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According to Rafieian-Kopaei, Setorisi, Doudi, Baradaran, & Nasri (2014) atherosclerosis is a result of hyperlipidemia and oxidation, and it has been a principal factor of mortality in developed countries. Atherosclerosis is a common disease where fatty deposits called atheromatuos plaques develop in the inner layers of arteries. This process begins with a deposition of small cholesterol crystals in the intima, so the plaque grows, and inflammation process develops in the same time, which results in the fibrous tissues development. As a result this process, clot formation and thrombosis are developed, which conclude in blood obstruction and consequently in heart deficit and other factors dependent of the place where it is affected. In the same aspects, Strain, Hughes, Mayet, Wright, Kooner, Chaturvedi, & Shore (2013) had described that some consequences related to atherosclerosis such as hypertension and ischemic heart disease, so these are two main disease, which can be developed in the process of atherosclerosis. Besides, Levine (1973) in her nursing theory has introduced the theory of conservation model where holism is a key factor in the process to care and manage a client. Throughout the course of this paper, I will describe a client’s history, a concise introduction about the Conservation Model theory, the application of this nursing theory for the client, and a response plan with a chronic care model, which can be applied for this client.
Firstly, the client’s history is necessary to know and understand, so the caregiver and health professional can develop methods, which facilitate the life this person. The patient V.D has described part of his history in the following information. Mr. D., 47 years old, married, has not concluded elementary school, is atheist, and is a farmer. In his family history, he described that his parents had died because of heart complications, but he did not know the exact cause. Mr. D. had been submitted to stent implantation where exams had proved the diagnoses of coronary artery disease. After six months, he was submitted to bypass surgery. Even though a focus hemorrhagic had developed, Mr. D. was resubmitted to another intervention surgery, in the same day, to control this hemorrhagic area.
Also, before the discharge, Mr. D. has received simple explanations about how to proceed in the recovery time; these explanations were about medication (teaching correct administration time and dose), caring about the dressing in the surgical site, and orientation to return to visit the physician in 60 days to have a revaluation about the general recovery and surgical site. The general knowledge to have adaptation was provided by Mr. D.’s family and friends, whom tried to provide better quality of life in this crucial moment of recovery and adaption for a new life style.
In addition, some key chronicity concepts can be understood in the client’s history. Related to Kramer-Kile, Osuji, Larsen, & Lubkin, (2014) these chronicity concepts are: 1- illness experience, Mr. D. was diagnosed with atherosclerosis a short period before to be submitted to surgery, so he had develop d method to adapt to symptoms of this disease when he was developing his daily activities; 2- stigma, it is related to the cultural background and level of education, so Mr. D. has restriction in his level of education so that it can promote an increase in the level of stigma; 3- adaptation and quality of life, during and after recovery, it promotes a drastic process to adapt in this new style of life because Mr. D. has experienced a new process (illness) in his life and his job (farmer) must be substituted, so he could have a adequate adaptation and quality of life; 4- sexuality, Mr. D has a cardiac disease and did a bypass surgery, so it must have affected his sexual activity; and, 5- self-care, as a farmer and has cardiac disease, Mr. D. must control his activities to provide better care and management for his life because the opposite side it develops worse affects. In fact, chronic concepts are present in all process of the illness, so it needs to adequate for the person.
Likewise, nursing theories are used to promote better care and the same time knowledge about the general process to manage the quality of life. As a result, the theory Conservation Model by Myra Levine describes the conservation model, which was originally a framework to teach undergraduate nursing student (Levine, 1973). The three major concepts for the conservation model are: first, conservation, which is maintaining together of the life system (balance between nursing interventions and client participation). Second, adaptation, which means an ongoing process of change, but the individual keeps his/her integrity within realities of his/her environment. Third, wholeness is existent when interactions or constant adaptations to the environment permit assurance of integrity (Alligood, 2010). This theory has conservational principles as energy conservation, structural integrity, personal integrity, and social integrity (Levine, 1973).
Still, in this theory, the metaparadigm concepts are the person, environment, health, and nursing. People are holistic beings who are sensitive, thinking, future-oriented, and cognizant. Though, people are in constant interaction with the environment, responding to change in an orderly, sequential pattern, adapting to forces that form and reform their essence. In fact, the goal of client care is promotion of adaptation and well-being (Alligood, 2010). These factors are reinforced by Levine (1973) that the process of client understanding his/her plan of care and diagnosis is vital. This theory reinforces the importance of the nurse holistic view during the nursing process to make a plan for the client.
Then, the Conservation Model Theory is applicable for Mr. D. in his process of disease and illness, so a nursing theory is applied to promote better process of care and quality of life. According to Alligood (2010) the Levine’s Conservation Model is applied in three main areas such as conservation, adaptation, and wholeness. In the aspect referent to conservation describes the conservation of energy, so Mr.D. must have restriction in his life to keep adequate levels of energy although he continues doing daily activities. For example, he is a farmer, so he needs to understand that some activities in the farming he cannot do because it will require high levels of activities. If he stops doing activities, he has a possibility to develop other factors, which decrease his quality of life. Also, farming requires different activities with lot of energy, but it is not a factor to leave these activities. A management in the process to work can be favorable, and working in small processes results in the job concluded and the body in action.
In addition, the adaptation is a rouge aspect present after the surgery, so it requires time and motivation from the client. In this process client, family, first caregiver, and health professional are involved in this process of adjustment. Though nurses have a crucial function for the client, which is teaching and doing management to provide better quality of life. Kramer-Kile et al (2014) emphasise the psychological and social result of chronic diseases require significant adaptations from the client. Consequently, Mr. D. has significant changes in his life such as alimentation, medication regimen, and daily activities (working).
Through alimentation is not considered an important factor for some society, it has a key for the prevention and promotion of atherosclerosis. The unhealthy diet where has food with high quantity of saturated and fats, cholesterol levels, sodium and sugar can increase development of atherosclerosis. The unhealthy blood cholesterol and lipoproteins levels promote an increase in the atheroma, so the process of occlusion of lumen is increased; triglycerides is other factor to increase the occurrence of atherosclerosis. Also, overweight or obesity contributes extremely in this process because the level of exercises is totally reduced and weight gain is increased. Rafieian-Kopaei et al (2014) Mr.D. must need an adaptation in the alimentation where alimentary factors can be controlled and managed to develop a health alimentation.
Moreover, the medication regimen and daily activities develop a reorganization in the routine. In the medication regimen a different types of medications are necessary to be taken, so a correct management of drug is necessary, so drug interaction will not result. Side effects can occur, so as a nurse must teaching the client about this process and emphasize for the client continuing the medication although he has this process. Even though medication regimen is prescribed by the doctor, nurse needs to verify if the patient understood and/or is taking correct. Furthermore, daily activities must be reformulated because Mr. D. cannot continue doing high levels of effort. Hence, client, family, and health professional must work together to develop an adequate management, which provides easily and comfortable adaptation.
Still, wholeness is a part of all these processes because the client and environment interactions to provide changes occurs in the same time that adaptation and conservation. The process of interaction with the environment is crucial whenever the human being interact with the environment and contrariwise, so both sides receive affects to increase or decrease life. As a result, conservation of energy and adaptation work in the same time with wholeness, and the quality of interaction must be satisfactory for client.
In the nursing process – assessment – the nurse and client will analyze challenges in the client’s environment and methods to be adequate in this system. Some aspects are necessary to observe in this process such as energy conservation (balance between energy supply and demand), structural integrity (the system defense of the body), personal integrity (client’s dignity and personhood), and social integrity (client’s involvement in the society or his community) (Alligood, 2010). Instead, in this process of assessment, the word holism is a fundamental definition in the general process to assess the client. As a result, looking for a short-long future some challenges can be observed, so it has great opportunity to change and develop other managements (Levine, 1973). Another example in the Mr. D. progress of illness is that his disease can be linked by genetic factor because as a described his parents had cardiac problems. Thus, his offspring has an increase possibility to develop cardiac problems in the life progress although it can be controlled by intervention such as educational factors, alimentation, exercises, and level of stress.
Shalhoub, Sikkel, Davies, Vorkas, Want, & Davies (2014) reinforce in a research about biologic factors of atherosclerosis that a person who has someone in the family (first lineage) has a genetic risk factors for susceptibility to develop atherosclerosis. Although a variant in the genetic and environmental factors can be present, genetic is an important factor-development to be considered. Likewise, Mr. D. needs to have orientation for other cardiac diseases, which develop in response of a first disease. In this progress, hypertension is a factor to be considered, so prevention and promotion are the basis in this progress. An adequate quantity of sodium by day is necessary, so teaching and explanation about it needs to be done (Rafieian-Kopaei et al, 2014). Consequently, a holistic view is necessary to understand the progress of disease and illness, so management in prevention and promotion are developed in conjunct with health professional and client.
Another process in the theory is hypotheses, more specific goals, the nurse seeks validation with the patient about his/her problem, so the nurse hypothesizes about the problem and its solution, which means the plan of care for the patient (Alligood, 2010). In order that, Mr. D. has some hypotheses for his situation such as risk for infection, deficit of knowledge in his process of care (post-surgical), inadequate cardiac output, acute pain, and, risk for compromised resilience (Ackley & Ladwig, 2014).After hypothesize client’s factors, it is necessary to develop intervention, which can develop to acquire the goals settled.
The interventions are hypothesis to direct care the client. It is based on the conservation principles: conservation of energy, structural integrity, personal integrity, and social integrity; the goal is to maintain wholeness and promote adjustment for the client (Alligood, 2010). In this case, Mr. D. has broad interventions in his case, which begins in the self-care to social involvement. The surgical wound he needs to have information about how caring it. The nurse needs to teach about cleaning and changing dressing though some indications of infections in the surgical wound, so he can contact his doctor and/or nurse to verify this process. Medications to control and relieve pain are necessary to know, so teaching about it is fundamental. Although he has different type of cardiac medications, he needs to know all of them besides analgesics and nitroglycerine drug for angina if he develops coronary spam.
Nevertheless, nurse helps in develop plans for the process of adaptation, which must be approved and oriented by Mr. D. This time for adaptation involves his recovery and after that for the process working in the daily routine. In the same time, he needs to be taught by the nurse about his disease and process of illness, so as much information (knowledge) he has, more easily the process of acceptance occurs. This explanation does not need to be said only one time, but in the different consults, which are reserved for him. Consequently, in the process to teach and manage his adaptation, working restriction must be considered because he is a farm, so a rouge part of his job needs to be revised provided that small portion of exertion. Thus, a holistic view for the mental process needs to be evaluated because in the process of adaptation a decrease in the level of self-esteem occurs although it can develop mental disorder such as depression. Mr. D. has an increase factor in this part since he is a farmer, so restriction in the working routine facilitates this occurrence. Controlling it, community support (friends) is one method helping in his farm, so he has his job done with some help and regulating anxiety and other mental circumstance. Therefore, intervention is a primordial aspect in the process to care the patient, so it needs to have a holistic view to promote better quality of life not only for the client as well for his family.
The last process in the Levine’s nursing process is the evaluation. The evaluation refers to the observation of organism (client) response to interventions. In the decision making assess the hypothesis to verify if it has done a support for the hypothesis or not. If the plan has not supported by the hypothesis, it is revised and proposed a new hypothesis to be applied (Alligood, 2010). Mr.D. and his nurse will evaluate his intervention knowing the quality of it, so modification and revisions may be necessary to do to provide better care in his process of life. Otherwise, all the process to adapt and provide health care is lost. Hence, evaluation is extremely necessary, and nurses must do it in every single client, as much it can be necessary.
Finally, an action plan with a model of care is applied for Mr.D. The model of care more appropriate is the Expanded Chronic Care Model (ECCM), which has expand the focus of chronic care management toward health outcomes for client and community. This model expands the client to community a large view in the process of care, and support in all directions is provided to guaranty adequate quality of life (Kramer-Kile et al, 2014). The plan of care for Mr. D. some aspects to provide care and adjustment in his life are emphasize. Fist, teaching he and his family (first caregiver) about how to care and change the dressing in the surgical incision, and provide a nurse (in his community) to check weekly in his house if the surgical incision has been cared correct so as his process of adaptation is been accepted. Second, teaching about the illness and illness course, and it provides a focus in some chronic concepts such as sexuality, adaptation, isolation, stigma, and cultural. Also, provide support to understand and accept these concepts are essential.
Then, involvement in community is necessary, so it avoids social isolation and increase self-esteem. Friend’s support is necessary, and they may help in the farm working, so Mr. D. could reduce psychological pressure because of the job. Fourth, psychological evaluation can determine if it is necessary to use antidepressant drug because a rouge change in his life has occurred. If necessary this type of drug, he needs orientation how to use and side effects that it can cause. Still, teaching about cardiac medication is significant, so it reinforces the management the correct time to take and side effects, which may be possible to occur. Fifth, cultural aspect about incapable may develop because he began to be restricted in his job. A support comprehension, which describes that he is capable to continue his activities, is decisive, so he is capable to do activities although some restrictions such as avoid high level of effort are necessary restriction. Sixth, body image is another factor present because scar of the surgery will be present for the rest of his life, so understanding how to accept this aspect in his body is crucial for the quality of life. Last, family support in the process to accept the disease and provide adequate adaptation is required. Nurse may provide sources for his family to understand and know how to manage this illness in order that Mr. D. has more acceptance and provides involvement in his family in the process to care him. Indeed, the nurse and client develop action plan, so both must have agreements, which provides better care and process of adaptation. A revaluation these plans are indispensable, so adding or taking off part this may result.
In brief, in the following paper was described Mr. D’s story, some chronic concepts, which are related with his history, a succinct nursing theory description, which was Levine’s theory, the application the Levine’s conservation model theory for Mr. D., and action plans with a chronic care model may be applied for Mr. D. I have written this paper based in Mr. D., who is my father, and I thank him to have been given all this experiences for me in the process to care and manage his chronic illness. It is not easily to accept a new situation in the life and beginning to have adaptations in the inspected period of the life, so every chronic disease and illness are difficult to manage if the family and client do not have correct support to confront it. As a result, nurses need to have as much as knowledge possible doing research and applying nursing theories to provide better care and support for their clients and client’s family.
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