Holistic Professional Nursing Capstone
The considered aggregate of this professional nursing capstone project is the elderlies who live in Providence (RI). Since it is impracticable to interview all the senior citizens of the town, a special working group of 5 people was assessed. Therefore, a care plan of the health care interventions was elaborated according to their health risks and nursing diagnoses. The final stage of the project was devoted to implementing this plan and evaluating its efficiency. As a result of the performed work, it is worth stating that the developed health care plan proved to be productive and managed to reduce some health risks of the aggregate, so the purpose of the capstone was reached.
Summary of MAP-IT
The MAP-IT (Mobilize, Assess, Plan, Implement, Track) framework has been a powerful instrument for the development of the project at all the stages. The first Mobilize phase was devoted to forming an aggregate of the elderlies from Linn Health Care Center, determining and discussing their health states. The Assessment stage of the project included the evaluation of the aggregate’s health risks, namely the negative consequences of diabetes and hypertension, and preparation of the care plan by phases. The Implementation and the Track stages of the capstone demonstrated how the plans were applied and evaluated their effectiveness correspondingly. The stages of the MAP-IT are unchangeable, as the system is useful for working with any kind of aggregate of any size. The latter may just influence the number of the organizations involved and interventions implemented. In order to evaluate the effectiveness of the project, each stage of MAP-IT will be considered separately.
Mobilize. Identification of Aggregate
The discussed aggregate of the elderlies consists of 5 people – N. (65 years old, male), M. (67 years old, female), L. (65 years old, male), P (68 years old, male) and S. (70 years old, female). The elderlies reside in the Linn Health Care Center, even though they regularly communicate with their families. In detail, N. and M. both have diabetes type II, but while N. was diagnosed with it 5 years ago, M. has been already suffering for eight years. S., L. and P. have hypertension. S. and L. found out about their health because of having continuous headaches and feeling weak. P.’s state was revealed by chance, in the course of the regular medical examination, which makes the disorder even more dangerous. The elderlies came to the Center as they hoped to get the corresponding nursing assistance to prevent the health risks. They were chosen as a control group for the project as their health states revealed the most common health problems, which the elderlies of Providence have.
Assessment of Aggregate
The considered aggregate had certain strengths and weaknesses. Thus, its main strengths included: (1) the elderlies lived in Linn Health Care Center, which is one of the best nursing homes in RI; (2) they had financial support from their relatives as the prices for health care in the Center are not low; (3) the conditions of a nursing home gave each participant of the control group a chance to have an access to prompt medical aid; (4) a team of nurses kept track of the patients’ health state and communicated with their families who assisted not only financially, but morally as well; (5) the Division of Elderly Affairs of RI was ready to satisfy all the needs of the elderlies in the sphere of health care and offer new programs. There were much fewer aggregate weaknesses, but they existed. First, the geographical location of RI make this region vulnerable to natural disasters: “Providence and Warwick, which are among those at the top of the list, are both larger in population size and economic activity than most other communities, and also are situated along the state coastline, putting them at a higher risk for natural disasters, such as a hurricane” (Beale, 2013, para. 6). Actually, the region may also suffer from tornados, storms and heavy snowfalls, so the elderlies are at risk of not having an emergency kit with all medications ready. Second, the plants and industrial enterprises in RI had polluted the environment that consequently had a negative influence on the patients’ immunity and contributed to the development of some diseases (for example, asthma, which is common for the area). Third, before applying to Linn Health Care Center, the elderlies did not have any proper education about their health states and did not observe any preventive rules. Thus, the strengths of the aggregate should be developed and exploited, while its weaknesses had already become a burning issue for the entire region.
The diagnoses of the elderlies from the considered aggregate, namely diabetes and hypertension, allowed the nurses and physicians assess the risks for the control group. Thus, the diabetes patients may develop different types of complications, affecting their kidneys, eyes, feet or teeth, whereas the greatest risk for hypertension suffers is a stroke. Surely, the unfavorable ecological situation in the area may accelerate the development of the enumerated complications. Therefore, certain preventive measures were needed for the elderlies to feel better and avoid negative revelations of their states.
As the doctors’ diagnoses of diabetes and hypertension were already determined, it was important to discuss some nursing diagnoses on the basis of the revealed symptoms. The nursing diagnoses of two aggregate members, N. and M., suffering from diabetes, included “imbalanced nutrition less than body requirements related to reduction of carbohydrate metabolism due to insulin deficiency” (“Nursing diagnosis for diabetes,” 2012, para. 5) and “fluid volume deficit caused by insufficient hydration” (“Nursing diagnosis for diabetes,” 2012). The nursing diagnosis of hypertension suffers included: “risk for decreased cardiac output related to increased afterload, vasoconstriction, myocardial ischemia, ventricular hypertrophy” (“Nursing diagnosis intervention,” 2012, para. 2) and “acute pains caused by elevated blood pressure” (“Nursing diagnosis intervention,” 2012). Therefore, the assessed risks were serious and needed urgent interventions.
Planning. Plan of Care
A plan of care for each member of an aggregate should be individualized. Taking into consideration the fact that two aggregate members had diabetes type II and three other members suffered from hypertension, there were some similarities in the care plans developed for them. It is important to understand that taking medicine under supervision of the nurses is not enough for receiving a positive, healthy outcome, since diabetes and hypertension condition the lifestyle of people not depending on their wishes. Hence, the care plan form would demonstrate interventions were necessary for all the elderlies to avoid health risks and their features specific to the differences in the diagnoses.
|Desired Outcome||Evaluation Criteria|
|Decreasing weight of the elderlies with diabetes, increasing weight of the members with hypertension||Imbalanced nutrition, unhealthy diet, fluid volume deficit||Performing assessment, consulting the physicians to elaborate a healthy diet (individual for diabetics and hypertension suffers, based on reducing sugar and sodium consumption correspondingly)||Physical activities (from 1 to 2 hours walking, taking into consideration the age of the members), regular weight measuring, healthy diet||Stable vital signs, good skin quality, normal weight||Healthy looks, the elderlies being active and not overweight|
|Lack of diabetes and hypertension awareness||Consumption of unhealthy food, no balance between the physical activity and the periods of rest, uncontrolled medicine intake, acute pains||Evaluating the current state of the patients and the mistakes related to healthy diet and physical activities in the course of their treatment||Determining the patients’ diet and coordinating it with the food they may consume, informing the patients about the preventive measures and communicating with their families on the matter||Normal energy level, stable or moderately increasing weight, consumption of the preventive medicine||The elderlies feel good and have no revelations of any symptoms|
|Lack of coordination between the institutions engaged in treatment, family health history not taking into consideration||Risk of not being aware of some innovative treatment strategies that prove to be effective||Preparing a health report based on family history, inviting the specialists from other centers for exchanging experiences||Keeping track of weight, blood pressure, heart rhythms and other indices necessary to evaluate the health state of the patients||Reports of normal state of health without pains or anxiety as a result of treatment modification and specialist advice||The patients look healthy, commune with the invited specialists, are aware of numerous aspects of their treatment|
The process of the care plan implementation has passed without any problems. The first two presented assessments needed three different interventions to be implemented to reduce the health risks. Being overweight puts a real danger of unexpected stroke for hypertension suffers, if some measures are not taken. Unhealthy diet for diabetics leads to the fact that their blood sugar level interferes with the normal functioning of their organs that can lead to serious complications. The nurses can implement the interventions of normalizing a healthy diet in accordance to physicians’ advice, promoting physical activities for them by spending some time with the patients, measuring their sugar level and blood pressure, walking with them, teaching and performing all other necessary actions. They will speak with the Center’s food providers in order to give them some instructions as to the necessary food components that the patients need. Moreover, the nurses will stay in contact with the family members and teach them how to take care of their elderlies at home in order to avoid the development of the complications and the health risks. The resources needed for the discussed implementations include the statistical data concerning hypertension and diabetes treatment from the Rhode Island division of Elderly Affairs, scales, record charts for indicating the changes in weight of the patients, any other objects needed for practicing physical activities (can be received from the patients’ families). The nurses will also have to print paper materials and handouts for all the elderlies and their families to have the most important guidelines at hand. Therefore, the implementation of the major interventions of the discussed care plan is a complex task and it is good that the elderlies stay in the conditions of a professional medical institution to facilitate this process.
The evaluation of the effectiveness of the discussed measures may be performed by the expressed positive or negative attitude of the elderlies and by the results observed by the nurses. Thus, all members of an aggregate expressed approval of the proposed interventions and followed the nurses’ instructions. As a result they reported a change in the conditions of the medical center. They found a balance between moderate physical activities and the periods of rest, and felt a positive influence of this combination on their health states. There were no objections expressed by the elderlies to a necessity to follow a healthy diet. They stated that they felt much better, consuming the food that was useful for them. Accordingly, healthy teaching proved to be effective.
The elderlies did not know about the simplest details of their states before the nurses’ lectures started. They confirmed that if they had known about some hidden symptoms of their states before, they would have taken some preventive measures earlier. The most important thing is that the patients verbalized a desire to lead a full life and see their families more often. The medical tests confirmed that their weight, blood pressure and heart rhythms stabilized, and the implemented changes in their treatment that were conditioned by the recommendations of the specialists from other centers were effective. The productivity of the interventions made the nurses think more about how to create better conditions for physical activities and find more food providers with the high quality of the healthy products.
In conclusion, it is important to state that this capstone project and its implementation were useful for the considered aggregate. Diabetes and hypertension are common health problems of the elderlies in Providence (RI) and a developed care plan for the aggregate can be applied to all individuals who have similar status and live at home. The realization of the plan was mostly successful, but more time was needed to see all of the outcomes. In order to effectively implement the developed care plan for all Providence elderlies, RI governmental authorities should cooperate with the hospitals in the area in the face of their nurses and provide all the required resources.