Refusal of Treatment

Topics: Chronic obstructive pulmonary disease, Nursing, Nursing care plan Pages: 12 (3872 words) Published: April 1, 2012
Safety and Comfort Essay

The purpose of this essay is to devise a plan of care for a patient. The plan must be in relation to an actual or potential problem as identified under the Activities of Living (ALs) using the Roper Logan and Tierney model of nursing. For this a patient has been selected after meeting with them in a ward setting in the geographical area. Adequate verbal consent defined by Kozier et al (2008) as ‘an informed decision making process’ has been obtained from the patient and in order to protect their identity and coincide with NMC guidelines of patient confidentiality the patients name has been changed and neither the ward nor the hospital shall be disclosed.

The patient is Miss Webster who is a 46 year old female admitted to the ward with shortness of breath and an exacerbation of her chronic obstructive pulmonary disease (COPD). Her past medical history includes asthma, COPD, chronic bronchitis, frequent chest infections, endometriosis, polycystic ovarian syndrome and a radical hysterectomy in 2007. As previously mentioned the Roper Logan and Tierney model shall be used in order to identify an actual or potential problem relating to any of the twelve activities of living and a care plan shall be devised and implemented based upon this. But what exactly is the Roper Logan and Tierney model of Nursing?

Holland (2008) summarise this model by stating that it is divided into two parts, namely the model for living and the model for nursing. For the purpose of this essay the model for nursing shall be used. In this model there are five components. The Activities for Living of which there are twelve namely- maintaining a safe environment, communicating, breathing, eating and drinking, eliminating, personal cleansing and dressing, controlling body temperature, mobilising, working and playing, expressing sexuality, sleeping and dying. Within these twelve activities there are five influencing factors; biological, psychological, sociocultural, and environmental and politicoeconomic. The next component is lifespan which is again divided into five stages as a person’s ability to be independent in the AL are affected by where in the lifespan they lie at any particular time. These stages are infancy, childhood, adolescence, adulthood and old age. The dependence/independence continuum is the next component which is previously stated is strongly interlinked with that of lifespan. The fifth and last component is individuality in nursing care. Roper et al (2000) consider that a person’s individuality can manifest itself in many different ways and that this is where individualised care and the nursing process comes into play. The nursing process can be broken down into four parts; Assessment, Planning, Implementing and Evaluating. Each of these parts shall be explained in depth throughout the body of the assignment.

Before a plan of care can be devised a holistic assessment of the patient must be carried out as described in the model but what is assessment and why is it so important? Heaven and Macguire (1996) and Kozier et al (2008) state that assessment is a systematic, continuous, interactive and deliberate process which involves collection, organisation and documentation of data which underpins every aspect of nursing care. Holt (1995) believe assessment to be ‘the only way in which the uniqueness of the patient can be recognised and considered in the care process’ and Holland (2008) believe it to be through assessment that the Nurse-patient relationship is established and a bond made. Although generally accepted as the first stage in the nursing process Roper et al (2000) point out that assessment should be ‘cyclic’ rather than a one of event. Harris et al (1998), however, point out that too much emphasis is placed upon following such a model to the letter resulting in the prevention of the nurse realising the significance of information presented to them. This controversial...
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