Assessment 1: NUR2102 Written Assignment Task overview
|Assessment name||NUR2102 Written Assignment|
|Brief task description||Apply|
|Rationale for assessment task.||This assessment will develop clinical reasoning skills and demonstrate the application of models of evidence-based care to work collaboratively with individuals with chronic conditions. It will develop theoretical concepts to assess, plan and intervene and evaluate care for people with a chronic condition. The assessment will develop graduates who are; well informed individuals who can integrate and apply knowledge and relevant nursing skills Employable, nursing professionals who are confident, resourceful and adaptable to the changing health care environment.|
|Length||1500 words (+/-10%). Word count includes in-text referencing and excludes the reference list|
|Marks out of: Weighting:||Marks out of 50|
Weighting 25% of overall course
|Course Objectives measured||Course Learning Objective 1.|
|Task detail||Step 1: Read the case study of Mrs Anya Strico as provided on page six of this task sheet.|
Step 2: Read the National Strategic Framework for Chronic Conditions via the link provided in the Resources available to complete the task section below.
Focus your reading on Strategic Priority Area 1.1 (Promote health and reduce risk), Strategic Priority Area 2.1 (Active Engagement) and Objective 3 - Target priority populations of the National Strategic Framework for Chronic Conditions.
Step 3: Using the information provided in the case study and supported by the best available evidence, apply the National Strategic Framework for Chronic Conditions Strategic Priority Areas (1.1, 2.1 and Objective 3 – Target priority populations) in essay format responding to the following criteria:
Assignment criteria Criteria One.
Identify the risk factors for Mrs Anya Strico and clearly explain why these are risk factors for her. The discussion must be linked to the National Strategic Framework for Chronic Conditions Strategic Priority Area 1.1 (Promote health and reduce risk).
Using the best available evidence identify the nursing assessments that are required to be conducted for Mrs Anya Strico and the rationale for each of these.
Using the best available evidence and demonstrating links to the National Strategic Framework for Chronic Conditions Objective 3 - Target priority populations, discuss why Mrs Anya Strico may be identified as being a priority population and the impact this may have on her chronic condition self-management.
Using the best available evidence, discuss the self-management priorities that would be developed in collaboration with Mrs Anya Strico. These should consider health promotion and reducing the risk of complications (Strategic Priority Area 1.1) and demonstrate links to the risk factors identified in Criteria One.
With support from the best available evidence, explain how goal setting may impact on Mrs Anya Strico actively engaging in her care (Strategic Priority Area 2.1).
|Formatting Style||Assessments must be presented as follows.|
|Mrs Anya Strico||Case Study; Mrs Anya Strico|
Mrs Anya Strico is a retired 75-year-old widower who is originally from Croatia. She has an eight (8)-year history of Chronic Obstructive Pulmonary Disease (COPD). Her past medical history includes increasing breathlessness, frequent respiratory infections, chest tightness, a chronic productive cough, persistent wheezing, pitting oedema in the lower extremities, exercise intolerance, fatigue, and a lack of energy. At the time of diagnosis, she was advised to lose weight (at least 5kg) as her BMI was 30 and to attend Pulmonary Rehabilitation, but no further action was taken. Mrs Strico lives in a rural and remote area that is 150 kms from the nearest tertiary hospital, medical centre, and Pulmonary Rehabilitation Clinic. English is her second language.
Mrs Strico presented to her nearest General Practitioner (GP) with another “chest infection”. Mrs Strico presents with a productive cough with green sputum, breathlessness, fatigue, pitting oedema in the lower extremities, confusion, chest
tightness and wheezing. She has visited her GP three or four times a year with similar symptoms for the past three years. Her last COPD plan was reviewed was nine months ago, where she was advised to cease smoking, given a prescription for Varenicline tartrate but relapsed after a week, and did not return for a follow-up appointment. Mrs Strico has been wanting to lose weight and increase her exercise tolerance over the past 12 months, but states that she lacks motivation.
Mrs Strico is prescribed an a short acting Beta2-agonist (reliever) inhaler and a long acting Beta2-agonist inhaler (maintenance). She tolerates these medications but admits that she regularly forgets to take these medications and can never remember which medication to take during a COPD flare-up. She routinely runs out of these medications as the nearest pharmacy is 150kms away.
|Mrs Stricos husband died 8 years ago, and she has been receiving an aged care pension since that time. Mrs Strico manages at home by herself, she refuses social help and is adamant that she does not want to leave the home that she has lived in for 30 years.|
She reluctantly relies on her nearest neighbour to travel with, as it is 150 kms to the closest metropolitan centre for food, health care services and other essentials. Mrs Strico used to be very active as a volunteer in the small community she resides in however, she now finds that she is too exhausted to keep this up. Mrs Strico states that she now has “nothing to do” and feels “isolated and lonely”. She has no children or living relatives in Australia. Although she is aware that her father had COPD, Mrs Strico has limited knowledge regarding the management of this condition and states that she thought little could be done to slow the progression COPD.
During the last year Mrs Strico has gained 6kg and has become less physically active. She has never seen a dietician and her diet consists mostly of snacks and packaged meals that are high in salt and saturated fat. Since her husband’s death, Mrs Strico has been consuming more alcohol (approximately 14 standard drinks per week).
As Mrs Strico is unable to regularly travel the distance to her closest medical centre or tertiary hospital, she only has occasional medical check-ups and her medical records indicate that that her exacerbations of COPD have increased over the last three years.
The national strategic framework is a policy document that formulates the means, standards and responsibilities of the government and healthcare for delivering comprehensive care, including checkups, screening, diagnosis, referral pathways, treatment, counseling and prevention. Patient with chronic condition such as chronic obstructive pulmonary disease (COPD) face constant challenge of psychological, physical and social changes. The essay describes various priority areas as provided in the national strategic framework through the case analysis of Mrs Strico, 65 years old female suffering from COPD residing in a remote rural region. The essay also evaluated various risk factors, strategies for self management, required nursing considerations and intervention and discussion on the priority population in Australia.
National Strategic Framework for Chronic Conditions explains that risk factors are a specific set of characteristics that a person exhibits or is exposed to increasing the likelihood of developing the disease ("National Strategic Framework for Chronic Conditions", 2016). These risk factors include behavioural factors, for example, smoking, diet, obesity, nutrition and physical inactivity, non-modifiable factors, for example, sex, gender. Ethnicity and genetics; social factors include beliefs, custom and employment status; physical determinant including geographical and environmental influences. These risk factors may co-exist and interact with each other to predispose for either disease initiation or progression similarly for Mrs Strico. She has risky alcohol consumption, the prevalence of physical inactivity, and increased smoking frequency (Zha et al., 2019). Her BMI is 3o, and she is obese. Her diet usually consists of high saturated fat and salt. She is mainly consuming processed and packed meals (de Miguel-Díez et al., 2019). The above-stated factors are the risk factors as through various studies; we know them predisposing her to several diseases, including cardiovascular and respiratory disorder associated with her current COPD condition (de Miguel-Díez et al., 2019). As per the National strategic framework for the chronic condition, she has evident risk factors of being between 45-75 years of age ("National Strategic Framework for Chronic Conditions", 2016). She is not taking her medication correctly, which might deteriorate her current respiratory distress. Her repeated respiratory infections, if not addressed, may cause respiratory failure. Most of the factors present for Mrs Strico are modifiable risk factors that can be modified by continuous motivation. As Mrs Strico has multiple risk factors, these should be identified and addressed through evidence-based interventions.
The nursing assessment for Mrs Strico should include assessing disease progression, complication, risk, additional comorbidities, wellbeing, and quality of life.
Assessment of acute exacerbation of COPD
Rationale: Each case of COPD should be assessed for the acute exacerbation for the treatment planning. It helps in evaluating the needs for hospital admission or her condition to be treated through at-home treatment. The NICE guidelines for COPD suggest that an acute exaggeration should always be evaluated when providing care (Gustafsson & Nordeman, 2018). The execution can be asses through the degree of disturbances in the vital signs, including breathlessness, respiratory rate, presence of pursed-lip, altered consciousness or acute confusion (Fletcher & Dahl, 2013).
The nurse should assess for ineffective airway clearance, including pulmonary function test and arterial blood gas analysis and probable symptoms & sign of respiratory distress.
Rationale: COPD is associated with altered blood gaseous measurement, which in turn can lead to a life-threatening condition called respiratory acidosis. A pulmonary function test is essential to analyze the lungs' functioning so that a suitable interventional plan can be adopted (Gustafsson & Nordeman, 2018).
Asses her musculoskeletal functional and limitation of the physical activities
Rationale: Chronic obstructive pulmonary disease is often associated with debilitating musculoskeletal muscle wasting and changes example, a barrel-shaped chest (Jaitovich & Barreiro, 2018). Skeletal muscle dysfunctions and respiratory distress may affect muscle endurance and strength, impacting the patient's daily activities like walking, dressing, and cooking. (Yuan & Li, 2018).
Asses the Cardiovascular systemic review with ECG
Rationale: prolonged respiratory disorder like COPD can result in a compensatory burden over the heart, resulting in a condition like Cor pulmonale, resulting in heart failure if not addressed in time. Risk behaviour like smoking, alcohol drinking and obesity may result in comorbidities, including hypertension, CAD, along COPD (Yuan & Li, 2018).
A chronic condition may impact all Australians, but few communities or populations are affected disproportionally due to inequities, including social, economic, physical, and geographical factors. This can be reflected through the more significant disease burden among this population resulting in undesirable health outcomes (van Gemert et al., 2015). Hence, such population required special attention to address the health needs and hence is known as the priority population. As per the national strategy for the chronic condition, the priority populations identified in Australia are: indigenous communities, people from cultural and linguistic diversity; older people; people with socio-economic disadvantages; people living in remote or rural locations and people with mental disability ("National Strategic Framework for Chronic Conditions", 2016).
Mrs Anya Strico is identified as the priority population because, as described, she resides in a remote rural location where there may be few geographical inequities impacting her health outcomes. She has the nearest pharmacy or hospital at 150 km; this impacts her reporting treatment and disease management. After being identified as the priority population she might have several benefits, including the possibility and affordability of the health care services. She can receive culturally appropriate and safe services which are effective and high quality ("Department of health", 2019). She will receive improved monitoring, screening and detection program designed for the risk factors of chronic disease. For example, Getting Australia health on track is a priority policy action plan for healthier Australia. Mrs Anya Strico capriority communities are recognized for their vulnerabilities and provided the solutions based on their preferences like awareness campaigns, educational support, and addressing barriers ("Department of health", 2019).
SELF-MANAGEMENT PRIORITIES DEVELOPED IN COLLABORATION
Self-management is an essential component of managing chronic illnesses. Health care professionals should develop strategies so that Mrs Anya Strico may learn more about her condition and be part of the established care plan. This can be achieved by supporting the information delivery system. As Mrs Strico is not well known about her disease, she may continue with the risk behaviour if not directed in the required direction (Tinetti et al., 2019). She has no children or living relatives in Australia; hence she feels lonely and deprived. The feeling of isolation and loneliness may add to the psychological impact that chronic disease has on Mrs Anya Strico (Franssen et al., 2018). Hence she may be encouraged for self-care and engagement within the community. She might be connected to the community outreach program, where she may indulge in diversional activities. She should be encouraged to meet the dietician and address her modifiable risk factors, including diet, nutrition and food habits (Hessler et al., 2019). She should be encouraged to see the physical therapist for her restricted physical movements. She should be provided freedom and flexibility to provide feedbacks and preferences on her care plans (Hessler et al., 2019). She can be encouraged to self-assess her condition and be an active partner. She can be provided engagement through technology, such as telepathy, community referral system, and outreach programs.
HOW GOAL SETTING IMPACTS THE ACTIVE ENGAGEMENT
As per the National Strategic Framework for Chronic Conditions Strategic Priority Areas, active engagement recognizes the positive effect of engaging individuals in patient-centred care ("National Strategic Framework for Chronic Conditions", 2016).
This enables them to feel empowered and plays an essential role in the healthcare process (Cameron et al., 2018). This includes informed decision making throughout the process of treatment. The goal-setting has a significant impact on how she will be participating in her treatment plans. The fundamental purpose of active engagement is to enable her to care for herself in isolation and play an active role in maintaining her health (Parsons et al., 2016). If these criteria are not fulfilled, it may eventually lead to barriers like resource deficit, patient knowledge deficit, treatment non-compliance and demotivation (Cameron et al., 2018).
Conflicting and complicated goal setting without considering the individual aspect of care may result in disempowering. Goal setting should be simple, sensible and straightforward based on the SMART format (Parsons et al., 2016). The goal should be set to enhance her social interactions and community participation for a better quality of life and be valued as an essential component of her care plan format (Parsons et al., 2016). The goals should be set to address her overall wellbeing and risk associations; for example, Individuals with COPD are often associated with the risk of developing depression,entricular dysfunction, and other cardiovascular conditions (Rabe et al., 2018). If goals are set in these directions, she will undoubtedly get confidence to express her needs and preferences, and these, when monitored by healthcare professionals, may help overcome the barriers and create more support for her (Cameron et al., 2018).
Through the case study of Mrs Anya Strico, we can understand that how vital role the national strategic framework for chronic disease has in Australia for providing better health services and outcome to its population in terms of screening, monitoring and evaluation chronic condition, especially in vulnerable individuals like Mrs Anya Strico.