Clients’ Teaching-Learning in Nursing Profession
January 6, 2017

Call and Response

Development of a healthy nation depends on numerous factors, such as the literacy rate, healthcare system, community’s trend towards healthy activities, and need for seeking health teachings. The role of knowledgeable nurses cannot be denied in this respect. Nurses work as teachers, healthcare counselors, administrators, research scientists, and as primary healthcare providers in the community. A knowledgeable nurse considers all the aspects of care for clients, such as clients’ ethical, emotional, aesthetic, and biological needs. A well-informed nurse understands the well-being and more-being of clients, by knowing them both scientifically as well as intuitively (Kleiman, 2006). Mr. A.B. is a 67 year-old client, who has been reported with an ischemic stroke. He has a history of hypertension, deep venous thrombosis (DVT), coronary artery bypass graft, which he had back in year 2006. Mr. A.B. has worked in hydro for 35 years. The client has been observed and interviewed about the following: his feelings towards his medical condition, being in a facility with all of these manifestations, the care that he has received, and the response received after his call for help. The purpose for this paper is to explore how nurses can better prepare and respond to their patients’ calls for help. In addition, importance of different nursing interventions for the well-being and more-being of clients will be discussed, as well as the shifting of nurses’ angular view as a result of interaction with clients.

Preparation for Practicum

Call for help from a client or from a community can be addressed effectively only if nurses have the knowledge of holistic and humanizing nursing care. Wholeness in nursing care involves care beyond conventional nursing interventions (Kleiman, 2006). In order to achieve better preparation for clients’ care and to respond to calls for help more appropriately, I take the client as a whole. This holistic, or all at once, approach helps the nurse to understand and respond to the client’s needs in a systematic manner. Making a list of clients’ biological, physical, emotional, aesthetic, ethical, and psychological requirements helps me to prioritize individual needs. As a nurse, I will be able to respond to clients’ calls for help if I have the knowledge of all the aspects of the client care.

To understand clients’ needs, it is significant to understand the pathophysiology of the disease, which helps nurses gain confidence in communication with clients or other healthcare professionals and also in their nursing practice (Wissen & McBride-Henry, 2010). The client, Mr. A.B., suffered an ischemic stroke which led him to hemiparesis, dysphagia, drooling, and facial neglect. Previously, I have learned that clients with these medical conditions are often at a higher risk of aspiration pneumonia because of swallowing difficulty, developed as a result of weak facial muscles. Risk of fall due to weakness can also cause fractures that eventually increase dependency on others even for comfort in bed. Prolonged bed rest can result in these patients developing varicose veins and bed sores. Change in body image can cause depression, drooling saliva from the patient’s mouth may require suctioning, need for oral hygiene, and emotional support (Crimlisk, 2010).

While I was putting together a care plan for the client, the questions that shook my mind, body, and spirit were the following: what would be my feelings if I were in the same situation as that client, and is it more important for the client to be treated using biomedical model or biopsychosocial model of care?

Patient’s Lived Experience

Development of a trusting nurse-client relationship is necessary to explore the lived experience of clients. This trusting relationship entails caring for the clients beyond the conventional nursing care. As nurses, there is need to understand that, next to medication or ambulation, our clients need management for their emotional, psychological, and spiritual needs (Burger, 2009). In order for better communication with the client regarding his lived experience, I centered my thoughts before going into the patient’s room, making sure that I was authentically present with the client. Any major illness can change a person’s life dramatically. Mr. A.B. feels that he is unable to do things on his own, and feels a sense of depression and hopelessness. I observed the client weeping during our conversation with regards to his illness. The client further stated that he felt like a burden on his family. However, I assured the client that the extent of recovery depends upon his own efforts for physical exercise, along with a rehabilitation team, family, friends, and relatives.

Studies have shown that strokes affect individuals’ physically as well as psychologically. These clients become more sensitive and require psychological support in conjunction with biological nursing interventions. The consequence of stroke does not only affect the patient’s suffering, rather it deeply affects the family and friends of these individuals. Their dependency on others increases for activities of daily livings, such as food, dressing, hygiene, toileting, and their social life also changes because of their disability (Pettersson, Berndtsson, Appelros, & Ahlstro, 2005).

Recognizing and Understanding the Call

Patients’ calls for help can be better recognized, understood, and addressed when there is proper collection of data regarding patients’ health history. This data includes subjective as well as objective data. The role of nurses in collecting this health history serves as a cornerstone in the process of diagnosis and treatment (Burger, 2009). The patient’s data has been collected from kardex, chart, professional team members, and his medication administration record. This data reveals that the patient was admitted to the healthcare facility on October 1, 2010 with cerebral artery ischemic stroke. He developed left hemiparesis, dysarthria, facial droop, and facial neglect on the left side as a result of his stroke. The health history of the client states that he had coronary artery bypass graft, back in 2006. He has a history of pulmonary embolism, previous deep venous thrombosis (DVT). The findings upon physical assessment of the client, blood pressure 140/92, with a heart rate of 80 beats per minute. He was afebrile (36.50C) and capillary refill <3 seconds. Crackles were heard bilaterally in upper lobes of his lungs on auscultation with every exhalation. No edema was seen on his lower extremities. The laboratory values are as follows: International normalization ratio (INR) 1.2, PTT 38 seconds, platelets count 240,000/mm3, which is in subclinical range, albumin 34 g/L, electrolytes is in normal range, oxygen saturation 94%, and hemoglobin 12.6 mmol/L. The INR and PPT has a significant importance in patients with ischemic strokes to monitor the need and effectiveness of the anticoagulative therapy. The patient’s INR 1.2 was set by his physician, depending on the partial prothrombin time which was 38 seconds. The normal range for INR is 2-3 for people on anticoagulants, higher the INR indicates bleeding and lower levels reveal early blood clotting (Carter, 2010).

As nurses, we can expect numerous calls for help from clients with ischemic strokes, dysphagia, and hemiplegia. Here I will be mentioning two calls from Mr. A.B., repositioning the client because he is at risk for developing DVT and feeding him. As mentioned earlier, the client has bilateral crackles on auscultation, which shows that he is aspirating his food or secretions. Mr. A.B. can develop aspiration pneumonia, pneumonitis, or malnutrition as sequelae of his stroke (White, O’Rourke, Ong, Cordato, & Chan, 2008). Studies have shown that aspiration pneumonia occurs in 50 % of the clients with swallowing disorders. The development of pneumonia can lead such patients to other complications such as hypoxia, increased breathing rate, and ultimately increased blood pressure. The hyperactivation of the sympathetic nervous system can cause hemorrhagic stroke or even death (White et. al., 2008).

The client, Mr. A.B., is at bed rest and I have observed that he is unable to reposition himself. Furthermore, prolonged bed rest can increase the risk for developing DVT. Carter (2010), a nurse specialist in thromboembolism, describes the risk factors for DVT, such as current episode of ischemic stroke, prolonged bed rest usually more than 3 days, acute medical illness, and increasing age. She further explains that diagnosis of DVT is a difficult task and 80% of the clients are not diagnosed because of the similarities of infestations of this disease with varicose veins, eczema, and cellulitis. Mr. A.B. has all of the above mentioned predisposing factors; therefore chances of developing DVT are high. This would eventually lead to pulmonary embolism, and ultimately right-sided heart failure.

Response to the Patient’s Calls for Help

Nurses’ response to patients’ calls for help is the central pillar to the nursing interventions suggested for the clients’ well-being and more-being. Well-informed nurses can respond to these calls very effectively. These knowledgeable nurses take care of their clients scientifically and intuitively (Kleiman, 2006).

Feeding clients with dysphagia is always a difficult and challenging task for nurses. Nonetheless, I tried feeding the patient because I had prepared myself for the client’s calls for help. The client had a yellow instruction sheet on his bedside with feeding techniques and type of diet. The patient was on a pureed diet and thick liquids. For preparation, I made the client sit upright at a 90 degree angle, as it was part of the instructions. Before feeding him, I gave him a mouth wash to provide oral hygiene. I started feeding Mr. A.B. on the right side of his mouth which was the stronger side of his body. While I was feeding the client, I also provided the client with Kleenex to wipe the drooling saliva and food particles on his mouth.

White, O’Rourke, Ong, Cordato, & Chan (2008) describe the safe feeding techniques and the importance of modified diet for patients with dysphagia. They state that pureed food and liquids of the viscosity of honey are well tolerated by dysphagic patients. Putting food on the stronger side of the mouth and swallowing slowly, helps patients use their facial muscles to swallow and prevents aspiration. The importance of oral hygiene before and after meals cannot be ignored because dysphagic patients may aspirate oral secretions that have micro organisms in it. Keeping the client upright during and after feeding for about 30 minutes, helps food and acidic secretions to go down, and stops gastroesophageal reflux.

The client has a history of pulmonary embolism. Development of a thromb in his lower extremities can increase the risk for another stroke and worsen the condition (Carter, 2010). At the healthcare facility, I have noticed that Mr. A.B. is receiving medication (PlavixR) for further prevention of thromboembolism. Furthermore, there are planned physical activities for him to participate in for the prevention of DVT. During the assessment of the client, I constantly reminded him the benefits of mobility, and encouraged him to change his positions to allow more blood to circulate through his lower extremities. The client is at complete bed rest; however, I always encourage him to do exercises of his legs, arms, and feet.

According to Farley, McLafferty, and Hendry (2009), nurses play a major role in the mobility of clients at risk for developing DVT. Patients at bed rest need encouragement for the exercises, such as planter and dorsiflexion of the feet that increases venous return to the heart. Some other nursing interventions include use of compression stockings that increases 30-40 mmHg pressure gradients, and ultimately enhances blood flow to the heart. The use of oxygen therapy and hydration helps in blood homeostasis and proper circulation of blood. (See appendix for more nursing interventions). Another important aspect of nursing interventions is the health teaching of the client upon discharge that includes the continuity of blood clot prevention medication as prescribed, light exercise for legs and feet, and use of compression stockings if they are planning to fly, as this reduces the symptoms of DVT (Farley, McLafferty, & Hendry, 2009).

Well-being and More-being of the Patient

Nurturing for the well-being and more-being of patients is the main purpose of nursing care. Patients’ well-being and more-being can be achieved if all the nursing outcomes and patients’ physical, biological, psychological, emotional, ethical, and aesthetic needs are met. Nurses with the knowledge of all ways of knowing are more successful for meeting the needs for patients’ well being. These caritas nurses treat their clients’ as a whole and consider them as unique individuals with specific needs. These nurses understand the importance of authentic presence, being only with clients and letting go all other thoughts while taking care of clients (Watson, 2006; Kleinman, 2006).

As a student nurse, I am aware of the benefits of feeding the client on the stronger side of the mouth. So, I started feeding the client on his stronger side of the body, on the right side of his mouth. This was so that the client used his stronger facial muscles to swallow the food and prevent aspiration. This would ultimately save him from other complications such as aspiration pneumonia, and eventually reduce the number of days at the facility, which would allow him to have more time with his family. I could see the drooling saliva from his mouth while he was trying to swallow his food. I provided the client with Kleenex to clean his mouth himself so that, he might not feel embarrassed and made sure that he was receiving humanizing nursing care. Furthermore, encouraging mobility would help the client develop self-confidence and reduce dependency on others. The client appreciated my efforts to feed him, while being with him authentically in that moment of care, even though he could not speak properly; however, he waved his arm to express his views.

I can recall, during light physical exercise of legs and feet, the client had phases of expression of grief because of losing his independence. At that moment of sorrow, I stood by the client, holding his hand into my hands to share his grief, and assured him that I was, and I would be, there to help him. At the same time, I was trying to talk about the facts of life and the disease. The client calmed down and listened to me to continue exercises.

My Contribution to Patient’s Health & Healing

Patients’ health and healing depends fully upon nursing care because nurses spend most of their time with clients and are responsible for providing humanizing nursing care (Kleiman, 2006). The humanizing nursing care involves knowing and taking care of patients scientifically as well as intuitively. The humanizing nursing care also considers every patient as a unique individual with individual needs (Kleinman, 2006).

To provide humanistic nursing care to Mr. A.B., I considered the all at once approach to implement all nursing interventions, which is the central theme to the humanistic theory of nursing care. The client was at risk for aspiration, but proper feeding techniques resulted in enhanced compliance for the patient, saved him from developing aspiration pneumonia, and ultimately saved the patient and his family from complications such as longer stay at the facility. While feeding the client, I provided him with Kleenex to wipe his mouth on his own which encouraged his mobility, self confidence, and maintenance of aesthetic sense. Mr. A. B. was at complete bed rest that could increase chances for build up of DVT. The continuous client and family teaching, regarding benefits of mobility and working with the client for light physical exercises, prevented the client from developing DVT and reduced his dependency on others, even for minor activities. I shared his sorrows regarding his illness and tried to make him feel that I was with him at that moment of care. As a student nurse, I am sure that the care I provided made a difference, not only for the client’s own life but also for his family.

The provocative questions that I had in my mind at the beginning of this paper were answered very well. As human beings, we are social and most likely experience similar feelings. My feelings would be the same as the client’s feelings. The answer to the second question is quite clear as well. It would be more appropriate to consider biopsychosocial model of care that covers all the aspects of care.

Well-being and More-being for Nurses

Nursing profession demands more than what we expect as nurses. Nursing is more than just a job. This can be comparable to teaching, where teachers take care of students’ academic as well as moral development. Nurses are responsible for patients’ well-being and more-being by providing humanizing nursing care that includes knowledge of scientific predisposing factors for a disease and the knowledge of inner feelings of clients as well (Watson, 2006). As a student nurse, I understand the importance of providing humanizing nursing care for clients. I will take care of my clients by keeping in mind that each client is a unique individual who has his or her own specified needs.

Conclusion

Nursing knowledge is an ongoing process and requires continuous efforts of nurses to upgrade their knowledge with the current, evidence based, and best practice guidelines. Learning from reflecting on daily nursing practice is another approach that nurses can use to learn and understand patients’ needs and respond accordingly. Knowledgeable nurses understand that chronic or acute illnesses not only change patients’ physical appearance but also affect patients’ emotions and feelings. So, there is need for holistic and humanizing nursing care for all clients. These nurses also recognize the importance of different nursing interventions and rationale for the well-being of their patients. This would help patients recover from a disease and prevent them from further complications.

There is further need for developing awareness among the general public about prevention of different diseases because prevention is always better than cure. As nurses, we are responsible for creating this awareness with current, evidence based, best practice guidelines and knowledge that will help us in developing a healthy nation.

References

Burger, J. (2009). Communication. In P. Potter & A. Perry (Eds.), Canadian fundamentals of nursing (pp. 245-262). Toronto: Elsevier Canada.

Crimlisk, J. (2010). Nursing management: Lower respiratory problems. In S. Lewis, M. Heitkemper, S. Dirksen, P. O’Brien, & L. Bucher (Eds.), Medical-surgical nursing in canada (pp. 625-669).Toronto: Elsevier Canada.

Carter, K. (2010). Identifying and managing deep vein thrombosis. Continuing Professional Development, 20(1), 30-39. Retrieved from http://cinahl.com/cgi-bin/refsvc?jid=1892& accno=2010565281

Farley, A., McLafferty, E., & Hendry, C. (2008). Pulmonary embolism: identification, clinical features and management. Nursing Standard, 23(28), 49-56. Retrieved from http://cinahl.com/cgi-bin/refsvc?jid=530&accno=2010235084

Kleiman, S. (2006). Josepine patterson and loretta zderad’s humanistic nursing theory and its applications. In M. E. Parker (Ed.), Nursing theories and nursing practice (pp. 125-138). Philadelphia, PA: F.A Davis Company.

Pettersson, I., Berndtsson, I., Appelros, P., & Ahlstro, G. (2005). Lifeworld perspectives on assistive devices: Lived experiences of spouses of persons with stroke. Scandinavian Journal of Occupational Therapy, 12, 159-169. doi: 10.1080/11038120510031789

Watson, J. (2006). Jean watson’s theory of human caring. In M. E. Parker (Ed.), Nursing theories and nursing practice (pp. 295-308). Philadelphia, PA: F.A Davis Company.

White, G., O’Rourke, F., Ong, B., Cordato, D., & Chan, D. (2008). Dysphagia: causes, assessment, treatment, and management. Geriatrics 63(5), 15-20. Retrieved from EBSCOhost database.

Wissen, K., & Mc-Bride-Henry, K. (2010). Building confidence: An exploration of nurses undertaking a postgraduate biological science course. Contemporary Nurse, 35 (1), 26-34. Retrieved from http://.cinahl.com/cgi-bin/refsvc?jid=597&accno=2010734258

 

These articles have been written by Nasir Ahmad BSc. (HONS) Nursing, a graduate from York University Toronto, Ontario, Canada. The writer of these articles authorize Peace In-Home Health Care Services Inc to use these articles on their website as an additional resource for their clients. However, any unauthorized copying or distribution of these articles will be dealt strictly by the laws of the state. Please contact author for any queries at 416-648-2717 or email: 23.ahmad@gmail.com