Roper- Logan- Tierney Activities of Living Case Study

Introduction

Illness of one family member inevitably affects other family members and the whole family (Navidian, Rezaei and Payan, 2016).The purpose of this essay is to explore how to deal effectively with nursing problems; patient-centred care and holistic approach with the use of Roper- Logan- Tierney (2000) activities of living, which is based on twelve activities of daily living that includes breathing, temperature, personal hygiene, communication, eating and drinking, mobilizing, eliminating, maintain a safe environment, working and playing, expressing sexuality, sleeping and dying (roper, logan and Tierney, 2000).

 In strict compliance with NMC Code (2018), Patient and hospital’s name used in this essay are changed for the purpose of privacy and confidentiality (Woogara , 2015). Mr Johnson, who is 75 years old, with body mass index of 30, went to the GP due to loss of balance, headache and impaired vision. His blood pressure was checked which indicates high blood pressure of 220/ 140 mmHg (Gov.Uk, 2019). Johnson was refered to hospital by the GP because of the high blood pressure where he was admitted in stroke unit. Martin and Manley, (2017) stated that an accurate assessment results to a good discharge and so, assessment becomes the first stage of every information collection

Dignity, Privacy and Confidentiality plays a vital role in patient care, therefore while observation and gathering information, Mr Johnson was communicated in loud tone as stipulated by Nursing and Midwifery Council (NMC, 2018).Initial assessment was carried out by the Nurse asking his past medical history, how often, for instance every five minutes and how severe is the loss of balance, how long he has been feeling dizziness and headache,  any high blood pressure history in his family, his health and lifestyle and some relevant questions regarding his condition. After that, general assessment concerning his level of response, ability to communicate, ability to see properly and difficulty in balancing (nhs.uk, 2019).  The Nurse asked the healthcare Assistant to do observation on Mr Johnson like taking his blood pressure to cross check the correspondent with 220/140 mmHg result from GP, his respiratory rate was 18%, body temperature 38^oC, saturation level 94% ok, blood sugar 6.5 ok but his condition was not improving.  As she was checking and observing him, the healthcare Assistant  noticed that Mr Johnson was sweating profusely. The information from observation was recorded  and documented properly and informed the Nurse concerning her observations (The Royal College of Nursing, 2018).As a result of his sweating and dizziness, the Nurse took Mr Johnson’s blood sample for further test to check for infection and the cause of continuous severe headache. The result indicated danger and possible signs of stroke. The Nurse informed the Doctor to review and decided to send him to C T Scan to confirm any damage, the level of damage, minor or developing stroke before prescription. The CT brain Scan result shows ischaemic stroke that affected his brain. Ischaemic stroke happens whenever blood clot blocks the easy flow of oxygen and blood to the brain by plaques deposit (Furie and Jayaraman, 2018). The Doctor prescribed Alteplase injection for  Mr Johnson’s treatment which should be taken originally 900 micrograms/kg maximum each dose 90 mg. Treatment must commence immediately within 4.5 hours of symptom noticed; was administered in more than 60 minutes, the beginning 10% of dose was given through intravenous injection and  intravenous infusion (Dworzynski et al., 2015). The medication was effective and his health improved.

The Nurse prepared a care plan using The Activity of Living assessment tool by Roper-Logan-Tierney (2000).Holistic approach and centred care was effectively achieved as a result of the Nurse, Mr Johnson and his family being involved in order to give his opinion and be aware of the process and set target to be achieved. (Kelley, Brandon and Docherty, 2016). The care plan includes all vital areas such as his psychological, sociological, and physiological, biological, his social, spiritual and cultural care (The King’s Fund, 2019). Furthermore, well-written information on his needs and medication was put into considerations. 
Effective communication and good teamwork plays vital role in entire stroke care and also enhance patient knowledge, reduce grievances and increase Nurses’ confidence (Mitchell et al., 2019), whereas failure or error in communication  among colleagues can lead to serious harm such as administering wrong medication to the patient. The confidence of patient increases when Nurses communicate effectively. The methods of communication; verbal and non-verbal communication helps in understanding the health needs of Mr Johnson and family.

Non-verbal message tends to be powerful than written or spoken words. As an Adult nurse, observation of patient body language can be as important as looking out for clinical symptoms and in order to be a good communicator body language should be kept in check. Physical reaction, facial expressions and eye contacts are also non-verbal. According to Montague et al (2013) found that eye contact and social touch made patient regard health professionals as empathetic (Montague et al 2013).

The Nursing and Midwifery Council’s Code (2018) stated that nurses should use a range of verbal and non-verbal communication methods, and consider cultural sensitivities, to better understand and respond to people’s personal and health needs (NMC,2018). Both communications helped in the rehabilitation process with Mr Johnson. The result of CT scan shows that part of his brain was affected by the stroke. As Adult Nurse, much care needs to be considered on how speech is made For instance, the tone and volume of message and use of calm words, tone, pitch and emphasis of phrase over others. (Nursing Times, 2019)

In the case of Mr Johnson his speech was affected which resulted in communication impairment (Akyurek, Unal and Bumin, 2018) .Teamwork and effective communication skills are important for Nurses in supporting the well-being of their patient. Teamwork (Librarian, 2019). Multidisciplinary team are healthcare professionals such as Doctors, Nurses, and other healthcare specialists from distinct area of specialization that work together, constant communication and share sources(Horton et al., 2011).An effective team priority centres on the patient’s condition, inquires on the patient problem, initially assess the patient, discuss and make provision for recommendation. Reeves( 2017) states that multidisciplinary meeting in the rehabilitation of stroke patient are challenging, emphasizing that a successful multidisciplinary team requires a good set of structured document with agenda;  pre-meeting preparation and skilled chairing (Reeves et al., 2017).

According to Royal College of Nurses (2018) Adult Nurses are the main point of contact for patients and their families (RCN, 2018). The Nurse worked in collaboration with Mr Johnson and his family to provide holistic approach and patient centred care, health and well-being such as psychological ,emotional, social and physical.The Nurse also administers medication, serves as an advocate and a communicator.( NICE, 2017). Part of Adult nursing role was achieved when the Nurse played crucial role in collaboratively working and planning  meetings with Mr Johnson, his family and healthcare professionals sure as Doctor, Speech and Language therapist, Physiotherapist, Dietician, his career, Occupational therapist and Psychologist to discuss the patient care plan and his discharge (Tyson, Burton and McGovern, 2014)

Mr Johnson’s speech was affected due to the effect in the neurological control of muscles. The Nurse often encourages the patient to use his own words. Closed question with yes or no anwers are encouraged. (Christiansen and Feiring, 2017). To assist, the Speech and Language, Therapist needs to assess Mr Johnson in the slurred speech, to check his impaired communication.

The reduction in physical function on his left side, the patient finds walking difficult and could not position himself while sitting; this poses him to a risk of fall. The physiotherapist needs to assess falls when dealing with his mobility and integrate it in his care plan. Other aspect to put into consideration is provision of low bed when discharged, standing and sitting aid. Mr Johnson’s weight and high BMI also exposes him to the risk of fall (Davidson and Waters,2000).Less or probably no physical excises contributes to weight gain.

The change in lifestyle and daily routine daunts patients after stroke likewise Mr Johnson, to handle such situation, Occupational therapist needs to be involved to assess and support in his daily living. (Amlani and Munir, 2014). On the other hand, all the needed referrals such as community Nurses to assist Mr Johnson will be arranged by Occupational therapist.(Barker,Treml and van der Velde, 2017).

Good nutrition enhances patient quick recovery, while poor nutrition affects most stroke patients (Himmelgreen, 2012). This was applied in Mr Johnson’s case, as a result of his difficulty in chewing and swallowing; his dietician will assess and review his diet, the food chart will indicate suitable foods for the patient. The Dietician teamwork with the patient family and Nurse involved, in reviewing his care plan. (Turkel, 2015).

The Psychologist assists in providing cognitive behavioural therapy, motivational and mindfulness intervention for Mr Johnson’s healthy behaviour to lessen depression symptoms and improve his quality of life (Amlani and Munir, 2014).

The argument observed is that some observations are carried out visually despite human error that can occur and so; this questions the accuracy of some result and observations. Although this depends on the Nurse that takes the assessment. Notwithstanding, the assessment process is useful and continuous (Berman et al. 2010).If the initial assessment fails to be accurate, it can be repeated.

Evaluation of Mr Johnson’s care activities, treatment and his performance using Roper-Logan-Tierney’s (2000) activities of living model. The Multidisciplinary team involved in Mr Johnson’s care planning and rehabilitation concluded the set plan and treatment. In evaluating it was realised that Mr Johnson met his targets and responded positively to treatment. His blood pressure was 240/140 when he was admitted presently 120/80, severe headache has stopped. His medication needs to be stop, with healthcare professionals’ teamwork such as physiotherapist and speech and language therapist, he can talk and move his left arm. He can be independent and self-caring at home (Orem, 2001).                       

In Conclusion: Holistic care approach and patient centred care is very vital in patient care, it reinforces the important nursing care and  the significant benefit in healthcare sector. It allows teamwork and gives opportunities to the patients and their families to be involved in the patient care plan unlike before patients depend on healthcare professional decision. The positive outcome shows its benefits and different health sectors across the globe adapted it as nursing care tool. 

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