This 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). However, a new stage nursing diagnosis (Toney-Butler, T. and Thayer, J. 2019) has been introduced between assessment and planning, which will not be tackled in this essay.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, the nursing process does not inform nurses on what to look for but encourages them to assess patients thoroughly.To overcome this barrier, there will be references to documents and guidelines such as the NICE guidelines which explains what to look for when assessing constipation in children.Assessment stage This is the first stage of the nursing process ,which consist 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).This put service users and their families at ease,which is beneficial 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 .These approach help 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 ’. More importantly,it assists in identifying factors that may have lead to constipation as 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).There are 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 service users may be embarrassed to discuss their bowel functions resulting in delayed reporting of concerns even though quality of life potentially being affected.So it is important that nurses 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( nursing principles and mnc code ). Furthermore, Dillon’s history and assessment being accurately documented may prevent unnecessary duplication of questions in a multidisciplinary team . Physical assessmentsDillon will need physical assessments as part of the nursing assessment. The idea of physical assessment is to locate the strength and lack of functional abilities. Again, finding the possible cause of abdominal pain by 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.The reason for this is to provide objective data to help nurses validate subjective data gained from initial history taking and medical records(Dawson,p.et al 2012).Dillons 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.Specific and relevant information may need to be obtained,so consent needs to be obtained from both his parents and appropriate information offered to make decisions on his best interest.Nevertheless,his assent to procedures should be considered 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).However, if he did not have a guardian , he may be assessed to see if he his Gillick competent otherwise multidisciplinary team may have to act in his best interest. Nurses may need to ask specific questions to get insight on what the Dillon thinks could have being the cause of his constipation.Privacy for elimination could be asked as many service users report that being away from home limits their ability to open their bowels (NIA,2013) . If so, Dillon may find it difficult to open his bowels if he requires to be hospitalised, traveling or in a different environment such as school. 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 it may prevent rectum no longer sensing or responding to the presence of stool and essentially becoming drier and harder in the colon leading to stool to difficult bowel opening( Andrews, C. 2011). This is 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. Nurses will have to liaise with other multidisciplinary teams such as Dillon’s school to find him accessible toilet,potentially a dedicated toilet cubicle or staff toilet.This helps tackle Dillon embarrassment and responds to the urge to defecate.This correlates with the nursing principles that encourages multidisciplinary team working to ensure that care and treatment is coordinated and has best possible outcome (RCN,2010). Despite this,schools may have limited resources which may make the goal difficult to implement however, other alternative may be considered.Nurses need to take responsibility for care they provide and answer for their judgements and actions(RCN,2014 .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 implementation of intervention in detail with Dillon and his family,explaining and giving them the choice stool softeners and requirement longer term alternatives.This ensure that information is understood to make informed decision on the treatment (RCN,2014,D. Pashankar, D. 2005).Nurses are encouraged to be aware of risks and help everyone keep safe.To ensure that the Dillon is protected, documentation and good record keeping in nursing practice is critical to ensure that there is continuity of care as well as provide factual, current, and consistent information about the assessment and care of patients which is accessible to the patient (Rcni,2009.Owen, K.2005) Evaluation Evaluation is composed of reassessing as frequently as necessary the implemented care to ensure that the positive outcomes has being met.According to Pashankar, D. (2005) If the interventions are working the service user should have three or more bowel eliminations in a week with no or with minimum soiling and no abdominal pain with bowel movement.This may not be the case for dillon in the view that his ‘’normal’’ frequency of bowel movement may be less than the number stated above.He may complain about abdominal pain in the first elimination after having constipation as pain is associated with it ( Loening-Baucke, V. and Swidsinski, A. 2007) and may have become softer after the first elimination.It is important for Nurses to educate himself on current knowledge and skills in line with the needs of each service users in care .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 may show that managing constipation in children is an ongoing process which may require frequent reassessment,adaptations and implementing of new interventions such as using different alternative such as diet and medications (Nice) helps prevent unnecessary suffering of patient and promote identification and management of constipation. Completion and monitoring of “stool charts” by nursing and medical staff is key to proper recognition 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 also considers the role co-existing factors which may have potentially impacted,the interventions and the health and wellbeing of Dillon.It looked at the impact of reassessment and adaptations of care as care needs changes and made sure that assessing Dillion was not just a mandatory requirement but care effectively delivered by members of a multidisciplinary team .
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