Importance of Nursing Assessment Procedure in Providing Holistic & Evidence-Based Care

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Importance of Nursing Assessment Procedure in Providing Holistic & Evidence-Based Care

Introduction 

As explained by ray (2016) the first and most crucial part of the nursing process, in delivery of effective care, is the assessment of patients. This refers to the collection of appropriate and adequate data pertaining to the social, physical and mental health of the patient to devise an appropriate care plan. The process itself incorporates a variety of methods, techniques and strategies. As it requires the collection, management, and evaluation of detailed information about the patients, the process implies comprehensive detailing and extensive implementation to assist in care planning effectively. Effective communication, history collection, pain assessment, evaluating mental stability and well-being, vital signs assessments, etc. are all included in the assessment process (Kaakinen et al. 2018). Another study by Toney-Butler and Thayer (2019) explains that nursing assessment is a highly essential part of effective holistic and person-centred care. As it enables healthcare professionals and cares to provide a team to develop comprehensive knowledge about different aspects, needs, and requirements of patients, another important aspect of care provision is the incorporation of effective evidence-based practices. 

It is explained as a nursing approach that focuses on critical thinking, evaluation and incorporation of certified and best-suited practices to ensure the optimal patient's health and satisfaction outcomes (Baldwin et al. 2016). In this regard, the essay aims to discuss implementing effective evidence-focused nursing assessment to Tom, to guide adequate person-centred and holistic care. The essay, in this regard, would explain the pathophysiology of Dyspnea and Hemiplegia. Further, the essay would discuss the nursing assessment of pathophysiological (dyspnea), psychological (hemiplegia/depression) and social (lower self-esteem) conditions of Tom. 

Case Overview

The essay discusses the 75-year-old Tom, a pre-medical history of Stroke, Cardiac Obstructive Pulmonary Disorder (COPD), and atrial fibrillation. However, the patient is suffering from right-sided hemiplegia and has been recently complaining about the shortness of breath since the previous night, with clear thin sputum. The patient has been a consistent smoker with smoking 20-30 cigarettes a day, until stroke. The social-historical aspects highlight that he is a retired miner, and has lived in the rocky street nursing since a year. Regarding the given information, the assessment is based on evaluating the physical health aspects, specifically hemiplegia and shortness of breath and its impact on the patient's physical and mental well-being. Similarly, while conducting the assessment, consideration would be given to COPD and Stroke to better insight into the severity and impact of the disease on Tom's well-being and develop an effective care plan.Pathophysiology of Shortness of Breath

Pathophysiology of Shortness of Breath

According to Mahler (2017), shortness of breath, also known as dyspnea is a stressing and deteriorating health condition that is a major cause of more than half of the emergency hospital admissions. Another study by Brij et al. (2016) suggests that shortness of breath, is most commonly not regarded as a sign, and it is rather a symptom, that patients often experience subjectively. It is further added that the condition may originate from different physiological, environmental and social factors and responses. The study by Maksimović et al. (2020) explains the condition's pathophysiology as the outcome of severe physiological impairment and is an expected result of serious homeostasis. The condition majorly results from dysfunction of the body's respiratory or cardiovascular conditions due to psychogenic malfunction, neuromuscular disorders, and metabolic imbalances. 

Another study by Sanchez et al. (2017) explains that the apparent conditions included in shortness of breath include increased muscle activity to maintain respiration, muscle tightness resulting from air hunger, increased blood pressure, and heart rate a result of subjected pulmonary ventilation. It is further stated by Maksimović et al. (2020) that the improper functioning of the body in the form of alienation between respiratory drive and pulmonary ventilation is the outcome of functional disparity of the receptors within the respiratory airway, chest wall structures, and lungs. It also includes the dysfunction of the respiratory motor activity that ultimately results in a reduced exchange of gases through the acid-sensing ion channels, lung receptors, and mechanoreceptors. Furthermore, as per the study by Mahler (2017), the three major components that contribute to shortness of breath include efferent signals, afferent signal and central information processing unit. The condition is the result of the analysis of the central processing unit that compares the two signals to evaluate the similarity. 

The study suggests that when the afferent and efferent signals do not match, the need for respiratory ventilation is not equal to the physical breathing. This results in dyspnea development, which ultimately increases the respiratory rate and reduces the oxygen saturation in the blood. A study by Anzueto and Miravitlles (2017) explains that shortness of breath is a common health condition in people with mild to severe COPD. The condition is commonly developed among patients as an outcome of the emphysema and chronic bronchitis. At the same time, it is also suggested that the condition is relatively common in patients experiencing an acute exacerbation of COPD flare-up. COPD flare-up is defined as the sudden development and severity of the COPD symptoms. This may include shortness of breath, inability to move and walk, feeling tightness in chest and inability to talk properly, etc.

A study by O'Donnell et al. (2020) suggests that as patients with COPD has damaged lungs that are not functioning appropriately, dyspnea is a common health condition.

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Pathophysiology of Hemiplegia

A study by Eyong et al. (2020) explains hemiplegia as the condition of muscle paralysis in the lower face, legs and arm on one of the sides of the body. The condition most commonly occurs due to the corticospinal tract damage in one of the brain's hemispheres. Marque et al. (2014) explains in a study that the corticospinal tracts spread from the lower side of the spinal cord and grow up to the cerebral cortex. Furthermore, the spinal tracts then intersect in the brainstem, because of which, the damage and dysfunction of the right hemisphere result in paralysis of the left side of the body. Therefore, in this regard, as Tom was suffering from right hemiplegia, it can be highlighted that patient was suffering from damage to the left hemisphere. In addition to this, 

Burke et al. (2013) also state that hemiplegia paralysis is the outcome of reduced activity and damage of the corticospinal tracts' motor fibres that originate from the brain and moves down to the lower spinal cord. The condition's significant symptoms, dependent on the severity of onset, include muscle weakness or stiffness resulting in reduced mobility, increased muscle spasm, reduced functioning of motor fibers, reduced walking, and inability to maintain balance or hold objects. Furthermore, Li et al. (2018) study that the several causes of hemiplegia include trauma such as brain tumours, brain infections, and spinal cord injury. The major and most common cause hemiplegia is stroke, which reduces the brain's functioning and ultimately results in brain damage. Therefore, the suspected reason for right hemiplegia in tom was the persisting Stroke, in the last one year. 

Eyong et al. (2020) study that stroke is a biological process resulting from the interaction between neurons, vascular cells, matrix components, and Gila that have an important role in tissue injury and repair. Stroke is the neurological disease, that has a complex inclusion of excitotoxicity, oxidative damage, inflammatory pathways, ionic imbalances, and neuroprotection. The disease has been the major and second leading cause of death and disability (Beyaert et al. 2015)

Pathophysiological Nursing Assessment 

A study by Bailey (2012) mentions that the shortness of breath in a patient, severely attacks the four major factors, that must be assessed while the provision of effective care, which include;

1. Identification the need for increased exchanges of gases

2. Resistance in airway

3. Altered pulmonary activity

4. Altered lung functioning and elasticity.

Similarly, another study by Brij et al. (2018) adds that to assess the presence and severity of shortness of breath in patients, the healthcare workers may evaluate the inability to speak, hypoxemia, chest auscultation, tachycardia, and diaphoresis etc. Therefore, to assess Tom's symptoms, the A-E approach was undertaken to evaluate the severity of the shortness of breath. The Resuscitation Council (2015) highlights that the A-E approach is useful in identifying and evaluating the vital signs and undertaking the patients' initial assessment. At the same time, Soltan and Kim (2016) suggest that the major aim of the approach is to identify and alleviate the life-threatening health conditions of the patient, for further health assessment and care plan. The implementation of the A-E approach for Tom, highlighted that reduced ability to talk properly, i.e., t Toms, was conversing using short sentences.

However, his speech was clear. Secondly, He had an elevated respiratory rate with 24 breaths per minute, reduced oxygen saturation level to 87%, and an unmistakable wheezing sound upon excretion. As mentioned in the study by Nishiyama et al. (2013), dyspnea in patients significantly results in hypoxemia, which is defined as the lack of oxygen supply to the blood vessels and tissues in the human body. The implementation was kept central to provide better assistance and develop an appropriate plan for Tom, to improve the person-centred care provision.

In addition to this, to further evaluate the presence of shortness of breath, An Electrocardiogram (ECG) would be conducted. A study by van Riet et al. (2014) explains that to study and evaluate the severity of shortness of breath, with an assessed presence of mild symptoms, ECG can be helpful. The study adds that ECG helps evaluate the heart conditions, activities and functioning as a result of shortness of breath. At the same time, another study by Berliner et al. (2016) suggests that breathlessness is, significantly present in severe heart conditions such as heart failure or heart attack. As the condition has a serious impact on heart performance and functioning, it is essential to conduct an ECG. Therefore, further evaluation for Tom would include ECG evaluation.

Psychological Nursing Assessment 

Li et al. (2018) suggest that nurses must acknowledge mental and emotional support to patients an integral part of providing effective nursing assessment and care. This may include effective assessment and cater to the underlying issue. Another study by Burke et al. (2013) also supports that psychological and psychosocial nursing assessment of a patient improves the provision of holistic and patient-centred care to improve their mental, emotional and psychological wellbeing.

In this given context, Tom was assessed for the delivery of effective psychological care and support. This was based on assessing depression and anxiety due to reduced mobility and paralysis due to right hemiplegia.  A study by Vasudevan and Browne (2014) suggests that people, specifically men with hemiplegia, experience difficulty mobility and speech, with persistent seizures. This not only impacts the physical wellbeing and stability of people; however, it also reduces the mental and emotional solidity and self-esteem of the patients. Another study by Gamarra et al. (2020) also adds this negatively impacts the physical wellbeing and appearances as well as fitness and physique of the patients. the study also mentions that it is a common perception that people with evident disabilities are significantly considered as weak, helpless and incapable of performing any tasks. In this regard, to effectively and comprehensively assess the presence and severity of depression and emotional illness in Tom, PHQ-9 tool was undertaken. The Patient Health Questionnaire-9 is a score-based assessment tool that is based on nine simple and concise questions. 

The questions are appropriately designed to assist healthcare and medical professionals to identify the persistent signs and symptoms of depression. As per the study by Dajpratham et al. (2020), the tool's use helps identify the presence, subjectivity, and severity of depression based on score rating. Another study also explains that the tool is easy and convenient to understand, use and interpret, provides better results in developing an appropriate care plan (Manea et al. 2012). Another tool used to assess the psychological illness and a separate mental issue was the Generalized Anxiety Disorder -7. GAD-7, as explained by Spitzer et al. (2016), is the commonly used assessment tool to identify the subjectivity and presence of common mental health issues such as anxiety and depression. The assessment tool results' cut-off points are 5 for mild, ten moderate and 15 and above for the presence of severe anxiety (Teymoori et al. 2020). 

Social Nursing Assessment

As mentioned in the study by Touchton and Wampler (2014), social strength and well-being are highly essential for individuals' emotional and physical health. This includes independence, social inclusivity, healthy relationships with friends and family members, and sufficient surroundings and living environment. Similarly, Blomberg et al. (2016) suggest that the provision of effective holistic care is integral to adequate consideration and acknowledgement of the patient's social well-being factors. This improves the quality and expertise of the care and enhances the person-centeredness as nurses and care providers focus and deal with all relevant aspects of health. In the given scenario, it was highlighted that Tom was living in a nursing home for eight months, was often visited by his son and could be suffering from emotional distress. In addition to this, as the patient was a retired miner worker and was involved in consistent smoking, he could have been suffering from serious social distress and issues. A study by Laganà et al. (2017) suggests that depression and anxiety and reduced mobility also result in social distancing and independence issues. 

Therefore, to effectively and comprehensively assess Tom's persisting social issues, the implemented assessment method was based on developing effective verbal and non-verbal communicative relations. A study by Strandås and Bondas (2018) explains that developing a trusting and healthy communicative relation, both verbal and non-verbal, helps nurses develop a nurse-patient relation and improves the provision of person-centred care (Feo et al. 2018).  It also helps nurses and healthcare professionals get a better insight into the patient's emotional, mental, and physical needs, expectations and perspectives. While Little et al. (2015) also highlights that effective nursing assessment to improve mental, emotional and psychological wellbeing, majorly includes developing effective verbal and non-verbal communication.

In this context, to get a better insight and appropriately assess Tom's social and emotional needs. The development of therapeutic relations and effective communication was undertaken to provide increased assistance to significantly assess the patient's needs through their behaviour, views, facial expressions, mood swings, and choice of words.

Conclusion

The essay aims to highlight the importance of nursing assessment procedure in providing effective holistic and evidence-based care. The essay explains that nursing assessment, being the first and crucial step in the nursing process, effectively devises a comprehensive and person-centred care plan. As nursing assessment is highly essential for delivering effective evidence-based practices, the essay also explains the importance of evidence-based practice. It is the process of incorporating relevant, professional and clinically effective interventions to ensure comprehensive care delivery. While the paper focuses on highlighting the provision of assessment, the essay incorporates Tom's case study to explain the process.

In this context, the paper has first explained the persisting health conditions of the patient, i.e., shortness of breath and Hemiplegia. The pathophysiology highlights that shortness of breath is a common condition and symptom of a patient suffering from COPD. In contrast, patients with a history of stroke are at an increased risk of developing hemiplegia. Further, the essay details the assessment of pathophysiological, psychological and social aspects of care. This includes assessing the presence of shortness of breath and its impact on physical health, depression and anxiety as an outcome of hemiplegia, and social inclusivity, independence and self-esteem as social aspects.

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