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Feasibility and Effectiveness of Delirium

Question:

Discuss about the Feasibility and Effectiveness of Delirium.

Answer:

Introduction:

Virginia Henderson is a renowned nurse who had out forward a nursing theory that had been highly appreciated and are used by modern day nursing professionals to ensure safe and quality care for the patients. She had developed this theory from her own experiences in nursing and the education she gained throughout her life (Fernandes et al., 2016). She stated that the main goal of nursing professionals should not be only ensuring clinically best care to patient to cure them but also increase the independence of the patient. This was important according to her so that the progression of the health of the patient after hospitalization and discharge would not be delayed. Her emphasis on the basic human needs of the patients is the main central focus of the nursing practice (Alligood, 2017). Over the time, this theory has formed the basis of further theory development regarding the needs of the patient and the different ways the nursing can assist in meeting those needs. Therefore, this assignment would be mainly based on the main concept of this theory, the four main concepts associated with it and the 14 component of daily life that are put much importance by the theory. The application of such theory in clinical practice would be also described.

Virginia Henderson is a renowned nursing professional who is called the “The Nightingale of Modern Nursing”. Many others are also seen to call her “Modern day mother of nursing”. Also referred as the 20th century Florence, she was actually born in Kansan city in Missouri in the year 1897. She had completed her diploma in nursing from the Army school of Nursing at Walter reed Hospital in Washington in 1921 (Ahtisham & Jacoline, 2015). After the period of graduation, she was seen to work for two years in Henry street visiting nursing service. After teaching nursing in the Norfolk Protestant Hospital in Virginia from the time of 1923, she entered the Teachers College at Columbia University in the year 1929 to gain a bachelor degree and she completed the bachelor degree in 1932 and completed her Master’s degree in 1934. She stayed as the member of faculty after joining Columbia until 1948 and since the time of 1953, she worked as the research associate at the Yale University School of nursing (Carvalho & Almeida, 2018). She had received a number of recognitions and she became the Honorary doctoral degrees from the Catholic University of America, Pace University, University of Rochester, University of Western Ontario, Yale University. She was also honored in the year 1985 at the Annual Meeting of the Nursing and Allied Health Section of the Medical Library Association. She died in the year 1996 on March 19. In the year 1939, she was seen to revise Harmer’s classic textbook of nursing for public for its fourth edition. Later she was also seen to write the fifth edition for incorporating her personal definition of the nursing.

Summarization of the theory and its relation to the nursing practice

The main aspect of nursing care that she focused on was the quality life of the patient not only during the time of hospitalization but also after the patients is discharged. She mainly emphasized the significance of increasing the independence of the patient so that progress of the health of the patient after discharge is not delayed (Girotti et al., 2015). She instructed that assistance provided by the nursing professionals should be such that it would help the patients to gain independence mainly in relation to the performance of the different activities of the patient that contributes to health and recovery of health. She was seen to describe the role of the nurse as substitutive where the nurses need to do and care for the patient (Fernandes et al., 2016). Her role is also supplementary where the professional would be helping the person as well as complementary where they should be working with the person. The main goal of the nursing professional is to be making the patient as independent as possible. She had stated four major concepts. The first one is the individual factor where the nursing professionals should be considering all the biological, psychological, spiritual as well as sociological components of health of the patient and consider patients as sum of parts with bio-psycho-social needs (Noddeskou et al., 2015). The nursing professionals should be such that they would be helping the patients in providing assistance so that the patients can achieve independence and health or a peaceful death. Another important factor is the environment where the nursing professionals should ensure an environment for the patient where the patient can perform important 14 activities (Fernandes et al., 2016). The settings should be such that the patients gradually learn the unique patterns of living. Another important concept was health where nurses need to assess that the patients are being able to conduct the 14 activities of daily life, help in health promotions and prevention along with cure of the diseases. The last important concept is the nursing where the professionals need to carry on the therapeutic plan of doctors and carry on their individualized plan of care. Nurses also need to be scientific problem solver where they need to get inside the skin of the patient, thereby help by supplementing the strength, and will of the patient according to his needs.

Researchers working on this theory had been seen to appreciate the concept of the theorist largely. This theory provides an interesting part. It states that nurses need to assess the 14 important actions in the life of every patients to get an idea about their present living condition, the potential areas where they might need help and the arenas where effective interventions need to be planned for theory better progression of health (Fehring et al., 2018). One of an article is selected where the researcher had used the theory in the geriatric care domain. The researcher had used the 14-health need assessment in a working but aged individual in order to find out the different areas where effective interventions need to be taken. It is seen form the research, that the 14-health need framework, described by the theorist does not help in recognizing or showing any health problems. However, they are successful in finding the areas where these problems are seen to occur and help the nurses to identify the elements that will guide the nursing care. The researcher after conducting the experiment had found out that the theoretical model is  facilitator in the clinical nursing care for the elderly patients as this theory helps in assessing all the important components of the human being as its entirety (Fairbrother et al., 2015). The researcher through his experiment had successfully found out that the theory also helps in collaborating in the organization of different aspects of nursing profession like critical thinking of the nurses, providing a systematized care that remains entirely based on systematic knowledge. This theory also helps nursing professionals to consider the stimuli that relates with the basic needs of elderly in the comprehensive as well as humane perspective.

One example of its utilization in the clinical practice

One of the most important areas of the theory is a 14 health need framework that nurses can utilize to recognize any component of the health of the patient which would require extra attention. The framework comprises of many important sections required for assistance and caring n patients like breathing normally, eliminating body wastes, sleep and rest, keeping the body cleaned and well groomed  as well as protection of the integument, avoiding dangers in the environment and preventing injury to others, moving ad maintaining desirable postures and many others (Tilley, 2017). These are of much importance n the clinical scenario and can be explained with the help of a typical example. After emergency treatment of stroke patients, they are often transferred to the rehabilitation unit for further treatment after their partial paralysis and other inabilities to conduct daily activities if life. In such a scenario, the nurse might use this 14 component framework to understand the important needs and requirements that should be met to help the patients overcome their barrier and lead independent lives. The nursing professional also needs to keep in mind four important concepts like “individual, health, environment and nursing while assessing and caring of the patient. In case of “moving and maintaining postures”, it might be found that as the stroke make them partially paralysis, they cannot move certain parts of their bodies that enhance the risks of occurrence of pressure ulcers (Bastos et al., 2014). They may also lose their mobility and cannot walk or move independently that might affect their activities of daily life also causing them depressed and anxious. In case of another component like “Keeping the body clean and well groomed and protect the integument”, it can be found that the patients would not be able to keep their bodies clean and well groomed. They would also fail to maintain their integuments that might result in enhancing the chances if infection in the wounds of the pressure sores or might also lead to skin infection. They may also fail in another component where the theorist had stated the importance of effective communication of the patients in expressing their emotions, needs, fear as well as opinions (Zamanzadeh et al., 2015). This might be mainly because stroke patients also face speech impairment issues. Hence, the professionals in nursing to identify the areas where the patients need care can use this framework and guidance and accordingly they need to plan their interventions. Preventing friction and shearing forces during transfers, reducing moisture of the wounds, skin inspection, relieving pressure of the sites (Smith & Grami, 2017). Positioning and repositioning, roper wound management, allocation of occupational and speech therapists, physiotherapists for mobility and many other interventions need to be taken.

We were assigned into a group of four people and we had the responsibility to complete the group assignment within the stipulated time and with the best outcome. Initially, I was quite excited and immediately I decided to conduct a meeting session on the weekend where we would be dividing the responsibilities. However, one of the members stated that he would not be able to come on the weekend as he had other commitment. When we asked him about one of his desirable times when he can attend the meeting, he was seen to be entirely confused and none of our suggested dates were liked by him. We got frustrated with the situation leaving hope and asking him to come whenever he would feel like. Not only that, it was also seen that another of the member also participated in every group meetings but never completed her assigned responsibilities on time for which there was an overall delay in the team output. When we confronted her, she grew angry and disappointed and threatened to leave the team. Due to such issues, we missed the deadline and the outcome of the work was not satisfactory qualitatively. Initially, I was quite excited and full of energy. However, with the passing of the days, many issues started to come up which affected my enthusiasm and my will power. The lack of flexibility of my team members and lack of effective participation from their end created huge pressure on me and another member. This made us felt stressed and disappointed at the same time. However, I tried my best not lose hope and kept working on the assignment until the last time until the results were out. On effective evaluation, I found that bad part of the event was that improper teamwork resulted in an unsatisfactory outcome, as the quality of the group assignment was not up to the mark as expected. My mentor was upset and this affected my self-esteem. After, the completion of the project, I was drained out physically, mentally and emotionally due to the excessive stress and pressure I and another member faced due to non-participative nature of the others. The good part of the event was that I understood the importance of effective teamwork and the different factors that might create barriers in teamwork. I also come to understand that without effective teamwork, individualized contribution in the team can never bring out effective results. On effective analysis, I found that there were no effective team working skills were present in all the members. Moreover, there was no bonding and effective relationships between all the embers. Researchers are of the opinion that development of bonds among the members is very important for collaborative and coordinated work output (Kalisch et al., 2015). Moreover, flexibility is another important aspect in teamwork. This was also missing among the team members. All the members were obstinate with their suggestions and no was ready to negotiate about any aspects of the teamwork (Tofil et al., 2014). Development of emotional bonds and a transparent nature with the self-regulation skills of openness, kindness, helpful behavior and allowing other for effective feedback are the skills also important in such arena. Mutual trust and respect was completely absent and hence this lead to failure of teamwork (Mi et al., 2016). Therefore, when such situations would occur again in the future, I shall first make sure that all the members develop bonds on an emotional level with each other and clear out their grudges through open and constructive feedback session. All the members should be given scope of disclosing their suggestions, issues and feedbacks so that a transparent environment can be created among the team. A sense of responsibility should be sneered and goals that should be set will be well understood by all (Souza et al., 2016). All members should develop effective negotiation as well as flexibility skills so that smooth workflow can be ensured with best outcome.

Conclusion

From the above discussion, it becomes clear that the Virginia Henderson nursing theory mainly wanted to define the unique focus of the nursing practice in ensuring quality care of the patients not only during the times of admission in the healthcare centers but also after they are discharged. The nurses need to consider that the mind and body of patients are inseparably connected and therefore it is extremely important for  considering the biological, psychological, sociological, and spiritual components of the patients while assessing their needs and planning their care. The environment should be such where the patients should be learning unique patterns of living under the assistance of nurses in such ways where they would be able to conduct the 14 components explained in the model. Health of the patient would be judged by the patient’s ability to conduct activities independently and accordingly the nurses should focus on how to develop their capabilities of the patient to ensure best health and high quality life. By following this principle, the nurses can ensure that they provide the best holistic care beside the effective evidence based clinical care so that patients lead quality lies.

References:

Ahtisham, Y., & Jacoline, S. (2015). Integrating Nursing Theory and Process into Practice; Virginia's Henderson Need Theory. International Journal of Caring Sciences, 8(2).

Alligood, M. R. (2017). Nursing Theorists and Their Work-E-Book. Elsevier Health Sciences.

Bastos, F. S., Brito, A., & Soares Pereira, F. M. (2014). Self-management in chronic illness: From theory to the practice.

Carvalho, V. A., & Almeida, J. P. A. (2018). Toward a well-founded theory for multi-level conceptual modeling. Software & Systems Modeling, 17(1), 205-231.

de Miranda, L. S. M. V., Enders, B. C., Lira, A. L. B. D. C., Medeiros, C. C. M., Vieira, C. E. N. K., & Dantas, D. N. A. (2018, July). Nursing care of overweight children: A concept analysis. In Nursing forum.

del Socorro Morales-Aguilar, R., & Pardo-Vásquez, A. C. (2016). Application of theoretical and methodological components of nursing care. Revista Ciencia y Cuidado, 13(2), 107-120.

Fairbrother, G., Chiarella, M., & Braithwaite, J. (2015). Models of care choices in today’s nursing workplace: where does team nursing sit?. Australian Health Review, 39(5), 489-493.

Fehring, G. (2018). Guest editorial: Reflections on a career in nursing. Journal of the Australasian Rehabilitation Nurses Association, 21(1), 5.

Fernandes, B. K. C., Guedes, M. V. C., da Silva, L. D. F., Borges, C. L., & de Freitas, M. C. (2016). Nursing process based on Virginia Henderson applied for a working elderly. Journal of Nursing UFPE on line-ISSN: 1981-8963, 10(9), 3418-3425.

Girotti, J. A., Loy, G. L., Michel, J. L., & Henderson, V. A. (2015). The Urban Medicine Program: Developing physician–leaders to serve underserved urban communities. Academic Medicine, 90(12), 1658-1666.

Kalisch, B. J., Aebersold, M., McLaughlin, M., Tschannen, D., & Lane, S. (2015). An intervention to improve nursing teamwork using virtual simulation. Western journal of nursing research, 37(2), 164-179.

Mi, Z., Baoying, P., Shuling, L., & Xiaoxia, H. (2016). Application of multi-disciplinary teamwork nursing mode in perioperative care to breast cancer patients. Modern Clinical Nursing, 8, 007.

Nøddeskou, L. H., Hemmingsen, L. E., & Hørdam, B. (2015). Elderly patients' and nurses' assessment of traditional bed bath compared to prepacked single units–randomised controlled trial. Scandinavian journal of caring sciences, 29(2), 347-352.

Smith, C. D., & Grami, P. (2017). Feasibility and effectiveness of a delirium prevention bundle in critically ill patients. American Journal of Critical Care, 26(1), 19-27.

Souza, G. C. D., Peduzzi, M., Silva, J. A. M. D., & Carvalho, B. G. (2016). Teamwork in nursing: restricted to nursing professionals or an interprofessional collaboration?. Revista da Escola de Enfermagem da USP, 50(4), 642-649.

Tilley, L. (2017). Showing that they cared: An introduction to thinking, theory and practice in the bioarchaeology of care. In New Developments in the Bioarchaeology of Care (pp. 11-43). Springer, Cham.

Tofil, N. M., Morris, J. L., Peterson, D. T., Watts, P., Epps, C., Harrington, K. F., ... & White, M. L. (2014). Interprofessional simulation training improves knowledge and teamwork in nursing and medical students during internal medicine clerkship. Journal of Hospital Medicine, 9(3), 189-192.

Zamanzadeh, V., Valizadeh, L., Tabrizi, F. J., Behshid, M., & Lotfi, M. (2015). Challenges associated with the implementation of the nursing process: A systematic review. Iranian journal of nursing and midwifery research, 20(4), 411.

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