Health Care Assignment: Evidence Based Therapeutic Plan For Older Person

Question

Task:
Write a detailed health care assignment on the topic “Health assessment and evidence based therapeutic plan of care for the older person in an acute/aged care setting”

Answer

Introduction
The health issue examined in the present health care assignment is urinary inconsistency which refers to the leakage of urine by accident. It can be considered to be one of the most common problems, especially in men (Yeni?ehir et al., 2019). In this case, Mr. George Agapanthas, an 84-year-old sociable and happy man has been suffering from urinary inconsistence and has been relocated to the residential aged care center which restricts him to enjoy the company of his extended family. It becomes difficult for his family members to maintain Mr. Agapanthas personal hygiene at his home and thus he is admitted to the hospital. This study will provide an overview of the presenting health condition, the legal and the ethical issues involved in caring for older individuals, the evidence-based learning, and the plan of care for the older individual.

Overview of the presenting health condition
Mr. Agapanthas has been suffering from urinary inconsistence and also has a past medical history of hypertension, arthritic pain, and obesity. Mr. Agapanthas has been admitted to residential care because of his sudden increased level of urination. Even though the doctors have provided him different medications for urine infection along with the dosage of multi-vitamin, but it is important to keep Mr. Agapanthas under observation because of his old age condition (Bliss et al., 2017). The extended family members of Mr. Agapanthas must consult with the specialist of urinary doctor and find out the exact reason for his urinary inconsistence. Moreover, it is the responsibility of the nurses to consult with the doctor as well as the family members of Mr. Agapanthas so that they can provide the exact care to the patient. As there are different types of urinary inconsistency among older adults such as stress inconsistency, urge inconsistency, overflow inconsistency, and functional inconsistency, the nurses need to determine the exact cause of urinary inconsistency and thus help Mr. Agapanthas to get relief from this problem within a short period.

The family members of Mr. Agapanthas must also consult the doctors for carrying out an in-depth medical examination of the patient so that the exact reason can be judged accordingly. Moreover, as Mr. Agapanthas is a social person and suddenly due to his urinary inconsistency, he has left being social, and thus this lack of physical activity might also be due to his decrease in overall strength. The nurses must remain involved in tackling the lifestyle management of Mr. Agapanthas and thus encourage him to drink fluids rather than consuming the medicines alone. Proper care should be taken by the nurses to help Mr. Agapanthas receive a balanced diet as well as avoid those food substances that irritate this urinary bladder.

Legal and ethical issues in caring for the older individual
In providing care to Mr. Agapanthas, the legal issues that are to be considered by the nurses include the avoidance of malpractice, negligence, and omission. This is because in most cases, the nurses neglect the patients or avoid taking care of those patients who require consistent monitoring. However, this should not be the case because it is the responsibility of the nurses to tackle elder abuse as well as carry out mandatory reporting of the patient in providing treatment to Mr. Agapanthas (Yeni?ehir et al., 2019). This should be done considering the comfort and the safety aspects of the patients. Further, an intentional tort can also be considered to be an important legal issue arising in caring the older individuals. As Mr. Agapanthas is suffering from urinary inconsistence, appropriate care is to be taken by the nurse in handling the patient without assaulting or touching his private parts before seeking his permission. There should be prevention of unwanted physical contact with the patient and thus this can be considered to be an act of respect and dignity (Wangpitipanit, 2021). The nurses must also avoid neglect or physical abuse with Mr. Agapanthas that might increase his mental stress as well as the exploitation of his financial resources.

The ethical issues that are to be considered in the provision of elderly care to Mr. Agapanthas include the decision-making capacity, the informed consent as well as the psycho-social aspects of aging (Bliss et al., 2018). Although Mr. Agapanthas is suffering from urinary inconsistence and varied comorbidities, he did not lose his decision-making capacity and thus the nurses must provide different choices of options while communicating with him. The informed consent of the patient is crucial for the enhancement of the decision-making process and thus this is essential for the nurses in providing care to Mr. Agapanthas (Erekson et al., 2019). With the help of this information, Mr. Agapanthas can make a choice thereby understanding and appreciating the issues. Moreover, this will also assist in making a coherent and informed choice so that it becomes easier to control the urinary inconsistence. However, care should be taken that the patient does not refuse to adhere to the treatment process else is likely to create problems and trouble for the nurses (Góes et al., 2019). There should be coherent and stable decision-making to manipulate the information of the patient and thus provide appropriate care to the patient. This will assist in maintaining the best standard directions and principles for tackling the urinary consistency of Mr. Agapanthas to a great extent.

Evidence-based learning to identify the healthcare needs and the plan of care for the older person
Evidence-based practice (EBP) can be considered as the judicious and conscientious use of the current evidence following the clinical expertise and the patient’s value in guiding the healthcare decisions (Talley et al., 2017). In the case of urinary inconsistency of Mr. Agapanthas, the evidenced-based healthcare needs that are to be considered by the nurses are discussed below:

Development of an inquiry stage: The nurses must collaborate with the extended family members of Mr. Agapanthas as well as with the patient to know about the problem. The questions are to be asked by adhering to the PICOT format:

Population (P): In the hospital

Intervention (I): how can the nurses

Comparison Intervention or Group (C ): compared to the other health care professionals

Outcome (O): tackle the urinary inconsistency of Mr. Agapanthas

Time (T): within a week.

Find out the best evidence: This search for the evidence is possible through typing the PICOT question in MEDLINE, CINAHL, or Google Scholar thereby finding out the available research papers. Care should be taken that the research papers that are considered in this study are published within the last five years so that the results of the study are not too outdated thereby assisting to arrive at a valid conclusion.

Critical appraisal of the evidence: Once the articles are chosen for the review process, they must be appraised rapidly to find out the most relevant, reliable, valid, and applicability of the clinical question. It is important to determine whether the research studies are valid as well as the research methods are rigorous enough to determine the findings (Gencbas et al, 2018). The results of the study are also to be interpreted so that it becomes easier for the nurses to arrive at a valid conclusion for tackling the urinary inconsistency of Mr. Agapanthas

Integration of the evidence with clinical expertise as well as patient values and preferences: According to the research, it has been found that the research evidence cannot be considered to be effective to tackle the change in practice (Khatony et al., 2020). The nurses must also possess clinical expertise, the reports of the medical investigation as well as the preference, values, and co-morbidities of Mr. Agapanthas to help him with the correct form of treatment. All these aspects are to be considered while managing the Evidence-based practices of Mr. Agapanthas.

Evaluation of the outcomes based on the practice decision or changes depending on the evidence: After the effective implementation of the Evidence-based practice, it is necessary to evaluate and monitor the change in the outcome so that Mr. Agapanthas can be assisted to maintain hygiene and thus get rid of the urinary inconsistency within a short period (Hunter & Wagg, 2018). This will make it easier to monitor the effect of EBP change on the healthcare outcome and quality to a great extent.

The nursing care plan is highlighted in tabular format:

The implications of this urinary inconsistency of Mr. Agapanthas to the professional practice of the nurses include understanding the concerns of Mr. Agapanthas and thereby seeking appropriate management that is essential for the enhanced level of professional performance. There should also be a proper nursing orientation to help the nurses understand the symptoms of urinary inconsistency and thus take preventive steps to protect themselves.

Conclusion
Thus, it can be said that it is the responsibility of the healthcare professionals including the nurses to pay proper attention to Mr. Agapanthas urinary inconsistency when the patient is admitted to the hospital. The nurses must also educate the carers of Mr. Agapanthas so that it becomes easier for them to maintain the hygiene of Mr. Agapanthas which will lower the rate of infection. Therefore, it can be said that appropriate steps are to be taken by the nurses in the clinical decision-making process of Mr. Agapanthas’s urinary inconsistence.

References
Bliss, D. Z., Gurvich, O. V., Eberly, L. E., & Harms, S. (2018). Time to and predictors of dual incontinence in older nursing home admissions. Neurourology and urodynamics, 37(1), 229-236.

Bliss, D. Z., Mathiason, M. A., Gurvich, O., Savik, K., Eberly, L. E., Fisher, J., ... & Larson, R. (2017). Incidence and predictors of incontinence associated skin damage in nursing home residents with new onset incontinence. Journal of wound, ostomy, and continence nursing: official publication of The Wound, Ostomy and Continence Nurses Society, 44(2), 165.

Erekson, E., Hagan, K. A., Austin, A., Carmichael, D., Minassian, V. A., Grodstein, F., & Bynum, J. P. (2019). Outpatient evaluation and management visits for urinary incontinence in older women. The Journal of urology, 202(2), 333-338.

Gencbas, D., Bebis, H., & Cicek, H. (2018). Evaluation of the efficiency of the nursing care plan applied using NANDA, NOC, and NIC linkages to elderly women with incontinence living in a nursing home: a randomized controlled study. International journal of nursing knowledge, 29(4), 217-226.

Góes, R. P., Pedreira, L. C., David, R. A. R., Silva, C. F. T., Torres, C. A. R., & Amaral, J. B. D. (2019). Hospital care and urinary incontinence in the elderly. Revista brasileira de enfermagem, 72, 284-293.

Hunter, K. F., & Wagg, A. S. (2018). Improving nurse engagement in continence care. Nursing: Research and Reviews, 8, 1-7.

Khatony, A., Mohammadi, M., Jafari, F., Vaisi-Raygani, A., Jalali, R., & Salari, N. (2020). Urinary Tract Infection among Iranian Older Adults: a Systematic Review and Meta-Analysis. Ageing International, 1-12.

Talley, K. M., Wyman, J. F., Bronas, U., Olson?Kellogg, B. J., & McCarthy, T. C. (2017). Defeating urinary incontinence with exercise training: results of a pilot study in frail older women. Journal of the American Geriatrics Society, 65(6), 1321-1327.

Wangpitipanit, S. (2021). Older People with Urinary Incontinence: A Nurse Practitioner’Role in the Assessment and Management. Medico Legal Update, 21(1), 1006-1011.

Yeni?ehir, S., Karakaya, ?. Ç., & Karakaya, M. G. (2019). Knowledge and practice of nursing home caregivers about urinary incontinence. European Geriatric Medicine, 10(1), 99-105.