NUR272 Palliative Rehabilitation And Continuing Care

NUR272 Palliative Rehabilitation And Continuing Care

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NUR272 Palliative Rehabilitation And Continuing Care

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NUR272 Palliative Rehabilitation And Continuing Care

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Course Code: NUR272
University: University Of The Sunshine Coast

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Country: Australia

Question:
Identify and Justify Nursing Care Assessment with Explanation of Health Care Goals for the Client.
 
 
Answer:

Introduction
The paper deals with the case study of Jordan who is diagnosed with cystic fibrosis. It is a genetic disease, which damages the exocrine glands. Due to excess secretion of mucus, pancreatic ducts, bronchi and intestines are blocked and high risk of frequent lung infections (Leung et al. 2015). The family belongs to Shine coast region of Australia. It is a third most populated region in Queensland. This region is known to have highest prevalence of cystic fibrosis. The residents of this region have a low health literacy.  Using the five tiers of the socio-ecological framework, the paper discusses the nursing care for the illness and the support needed by the family to address the health needs of Jordan. The paper identifies and justifies the plan of care required by the client. The paper illustrates how the nurse coordinates and delivers the required care keeping in view the health care priority.
Case study scenario
The paper deals with the case study of Jordan a eleven-year-old girl diagnosed with cystic fibrosis. In the story, the CEO of Cystic Fibrosis, WA Mr. Nigel Baker narrates as to why the story is named 65 roses. He narrated a story of Mary whose son was diagnosed with Cystic fibrosis. While Mary was trying to seek help from her friends and relatives, her son overheard the conversation and thought that his mom was collecting funds for buying 65 roses.
Later the story unfolds the illness of Laura. According to her parents, she was diagnosed with the illness when the child was seven week of age. Laura’s parents had no awareness of the illness. Laura’s father Jason had a traumatic experience earlier. His first cousin passed away at the age of 12 due to Cystic fibrosis.  The incident keeps the parents depressed and it has created a black picture of the illness.  She is loved by her sister Klara informs that she takes care to keep Jordan away from flu. Another sister, Claudia says that she loves spending time with Jordan. Playing on trampoline and Chasey are her Jordan’s favourite. She also loves playing with her pet, music and dance. Her father says that since the illnesses have no physical disability she will be like any other normal child and can enjoy her social life. Despite the advancement in the medical field, the parents are worried as the disease decreases the life expectancy. Jordan enjoys the support and special care given by her parents and stays happy. Currently, she is administered with Pancreatic Korean to keep her pancreas functional.
 
Socio-ecological framework
The socio-ecological framework of health care intervention is a multi-level approach. The model includes an individual as a core of the model. The four levels of influence on the individual are interpersonal, institutional or organisational, policy and community level (Madan et al. 2014). The framework is developed with the intention to implement the public health activities at these five levels. The framework maximises the synergies of intervention for successful health outcomes. Each of the level is discussed below with the specific health needs of the client and the family. The process of implementing the framework includes making evidence based nursing assessment of Jordan, identify the health care needs and provide the required care using the five tiers in the framework (Betz et al. 2014).
Individual level
The first tier of the Socio-ecological framework is the individual needs of the illness. It includes the individual’s knowledge and attitude towards the illness. It refers to interest of the client in health screening and understanding the risks and benefits of the screening. It also includes approaching the conventional diagnosis and treatment. A nurse pays a vital role in providing the individual with the affordable and convenient treatment source and high quality surveillance (Madan et al. 2014).
It was identified from the case study that the patient and the family have active participation in the health care promotion. Jordan is very young and needs to learn about the consequences of the illness. It is identified that Jordan’s parents want her to have a normal lifestyle as the illness has no phenotypic characteristics. The disease only affects the internal organs of the body. Therefore, it is needed for Jordan and her parents to learn about the health promoting activities that are cost effective and reduce comorbidities.  
The nursing intervention for Jordan includes education program that helps her better understand the illness and take necessary precautions when in emergency. Jordan will be educated about the nutritional requirements, diet she needs to maintain and on time intake of medicines. It will increase her adherence to the treatment and reduce frequent infections (Tointon and Hunt 2016). Further, she will be taught physical exercises that will improve her lung functions. Yoga and meditation have been found effective in providing relief from symptoms. She will be provided with the instructors for dance and music therapy. These interventions are cost effective and can be implemented in home once trained. It may reduce the comorbidities associated with the disease and improve the life expectancy. A physical exercise increases the immunity and decrease the chance of infection (Radtke et al. 2015). It may reduce the burden of additional financial expenditure.
Interpersonal level
At the interpersonal level, the health interventions that are effective for preventing the disease and reducing the comorbidities of the illness are provided to the client. These activities or interventions are provided with the aim to invoke behaviour change in the client while overcoming the individual level barriers. The services at this level are intended to affect the social and cultural norms (Cook et al. 2014).
Cystic fibrosis is the life threatening disease and the treatment process involves various challenges. Her parents have psychological issues that need to be resolved in order for them to make effective clinical decision for Jordan. They have already experienced black consequences of the illness after the death of Jason’s first cousin. Despite the progress in the field of medicine, Klaudia lacks trust in the survival chances of Jordan. Therefore, they need motivation to cope up with the illness and its demands.
Further, the family will be provided with the cognitive behavioural interventions. It will help them to make effective decisions in the treatment process of Jordan and believe in the successful health outcome of the illness. These interventions will give them the skills often to care for Jordan. This intervention is effective in helping the clients deal with their thoughts and feelings. These interventions will help the parents to reconstruct their lives and maintain balance between the social, emotional, physical and financial resources. It will also help them to come to terms with the fact that their child may die at a very young age. Cognitive behavioural interventions have been effective in enhancing the interpersonal level (Goldbeck et al. 2014). The family will be provided with the infection control guidelines so that they can stay away from the people infected with the same disease.
 
Organizational level
The third tier of the social ecological model is the organizational level where the healthcare professionals, healthcare systems, healthcare plans, health clinics, local health departments and professional organizations are the potential sources at the organizational level. The interventions required at this level comprises of the promotion of the reminder systems for the client and the providers and providing the provider assessment and feedback for the performance (Simplican et al. 2015).
Sunshine coast region in Queensland, Australia is the third most populated peri-urban area with dispersed urban growth. There are small hospitals situated in the region with limited facilities. As a result, there is under-staffing and overcrowding at the hospital affecting the healthcare system and quality of care at the region. There is great requirement of nurses and healthcare professionals. In the context of cystic fibrosis, there is need for organizational capacity in terms of organizational support and effective partnership among the doctors and nurses to support the client needs and requirements. A nurse can promote a healthy working environment where their competency and professional role would have an impact on the quality of care to be provided to Jordan. As a nurse, one should fully support the professional role and legitimize their power in increasing the organizational capacity of that area in the healthcare system (McGinnis and Ostrom 2014). At the same time, a nurse along with the organization should dedicate to the needs of Jordan and provide her the facilities that she requires while batting with the disease. The nurses should be informed about the health insurances schemes that address cystic fibrosis so that they are able to get financial assistance regarding the treatment and cost of medication. The nurses can also contribute by reaching out to the family of Jordan and helping in an immediate manner are some of the organizational needs that can be fulfilled as a nurse. The school based programs in Jordan’s school with participant involvement that promotes healthy nutrition and education about cystic fibrosis.
 
Community level
The fourth tier under SEM framework is at community level where there is participation of the community level by leveraging resources comprising of health departments, advocacy groups and media that represents the potential sources for communication and community support. The interventions encompass the working of the collaborative and coalitions in promoting awareness among the people of Sunshine coast region along with Jordan’s family and through conducting educational campaigns. The nurses can collaborate with the peri-tribal health departments in Sunshine coast region that helps to extend services and facilities to Jordan’s family. People in that region are not aware of the cystic fibrosis condition and the nurses along with the other healthcare professionals should promote health literacy so that the early detection and co-morbidities can be reduced to a larger extent. The nurses can collaborate with the support networks that would be dedicated in providing the direct and indirect services that enhances the life of Jordan in leading a normal life and helps the family in coping with the condition (Sallis and Owen 2015).
Nurses along with the community can help to assist Jordan’s family in providing them services through cystic fibrosis centres that give evidence-based practice for the management and care of Jordan. These centres provide care through the established guidelines that promote and communicate through practice guidelines on all aspects of care. The nurses can also promote adherence to the treatment with the disease. These community centres provide adequate support to the families with cystic fibrosis that are staffed with multidisciplinary care providers like nurses, physicians and other healthcare professionals (Berkes and Ross 2013).
Policy level
This is the outermost tier in the social ecological model that comprises of activities tat involve interpretation and implementation of the existing policies. The local, state, federal and peri-tribal government agencies support the policies and their promotion in providing assistance to the clients and their families dealing with cystic fibrosis. Effective communication in policy making decisions that addresses the people of Sunshine coast region in coping with the condition. The insurance mandates that are required for the treatment and management of the condition can also be provided by the nurses by working in collaboration with the community members in implementation of policy (Levin et al. 2013). They can also assist in translating the local policies for the community members so that they are able to educate and create awareness about the cystic fibrosis among the public. This is the authoritative decision where environmental change is important that affects the policy decisions. It is important to create sustainable change that targets the interventions and policy making (Ban et al. 2013).
Nurses can educate the local officials and community workers about the importance of balanced nutrition and eating vegetables a day. Nurses can support the policies that foster community empowerment through effective partnership and environmental structures that promote healthy education and physical activity.
A food policy that can be implemented in the Jordan’s school that promotes the importance of eating healthy nutrition and children education about the current food systems in peri-urban Sunshine cost region. Moreover, the integration of food policies, local food systems and resilience can support to give sustainable food strategy in the region (Golden et al. 2015).
Behaviour support can also be give to the children like Jordan living with cystic fibrosis. The behaviour expectations should be predictable and consistent so that it is helpful in accommodating the stress related to the condition. A health support plan is required for Jordan in conjunction with her family that support the health needs and care information in cystic fibrosis. Nurses can also support by educating in planning support and in areas of personal care, first aid and additional support that ensures continuity of care and education (Eldredge et al. 2016).
 
Conclusion
As such, there are no such evidence based practices and behavioural interventions that target the key issues in cystic fibrosis. There is requirement of psychological interventions and evidence based practice for the treatment and management of cystic fibrosis faced by people and their caregivers. The social ecological model addresses the patient health care needs through multi-level approach. It has multiple bands that comprises of individual, interpersonal, organizational, community and policy levels. The model helps to implement the public health activities that help to maximize intervention and provide support to Jordan and her family in dealing with cystic fibrosis.
 
References
Ban, N.C., Mills, M., Tam, J., Hicks, C.C., Klain, S., Stoeckl, N., Bottrill, M.C., Levine, J., Pressey, R.L., Satterfield, T. and Chan, K., 2013. A social–ecological approach to conservation planning: embedding social considerations. Frontiers in Ecology and the Environment, 11(4), pp.194-202.
Berkes, F. and Ross, H., 2013. Community resilience: toward an integrated approach. Society & Natural Resources, 26(1), pp.5-20.
Betz, C.L., Ferris, M.E., Woodward, J.F., Okumura, M.J., Jan, S. and Wood, D.L., 2014. The health care transition research consortium health care transition model: a framework for research and practice. Journal of pediatric rehabilitation medicine, 7(1), pp.3-15.
Cohen-Cymberknoh, M., Shoseyov, D. and Kerem, E., 2014. Standards of care for patients with cystic fibrosis. Cystic Fibrosis, 64, p.246.
Cook, J.E., Purdie-Vaughns, V., Meyer, I.H. and Busch, J.T., 2014. Intervening within and across levels: A multilevel approach to stigma and public health. Social Science & Medicine, 103, pp.101-109.
Eldredge, L.K.B., Markham, C.M., Kok, G., Ruiter, R.A. and Parcel, G.S., 2016. Planning health promotion programs: an intervention mapping approach. John Wiley & Sons.
Goldbeck, L., Fidika, A., Herle, M. and Quittner, A.L., 2014. Psychological interventions for individuals with cystic fibrosis and their families. The Cochrane Library.
Golden, S.D., McLeroy, K.R., Green, L.W., Earp, J.A.L. and Lieberman, L.D., 2015. Upending the social ecological model to guide health promotion efforts toward policy and environmental change.
Leung, D.H., Ye, W., Molleston, J.P., Weymann, A., Ling, S., Paranjape, S.M., Romero, R., Schwarzenberg, S.J., Palermo, J., Alonso, E.M. and Murray, K.F., 2015. Baseline ultrasound and clinical correlates in children with cystic fibrosis. The Journal of pediatrics, 167(4), pp.862-868.
Levin, S., Xepapadeas, T., Crépin, A.S., Norberg, J., De Zeeuw, A., Folke, C., Hughes, T., Arrow, K., Barrett, S., Daily, G. and Ehrlich, P., 2013. Social-ecological systems as complex adaptive systems: modeling and policy implications. Environment and Development Economics, 18(02), pp.111-132
Madan, A.S., Alpern, A.N. and Quittner, A.L., 2014. Transition from paediatric to adult cystic fibrosis care: A developmental framework. Cystic Fibrosis, 64(272), pp.00150-6.
McGinnis, M. and Ostrom, E., 2014. Social-ecological system framework: initial changes and continuing challenges. Ecology and Society, 19(2).
Radtke, T., Nolan, S.J., Hebestreit, H. and Kriemler, S., 2015. Physical exercise training for cystic fibrosis. The Cochrane Library.
Sallis, J.F. and Owen, N., 2015. Ecological models of health behavior. Health behavior: Theory, research, and practice, 5, pp.43-64.
Simplican, S.C., Leader, G., Kosciulek, J. and Leahy, M., 2015. Defining social inclusion of people with intellectual and developmental disabilities: An ecological model of social networks and community participation. Research in developmental disabilities, 38, pp.18-29.
Tointon, K. and Hunt, J., 2016. How holistic nursing can enhance the quality of life of children with cystic fibrosis. Nursing Children and Young People, 28(8), pp.22-25.

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