Nursing Interventions For The Client Focus Issues Case Study Samples
As people continue to age, various factors make them vulnerable to disease. Indeed, the biological processes continue to wane down with use. Certainly, this makes their immune system weaker and thus prone to disease. This paper focusses on pneumonia. Specifically, it describes the possible nursing interventions for the illness especially among the old people. The client in focus is a 60-year-old male diagnosed with pneumonia in the process.
This paper considers nursing interventions from two broad perspectives. These are the client-focused interventions and the practitioner-focused interventions. Ideally, the former refers to interventions that bring direct improvement to the client. On the other hand, the latter are interventions designed to empower the clinician attending the client.
The Nursing interventions
Possible nursing interventions for pneumonia based on evidence-based research.
Based on the factual research, there are various interventions, in addressing the pneumonia among the elderly. This section explores the current modes of response and provides the rationales behind them.
Melnyk (2011) did a study focusing on the interventions aimed at reducing the ventilator-associated pneumonia (VAP). Accordingly, this study brought significant results that contain possible solutions to the problem. Indeed, they came up with three-pronged intervention strategy. Namely, nursing care that follows a percutaneous coronary intervention, an educational intervention, and the musical intervention (Melnyk, 2011). However, particular focus will be on the last two.
Educational intervention lays emphasis on progressive education of the client on various issues. Firstly, it involved training the client on hand hygiene lessons. As well, it considered the use of oral care and the head-on-the-bed elevation.
The rationale behind these interventions was to bring about the knowledge empowerment to the client. Indeed, this aimed at utilizing the cognitive and perceptive capacities of the client. Thus, the idea was to enable the client exercise personal responsibility in caring for themselves. As well, it aimed at teaching healthcare providers and clinicians on the current strategies for providing care. As well, it includes evidences that enhance proper compliance with the clinical practice guideline (CPG).
The educational intervention also involved the relational component. The interactions of the clinicians with each other are of paramount concern. Indeed, dysfunctional interactions among the clinicians can have a ripple effect on their interactions with clients. As such, these need to be adequately addressed. Thus, the philosophy behind the educational intervention is to instill cultural change among the physicians in their manner of interaction.
Use of live music intervention
Music has for many ages been considered a past-time activity and a source of entertainment. However, medical studies have revealed the therapeutic effect of music. Surprisingly, music has been seen as a potent method of facilitating the healing process of various patients (Melnyk, 2011). In 2010, Sand-Jecklin K. & Emerson H. did a study on the role of live music in providing the therapeutic care for the patients suffering muscle tension, anxiety, and pain. Ideally, the study sought to evaluate the impact of the live music as a holistic intervention for the patients admitted to the tertiary health care. Apparently, it focused on the patients having anomalies in their heartbeat rates, blood pressure, pulse rates and muscle tension. The musical intervention involved a twenty-minute play of the Celtic Harp music by a Certified Music Practitioner (CMP) sitting or standing beside the patient. Surprisingly, the study noted reduced rates of anxiety, muscle tension and pain after the music intervention. Moreover, the systolic blood pressure and the respiratory rates of the patients reduced after the musical intervention (Melnyk, 2011).
Psychosocial support intervention
VAP patients demonstrate significant psychosocial imbalance and hence require support (Melnyk, 2011). Essentially, psychological support can come from both the clinicians as well as the patient’s family. Notably, it can come in the form of one-to-one conversations in which the nurses discuss the medical progress with the clients. Ideally, these discussions look into the perceptions, anxieties, and other emotional concerns that VAP patients have. In addition, the close relatives and significant others can play the role of providing hope and encouragement. The family can provide this hope through various ways. One way is through daily visitations and assurances of a better tomorrow. According to Melnyk (2011), psychosocial support ranked highest in the educational intervention. Hence, there is a need for the re-education of pneumonia health workers on the various aspects of the psychosocial care.
The rationale behind psychosocial support is the enhancement of the will to live in the clients. In other words, it aims at reinforcing the hopes and positive thinking in the client. Mainly, this helps the client to go through the medical process with a strong will and desire for better. As well, it helps to dispel fears as it provides a social cushioning for the emotional pains that the client may have. Thus, the client rests assured of the possibility of real outcomes from the process.
Oral care intervention
Oral care is another intervention strategy for pneumonia patients, especially those on intubation (Melnyk, 2011). According to Yao et al., (2011), oral care is quite important in attaining remedial capacity of VAP patients. Notably, they did a study on the effectiveness of oral care on VAP rates, oral health, and the hygiene of the ICU and the post neurosurgical patients. Accordingly, the study showed a significant reduction in the cumulative rates of VAP within the experimental group. Apparently, the study comprised of patients consecutively admitted to the surgical ICU in a suburban hospital in 2007. The study focused on people who had no current diagnosis of pneumonia and who had been in ventilator support for between 48-72 hours. Later, the researchers grouped the participants into two that is, the control group and the experimental group. Both groups received standard oral care using cotton swabs. However, the experimental group received more care. Precisely, they received the head-on-the-bed (HOB) care, twice a day oral care protocol of the tooth brushing with purified water. Moreover, these participants received before-and-after hypo pharyngeal suctioning. The control group received mock oral care twice per day. Ideally, this care included the moisturizing of the lips, the HOB elevation and the hypo pharyngeal suctioning. 64.2% of the participants were male whose mean age was 60.6 years. 75.5% of the patients had received emergency surgery. Subsequently, the experimental group was observed to have lower VAP rates as well as higher scores on oral health and plaque index. Therefore, this study concluded that the use of simple tooth brushing twice per day with purified water can lower the VAP rate in the patients. Worthy of noting is that this kind of intervention of inexpensive compared to the existing oral care protocols (Yao et al., 2011).
The rationale behind tooth brushing is to enable clinicians to provide effective VAP interventions with minimal cost for the client. Perhaps, this will allow, the client to have spare money for other more demanding services such as the operations.
Mechanical ventilation involves the use of specialized machines that enhance the breathing process of the client. Certainly, they are of paramount assistance especially, to the patients affected by severe breathing problems. The rationale behind this sort of intervention is to boost the respiratory organs and functions, which have seemingly become numb (Melnyk, 2011). According to Driver (2012), the external respiration is the process in which gasses exchanges take place between the blood capillaries and the alveoli. Certainly, the gaseous exchange takes place from an area of high partial pressure to that of the low partial pressure. Ideally, the gaseous exchanges involve the release of carbon dioxide and the absorption of oxygen by the capillaries. Notably, this kind of exchange occurs because of higher concentration of oxygen in the alveoli and higher concentration of carbon dioxide in the capillaries. Thus, the machine assists in enhancing this process.
The machines tend to provide the movement of the air in and out of the lungs by combining their operations with the atmospheric pressure. Precisely, this action involves two primary processes, the inspiration, and the expiration. Inspiration leads to the absorption of oxygen while expiration leads to the release of oxygen. Incidentally, the machine ventilation uses these processes to ensure the proper flow of air. Inspiration occurs through the drawing of the air in and out of the body. Indeed, this is the result of the expansion of the lungs through the contraction of the intercostal muscles and the diaphragm. The drop in the intra-alveolar pressure to below 2mmHg less than the atmospheric pressure results in the negative pressure. On the other hand, the expiration results from the relaxation of the diaphragm and the intercostal muscles leading to higher intra-alveolar pressure compared to the atmospheric pressure. Notably, the moist membranes aligning the alveoli tract can severely impede the inspiration process. As such, proper effort must be put to ascertain that the process speeds up.
Nursing Interventions (Driver, 2014; Driver, 2012; Melnyk, 2011)
In sum, nursing interventions require keenness to the client’s unique needs. As such, they must be unique per client. Other than that, the nurses must demonstrate personal care and concern for the client. Notably, the healing process is a compound of various interventions including professional and social measures. Hence, they must certainly remain client-centered.
Driver, C. (2014). Understanding pneumonia: anatomy and pathology. Nursing and Residential Care, 16(3), 136-141.
Ibid (2012). Pneumonia Part 1: Pathology, presentation, and prevention. British Journal of Nursing, 21(2), 103-106.
Melnyk, B. M. (2011). Nursing Interventions to Improve Outcomes in Hospitalized Adults. Worldviews on Evidence‐Based Nursing, 8(4), 252-255.
Sue Eisenstadt, E. (2010). Dysphagia and aspiration pneumonia in older adults. Journal of the American Academy of Nurse Practitioners, 22(1), 17-22.
Yao, L. Y., Chang, C. K., Maa, S. H., Wang, C., & Chen, C. C. H. (2011). Brushing teeth with purified water to reduce ventilator-associated pneumonia. Journal of Nursing Research, 19(4), 289-297.