Community Nursing

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Throughout this piece the writer will discuss the fundamentals of nursing (primary,secondary and tertiary care) when assessing Mr Murphy who is a seventy two year old gentleman recently discharged home from hospital on oxygen, post an exacerbation of his chronic lung disease. The assessment setting takes place within the commuity where the comunity nurse plays a pivotal role in assessing both Mr Murphy and Mrs Murphy within their home. This is appropriate due to Mr Murphy not being the only person who will suffer from psychological and physical hardship during this time in life. Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow obstruction worsening exercise performance, and contributes to general deterioration in health (Smith et al. 2008). When asssessing the patient on a local level, the implementation of care plans (primary, secondary and tertiary; including assessment and challenges), the continuous expansion in the role of the community nures, multi diciplinary team and the rationale for the use of the wellness/illness continuum is aslo discussed within the assignments (Telford 2006; Buswell (2000) cited in Porche 2004). Utilising models by Hoeman community based rehabilitation nursing 1996 purple book seen in fig 1.0, adaptation of Roach (2002): caring, the human mode of being in juxtapose with Barnhill’s system theoretical circular model of healthy family dynamics (Barnhill 1979) fig 2.0 and an adaptation of Roper Logan and Tierneys model of nursing (2004) fig 3.0/3.1, the writer will begin to elaborate on each individual assessment stated above.

Utilising an adaptation of Roper, Logan and tertiary model of nursing (2004) and other models of assessment including rehabilitation within the community and family dynamics. The topics which the writer wishers to discuss are, rehabilitation into the community, maintaining a safe environment, care of the primary carer, breathing and oxygen therapy and anxiety. According to Chalmers (1992) and Appleton and Cowley (2008), assessing individuals within their community setting of the family home requires the ability to uncover needs and issues that are potentially harmful to the patient and strength of charactor to stimulate awareness of health needs of the individuals being assessed. When Mr Murphy is discharged into the community he and his family face rehabilitation into the community. With the aid of Hoeman’s community based rehabilitation nursing 1996 purple book seen in fig 1.0 the writer willl elaborate on the importance of rehabilitation into the community.

Fig 1.0 Adaptation of Roach 2002: caring, the human mode of being.

Negotiate with client
Caregiver to etsablish
Goals and interventions
To ada.t to changes

The stressor in which Mr Murphy is suffering from is the degeneration of his lung capacity caused by lifestyle factors and or results from his past employment (Mc Kenzie et al.2006). Utilising the aid of health promotion staff (community health nurse and the multi diciplinary team), establishing a therapeutic coping mechanisms can be achieved. Such a coping mechanism may include, the patient and carer keeping a diary of events that have happened or exacerbated their conditions (Bandura 1986, Prochaska et al. 1992, Battersby et al 2003). By keeping a journal of events (Battersby et al. 2003), the community nurse and others health professionals can indentify issues that contribute to tachi-apnoea (rapid breathing) or dyspnoea (shortness of breath). When the care is critically analysed in a holistic manner, and found to be ineffective, the community nurse can assist by modifying the current health promotion tools; for example, re-evaluating the topics discussed on the benefits of self care and importance of good inhaling techniques of pulmonary medications (Robinson et al. 2008). Although further empowerment and negotiation with...
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