To aid in the analysis of the integrated nursing care plans, a case study on the biography of Pamela Allen was provided. An overview of her case shows the process she undertook as she went through her treatment from her first diagnosis, various treatment processes, and lastly, her unfortunate demise at the end of the article. It is with this understanding of the case study that the main aim of this paper seeks to analyze and state the main differences between the adverse complications or effects within the nursing interventions and their intended therapeutic effects, incorporating care plans within the specified interventions that involve client teachings into the study. The paper will also analyze the rationale, advantages, and disadvantages of selecting the stated interventions of nursing, while finding relating theoretical components within pharmacology, pathophysiology, and critical thinking in divergent clinical situations. Finally, integrate into the context the goal attainment theory as stated by theorists King and Duffy’s namely determinant of health care into nursing care and quality care model, the main issues, in the article that aides in the assessment of the two theories integration include analyzing the nursing palliative care and the disease progression, in the case study.
The understanding that nursing is a process of interaction, action, and reaction, whereby the client and nurses have to share both their perception and information in the nursing situations is a key aspect while analyzing nursing profession. The article helps to support King’s theory of goal attainment that can be effectively used to analyze the case study, in that it clearly supports the fact that the client had the right to accept or reject treatment, and client perception, and nurse relationship. Actions and judgment lead to direct goal transactions if congruent in their application, as was in the case of the study, where the caregiver and the patient had to effectively synchronize to advance any treatment procedures. This is demonstrated by Pam’s refusal to be treated at the hospital, and the nurse finally provided the option of home treatment; and through this, it was evident that there was a synchrony in the values, goals, and the needs of the client and nurse interaction, which influenced their interaction process positively (McGowan, 2001).
The relation of the context to Duffy’s theory is that as seen in the article, the use of the nursing tool is seen in the attitudes, values, and behavior of the nurses who took care of Pam. They demonstrated their skills to quantify patient satisfaction in the clinical care as demonstrated by their provision of pain killers and through their physical caring of the patient at home, early discharge from the hospital, and listening and attending to her needs. Through this, they managed to give the patient support and peace of mind through the treatment.
Caregivers often implement the use of NANDA analysis to execute patients psychosocial and physical diagnosis. In the case study, its application revealed Pam’s psychosocial condition as the one coping with stress as seen when she expressed her wish of death to her husband. However, indirectly, this was mainly due to the close connection she had with her family, and the progression of the disease affected her to the point of giving up. In addition, she expressed psychosocial signs with her abnormal nutritional-metabolic patterns mainly in her food and fluids intake, which led to her drastic loss of weight and difficulty in eating and other normal bodily functions.
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In the physical aspect, NANDA diagnosis revealed the limited purposeful and independent physical movements of the patient as well as other underlying factors like depression, pain, discomfort, or fear and physical limitations due to the disease or situation the patient was in. This implied that the patient had limited control over the physical aspects of the body that mainly involved normal things like movement. In addition, it also brought out other related factors arising from within the person that manifested themselves in her open demonstration of pain or fear of discomfort, and physical limitations due to musculoskeletal or neuromuscular impairment. In the case study, Pam exhibited the signs of not being able to move within her normal physical environment as seen through her decreased muscle strength, prolonged bed mobility, transfers from hospital to home to continue her treatment, and a limited range of motion. This is shown by the fact that she could not even resist her husband forcing her to go to the hospital, which all are the signs that can be diagnosed physically (Van der Riet, Higgins, Good & Sneesby, 2009).
A SMART matrix is a planning and communication tool used for the identification of specifics mainly on tasks or actions. The SMART acronyms stand for specific, measurable, attainable, resources, and time; their integration in the case study can be implemented in the following aspect. The specific objective would be to increase or boost her white blood cells and as a result, increase her body’s immunity system, which will in turn help her gain some strength and in addition help her not be susceptible to some illnesses. The measurements needed to achieve this should be based on the increased intake of 0.8 and 1 kg of protein per kilogram of body weight daily through the stipulated intakes over a period, eat foods that contain folic acid, which is a type B vitamin, for example, milk and oranges; these fruit help increase white blood cells. Food supplements help her increase her appetite while undergoing the diet change and the treatment process. The needed resources to achieve this include the joint collaboration by both the family caregivers and nursing caregivers taking turns to ensure the routine is implementing through vigilance and support as well as to ensure the patient adheres to the new diet on a daily basis. This implementation is realistic since it does not involve any overexertion or unrealistic expectations on the clients or caregivers part; in addition, it will help bring the client and family closer since they will take part in the provision of both physical and emotional support during the process. The time implication for the analysis of the implemented goals can be set at a monthly basis but can be changed if necessary since by then, the patient needs time to readjust to the induced gradual changes (Van der Riet, Higgins, Good & Sneesby, 2009).
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The interventions observed in the client during the observation process included the improved communication and support of the patient by the family members during the strategy implementation 2nd week. It was evident that the bonds that were made between the family members and the patient improved the way they communicated, which was shown by the response and alertness exhibited by the physical and psychological changes of the patient. The progressive observation of the patient by the end of second week had set a pattern on effects the different types of food supplements, vitamins and fruits induced on the patient, which included signs like difficulties in swallowing, allergies, vomiting, and nausea. By knowing this, it was easier to make an effective nutritional diet. The effectiveness of the rotational pattern of the caregivers provided a chance to pay attention and anticipate the patients’ needs. Because of this, all the needs of the patient were met, which also helped in improving the effectiveness of treatment and comfort of the patient, since there was no room for negative thoughts and all her needs were met (Holmes, 2010).
In relation to achieving the initial SMART goals of the assessment, the implementations have helped reveal other unforeseen underlying implications on the patients’ health. Unknown issues like family chronic disease history and allergies have been revealed, and by taking, these observations into consideration within the remaining time of the exercise, and this contributed to the relevance of the procedure. In terms of the specific aspect of the analysis, the exercise revealed to be successful in that it not only helped in strengthening of family ties but also helped in the provision of emotional support, which helped in giving the patient a more positive outlook on the disease. In addition, it helped to bring the family closer through the improved communication systems. The exercise time and measurements were not adequate and an increase was necessary on both aspects, since the treatment was still an ongoing process. In this aspect, it could by extended indefinitely since the overall goal of the implementation is to regain the wellbeing of the patient.
In conclusion, the effective application of the care plan for nursing diagnosis can help the caregivers gain a much clearer grasp of the application of their practical practitioner expertise and evidence-based nursing theories and find ways to use them in conjunction with patient participation in order to provide quality and efficient nursing care for the patients.