Nursing Processes: From Admission to Discharge

Nursing Processes: From Admission to Discharge Shan Jiang Develop an understanding of the nursing process from admission through to discharge of a client in a health care facility My patient is Mr. Peter William, 71 years old male, was found slumped in the shower accomplishing flaccid right limb and mouth and face drooping. In addition, this client also had slurred speech, and urine incontinence problems. In my care plan, I will outline the specific assessment tools and major health problems on Peter and present outcomes and interventions. There are two assessment tools that a nurse needs to do. One of these is the acute falls risk assessment tool. The main reason is that this client has right side weakness. This means that older people with limb flaccid contributes to high risks of falls. Nystrom and Hellstrom (2012, P. 473) state that the falling incidence of elderly with limb weakness is two times the number of those who are the same age without limb flaccid. Furthermore, Braden risk assessment scale also should be considered as a significant tool for this patient. The main reason is urine incontinence and limb weakness could lead to the impaired skin integrity and even pressure ulcer. Therefore, those two tools would be implemented due to urine incontinence and right side weakness. Peter has three main health problems, which are the guidelines to offer safe and high quality of care. The first and most urgent health problem is the risk of aspiration manifested by slurred speech and face and mouth drooping. The reason is that swallowing dysfunction contributes to high risk of aspiration and the difficulty of moving foreign materials from the airway (Garcia and Chambers 2010). As a result, this patient could not clear the airway effectively, leading to high risk of death. Another significant health problem is the risk of falls because of right side weakness. The reason is that this client would have high risk of injuries such as fracture even death, due to the high incidence of falling (Hindmarch et al. 2009 Naqul et al. 2007). The third health issue is risk of impaired skin integrity caused by urine incontinence and limb weakness. The reason why impaired skin integrity should be a priority is that broken skin contributes to various infections. All those evidence demonstrates that the key health problems are the risks of aspiration, falls, skin integrity and the prioritization bases on severity of threatening life safety. Relatively desired outcomes could be achieved by means of nursing interventions basing on the two priority health problems. Firstly, the incidence of aspiration is minimized and relevant complications would be prevented by multiple interventions. Rofes et al. (2011) report that food modification and other swallowing function rehabilitation contribute to preventing aspiration-related malnutrition and pneumonia and improving dysphagia. Furthermore, the falling rate decreases during hospitalized time attributes to professional nursing care. In other words, the falling rate of inpatient would decline dramatically due to the implement of multiple prevention methods. Therefore, professional and effective nursing interventions facilitate desired outcomes in terms of effective airway clearance and reducing falls rate. There are two interventions could be implemented to reduce aspiration. One of these is postural strategy. This means that modifying body and head position could minimize the incidence of aspiration and relevant respiratory complications. Rofes et al. (2011) report that postural approaches are easy and effective to be performed due to little fatigue and those involve head extension, turning head towards the unhealthy side and so forth. Those strategies could prevent residues from aspiration, such as titling head to the health side before making bolus directly to the stronger side through the gravity (Rofes et al. 2011). Another one is dietary modification. According to Garcia and Chambers (2010, p. 30), appropriate food texture according to the patient’s swallowing capacity contributes to ingesting foods sufficiently and thin liquids should be avoided due to fast transiting and solids. As a result, aspiration would be minimized. Therefore, postural methods and food modification could minimize the occurrence of aspiration. After discharge, various issues this patient might meet and relevant strategies could be implemented to combat those problems. Firstly, risk of falls still exists after hospital discharge. The main intervention is combining environment modification and education (Lord, Menzand Sherrington 2006; Hill et al. 2011). According to Lord, Menz Sherrington (2006, p. 58), there are a variety of factors associated with high risk of falls, such as home surroundings and falling incidence could be decreased to 31% in one year by assessing home hazards and educating the use of multiple mobility aids. Moreover, communication barrier is also a significant issue for this patient after discharge due to poor verbal communication. The reason is that aphasia would lead to low quality of life even depression (Hilari and Byng 2009). Therefore, relevant efforts should be taken to resolve this problem. According to Lanyon, Rose Worrall (2013, p. 360), aphasia groups contribute to promoting friendship and social issues through different modality communication activities, such as regaining meaningful interactions and communication skills. As a result, depression is minimized due to communication effectively and confidently. In present-day society, multiple chronic diseases are very common among the elderly and the clinical manifestations are complicated comparing to adults. This care plan indicates that the whole nursing procedure of an old patient with slurred speech, right side flaccid and urinary incontinence, which involves using assessment tools to identify major health problems: ineffective airway clearance and risk of falls and impaired skin integrity. Professional care could be applied to solve those problems including in hospital and post discharge. References Nystrom, A, Hellstrom, k 2012, ‘Fall risk six weeks from onset of stroke and the ability of the prediction of falls in rehabilitation settings tool and motor function to predict falls’, Clinical Rehabilitation, vol.27, no. 5, pp.473-79. Garcia, J M, Chambers, E 2010, ‘Managing dysphagia through diet modifications’, American Journal of Nursing, vol. 110, no.11, pp. 26-33. Hindmarch, D M, Hayen, A, Finch, C F, Close, J C T 2009, ‘Relative survival after hospitalization for hip fracture in older people in New South Wales, Australia’, Osteoporosis International, vol.20, no. 2, pp. 221-29. Rofes, L, Arreola, v, Almirall, J, Cabre, M, Campins, L, Peris, P G, Speyer, R, Clave, P 2010, ‘Diagnosis and management of oropharyngeal dysphasia and its nutritional and respiratory complications in the eldly’, Gastroenterology Research and Practice, vol.2011, viewed 7 May 2014, http://dx.doi.org/ 10.1155/2011/818979> Lord, S R, Menz, H B, Sherrington, C 2006, ‘Home environment risk factors for falls in older people and the efficacy of home modifications’, Age and Ageing, vol. 35, no.2, pp.55-59. Hilari, K, Byng, S 2009, ‘Health-related quality of life in people with severe aphasia’, International Journal of Language Communication Disorders, vol. 44, no.2, pp. 193-205. Lanyon, L E, Rose, M L, Worrall, L 2013, ‘The efficacy of outpatient and community-based aphasia group interventions: a systematic review’, International Journal of Speech-Language Pathology, vol.15, no.4, pp.359-74. Theoretical Framework in Sociology Research: Bradford Riots Theoretical Framework in Sociology Research: Bradford Riots What kinds of questions do the different theoretical frameworks encourage you to ask about the Bradford ‘riots’? Which of these questions do you find useful and worth pursuing? Why? What are the limitations of the theoretical frameworks you have considered? What questions do they neglect? The following is a brief discussion of how some of the different theoretical frameworks of sociology can be used to gain an understanding of social events and structures, with the Bradford riots as the selected case study. The different theoretical frameworks of sociology offer us the structures to carry out and then evaluate social research on particular events or issues, although the differences in these theoretical frameworks need to always be taken into account. The different theoretical frameworks of sociology in fact emphasise differing actors such as individual choices / freedom of action, the impact of economic, political, and social factors, as well as social institutions and social structures. Several research questions are put forward for discussion and evaluation to assess which ones will fit in best with the different theoretical frameworks of sociology that are discussed. The reasons for selecting the final research questions will be explained. Finally the potential sho rtcomings of the selected research questions as well as the chosen theoretical frameworks will be discussed. There are arguably various kinds of questions that the different theoretical frameworks of sociology would encourage us to ask about the Bradford riots, or any other social event for that matter. The different theoretical frameworks of sociology are after all meant to give people the ability as well as the capacity to evaluate and therefore to understand general societies as a whole and indeed specific social events in isolation. The shared purpose of the different theoretical frameworks of sociology is to analyse and to comprehend contemporary societies, the asking of pertinent questions being a widespread and also a sound means of determining the direction and the results of sociological research into specific events or areas. The different theoretical frameworks of sociology would in all probability encourage us to ask probing and open ended kinds of questions to find out more details concerning the Bradford riots. Of course the different theoretical frameworks of sociology would then probably go on to provide differing explanations of why the Bradford riots happened, as well as the main causes of what took place. For example questions like the following ones would be highly useful for the different theoretical frameworks of sociology to ask in order to evaluate what happened: Could the Bradford riots have been accurately predicted? Did the Bradford riots have long-term social and economic causes? Did the Bradford riots have short-terms social and economic causes? Could the Bradford riots have been averted at all? What role did social factors such as alienation, racial discrimination, and poverty play in causing the Bradford riots? Why were the local authority, the West Yorkshire Police, and the central government unable to prevent the Bradford riots from taking place? Are there any lessons that the local authority, the West Yorkshire Police, and the central government can learn from the Bradford riots? And if so should changes be made to prevent further riots in the future? All of the questions mentioned above would certainly prove to be useful in the provision of a meaningful analysis of the Bradford riots within the context of the different theoretical frameworks of sociology to ensure that important and accurate conclusions are reached about the causes of the violent outbursts. To a large extent all of the questions that could be asked would provide pertinent answers and research for a full analysis of the events surrounding the Bradford riots. However some of the questions would undoubtedly provide more complete levels of data as well as relevant information than other questions concerning the Bradford riots. If answered in full some of the questions would provide enough information to answer the other closely related questions. Indeed some of the less important questions could be used as follow up or secondary questions to the main questions actually being asked. The main questions chosen to gain the most useful information about the Bradford riots would be the following ones: Did the Bradford riots have long-term social and economic causes? Did the Bradford riots have short-terms social and economic causes? (With a possible follow up question of ‘Could the Bradford riots have been accurately predicted?). What role did social factors such as alienation, racial discrimination, and poverty play in causing the Bradford riots? (With the back up question of ‘Why were the local authority, the West Yorkshire Police, and the central government unable to prevent the Bradford riots from taking place?). Are there any lessons that the local authority, the West Yorkshire Police, and the central government can learn from the Bradford riots? And if so should changes be made to prevent further riots in the future? These questions have been chosen as theoretically at least they offer the best prospects of gaining as a wide a perspective of possible of the social and other possible causes of the Bradford riots. The selected questions depending upon how they are actually answered would allow functionalists, Marxist, and structuralism sociologists for example to come up with highly diverse conclusions based on the same data and research information about the Bradford riots. The answers given in response to these questions could and will undoubtedly be interpreted in various ways that may or may not fit in with the different theoretical frameworks of sociology already studied such as functionalism, Marxism, and structuralism. Of course there is a long tradition of the adherents of functionalism, Marxism, and structuralism interpreting data and research information in ways that make their theoretical frameworks appear to be the best method of understanding social events such as the Bradford riots. Thus the proponents of the different theoretical frameworks of sociology would almost certainly argue that their preferred theoretical framework is better than all the other alternative frameworks in explaining and subsequently understanding the Bradford riots. They would also be arguing that their preferred theoretical framework would be the best for analysing entire societies as well as highly specific social events. If answered in full the questions to be asked in relation to the causes of the Bradford riots should provide enough evidence to draw up research findings and also conclusions that fit in with the different theoretical frameworks of sociology such as functionalism, Marxism, and structuralism. However the conclusions would of course vary depending upon which of the different theoretical frameworks of sociology was actually being used at the time. Although there might be some similarity with the social and economic factors believed to have contributed to the causes of the Bradford riots, even if the different theoretical frameworks of sociology will rank such factors in different orders of over all importance. At the centre of the theoretical differences between the different theoretical frameworks of sociology is the issue of causation. Basically deciding whether or not individuals are free to act as they wish, or whether social structures, or indeed whether social and economic factors have the greatest influence in causing or worsening social events such as the Bradford riots. In many respects the Bradford riots are a very pertinent example of a social event that could be used as a case study to enable us to understand the ways in which the different theoretical frameworks of sociology use data and information to come up with evaluations of society. Although the different theoretical frameworks of sociology would all claim to have the ability to fully analyse and also to evaluate whole societies in general as well as specific social events in this case the Bradford riots. For those academics and sociologists that fervently believe in the accuracy and the validity of any specific one of the different theoretical frameworks of sociology then it is harder to accept criticism about those frameworks. Criticism and comments that their preferred theories and the other theoretical frameworks do in fact have shortcomings that can adversely affect the validity of research findings based upon their concepts and theories. Functionalism was one of the different theoretical frameworks of sociology that has the ability to analyse and evaluate the causes of the Bradford riots despite having some serious shortcomings from theoretical perspectives. Functionalism contends that when taken as a whole and also in the case of specific social events are shaped as well as heavily influenced by the inter relationships between individuals, social groups and also social institutions. Functionalism contends those individual beliefs and also social groups such as families or religious communities and social institutions like the West Yorkshire Police, the local authority, and the central government heavily influence their actual behaviours. Functionalism does have the capacity to analyse and to also evaluate the consequences of the interaction between individuals, social groups, and also social institutions. There is a very serious weakness when it comes down the suitability of functionalism for examining the Bradford riots. Functionalism as such does not recognise the possibility of the conflict between individuals, social groups, and also social institutions taking place. A social theory that does not recognise social conflict or struggles is certainly limited in its scope to understand violent events, like riots for instance. Marxism as a theoretical framework does provide some useful methods for analysing and evaluating the Bradford riots, yet it has obvious drawbacks. Marxism generally contends that class divisions as well as social heavily influence societies and economic inequalities that increase the prospects for conflict. Using Marxism as a theoretical framework allows us to understand the part that social and economic inequality as well as poverty played in causing the Bradford riots. Marxism unlike other theoretical frameworks does not recognise racial discrimination as a direct cause of social conflicts, which ignores the possibility that the Bradford riots were partially or completed caused by issues related to race relationships inside Bradford itself. The Bradford riots were also linked with religious issues, most notably the increased levels of alienation and aggression found within young Asian Muslim men in Bradford that felt isolated due to their race as well as their religion. Whilst Marxism is useful because it acknowledges that alienation can be a significant cause of social conflict, it tends to over emphasise the importance of class conflict. In the case of Bradford the issues of race discrimination and race relations are more relevant to the situation leading up to the riots, due to the high ethnic minority population within the city. In those circumstances Marxism’s emphasis upon class conflict does appear to be relevant at all. The theoretical merits of structuralism are that it has the capacity to evaluate as well as examine the various structures and also institutions within contemporary societies, and theoretically at least their impact on specific social events such as the Bradford riots. Over all structuralism actively contends that it is social structures and also social institutions that under normal circumstances the position of individuals within their own societies. The supporters of the structuralism theory go on to contend that individuals within their own societies do not actually have any influence as well as meaningful power over the main decisions and events within their lives. Structuralism as a theoretical framework does tend to stress how important social structures and institutions such as the emergency services, local authorities, education services, and most importantly of all the central government are responsible for providing individuals with opportunities as well as maintaining social stability. The central government and all the institutions and social structures it controls have the capacity to positively improve peoples lives alongside the negative function of punishing those that attempt to overturn existing social structures. It is thus a theoretical framework that stresses the overwhelming importance of structures and institutions in contemporary societies, and how they can solve social problems. Perhaps more importantly how social structures and social institutions can solve social problems if there is the political The main practical and also theoretical shortfall of structuralism is that it underestimates the influence that individuals an d linked small social groups can have over specific social events including the Bradford riots. Individuals and linked small social groups, especially the most alienated and angry ones can cause a great deal of destruction as well as disruption within their local area, or indeed beyond it. Alienated individuals and small groups may be particularly destructive and disruptive when social institutions and structures fail to understand them or underestimate the threat to law and order that they actually pose. Bibliography T. Bilton et. al., Introductory Sociology, 4th edition (Basingstoke: Palgrave Macmillan, 2002). J. Macionis and K Plummer Sociology: A global introduction (Pearson), 3rd edition, 2005 James Fulcher and John Scott’s Sociology (OUP, 2nd edition, 2003) Kenneth H. Tucker, Classical Social Theory. A Contemporary Approach (Oxford, Blackwell, 2002). John Hughes, Peter Martin and W. Sharrock, Understanding Classical Sociology. Marx, Weber, Durkheim (London: Sage, 1995). Pip Jones, Introducing Social Theory (Cambridge: Polity Press, 2003). K. Morrison, Marx, Durkheim, Weber. Formations of Modern Social Thought (London: Sage, 1995). Steven Seidman, Contested Knowledge. Social Theory Today, third edition (Oxford, Blackwell, 2004). Rob Stones (ed.), Key Sociological Thinkers (Basingstoke: Palgrave, 1998).