STEP #3: Care Like a Nurse by Providing Holistic Care Holistic Care: 1. Integrate caring, empathy, engagement, and presence while providing care 2. Care for the entire person (physical-emotional-spiritual) 3. Identify educational and psychosocial needs 4. Determine psychosocial PRIORITY and plan of care History of Present Problem: JoAnn Smith is a 68-year-old woman who presents to the emergency department (ED) after having three days of progressive weakness. She denies chest pain, but admits to shortness of breath (SOB) that increases with activity. She also has epigastric pain with nausea that has been intermittent for 20-30 minutes over the last three days. She reports that her epigastric pain has gotten worse and is now radiating into her neck. Her husband called 9-1-1 and she was transported to the hospital by emergency medical services (EMS). Personal/Social History: JoAnn is a recently retired math teacher who continues to substitute teach part-time. She is physically active and lives independently with her spouse in her own home. She has smoked 1 pack per day the past 40 years. JoAnn appears anxious and immediately asks repeatedly for her husband upon arrival. What data from the PERSONAL/SOCIAL history are RELEVANT and must be interpreted as clinically significant by the nurse? RELEVANT Data from Social History: Clinical Significance: - smokes 1 pack of cigarettes a day for past 40 years. - JoAnn appears anxious and immediately asks repeatedly for her husband upon arrival. - physical activity. - modifiable risk factor and could relate to blockage to arteries. -absence of her husband could be contributing to pt’s anxiety., - could promote pt’s ability to recover. Put it All Together and CARE Like a Nurse! 1. Based on your identification of RELEVANT clinical data, is a psychosocial concern present? Yes. 2. If a psychosocial concern is present, what is it? Inability to cope with diagnosis. 3. How does the psychosocial concern contribute to the primary medical problem or disease progression for this patient? increase in respiration/HR/anxiety. 4. What are your PSYCHOSOCIAL nursing PRIORITY (ies)? - education, - ativan, - breathing exercises, - bed positioning, - contact spouse,- incorporate social support in discharge plan. © 2016 Keith Rischer/www.KeithRN.com 5. What holistic interventions will you initiate based on this psychosocial nursing priority? Nursing Interventions: Rationale: BASIC CARE/COMFORT: -positioning- facilitates breathing. -reduce stress -breathing exercises - reduces HR and brespirations. Expected Outcome: - anxiety subsides - HR and respirations are reduced. EMOTIONAL: - contact spouse - support groups (discharge) -therapeutic communication - anxiety subsides - pt will be able to better cope with diagnosis upon discharge SPIRITUAL: - religious and cultural consideration - contact wellness services at hospital - promote patients ability to cope with diagnosis. 6. What principles of therapeutic communication will be needed to encourage dialogue between the nurse, patient, and/or family? - Trust, - respect, - understanding, - empathy, - honesty, - cultural/spirutual sensitivity. 7. What educational priorities will be needed to develop a teaching plan that will impact disease progression for this patient and/or family? - Patients readiness to learn. - Smoking cessation. - Continuation of activity. - Speaking to a dietician. - Recognizing S/S of anxiety. - Adhering to meds. - Setting checkups with doctor. 8. How can the nurse assess the effectiveness of teaching with this patient? - Pt shows up to appointments. - Demonstrates ability to take medications.- Verbalizes understanding using teach back method. - Verbalizes intent to smoking cessation. - Pt speaks to a social worker about rehab placement. 9. What is the patient likely experiencing/feeling right now in this situation? - Anxiety/Fear. - Sensory overload. - Denial. Lonliness. 10. What can you do to engage yourself with this patient’s experience, and show that he/she matters to you as a person? - Maintain eye level eye contact with patient. - Show empathy. - Ask open ended questions. - Open body language. © 2016 Keith Rischer/www.KeithRN.com
