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Scenario One Jaxson is a 5 year old boy who lives with both parents and his older sister in the suburbs of a large city. Jaxson was diagnosed with Type I diabetes 2 years ago which has been well manag
Scenario One
Jaxson is a 5 year old boy who lives with both parents and his older sister in the suburbs of a large city. Jaxson was diagnosed with Type I diabetes 2 years ago which has been well managed by his parents. He is developing normally and is about to start pre-school. As he will need to become more independent in the management of his diabetes he requires further education on how to test his blood glucose level (BGL). It is your role as the practice nurse of his local medical centre to teach him how to do this.
Scenario Two
Charlotte is a 13 year old girl who lives with her father and her younger brother in a small house in the suburbs. Her mother passed away four years ago and Charlotte often stays with her grandmother during the week to be closer to school. Charlotte has made an appointment with the school nurse because she is concerned about when menstruation will commence. You are the school nurse working with Charlotte today.
Scenario Three
You are the registered nurse working in a Women’s health centre. Jessica is a healthy 36 year old mother of 2 young children aged 4 and 7. Jessica has become more aware of the risk of breast cancer due to her maternal aunt’s recent diagnosis and subsequent treatment and she is seeking education regarding how she can be proactive in her health care.
Assessment Instructions
For this assessment students are required to choose one (1) of the scenarios outlined below and present a client teaching activity (CTA) that is culturally and developmentally appropriate. The nursing and teaching process must be adhered to and the following points must be included:
The assignment will be marked out of 100 and then calculated to a mark out of 40, which is what you will see in grade centre and Turnitin
Refer to the Rubric for individual criterion mark allocation.
Structure and presentation 0 – 20 marks
· Adhere to the SNM assignment guidelines for semester 1- 2017 (link is in the assessment 2 folder) e.g. NO headers and footers, page numbers Top RH, margin sizes, spacing, font, word count etc.
· Use the electronic Turnitin covers sheet with ELP (link is in the assessment 2 folder).
· Please identify which scenario you have addressed in the Turnitin title when you submit, eg CTA scenario 1 .
· If you have been granted an extension please attach the completed form as the last page of the assignment.
· Ensure that you have good paragraph structure e.g. one topic per paragraph, refer to Grellier and Goerke textbook and NCS1102 notes for a refresher on this.
· This is an academic paper so should be written in the 3rd person.
· Succinct introduction and conclusion. The introduction should include a brief overview of the chosen client but do not copy verbatim as this is an unnecessary use of your word count. You may include the scenario as an appendix if you wish.
· No new material to be included in the conclusion
Content 0 – 40 marks
· Assessment: assess the client thoroughly, this means their physical, cognitive, psychomotor skills, psychosocial status and developmental stage. Link the developmental discussion to at least one theorist, for instance you may choose Piaget for Jaxson or Erikson for Jessica. You may use different developmental theorists for other categories to demonstrate your depth of knowledge. Emphasis on each component of the assessment may differ depending on the client. Consider social, cultural and family issues. Identify the client’s learning needs, language skills, motivation, ability to learn, teaching environment and resources for learning. You need a comprehensive assessment in order to identify the problem / nursing diagnosis.
· Nursing Diagnosis: Provide a problem statement that reflects the client’s specific learning needs. This only needs to be a couple of lines and remember this is a CTA so it will be related to a knowledge deficit either cognitive, psychomotor or affective or a combination of these.
· Plan: Develop one short-term and one long-term client learning objective. Ensure that these goals follow the SMART format (e.g. specific, measurable, achievable, realistic and timely). Once this is done think about how you will deliver the education, plan your activity. Select appropriate teaching methods based on the client’s developmental stage (cognitive, physical and psychosocial ability), this could be role play, a game, demonstration of the task. This plan needs to be matched to the clients learning needs and your assessment of the client. Consider timing as well as teaching materials to maintain the client’s attention
· Implementation: Describe your teaching approaches, what instructional methods that will be used and give details about how you will implement the education of the client. It could be that you use telling, selling reinforcing etc. Will you need to use any props or equipment such as posters, blood glucose machines?
· Evaluation: Explain how you will determine if the client’s learning outcomes have been met. When will you evaluate the client? Maybe it will be to get the client to explain the information back to you or demonstrate what task you have shown them.
Application of critical thinking 0 – 20 marks
· You need to integrate / relate the theories (developmental and learning) to the case study to demonstrate that you can apply your knowledge to the development of the CTA and its delivery to the client. Think about Blooms taxonomy and other learning theories (affective, cognitive and psychomotor) when you are writing your assignment. The ability to make appropriate reference to these helps demonstrate your critical thinking.
Referencing 0 – 10 marks
· 5 – 10 references, 3 MUST be from peer reviewed journals.
· Must follow APA style. The ECU referencing guide is your best friend!
· Must be error free both in and end text to achieve the higher marks.
· References must be “quality” to achieve the higher marks.
English language proficiency 0 – 10
· Good sentence and paragraph structure
· Easy to understand sentences
· Error free spelling and punctuation.
· Logical application of ideas and arguments
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- ANSWER
Introduction
Nursing process provides a platform for effective interaction between the nurse and the patient, this process enables the proper understanding of the patient before diagnosis. The following is an assessment done to Charlotte, she’s a 13-year-old teenage girl concerned with her menstrual cycle. She lives with her father and brother and she luck a female companion to talk to her since she lost her mother.
Assessment of Charlotte will be done based on Ida Jean Orlando nursing process theory. The theory is based of the need of care of the patient which will structure the plan of care of the problem. The start of giving care to a patient signals the action process which start with the nurse patient conduct. The action process can be either automatic or deliberate because both the nurse and the patient have different opinions, thoughts and feeling concerning the problem at hand.
Perception from both the parties is very vital that forms the background of the study and observation of both verbal and nonverbal behavior is very important. The assessment of Charlotte will follow the five main steps: assessment, diagnosis, plan, implementation and evaluation, these steps have a positive outcome as they increase the quality of care given by the nurse to the patient or client (Candan et al,2008).
Assessment
The process of nursing kicks off with the assessment phase that start with the first contact between the nurse and the patient and this will proceed throughout the process. The first step which is the initial assessment involves the use of observation and interviewing. The first assessment will be a physical one to determine any abnormalities that she’s facing which may influence her menstrual cycle, in order to determine this her medical history will be collected and interviews will be done to ascertain her lifestyle such as where she lives, the diet and the relationship she has with her relatives. During this phase, observation of her behavior and vital signs will be recorded since the nursing records are very useful to estimate the effectivity of organizing plans of care. The information collected will be used to determine her problems that might affect her menstrual cycle or if they have delayed the cycle.
Re-assessment which is the second phase of this step will be done to check on her progress after the first meeting. This step will be done since she might need to undergo some diagnostic tests to check on her hormonal changes and variation based on her medical condition. Interviews will be done to ascertain emotional state if the lose of her mum is affecting her cycle and the reason why she fears asking her grandmother about her problem. Re-assessment will be done by performing specific actions and observe her behavior to evaluate the outcome, if there will be no change the process will be done again in a continuous cycle. Re-assessment also increases the quality of nursing care by improving the accuracy of data and in this reduces the cases of the risk involved when the patient needs are not acted upon in full (Charles & Michie,2008).
Assessment is a very important step and as such paying attention to not only the physical health but also it is very vital to observe the mental, social and behavioral status as menstruation can be affected by all of the above factors. Assessment provides a perception of a problem and depending on accuracy of the information the essence is to open up communication into understanding the problem. Deliberate communication between a nurse and patient has been found to reduce stress in children and this will really provide more understanding to Charlotte problem (Karen et al,2009).
Diagnosis
Based on the assessment data about Charlotte, she lucks knowledge on menstrual cycle. Her problem can be due to the fact that her social life is a challenging one since she doesn’t thave anyone to talk too about female reproductive health. She lives with her father and brother but the environment also doesn’t give her the freedom and privacy of teenage girl. Understanding female reproduction need knowledge of both the patient medical history and the mother records too.
Menstruation can start as early as 10 years to some girls and some may even delay up to 16 years based on the nutrition and environment. In order to provide a proper conclusion that can be documented and be used for further references, her physical assessment have shown that she is almost starting puberty and she’s concerned when her cycle will start so that she can be ready for that.
Luck of knowledge on the medical records of her mother leads further assessment to determine her flow cycles which can only be done after her menstruation begin. Since she lucks knowledge on reproduction health, further teaching is required to fully prepare her and also give her advise to be open with her grandmother.
Diagnosis is a very crucial step that require good knowledge and expertise. Diagnostic decision should consider evidence found, the patient views and also further research in order to come up with a concrete conclusion. Evidence based results may come from critical thinking which all must be in line with the situation of the patient. The results obtained must be evaluated and cross checked before any conclusion (Polit et al,2012).
Plan
Planning has been described as the phase of patient care that is followed after diagnosis. The step is aimed at coming up with the strategy of solving the patient problem. Planning forms the goal of care that must follow the SMART model. The short goal is to teach Charlotte about female reproductive health so that she can understand the changes that are taking place in her body and also what will come. The long-term goals will be on how to use sanitary towels and keeping her hygiene during the cycle and also teenage pregnancy (Throroddsen & Ehnfors, 2007).
Reproductive health teaching will be done using charts and graphs, charts will demonstrate the reproductive system and graphs will demonstrate the menstrual cycles and the hormones involved together with the time of every stage. The systematic framework for reproductive health teaching will start with the understanding of adolescent stage and the changes that are involved, the second step will be understanding what ovulation and menstruation in females is and its importance together with the problems that are involved.
To understand how sanitary towels are used, the use of female dummy dole will be used to demonstrate and also improve the understanding. Assessment will be done to ascertain understanding and also provide correction where necessary. Information on hygiene will target disposal of used sanitary towels and the timing for exchange together with general hygiene to prevent infections. Knowledge on infections will be undertaken on the most common infection such as the yeast infection and its signs and symptoms together with possible treatment and measures of avoiding.
Teenage pregnancies affect many girls who have no knowledge on sexual education and since Charlotte has started her puberty stage and soon to menstruate, education on sex will be a long-term goal to make her understand the disadvantages of early sex which not only include pregnancy but also it may put her on the risk of conducting sexual transmitted diseases and infections.
Implementation
Achievement of goals is the sole purpose of nursing action; the action can be medical or even social but both of them the nurse is accountable. The needs of Charlotte are both short and long term. The approach to be taken in ensuring that the goals are achieved are supposed to bring positive outcomes with both the parties involved being in line with them.
Topic that involves sexual health often feels awkward even to the parents and for her to participate and ensure understanding, the mode of implementation should first ensure that she has open up to the topic and ready to give views and learn. Demonstration will prove to be the best strategy as it will involve interaction in form of questions and answers. Practical approach will also be used based with the fact that practice of using sanitary towel will require experimentation with the use of dummy or even other volunteers willing to participate in demonstration.
The treatment of a patient should be done when both the patient and the nurse are in mutual understanding, such can only come out when the patient is actively participating on all aspect aimed at his/ her care. Implementation of Charlotte cure plans requires her involvement in practical activities together with experimentation and evaluation because an active patient involve in decision making will always lead to a successful care (Marita et al.2001).
Evaluation
Evaluation forms the non-stop ongoing process in the nursing activity. Evaluation is done at the first step during assessment by several test of affirmation and confirmation of behaviors to collect data, its done during the diagnosis step to ascertain the accuracy of the information obtained before final recording, its done at the planning stage to affirm the effectiveness of the strategy to be used and also its done at the implementation stage to confirm the whether the problem has been solved.
The nursing process has to be systematic when implemented to ensure authenticity and accuracy in delivery, if change has to be made it should fall on the same line to avoid confusion. Sexual education requires much attention and in order to evaluate the achievement of the short-term goal charlotte has to recognize and record all the changes that are taking place in her body, this include a record of physical changes that include height, weight, change in the size of her breast and also, she should be able to keep record of emotional changes that might push her to even avoid people more (Haobin et al,2008).
Evaluation of the long-term goals will be done by overserving how she carries herself during her menstrual cycle, this will include hygiene check and regular medical check up for STDs and STIs. All the evaluation data will be documented for follow up and for further intervention which is according to Finnish law that encourages that all healthcare professional should document patient information for follow up.
Evaluation will be done on regular basis for the short-term goals and monthly for the long-term goals until the needs of Charlotte have been met. During the first approach, evaluation will be done by demonstrating her understanding through repetition of the procedures done practically and for the studies, evaluation will be done on question answer basis and determination of weaknesses will call upon further clarification (Scott & McSherry, 2008).
Nurses tend to make decisions based on their care to the patient but the health care of Finnish law upholds that conclusion should only be made based on evidence and should follow the practice of good care. The decision made during diagnosis should be based on evidence so that evaluation will follow the conclusion that had been made (Sahlsten et al,2005).
Conclusion
Nursing activities have a positive outcome on delivering nursing care, this procedure provide a platform for more understanding of the needs of the patient which are very vital for data collection. A nurse that follows a systematic step will always have a better chance of understanding their patients and have a better chance of establishing communication. Interaction established is very crucial for identifying the needs of the patient and this will enhance the planning strategy.
Assessment is a very crucial step, it forms the basis for all the other steps, the accuracy of information depends on expertise of the nurse and interaction. Assessment is based on interaction and its effectivity improve documentation which forms the first step of diagnosis and also for intervention.
Charlotte faced with social problem of luck of reproductive health education requires help to understand how her body is going through changes, assessment of her reveals her need and a proper plan of care should be undertaken and implementation done to ensure if her problems have been solved. With evaluation, the care strategy can be ascertained if they are working based on diagnosis and proper nursing process.
Reference
Candan Ozturk, Gonca Karayagiz Muslu, Aklime Dicle. (2008) A comparison of problem-based and traditional education on nursing students’ critical thinking dispositions Nurse education today 28 (5), 627-632
Charles Abraham, Susan Michie. (2008) A taxonomy of behavior change techniques used in interventions. Health psychology 27 (3), 379
Haobin Yuan, Beverly A Williams, Lin Fan. (2008) A systematic review of selected evidence on developing nursing students’ critical thinking through problem-based learning Nurse Education Today 28 (6), 657-663
Karen Bulmer Smith, Joanne Profetto-McGrath, Greta G Cummings. (2009) Emotional intelligence and nursing: An integrative literature review International journal of nursing studies 46 (12), 1624-1636
Marita G Titler, Charmaine Kleiber, Victoria J Steelman, Barbara A Rakel, Ginette Budreau, Linda Q Everett, Kathleen C Buckwalter, Toni Tripp-Reimer, Colleen J Goode. (2001) The Iowa model of evidence-based practice to promote quality care Critical Care Nursing Clinics 13 (4), 497-509
Polit D.F., Beck C.T. (2012). Nursing research: generating and assessing evidence for new nursing practice. 9th edition. Philadelphia: Wolters Kluwer Health: Lippincott Williams & Wilkins.
Sahlsten M. JM., Larsson I.E, Lindencrona C. SC., Plos. (2005) Patient participation in nursing care: an interpretation by Swedish Registered Nurses. Journal of Clinical Nursing. 14 35-42
Scott K. & McSherry R. (2008) Evidence-based nursing: clarifying the concepts for nurses in practice. Journal of Clinical Nursing. 181085-1095
Suhonen R., Välimäki M., Leino-Kilpi H. (2006). A review of outcomes of individualized nursing interventions on adult patients. Journal of Clinical Nursing. 17 843–860
Throroddsen A. & Ehnfors M. (2007). Putting policy into practice: pre-and posttests of implementing standardized languages for nursing documentation. Journal of Clinical Nursing. 161826-1838