his essay looks at the role of the Nursing Process in the case study of Dillon who has constipation and abnormal pains.It looks at the holistic and structured approach to the assessment, planning, implementation and evaluation of car for Dillon.It takes into consideration the code of conducts and principles that underpin the Nursing process in relation to essential care needs of the patients.The Nursing Process (NP) is a widely used approach which helps nurses identify the health needs of service users and to fulfil their expectations of healthcare provision (Brown.J,Libereton P.2007).There are a variety of definitions for the term Nursing Process, ,this paper uses the definition suggested by Toney-Butler, T. and Thayer, J. (2019)who defined it as a systematic framework that integrates the principles of critical thinking , person centred and evidence based practice recommendation in effective decision making.They include four stages; Assessment,Planning, Implementation and Evaluation (Brown.J,Libereton P.2007).This framework is chosen to ensure that a standardised procedure is used to attain relevant data in order to provide holistic, compassionate and to establish an effective care plan for Dillon. Aggleton and Chalmers (2003) cited in Brown.J,Libereton P.(2007) that, nursing process does not inform nurses on what to look for. To overcome this there will be references to guidelines such as the NICE guidelines which explains what to look for when assessing constipation in children.Assessment stage This process consists of collecting information from the service users and their families concerning their perceived condition(Dougherty ,L.Lister, S.2011).The information gathered during this stage may guide nurses to create an individualised care plan relevant to Dillons care needs(Dawson,P et al.2012 )and essentially providing a baseline for planning of interventions and outcomes to be achieved. Another key thing to remember is that, information could come in the form of subjective data which include verbal statements from service users and their family members.Checking for vital signs,height and weights of patients are ways in which objective data can be measured.It can also be in a form of medical notes (Toney-Butler, T. and Thayer, J. 2019). However, Ford and Mccormick 1999 cited in Dougherty ,L.Lister, S (2011) that nurses may not be aware that discrete decision making systems forms part of nursing assessment.This could mean that patients could be put in danger because nurses are focused on the assessment tools rather that the significance of the information gathered.Edward and Miller( 2001)cited in Dougherty ,L.Lister, S (2011) that nurses need to apply critical thinking and clinical judgement throughout the assessment process for the purpose of continually developing their skills in generating information about patients, concerns and using this to inform care.History Taking History taking should be used to collect both subjective and objective data.This stage is considered as a crucial stage for nurses; it presents a good opportunity to collect details and listen to the patients perception and concerns on their condition(Lloyd H, Craig S 2007). History taking involves nurses checking medical notes and enquiring about any previous conditions.So prioritising effective communication when caring for Dillon and his family is important to forming therapeutic relationships(Dawson et al 2012),which helps when trying to understand their health needs and providing appropriate care.Dillion may be asked questions about his bowel habits, diets , medications and other lifestyle changes such as:changes in his usual bowel movement,like blood ,undigested food or offensive odors in stool and possible condition being the cause. Bristol stool form chart shows 7 different types of stools to determine what a normal stool should look like which will help to identify frequency of bowel opening , consistency, color and volume .Nurses eliminate other medical conditions to promote a speedy diagnosis of constipation ( Toney-Butler, T. Thayer, J. 2019) and establish Dillons ‘’normal’ or any changes in bowel habits at this stage. More importantly,it assists in identifying factors leading to Dillons constipation because effective treatment of constipation depends on the cause being identified according to Dougherty ,L. Lister, S.( 2011). These questions are asked because constipation can be interpreted as a persistent, difficult,infrequent or incomplete defecation which may or may not be accompanied by hard dry stool, however there is an inconsistent understanding on the causes of constipation but lack of aforementioned may be contributing factors (Norton 2006 cited in Dougherty ,L .Lister, S (2011) ,NICE 2019).Various points nurses need to take into consideration when dealing with service users such as Dillon . Cadd et al cited in Dougherty ,L.Lister, S (2011) that individuals may be embarrassed to discuss their bowel functions resulting in delayed reporting of concerns even though quality of life potentially being affected.Therefore, nurses must consider the environment that the assessment is taking place,showing compassion by taking dillon to a private room to ensure that his dignity and confidentiality is maintained( RCN,2010 A .and NMC,2019). Furthermore,accurately documented history and assessment may prevent unnecessary duplication of questions in a multidisciplinary team . Physical assessmentsThe idea of physical assessment is to locate the strength and lack of functional abilities. Again, finding the possible cause of Dillonds abdominal pain will require performing a structured assessment of all the body systems (Dougherty ,L.Lister, S.2011),taking vital signs and physical examinations (Dawson,p.et al 2012).Vital signs consists of taking temperature, heart and respiratory rate whilst physical examination requires careful inspection of Dillion form head to toe. Objective data to collected to help nurses validate subjective data gained from initial history taking and medical records(Dawson,p.et al 2012).Dillon may be in distress,this could be as a result of separation anxiety,being overwhelmed and being in strange environment (Coyne et al 2010) or abdominal pains, nurses must respond politely, compassionately and with an open mind (NMC 2015) . It is essential that nurses to also establish dillons preferences about the presence of family members prior to the start of assessment.Also,Specific and relevant information may need to be obtained, parents consent is needed and appropriate information offered to them for effective make decision. Nevertheless,his assent to procedures is key to help develop his awareness on processes of his condition and be more inclined to be compliant further feeling in control of his care (Dawson,p et al 2012). Specific questions will be asked to get insight his understanding of the cause of his constipation.Privacy for elimination could be asked as many some patient report that being away from home limits their ability to open their bowels (NIA,2013) If so, being hospitalised or away from home may discourage opening his bowels. This may lead to further complication such as withholding or ignoring the urge to defecate.Nurses may consider assessing this as a factor contributing to constipation as prevent as withholding causes rectum no longer sensing or responding to the presence of stool essentially becoming drier and harder in the colon leading difficulty in bowel eliminate( Andrews, C. 2011). This may be a problem because he needs to be aware of his rectum feeling up, propel the stool and relax his pelvic floor muscles in a coordinated means to maintain normal defecation(Bharucha AE 2006 cited in Andrews, C. 2011). Finally,a decision needs to be made using information acquired by analysing ,identifying gaps with ‘’normal’’ and present state in order effective assessment .Nurses will then prioritise and identify his health needs such as;MedicationEliminationHydrationNutritionSkin integrity PLANThe planning stage is where specific goals and interventions are developed to directly impact patient care based on nursing standards and NICE guidelines of ensuring a positive outcome. (NMC,2014). Elimination is the chosen care need to be focused on for Dillon. The SMART tool which is a acronym for Specific,Measurable ,Achievable ,Realistic and Timely(Hamilton and Price, 2013) will help nurses to plan three goals in collaboration with Dillion.Dillion states relief from discomfort of constipation and abdominal pains with pain reliefs and stool softeners.S-This is to ensure that pain is not one of the reason why he is anxious to open his bowels.M-nurses should check when the recovery time on the medications and when patient will be cured to inform doctors the necessary multidisciplinary team. A-This can be achievable without the medication through exercising and changing of diet.R -dillion will be able to take it wherever he want to so far as he has access to toilets he is comfortable using.T-Dillon’s family and himself would be called in for a weekly review that effectiveness of the medication and taking any concerns make any changes.Dillion maintains passage of soft ,formed stools at the frequency recognised as ‘’normal’’ to him.S-To check the the frequency and consistency of of his stools have gradually returning back to normal .M-Documentation of stool pattern using a stool chart and comparing it to the previous history enable nurse know if the goals is being achievedA-Regular sitting on the toilet in the morning and evening with the position,hydration and diet , especially 20-30 minutes after meals may help dillonR-He may be able to identify and acknowledge when the urge to open his bowl and sit on the toilet.T-Dillon’s goal may have at least 2 soft stools per day or at the frequency normal to him but with a consistency of 3 or 4 according to the bristol stool chart.Patient identifies measures that prevent of treat constipation S- This aims to educate Dillon on preventative measures available for constipationM-Dillon and his family will identify and repeat signs,symptom and preventative measures for constipation whenever there is a an assessment or review of care needs.A-It is achievable because information will be provided by nurses and the make sure that it is in clear and understandable language R-They will be able to access evidence based resources electronically and hard copies whenever and also have a point of contact if need be. T-They will be assessed throughout the duration of his care.ImplementationIn order for Dillion to be able to achieve his set goals and outcome,he may need stool softeners to help with elimination and a comfortable toilet to enable him to have privacy. Liaising with other multidisciplinary teams such as Dillon’s school about giving him a private toilet where he can easily access could help tackle Dillon embarrassment and responds to the urge to defecate.This correlates with the nursing principles which encourages multidisciplinary team working to ensures that care and treatment are coordinated to help achieve positive outcomes (RCN,2010).Schools may have limited resources,resulting in difficulty in implementing goal,so other options may be considered.Nurses need to take responsibility for care they provide and answer for judgements and actions (RCN,2010 .B)So,educating Dillon and his family using diagrams and websites on the pathogenesis and measures taken is crucial to help with easier bowel movement and prevent constipation (NICE Clinical Guidelines, No. 99.2010.Pashankar, D. 2005).Nurses need to have a positive and supportive viewpoint when discussing interventions and the duration available with Dillon and his parents to ensure that information is understood to make informed decision on the treatment (RCN,2010,D. Pashankar, D. 2005).Nurses are encouraged to be aware of risks and help everyone keep safe.It is critical to provide factual, current, and consistent information about the assessment and care of Dillon which could be done through timely documentation and good record keeping.(RCN ,2010 . Owen , K.2005) Evaluation Evaluation is composed of reassessing the implemented care to ensure that the positive outcomes has been met(Toney-Butler, T. and Thayer, J. 2019). Constipation interventions are working if a patient have three or more bowel eliminations in a week with no or minimum soiling and no abdominal pain with bowel movement.This may not be the case for dillon since his ‘’normal’’ frequency of bowel movement may be less than the number stated above.Complaining about abdominal pain in the first elimination after constipation could be eliminating of hard dry stool ( Loening-Baucke, V. and Swidsinski, A. 2007) and may become softer as frequency increases.Van Ginkel et al (2003) trailed some children on different interventions used to deal with constipation for different time periods ,he found that children in their adolescence were still having with constipation and encopresis.This demonstrates that managing constipation is a long term process which requires frequent reassessment,adaptations and implementing such as using different alternative such as diet and medications (Nice) to prevent unnecessary suffering of patient and promote identification and management of constipation (Jackson, R.et al (2016). Dennison, C. 2005). In conclusion,this essay has discussed the effectiveness of using the nursing process as a structured and holistic procedure to cater for the need of Dillon.It considered the role coexisting factors which may have potentially impacted,the interventions and the health and wellbeing of Dillon.This essay looked at the impact of reassessment and adaptations of care as care needs changes and the role of nurses and multidisciplinary team in providing effective care.
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