Theoretical Framework for Nursing Practice – Module 4
A. As you read Henderson's definition of nursing, what nursing functions and actions are applicable today? Explain.
Almost all basic independent nursing interventions have its basis on the fourteen nursing needs by Henderson. She described the role of the nurse as one of the following: substitutive, which is doing something for the patient; supplementary, which is helping the patient do something; or complimentary which is working with the patient to do something (http://nursing-theory.org). In essence, all patient needs across the dependent-independent continuum would need some sort of intervention from the nurse while the patient is under her care with the main end-goal of full independence by the time the patient is discharged. Among different types of patients, those admitted in the intensive care units, particularly those who are rated 3 to 7 out of 15 on the Glasgow Coma Scale require a mostly supplementary form of care. Simple activities of daily living are fully performed by the caregiver that includes, but not limited, to the following: maintaining patent airway by placing an oral protective airway and suctioning of secretions via oral or endotracheal tube (breathe normally); ensuring adequate nutrition by tube feeding either through NGT, PEG or intravenously (eat and drink adequately); frequent changing of soaked/ soiled diapers or underpads (depending on institution policies) or the insertion of a foley catheter as well as emptying of excess bodily fluids such as that from an ostomy appliance or a Jackson-Pratt drainage (eliminate body wastes); unless contraindicated, routine positioning and turning of the patient from side-to-side and flat on back for the prevention of bedsore formation and promotion of comfort or by employing postural drainage for mobilization of pulmonary secretions (move and maintain desirable body postures/protect the integument); ensuring ambient noise is minimized, providing dimmed but adequate lighting, maintaining room temperatures in check, and reducing patient manipulation during time of sleep (sleep and rest/maintain body temperature); routine hygienic measures such as daily bed baths and oral care, shaving of facial/body hair as necessary and regular change of linens and patient clothes/hospital gown (keep the body clean and well groomed/select suitable clothes); ensuring that side rails are up at all times, making sure that the bed is free from sharps or other objects that could be potentially harmful to the patient, following the 10 R’s and hospital protocols when administering medications (avoid dangers in the environment).
In other cases a client (may it be the patient or a relative) maybe fully capable but is simply unaware, incompetent, uneducated, confused, or perhaps is undergoing some stressful situation at present, that a nurse is needed to guide, coach, counsel or teach. This is where a nurse’s most often overlooked roles come in the form of patient/client education and compassionate care through sympathizing and empathizing. Numbers 9 up to 14 of Henderson’s components fall under this type of nursing function.
B. Select a patient in your practice setting or recall a patient when you were a student. Use Abdellah's typology of 21 nursing problems to assess the patient. Make an NCP and identify outcome measures.
Patient A.M., a 55 year old male comes into the ER with complaints of a left sided chest pain that is 7/10 on the pain scale. Upon assessment, the patient is diaphoretic, his right hand clutching his chest and is short of breath. Upon interview, it was learned that started 6 hours ago as an epigastric pain and so he thought that he was just having a heart burn but has now gotten worse and is now accompanied with difficulty of breathing. He states he is on hypertensive and diabetes medications and has had a previous double-vessel bypass surgery in 2008. Upon arrival,...
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