Nursing Goals and objectives Goal: Design of the nursing system: Explore the past experience of pain and methods used to manage them.
Now that she is cleared for discharge and her son arrives to drive her to her apartment, how well do you anticipate Mrs McCarthy will care for herself at home? This issue of Critical Care Nurse highlights the concerns of monitoring and neuro-trauma.
As every critical care nurse knows, an essential aspect of care for any acutely ill or injured patient—particularly one suffering from neurologic trauma—entails close, continuous assessment of numerous clinical parameters.
In addition to patients with known neurologic deficits, however, many other critical care patients incur perhaps less dramatic, but still noteworthy impairments that have the potential to prolong, impede, complicate or completely preclude their ability to fully recover.
As long as these patients are hospitalized, their limited abilities to take care of themselves at home may not be recognized. For some, those impediments may be apparent only after they are prematurely readmitted in a deteriorated state rather than in the stage of recovery they should have attained.
Some of the issues that need to be considered in this effort include clarifying what constitutes self-care, identifying factors that may affect self-care, recognizing patients at risk for self-care deficits, and specifying the clinical parameters to include in an assessment of self-care capacity.
Examples will focus on 2 prevalent critical care patient groups: For healthy individuals, self-care encompasses eating a balanced diet, exercising regularly, getting adequate sleep, and avoiding high-risk behaviors such as smoking.
When individuals become critically ill or injured, however, the potential scope of self-care activities they may need to assume after hospital discharge could expand far beyond taking prescribed medications to sampling and interpreting their own blood or urinary laboratory values, changing dressings, administering parenteral nutrition, monitoring and adjusting fluid and dietary intake and output, and suctioning their airway.
Orem 1 referred to these influences as basic conditioning factors: When health changes occur, the ability to make necessary adaptations to those changes is influenced by a wide range of variables that include understanding the changes necessary, the readiness and motivation to change, and the motor and sensory abilities to execute those activities.
Actual performance of self-care behaviors was subject to factors as diverse as age, race, gender, income, living conditions, and symptom severity in addition to knowledge of self-care for HF. In its standard for assessment of hospitalized older adults, the Hartford Institute of Geriatric Nursing 3 identifies the following coexisting conditions as risk factors for functional decline: Many of these risk factors are experienced by HF patients eg, use of medications with significant side effects, limited mobility, depression, cardiac cachexia.
More specifically, Riegel et al 6 found that poor self-care in HF patients is associated with the following factors: Cameron et al 7 found that even a mild degree of cognitive impairment represented one of the single most influential contributors to diminished capacity for self-care.
Some risk factors were more clearly discerned when researchers asked HF patients why they did not respond when significant symptoms first appeared; that telling list of risk factors encompassed 8: Previous Section Next Section Parameters to Assess to Estimate Self-Care Capacity When so many diverse influences need to be considered to gauge whether patients will be able to complete the necessary self-care activities, it becomes a challenge to distill these considerations into a list sufficiently inclusive yet as brief as possible to make its utility feasible for busy critical care nurses.
With these prerequisites in mind, I have drafted a single-page checklist of parameters identified in the literature as relevant to self-care capacity. The activities in this checklist see Figure cluster around universal aspects of self-care and others common and specific to geriatric and HF populations.
When the patient needs assistance by another person, the checklist provides a location for identifying who will be lending that support.The self-care agency and self-care demands are important contributors to maintain well-being of an individual.
Increase in self-care demands require nursing agency to work for the patient to help an individual to achieve self-care. Orem’s 1 theory of nursing, often characterized as the self-care deficit nursing theory, 2 describes self-care as comprising all of the voluntary activities that individuals undertake in order to maintain their health, life, and general well-being.
For healthy individuals, self-care encompasses eating a balanced diet, exercising regularly. In the self-care deficit theory, the importance of nursing is highlighted because humans have limitations to performing self-care. In the nursing systems theory, the nurses use the nursing process to meet the healthcare needs of individuals as well as developing their capabilities in self-care (Taylor & Renpenning, ; Hartweg, ).
I am a first year nursing student in my first semester. We have a care plan due and I am having problems coming up with Goals, outcomes and interventions for my nursing Dx- Self care deficit rt cognitive decline AEB inability to perform ADL'S.
The theory of nursing systems describes how the patient's self-care needs will be met by the nurse, the patient, or by both. Orem identifies three classifications of nursing system to meet the self-care requisites of the patient: wholly compensatory system, partly compensatory system, and supportive-educative system.
Determine the aspects of self-care that are problematic to the patient. The patient may only require assistance with some self-care measures. Assess specific cause of each deficit (e.g., weakness, visual problems, cognitive impairment).