Person-Centred Care
Instructions:-
Solution
Person-Centred Care
In the provision of person-centred care, patients, families and the public are seen as equal partners during the planning, development and monitoring of care so as to ensure their needs are met. It implies that people are put in the centre of decision making, in which they are taken as experts assisting professionals to come up with the best outcome (Dekker, 2012). This does not, however, imply that person-centred care is all about offering people whatever they want. On the contrary, the desires of people, their values, lifestyles, family situations, and social circumstances are considered. The person is viewed as an individual and the caregiver works together with him/her to reach appropriate solutions. It is important in this process to be compassionate, view things from the person’s perspective and respect the individual’s decisions and views. This essay presents an analysis of a case in which the clinical reasoning cycle is used to come up with the best person-centred care to a woman who is admitted for an elective caesarean section.
Patient’s Condition
The patient, Candace, is still in the childbearing age, 42 years old. She is expecting her second child, which means she has some prior knowledge of childbirth and what it entails. The patient experienced gestational diabetes during her first pregnancy. This took place five years ago, and the diabetes resolved after the birth. The condition has not resurfaced during the current pregnancy. Candace had had depression and anxiety. After she gave birth to her first child, she had been treated for post natal depression. She was admitted to PACU following an elective caesarean section via spinal anaesthesia. She gave birth to a son via LUSCS and the operation was uneventful. Her dressing insitu is dry and intact, and the IDC insitu has a minimal drainage. She has an IVT of CSL at 84mls/hour using an IV pump. The spinal anaesthesia that was used to give her the LUSCS is still affecting her but she is alert. During the procedure, Candace had a total blood loss of 150mls. As her vital signs, she has a body temperature of 36.60C, HR of 88, BP of 104/76 and oxygen stats of 97% RA.
Collection of Cues
Candace gave birth to her first child when she was about 37 years old, which means she was a mature adult, but she still developed anxiety and depression. She was even treated for post natal depression. At the time the patient was received from the operating room, there were no signs of anxiety or depression. There had not been any recurrence of gestational diabetes in this pregnancy too.
Candace’s vital signs taken immediately after the successful completion of the operation indicated that she was normal. According to the Royal Prince Alfred Hospital policies, the normal adult’s body temperature should be between 36.50 and 370C (Royal Prince Alfred Hospital, 2010). Candace’s temperature was 36.60C indicating that her body temperature was perfectly normal after the operation. The systolic BP of an optimal adult should be less than 130 mmHg and the diastolic BP less than 85 mmHg with a difference between the two ranging from 30 to 50 mmHg. Candace’s BP being 104/76 indicates that she has a normal blood pressure. Her heart rate (HR) of 88 is within the limits of the 60-100 bpm for normal adults. The normal oxygen saturations should lie between 97% and 100% suggesting that Candace’s 97% was also perfectly okay. The woman’s dressing insitu is intact and dry suggesting that the incision was precise and had no complications. The IDC insitu had minor drainage (Gascho et al., 2017).
Candace had lost 150mls of her blood during the operation, which was way below the amount considered to be minimum and normal in any given caesarean section operation (Jin et al., 2016). As a result, there was no need for blood transfusion. She was received while alert, meaning she could interact with the nurse. This implies that she had not been adversely affected by the operation (Vera, 2012).
Processing Information
Despite the fact that Candace had experienced anxiety and distress in the past and had been treated for postnatal distress after her first pregnancy, there are no signs to indicate that her second pregnancy, just concluded, has left her with similar effects. Her body temperature is normal, and so are her heart rate, blood pressure and oxygen saturation is also normal. Candace lost a very little amount of blood in comparison to the reported past blood losses that have been registered by other physicians, and that did not require any blood transfusion. Her dressing insitu are dry and stable, suggesting that she is going to heal quickly. The slight drainage in the IDC may present an issue and might have to be monitored more closely. The IV pump must be carefully handled and withdrawn at the right time when the patient can regain taking oral foods (John et al, 2013). As a result of the spinal anaesthesia, Candace indicated that she feels dizzy and has a slight headache.
Identify Problems
The major problems that need addressing in Candace’s case are minor headache, dizziness, pain in the stomach and the drainage in the IDC. All patients deserve to be relieved of pain and given better health both while still admitted and when they get discharged (Levett-Jones, 2013). Candace is therefore entitled to receive pain relievers and any other medication that can help ease her condition.
Establishing Goals
The first step is to ask the patient about what she thinks is the best course of action considering her problems. This is done in accordance with the requirements for professional codes of conduct for nurses and midwives. It is also important to act with compassion and respect for the patient’s needs, values and decision (Nursing and Midwifery Board of Australia, 2016).
The next step is to discuss with the patient the implications of her problems, what they entail and what they mean with regard to her present condition. The caregiver then moves on to discuss with her the available options (Nursing and Midwifery Board of Australia, 2013). Working with the patient, after giving her an assessment of her current problems, the nurse proceeds to develop a plan of action with the help of the patient (NMBAb, 2008). Candace is to first receive pain relievers. Her headache and pain in the stomach should then be monitored to see if there are any improvements. The IDT should be kept insitu, but the drainage should be allowed to drain completely. Candace should be asked for the type of exercises she feels comfortable doing so that the nurse can begin to help her get back on her feet. The IV pump should be removed as soon as the patient is able to take oral drinks. Soon the patient is allowed to eat solid foods, but only if she feels okay with it (Lee, 2016).
Taking Action
Candace is given painkillers to help cure her headache, dizziness and stomach pain. The IDC insitu is allowed to drain by helping the patient to assume the appropriate posture after six hours, the IV pump is removed from the patient’s system (NMBA, 2006).
Evaluating Outcomes
The caesarean section operation was uneventful and Candace has given birth to a male child. Her dressing insitu is dry and intact, and the IDC insitu has a minimal drainage, which is resolved during post-operative care. She has and IVT of CSL at 84mls/hour using an IV pump, which is removed after six hours and the patient is allowed the first sip of water taken orally. The spinal anaesthesia that was used to give her the LUSCS is still affecting her by making her dizzy, feeling a headache and a pain in the stomach, but she is alert. During the procedure, Candace had a total blood loss of 150mls but that loss was normal and did not indicate any health threatening possibilities. She has a body temperature of 36.60C which is within the normal range, HR of 88, BP of 104/76 and oxygen stats of 97% RA. This means that the operation was successful and did not lead to any complications. Her blood loss during the procedure was normal; her body temperature is only slightly higher than normal but should go down soon. Her heart rate is normal, the blood pressure is normal and the oxygen stats are also normal.
In the end, the pain is relieved, the wounds are healing properly, signified with complete draining of the IDC insitu. The patient is also responding positively to the recovery since, after only six hours, she no longer needed the IV pump to keep her nourished. By taking walking exercises, Candace is quickly getting back to her life and readying herself to take care of her son. The situation has improved now because, unlike the previous pregnancy, Candace has not had any complications giving birth. The patient has had a caesarean section but has not shown any signs of anxiety or depression after birth. Her child is also alive and normal.
Reflection on the Process and New Learning
The
process has been successful in helping Candace in giving birth to her son. The
outcome suggests that caesarean section was an effective method of helping the
patient deal with her previous anxiety and depression. Since the patient went
through the operation uneventfully, she did not see the need to tense or become
anxious. The new learning is that caesarean section deliveries help many women
in avoiding anxiety and depression. However, as has been seen, it is important
to be respectful to the choices made by the patient, to act professionally and
ethically (NMBAa, 2008). However, compassion and respect must prevail in every
decision made, letting the patient be at the centre of the decision making
process.
References
Dekker, R. (2012). What is Patient-Centered Maternity Care? Evidence Based Birth. Retrieved from https://evidencebasedbirth.com/what-is-patient-centered-maternity-care/
Gascho et al. (2017). Predictors of caesarean delivery in pregnant women with gestational diabetes mellitus. PubMed. NCBI.
Jin et al. (2016). Prevalence and risk factors for chronic pain following caesarean section: a prospective study. BMC Anesthesiol. Received from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069795/
John et al. (2013). Nurse Anesthesia. Elsevier Health Sciences.
Lee, A. (2016). ‘Bolam’ to ‘Montgomery’ is result of evolutionary change of medical practice towards ‘patient-centred care’. BMJ Journals. Retrieved from: http://pmj.bmj.com/content/early/2016/07/27/postgradmedj-2016-134236.full
Levett-Jones, T. (Ed.), (2013). Clinical reasoning: Learning to think like a nurse. Sydney, Australia: Pearson Education.
NMBA. (2006) National Competency Standards for the Registered Nurse (4th edition)
NMBAa. (2008). Code of Professional Conduct for Nurses
NMBAb. (2008). Code of Professional Conduct for Midwives
Nursing and Midwifery Board of Australia. (2013). Professional Standards. Retrieved from:
http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
Nursing and Midwifery Board of Australia. (2016). Registered nurse standards for practice. Retrieved from:
http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx
Royal Prince Alfred Hospital. (2010). Patient Observation (Vital Signs) Policy – Adult. Sydney West Area Health Service.
Vera, M. (2012). Perioperative Nursing. Nurselabs.
