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M2006 Bachelor Of Nursing

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M2006 Bachelor Of Nursing

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Course Code: M2006
University: Monash University

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Country: Australia

Question:

Make a Nursing care plan for the given case.
Paul and Eddie video – Transcript
[On-screen captions]
Aboriginal and Torres Strait Islander viewers – please be informed that this video may contain footage of people who are since deceased.
[On-screen captions]
A few days after his cataract surgery, Paul has a home visit with Eddie – an Aboriginal Health Worker from his local Aboriginal Community Health Service.
[Knock at the door]
Paul: Can you get the door, Rodney? … Thanks.
Paul: Hey!
Eddie: How you doing bro?
Paul: I’m alright… Yeah, not bad. You want a cuppa tea?
Eddie: Yeah.
Paul: Yeah, cool. Rodney, can you get us a cuppa tea? I know it’s asking a lot! Thank you!
Eddie: So how ya been?
Paul: Yeah, well. Yeah, I just had surgery on my eyes… so…
Eddie: Yeah. How’s it all going?
Paul: Erm…
Eddie: Not sore or anything?
Paul: They’re not too bad. They’re a bit painful, but I’ve been taking Panadol so I don’t notice, I guess.
Eddie: Good. So you got down there alright?
Paul: Yeah, yeah. The health service organise it for me. And, erm, I don’t like hospitals very much. You know, there’s a lot of waiting and a lot of old people.
Eddie: Yeah.
Paul: In that eye hospital, man! [[01m05s]]
Eddie: Yeah, it can be, eh, a long time.
Paul: I know you just, like, shuffle from one thing to the next, you know?
Eddie: Yeah.
Paul: But they’ve changed a lot. They’ve done a lot of, you know, in my time… When I first went there I had to tell them I was Aboriginal. They didn’t ask.
Eddie: They didn’t ask if you were Aboriginal?
Paul: No, but they had the posters. The Closing the Gap posters. I don’t know. You know what I’m like. You know I’ve, sort of, worked in health…
Eddie: Yeah…
Paul: … a while ago, but I’ve always, you know we always talk about identification, so…
Eddie: Well it’s actually mandatory to ask the question if you’re Aboriginal or not…
Paul: Yeah.
[Paul and Eddie talk over each other]
Paul: They still don’t do it!
Eddie: So it’s good they look after you.
Paul: Yep.
Eddie: And treated you well…
Paul: Yep.
Eddie: They, erm, when you left, they gave you the medications and…
Paul: Yeah, cos my eyes weren’t good, weren’t good, and they gave me these drops and Panadol and stuff, and I’ve been putting them in, like, twice a day.
Eddie: Yeah, you need to take these… you probably can’t see this properly, but you need to take these, well apply them, every 4 hours.
[[02m04s]]
Paul: Oh, every four hours?
Eddie: Yeah.
Paul: I’ve only been putting the in twice a day.
Eddie: Oh no. They’ll probably… yeah it’ll help you to recover a bit better. And do it right to the end. Don’t stop, you know, three quarters of the way through…
Paul: Yeah
Eddie: Do it until it’s all finished.
Paul: Yep.
Eddie: And then you know the course has been completed.
Paul: I’ve got some scripts. I guess I’ll get them to help me out.
Eddie: You’ve got some follow-up appointments. Did they tell you about your follow- up appointments?
Paul: Yeah. And I think they’re going to get help to organise, between the health service and the hospital, so…
Eddie: Yeah. And we’ll be able to organise some transport.
Paul: That’d be great, cos it’s a bit of a hike and… not being able to drive.
Eddie: I can give you a lift. I can organise that.
Paul: That’d be good.
Eddie: So how’s it been? Because I know you got a bit wild you can’t drive any more…
Paul: You know me..
Eddie: Restricts you a bit.
Paul: Yeah, it’s just I can’t get out and do my own thing, being independent. Rodney doesn’t drive, so I feel a bit hemmed in, you know? I don’t like it; I like a bit of freedom, so…
Eddie: So what are you doing to try to keep yourself sane or…
Paul: Oh just, you know, it’s early days. My vision’s a bit crappy so I just, you know, make sure I stay here and just stay out of bright light for a while and… yeah, I’ve been feeling a bit flat, but I don’t know whether that’s the hep. C, so…
Eddie: Yeah, it could be. [[03m25s]]
Paul: But I am a bit blue, I dunno.
Eddie: Need to get you out, so…
Paul: Yeah, that’d be great…
Eddie: We missed you at the Men’s Group, eh, last week.
Paul: Did ya?
Eddie: Yeah! We had a fella come down talk about prostate cancer.
Paul: Yeah, no wonder!
Eddie: All the boys were laughing, eh [inaudible] but they all missed you, eh, they missed your laugh.
[talking over each other]
Paul: That’s good, I missed them.
Eddie: They’re wondering how you’ve been.
Paul: Not being able to drive and that’s made it, you know, hard. I know that, you know, I just need to get to those community things sometimes. You know? You just get a bit… I dunno, isolated.
Eddie: Yeah, exactly. So we’ve got a fishing trip coming up.
Paul: Oh? Right.
Eddie: So the boys want you to come to that. Paul: Two weeks? Well my eyes might be fixed… Eddie: Well I’ll give you a lift anyway…
[talking over each other]
Paul: …Yeah that’d be great…
Eddie: …just to make sure too, but yeah, we’ve missed you around the place. So it’ll be all good to see you… So you just mentioned about Hep. C. So you want a bit more information about that?
[[04m15s]]
Paul: Yeah, you know I’m really, you know, open about that stuff, and, you know, things I did in the past, but, you know, I’ve heard there’s some newer treatments [inaudible] so… You know, I’m getting things fixed, so maybe it’s a good time.
Eddie: Yeah, it might be a good opportunity for that. So I think the nurse is coming around tomorrow? Is that appointment for her to come and visit you tomorrow?
Paul: Yeah.
Eddie: So I might have a chat with her, and get her to bring some resources around about hep. C.
Paul: Yeah, it’d be good to know anyway, you know? So I’ve left it slide a bit for a while.
Eddie: Yeah, ok. That’s good… Alright, so I’ll go and have a chat with the nurse…
Paul: Yep.
Eddie: … when I get back to the health service and arrange for her to get some resources together for you. But if there’s anything else that you need, you’ve got my mobile.
Paul: Yep.
Eddie: So I’m just a phone call away and I’ll come and help you wherever I can so…
Paul: Yep.
Eddie: If everything’s all good then… Paul: Yeah… Yep, that’ll be good, thanks. Eddie: Alright then.
Paul: Thanks. I appreciate you dropping in [bruv?], Thanks Eddie.
Eddie: Yeah, alright. Cheers mate. Look after yourself.
Paul: See ya.
Video produced by Gukwonderuk Indigenous Engagement Unit, Monash University, Australia.
With thanks to Edward Moore, Peter Waples-Crowe.

Answer:

Rationale for the care plan:
The care plan has been developed for Paul Eddie, who recently had cataract surgery. Other health issues found in Paul is hepatitis C, depression and diabetes. Care plan was developed in relation to two main issues identified for the client. The first issue identified in Paul was disturbed sensory perception because of sore eyes and blurry vision. The second issue identified for the client was symptoms of depression, isolation and self-esteem disturbances. This section describes the rationale for the care plan developed for each of the two issues identified with support from current literature and evidence based practice.
In response to the issue of sore eyes and blurry vision after cataract surgery, it was planned to support Paul to adapt to post-op complications, reduce fall risk and promote his independence. As the video transcript revealed that Paul has a sore eyes and blurry vision, he is at high risk of injury due to fall. Hence, the intervention or action of making environmental changes like providing adequate light, safety equipment and visual aid is effective in reducing risk of injury for Paul. National Academies of Sciences, Engineering, and Medicine (2017) gives the evidence that vision loss or vision impairment significantly influence quality of life (QOL) because of loss of independence and mobility linked to falls and injury. The setting in which Paul live may contain many hazards. In such situation, environmental modifications like rough floor surface and good lighting removes hazards for the visually impaired. Visual aids like grab bars and external support device prevents fall too. Review of a study on fall prevention intervention for people who are blind or visually impaired has revealed that environmental assessment and modification is an effective intervention to address concerns of visually impaired elderly adults apart from education and medical assessment (Steinman et al., 2011). Hence, environmental modification is one of the most effective options to reduce falls and improve mobility of patient.
Another nursing action that was planned in relation to sore eyes was monitoring post op complication, pain management and use of eye drops to prevent infection. Routine monitoring of visual outcome after cataract surgery is essential to identify signs of post-op complication. Astbury and Nyamai (2016) reports that pain, redness, swelling and poor eye sight are some common complication that is seen immediately after operation and adequate monitoring of patients post-operatively can help to detect complication for patient.  Hence, regular monitoring is considered as an effective intervention to reduce discomfort for Paul after the surgery. To prevent any chance of eye infection, the care plan also mentioned taking proper safety technique while administering eye drops. This strategy was important because contamination of the tip of eye drop increase risk of infection for patient (Shaw, 2014). Hence, while administering any eye drop, it is important to educate patients regarding the correct procedure of administering eye drop. Washing hands before and after applying eye drops is essential to prevent cross infection.
Pain management was also an important part of the care plan in relation to the problem of sore eyes and blurry vision. Paul might have developed pain related issues also because of diabetes. Rajpal et al. (2013) indicates that pain is a common occurrence after cataract surgery. However, assessment and management of pain is essential for the early recovery in cataract patients like Paul. Challenges may be encountered during pain assessment because of subjective nature of pain and challenges faced by elderly population in evaluating pain perception. Another issue that may be encountered during pain management is selection of appropriate analgesic for elderly people. This is because of presence of concomitant disease in elderly population (Porela-Tiihonen et al., 2013). Hence, those drugs should be provided that has short term use. Therefore, pain related counselling and pain management is an important part of routine postoperative care of patients with cataract surgery.
In response to the issue of depression and isolation in patient, the main care plan was to reduce anxiety and depression in patient and promote independence in patient. The main nursing action proposed for reducing anxiety for Paul included engaging him in social activities and referring to aboriginal community health services. The main rationale for referral is that the service will increase Paul’s satisfaction with care and it will increase the likelihood of receiving culturally appropriate care. The video transcript revealed that poor attitude of staffs and discrimination from care providers were some reasons for him to avoid visiting health clinic. Hence, aboriginal community health services can provide him the opportunity to receive care from Aboriginal staffs and it has also the potential to address language barriers in care (Victorian Aboriginal Community Controlled Health Service, 2014).  In addition, social activity participation is an essential to reduce feelings of isolation and promote self-esteem in Paul. Steger and Kashdan (2009) suggest that social withdrawal makes people prone to depression and participation in social activities can provide such people the scope to reduce depressive symptoms and overcome anxiety.
In addition, counselling, education, awareness about Paul’s life story and engagement of Paul in a good support network has also been proposed in the care plan to reduce her isolation. The main rationale for counselling is that it can help psychologist to understand the reason behind depression and understand any false perception or attitude of patient. This form of revelation may help psychologist to change thinking pattern of Paul and teach him ways to cope with negative emotions. Kontunen et al. (2016) gives the evidence that that interpersonal counselling is an effective strategy to promote health and well-being in patients and empower them to positively deal with negative emotions. In addition, the main rationale for reviewing Paul’s life story is to identify any negative life events or incidents of trauma that might have led to depression for Paul. Paul’s life story may also help to understand client’s values and belief and provide care as per patient’s preferences. The rationale for providing good support network is to promote health care equity with indigenous population and give Paul an environment where he can freely express all his concerns and obtain all information to manage his health. Browne et al. (2016) explains that good support network can help in developing partnership with indigenous people and provide culturally safe and contextually tailored care.
References:
Astbury, N., & Nyamai, L. A. (2016). Detecting and managing complications in cataract patients. Community Eye Health, 29(94), 27–29. retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100470/
Browne, A. J., Varcoe, C., Lavoie, J., Smye, V., Wong, S. T., Krause, M., … Fridkin, A. (2016). Enhancing health care equity with Indigenous populations: evidence-based strategies from an ethnographic study. BMC Health Services Research, 16, 544. https://doi.org/10.1186/s12913-016-1707-9
Kontunen, J., Timonen, M., Muotka, J., & Liukkonen, T. (2016). Is interpersonal counselling (IPC) sufficient treatment for depression in primary care patients? A pilot study comparing IPC and interpersonal psychotherapy (IPT). Journal of affective disorders, 189, 89-93. doi:10.1016/j.jad.2015.09.032
National Academies of Sciences, Engineering, and Medicine. (2017). Making eye health a population health imperative: vision for tomorrow. National Academies Press. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK402367/
Porela-Tiihonen, S., Kaarniranta, K., Kokki, M., Purhonen, S., & Kokki, H. (2013). A prospective study on postoperative pain after cataract surgery. Clinical Ophthalmology (Auckland, N.Z.), 7, 1429–1435. https://doi.org/10.2147/OPTH.S47576
Rajpal, R. K., Roel, L., Siou-Mermet, R., & Erb, T. (2013). Efficacy and safety of loteprednol etabonate 0.5% gel in the treatment of ocular inflammation and pain after cataract surgery. Journal of Cataract & Refractive Surgery, 39(2), 158-167. doi:  10.2147/OPTH.S47576
Shaw, M. (2014). How to administer eye drops and ointments. Nursing times, 110(40), 16-18. Retrieved from: https://www.nursingtimes.net/Journals/2014/09/26/c/d/p/011014-How-to-administer-eye-drops-and-ointments.pdf
Steger, M. F., & Kashdan, T. B. (2009). Depression and Everyday Social Activity, Belonging, and Well-Being. Journal of Counseling Psychology, 56(2), 289–300. https://doi.org/10.1037/a0015416
Steinman, B. A., Nguyen, A., Pynoos, J., & Leland, N. E. (2011). Falls-prevention interventions for persons who are blind or visually impaired. Res Pract Vis Impairment Blindness, 4, 83-91. Retrieved from: https://www.researchgate.net/publication/267788895_Falls-Prevention_Interventions_for_Persons_Who_Are_Blind_or_Visually_Impaired
Victorian Aboriginal Community Controlled Health Service. (2014). Koorified: Aboriginal Communication and Well-being. Retrieved from https://www.vaccho.org.au/vcwp/wp-content/uploads/2011/03/Koorified-Aboriginal-Communication-and-Well_Being.pdf

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