Nursing Practice and Decision Making 1 – Dementia Scenario

Nursing Practice & Decision Making 1 Essay
June 15, 2021

Nursing Practice and Decision Making 1 – Dementia Scenario

Assessment task:

Students will select a case study patient. The case patient will either be one of the two field specific care scenarios provided on Blackboard or, if agreed with your tutor and managed well in the formative assessment, a patient from practice. Students will continue with the patient selected in the formative assessment for this assignment unless otherwise advised by their tutor.

In the care study students will discuss and critique the decision making processes required in the assessment and delivery of care for their selected patient (3,500 words +/- 10% excluding references).

This will enable students to draw on some of the theoretical perspectives explored during the module so that the learning outcomes are met. The nurse’s role will be an important focus but students will need to demonstrate that they understand the importance of shared decision making in the assessment, planning, implementation and evaluation of care. Although symptom management is an important area additional dimensions are to be considered which can influence how well individuals cope. This will involve addressing psychosocial factors as well as reflecting on how policy in terms of service delivery can promote client centred care.

Service User:
Edith Jones is a 72 year old woman who has a diagnosis of Dementia.

Present situation:

Edith has recently been discharged from an acute hospital following an admission for acute confusion and a UTI. Prior to discharge Edith was assessed by social services who increased the care package to twice daily visits for personal care and domestic help. Edith is under the care of the Older Adults CMHT who see her weekly and are in the process of arranging for Edith to attend a day service twice a week. The carer informed Edith’s son Brian that she is increasingly concerned that Edith is becoming more confused and agitated over the last 2 weeks. Edith often pushes the carer when she is trying to assist her with bathing, and prepared food is often not eaten and sometimes found on the floor. The carer also says that sometimes Edith will speak to her in Welsh and gets frustrated when she doesn’t reply in Welsh.

Personal and social history:

Edith originates from South Wales and is a retired seamstress; is widowed and lives alone with the support of her family and carers visiting once a day. She has one son, Brian, who lives 20 minutes from her and often calls in to see her most evenings. Brian is married and has two children (4years and 6months). Edith was brought up to speak Welsh as her first language and often talks with Brian in the evenings in her preferred dialect.

Medication on discharge:
Rivastigmine

Assessment:
The CPN is visiting Edith and Brian is present.
Mini Mental State Examination Score: 19
Edith is agitated and restless. Her skirt is damp which she says was due to a spilt drink but hasn’t had chance to change. There is half a glass of water on the coffee table.
There are several bruises on her arms and shins, which the son was not aware of. Edith says she got the bruises from doing the gardening.
Edith spontaneously speaks Welsh during the visit.
Edith refers to Brian’s wife as his fiancée and that she can’t wait to have
grandchildren, telling him to hurry up because she isn’t getting any younger. Brian is concerned that his mother has no recollection of her grandchildren and is finding her behaviour very distressing.
Edith refuses to let you do her vital signs.
Edith tells the CPN she has eaten a roast because its Sunday and it’s the family tradition to get together to have a family meal, yet it is Wednesday and there is food left uneaten and a cold pot of tea on the table in the kitchen.

Your reflective care study should include the following:
o An introduction:

o Briefly describe the purpose of the assignment with clearly stated aims and objectives
o Explain how these aims/objectives will be addressed

o A brief background to include:

o Brief discussion of the theory of decision making
o Explain the significance and importance of this topic to nursing practice and/or your development as a student nurse (rationale)
o Set the scene for the case-study and offer a rationale offering evidence regarding the significance of the chosen case-study.
o Present a short summary highlighting the important points of the case study (if choosing a patient from practice, include more detailed information as an appendix. Remember to maintain patient confidentiality and remove any identifiable information throughout).

o The main body of the work should demonstrate an understanding of clinical reasoning and decision making processes applied to the following themes:
 A systematic, comprehensive and holistic assessment of your case patient
 An interpretation and response to the assessment including appropriate symptom management and a plan of on-going care. You must consider any signs of actual or potential deterioration of physical and/or mental health.
 A plan of care and appropriate interventions that promote an environment in which human rights, values, customs and spiritual beliefs of the person and family are respected.

You should be able to support your interventions, plan of care and nursing
practice with appropriate evidence based decisions

Throughout you should:

 Demonstrate knowledge of the health problems as well as possible co-morbidity, relevant to your case patient
 Where appropriate demonstrate shared decision making with users, carers and other health care professionals
 Present relevant arguments to support the clinical decisions made
 Identify any strengths/weaknesses of the decisions made

o A conclusion:

o Summarize the main point of this assignment. Pulling out the main points from your essay
o Identify any implications for practice and/or identification where more evidence (research) is required to inform best practice.
There will be a more detailed assessment guide on blackboard. Go to the assessment section.
Weighting: 100%

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