Purpose of Assignment

The purpose of this case study it to integrate knowledge from the humanities and sciences, including nursing research and theory, to plan, provide, and evaluate holistic care provided to a client selected during this clinical rotation. This case study was built to examine the nursing care in terms of the nursing diagnoses, patient outcomes, interventions, and the evaluation of said interventions.  

 

Student Approach to Assignment
  

The patient in this assignment was a 26 year-old African American female who was admitted to the hospital for hyperkalemia. Diagnosed with lupus nephritis at the age of 19 when a kidney biopsy confirmed that her kidneys had been severely compromised by the autoimmune disease. This case study concerns the diagnosis and nursing care of J.G. due to her chronic autoimmune condition, lupus nephritis, which led to her End Stage Renal Disease. I chose this patient in order to implement my critical thinking skills as I examined the interrelatedness of the patient’s health conditions. 

 

Reason for Inclusion of this Assignment

 

This assignment is included in order to detail my understanding of the nursing process as it includes all of the necessary nursing components: assessment, diagnosis, outcomes, planning, interventions, and evaluation. Throughout the course of the essay, the role and the impact of the nurse is elaborated upon as part of the collaborative healthcare team. Below, the following objectives are highlighted. 

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Critical Thinking 

• Demonstrates critical thinking to facilitate nursing practice through inquiry, problem solving, and synthesis. 

  • Uses nursing and other appropriate theories and models to guide professional practice  

    • Example: I used Orem’s Self Care Theory and Peplau’s Interpersonal Relationship Model to construct the care that I provided to my case study patient, J.G. Because Orem believed that patients should be as responsible as possible for their own care, I structured my nursing interactions with the patient so as to encourage her to return to ODU to finish her degree and to seek some council outside the hospital in order to support her overall mental health. Peplau's Theory was implemented as I utilized the identification and exploitation steps of her theory. My goal was to have the patient identify her own need for the nurse, allowing the nurse to "exploit" the nurse-patient relationship to motivate her to stop picking at her discoid lesions because this habit was contributing to her impaired skin integrity, openning her to infection and causing scarring. 

  • Evaluates nursing care outcomes through the acquisition of data and the questioning of inconsistencies  

    • Example: J.G. exhibited almost obsessive-type levels of picking at the discoid lesions on her skin caused by her ESRD. Although J.G. had already been provided with different medications to alleviate her itchiness, I believe that J.G was so fixated on the scabs and scars on her body that she did not stop picking even though relief for the itchiness had been provided. I posited that J.G. could benefit from a strong nurse-patient relationship where a nurse could motivate her to leave her scabs and scars alone. This would involve more one on one time in order to understand the compulsive nature behind her picking habit, but would be well worth it if we could help to prevent further scarring to her person. While I was present during my 12 hour clinical shift, I tried to spend as much time as possible with J.G. in order to build rapport but this type of emotional and mental-health intervention would need to be implemented over a longer period of time than just one shift. 

 

Nursing Practice 

• Performs therapeutic nursing and interdisciplinary interventions to deliver nursing care in the cognitive, affective, and psychomotor domains. 

  • Demonstrates an awareness of complementary modalities and their usefulness in promoting health 

    • Example: Other than anti-anxiety medications to compensate for my patient’s OCD tendencies and her heavy reliance on her family for support, I suggested that J.G. implement some mindfulness interventions, acceptance and commitment therapy, and behavioral activation therapies in order to reach a greater level of acceptance for her physical condition and comorbidities. Additionally, I believe that J.G. would benefit from yoga and mindfulness classes, nutrition classes, and access to a mental health professional as she and her nursing team work to promote her health. 

  • Establishes and/or utilizes outcome measures to evaluate the effectiveness of care

    • Example: I evaluated the effectiveness of one’s healing when it comes to the relationship between mind and body. I believe that J.G.’s impaired skin integrity and her risk for compromised resilience are related and that affirmations, creative visualizations, and prayer should be encouraged for her. When she participates in these self-care practices, I believe that she will start to facilitate her own healing.

 

Communication 

• Justifies verbal, non-verbal, and written communication techniques appropriate for clients and professionals. 

  • Accesses and utilizes data and information from a wide range of sources to enhance patient and professional communication

    • Example: In order to provide my patient with the resources surrounding mindfulness, I found several handouts maximizing resilience, especially in the face of chronic disease management and wound-healing techniques. Furthermore, I found research articles related to related to positive psychology interventions and expanded my knowledge of these techniques so to be able to implement them with a future patient. 

 

Teaching 

• Utilizes teaching strategies to maximize client health and enhance professional development. 

  • Provides relevant and sensitive health education information and counseling to patients, and families, in a variety of situations and settings 

    • Example: J.G. needed teaching about therapies or medications that could help address the patient’s obsessive-compulsive excoriation tendencies. I researched different techniques such as mild teaching opportunities that would include wound care, clipping nails to discourage picking, and wearing gloves or other restrictive options in order to avoid excoriation. Another arena where the patient would benefit from teaching is that of setting boundaries for herself when it comes to time spent with her family. The patient was very excited to see her family when they arrived at 4:00pm on the day of my clinical, however, they stayed until almost 7:00 and the patient was clearly exhausted by the time they left. The patient may need to view this boundary setting as a step towards enhancing her own personal health so that she feels more empowered to follow through with her own self-care.

 

Research 

• Incorporates primary nursing research findings as a basis for therapeutic nursing interventions. 

  • Differentiates between descriptive nursing literature and published reports of nursing research 

    • Example: I utilized several different meta-analyses, theoretical models, case studies, descriptive patient handouts, and other nursing articles addressing OCD, the management of chronic diseases, and wound management in order to educate my patient. The descriptive articles that I included were the patient handouts in order to maximize resiliency during chronic illness as well as the article by Qui & Lu titled, “Applying Peplau's Interpersonal Relation Model in the Nursing Care for a Teenager with Adjustment Disorder.” The published reports of nursing research that I referenced included “Resilience Revisited,” “Identification of Lupus Nephritis,” and “Pediatric Obsessive- Compulsive Disorder: An Update for Advanced Practice Psychiatric Nurses.”

 

Leadership 

• Demonstrates self-direction, professional accountability, and advocacy adhering to legal and ethical nursing practice as a novice nurse.   

  • Delegates and supervises the nursing care given by others while retaining the accountability for the quality of care provided

    • Example: I evaluated the care provided by the different medical professionals on J.G.’s team. The medical needs of J.G.’s care were being met, however, I pointed out that J.G. needed more psychosocial support because of her obsessive picking at her discoid lesions, resulting in open wounds, scabbing, and scarring over 50% of her body. 

 

Culture 

• Demonstrates cultural awareness and sensitivity.   

  • Demonstrates sensitivity to personal and cultural definitions of health, and how these beliefs influence an individual’s reactions to the illness experience and end of life 

    • Example: I discussed ways for J.G. to address her health by leveraging her family’s support but also by setting boundaries with her family when they are overly involved in her care. J.G. frequently sought approval and reassurance from her family so would need to identify other healthy coping strategies to supplement their support so that she is not so heavily relying on them. J.G. stated that she believed that no one would find her physically attractive, so she needed to be sure that she was kind to her family because they were always there for her. This culture of familial-reliance made it very difficult for J.G. to set boundaries with her family because she did not want to push them away.