in in hurry to reach home to care for her son while the A&E is found to be extremely busy. The inability and fear of failing to access immediate care for her breathlessness which she explicitly requires have led her to feel anxious regarding the way to access help as well as manage time to get back home in time to care for her son. In this condition, one of the coping strategies for Hayley is arranging social support. This is because social support to single mothers makes them access support workers or neighbours or willing individuals who would take care of the baby in urgent condition (Liang et al., 2019). Thus, it would make Hayley remain calm and avoid being anxious due to worrying of the baby to be cared for while she faced intense breathlessness and personally rush to the hospital where care may be delayed due to a busy environment.

One evidence-based coping strategy to be implemented for Hayley for managing her anxiety is Cognitive Behaviour Therapy (CBT) as mentioned by NICE for manage generalised anxiety (NICE, 2019). The CBT is to be used because it allows the patients to control their overwhelming problems in a positive way by allowing them to break the problem in smaller parts to think strategically how to resolve them so that anxiousness can be controlled (Tyrer et al., 2017). The study by Kishita and Laidlaw (2017) mentioned that CBT is one of the effective therapies for anxiety in medical patients. For this purpose, the study included total of 444 patients of 16-75 years from respiratory, cardiology, endocrinology, neurology and gastroenterology clinic. The results revealed that improvement in anxiety was seen in each of the patients by the end of 6 months session of CBT with no loss of efficacy to control anxiety on the progression of CBT from 2-5 years. Thus, CBT would be used for Hayley to make her understand the way she can arrange care for her son in case of further breathlessness incident which has become quite common to avoid being anxious in the situation that further worsen the condition. This is evident as anxiousness disrupt the normal breathing process and upset the balance of oxygen and CO2 in the system leading to further shortness of breath in asthma patients (Licari et al., 2019).

Holistic Role of the Nurse

The holistic role of the nurse is to consider each patient to be single individual, acknowledge the patients entirely, interact with the patients and colleagues mindfully and respectfully and provide care with mutual understanding regarding psychological, physical, spiritual and emotional dimension of the patient (Eriksson et al., 2018). Thus, the holistic role of the nurse caring for Hayley is to initially regard the patient as an individual and not to be commonly treated like patients with similar complication of asthma and afterwards the nurse caring for Hayley is to acknowledge her. The patients are acknowledged by nurses by introducing herself in detail, duration of time to be required in testing and providing care along with explanation of any delay to be faced by the patient (Eriksson et al., 2018). The following process is to be followed and during acknowledgement, the physical, psychological, emotional spiritual needs of Hayley is to be assessed. The holistic assessment of Hayley’s health indicates that she is suffering from increased breathlessness and anxiety as key problems. The evidence-based intervention for anxiety control is explained before and the evidence-based nursing intervention for managing the breathlessness condition in Hayley would be implementing the use of pressurised metered-dose inhaler by her.

The study by Muraki et al. (2017) informed that use of long-acting beta2-agonist (LABA) therapy with combination by pressurised metered-dose inhaler was effective in long-term control of asthma symptoms in individuals. This is evident as 57.4% of the patients in the study reported using pressurised meter-dose inhaler to be effective controlling asthma compared dry powered inhaler. Thus, the pressurised metered-dose inhaler was effective intervention to be used for Hayley. This is because it would help her to remember the number of dose of inhaler left for her preventer inhaler so that she can buy the medication at the proper time to avoid exacerbation of the disease as seen in current condition. It is evident as she reports her preventer inhaler to have ended 5 days before which she discovered only after facing breathlessness since there was no meter to determine it. Moreover. aerosol delivery of asthma medication that is usually able to be achieved through the use of pressurised inhaler leads to maximise the effect of the medication on the lungs to improve breathing in asthma patients (ElHansy et al., 2017).

Conclusion

The above discussion concludes that due to increased breathlessness that is raised by exacerbation of asthmatic condition in Hayley, she has currently come to the hospital to receive care. In order to communicate to her regarding her care, linear communication model along with non-verbal communication is to be used with minimum verbal information as she cannot response effectively due to current breathlessness in full sentences. Cognitive Behaviour Therapy is the evidence-based care support to be provided to Hayley to resolve her anxiety that is created out of breathlessness and environment of care. As evidence-based nursing intervention for managing breathlessness related to asthma in Hayley, the pressurised metered-dose inhaler is to be used.

References

Azevedo, A.L.D., Araújo, S.T.C.D., Pessoa, J.M., Silva, J.D., Santos, B.T.U.D. and Bastos, S.D.S.F., 2017. Communication of nursing students in listening to patients in a psychiatric hospital. Escola Anna Nery, 21.

ElHansy, M.H., Boules, M.E., El Essawy, A.F.M., Al-Kholy, M.B., Abdelrahman, M.M., Said, A.S., Hussein, R.R. and Abdelrahim, M.E., 2017. Inhaled salbutamol dose delivered by jet nebulizer, vibrating mesh nebulizer and metered dose inhaler with spacer during invasive mechanical ventilation. Pulmonary pharmacology & therapeutics, 45, pp.159-163.

Eriksson, I., Lindblad, M., Möller, U. and Gillsjö, C., 2018. Holistic health care: Patients' experiences of health care provided by an Advanced Practice Nurse. International journal of nursing practice, 24(1), p.e12603.

Grant, A. and Goodman, B., 2018. Communication and Interpersonal skills in nursing. Learning Matters.

Hunter, D.J., McCallum, J. and Howes, D., 2017. Doing the little things: the meaning of compassionate care to Scottish student nurses. Journal of Nursing and Health Care, 5(1).pp.45-89.

Kishita, N. and Laidlaw, K., 2017. Cognitive behaviour therapy for generalized anxiety disorder: Is CBT equally efficacious in adults of working age and older adults?. Clinical Psychology Review, 52, pp.124-136.

Liang, L.A., Berger, U. and Brand, C., 2019. Psychosocial factors associated with symptoms of depression, anxiety and stress among single mothers with young children: A population-based study. Journal of affective disorders, 242, pp.255-264.

Licari, A., Ciprandi, R., Marseglia, G. and Ciprandi, G., 2019. Anxiety and depression in adolescents with severe asthma and in their parents: preliminary results after 1 year of treatment. Behavioral Sciences, 9(7), p.78.

Muraki, M., Gose, K., Hanada, S., Sawaguchi, H. and Tohda, Y., 2017. Which inhaled corticosteroid and long-acting β-agonist combination is better in patients with moderate-to-severe asthma, a dry powder inhaler or a pressurized metered-dose inhaler?. Drug delivery, 24(1), pp.1395-1400.

NICE 2019, Generalised anxiety disorder and panic disorder in adults: management, Available at: https://www.nice.org.uk/guidance/cg113/chapter/1-Guidance#principles-of-care-for-people-with-generalised-anxiety-disorder-gad [Accessed on: 20 July 2021]

NMC 2018, Professional standards of practice and behaviour for nurses, midwives and nursing associates, Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on: 20 July 2021]

O’Connor, M. and Carey, E., 2017. The role of nurses in supporting people with intellectual disabilities to manage asthma. Learning Disability Practice, 20(1).pp.56-70.

O'Connell, S., McCarthy, V.J., Queally, M. and Savage, E., 2021. The preferences of people with asthma or chronic obstructive pulmonary disease for self‐management support: A qualitative descriptive study. Journal of Clinical Nursing.32(2). pp.90-112.

Song, P. and Tang, W., 2019. The community-based integrated care system in Japan: health care and nursing care challenges posed by super-aged society. Bioscience trends, 13(3), pp.279-281.

Tyrer, P., Salkovskis, P., Tyrer, H., Wang, D., Crawford, M.J., Dupont, S., Cooper, S., Green, J., Murphy, D., Smith, G. and Bhogal, S., 2017. Cognitive–behaviour therapy for health anxiety in medical patients (CHAMP): a randomised controlled trial with outcomes to 5 years. Health technology assessment, 21(50), pp.1-58.

Wittenberg, E., Goldsmith, J.V., Ragan, S.L. and Parnell, T.A., 2019. Communication in palliative nursing: The COMFORT Model. Oxford University Press.

Looking for further insights on Independent and Supplementary Prescribing For Nurses and Midwives? Click here.