Foundations in Professional Practice

Foundations in Professional Practice
Experience of inter-professional Collaboration in your
area of clinical practise

The aim of this essay is to identify a client or patient in which to focus upon, in order

to be able to maximise their health. The essay will focus on the health and wellbeing

of the client rather than the disease or illness. It will look at the Physical,

Psychological, Spiritual and Social needs of the client and their family. The essay

will focus on the nurse??™s role in the Assessment and planning of the patient??™s health

and wellbeing. The patient will be reviewed holistically. It will also identify the

importance of health promotion and how it can help to maximise a patient??™s health

and wellbeing.

In order to consider maximising health it is first necessary to define the meaning of

health itself. The world health organisation (WHO1984)` defines health as, a state of

Complete physical, mental and social wellbeing, not merely the absence of disease

of infirmity`. However, Amitai Etzioni (1998) argue that health cannot be defined as

a state at all, but must be seen as a process of continuous adjustment to the changing

demands of living and the meanings we give to life.

The client will be referred to as Mrs Jones for the purpose of the assignment, this

name is minimised to confirm to the NMC (2008). Mrs Jones is a 43 year old lady

admitted into hospital with chest pain and shortness of breath. On assessment it

appears she suffered a heart attack also known as a Myocardial Infarction (MI). She

has just recently been diagnosed with coronary heart disease and angina within the

last 6 months by the specialist cardiology team at her local trust.


Mrs Jones has a family history of heart disease and diabetes, her mother died 2 year

ago following a heart attack. She currently takes medication to help control angina.

She is currently overweight and has been a heavy smoker for the past 29 years. Mrs

Jones is a single parent of 2 children aged 12 and 15 and is currently a full time

cleaner for a children??™s care home.

To assist us in the assessment of Mrs Jones we have entered into a systematic

approach to care using the nursing needs process. this is described as Planning,

Implementing, and Evaluation. This is seen as a problem solving framework of care,

clinical in nature and when used in nursing practise will result in competent nursing

care. This was used in conjunction with the Roper, Logan and Tierney model of

living, which states there are 5 components in the models of living(Roper, Logan

and Tierney 2003)which include activities of living (AL`s)lifespan, Dependence/

Independence, Factors influencing the(AL`s)Biological, Psychological, Social

Culture environment and political economic)individuality in living.

Assessment is the first stage of nursing care, which is defined as the first stage of the

nursing process in which data about the patient??™s health status is collected and from

which a care plan may be devised (Oxford Dictionary For Nurses 2003). To able to

consider maximising Mrs Jones health and social wellbeing it is first necessary to

identify and assess her using the Roper, Logan and Tierney Model(1996).


This model uses the activities of living as a framework to establish any problems or

potential problems which also require nursing care. The 12 activities of living

include breathing, eating and drinking, eliminating personal cleansing and dressing,

controlling body temperature ,mobilising, working and playing, expressing

sexuality, sleeping and dying. These activities, outlining both the norm for the

patients as well as any changes that may have resulted from previous changes in

there condition, to provide effective care to the patient needs the author will be

assessing the patients specific abilities and preferences relative to each activity.

How this model was applied to Mrs Jones was through the nursing process, the

nurses assessed her and highlighted that eating and drinking be one of them obesity,

mobility because shortness of breath and to maintain a safe environment because of

pain, death and dying because of worries of her future. The other activities she

remains self caring. For the purpose of this assignment, the author will focus on

eating and drinking in terms of her weight management.

Assessment the nurse weighed Mrs Jones by using the necessary equipment on the

ward, the nurse assisted her from her bed onto the seated scales Mrs Jones her height

was documented and this lead on to a nutritional assessment score which was low

risk. However because she wasn??™t malnourished their nutrition assessment does not

account for obese patients, Mrs Jones(BMI)was 45 Planning will be a referral to the

dietician however before they come the nurses can focus on a food chart, monitor

intake, weekly weights, fluid balance, low fat sweets.

Implementing, when the nurse come on duty food chart wasn??™t completed and

therefore problems at this stage evaluation as not worked and therefore needed to

feedback at handover to staff to ensure completion, once this was done the

implementation was more successful.

The Dietician come and give advice, however nurses provided care initially as well

assessing the patients health status, it is important to determine the dietary patterns

and average food intake before nursing problems can be fully identified and

interventions planned. the nurse identified all food and drinks consumed in the past

24 hours, including times of meals and snacks, methods which Mrs Jones prepared

her food and circumstances under which food was consumed.

The nurse would also like to know an estimate of the quaintly of foods eaten, using

familiar measures(e.g three egg sized potatoes, etc)details about specific types of

food consumed for example type of milk(whole or skimmed)food preferences or

dislikes, food allergies strengths or lack of appetite this is why the nurse have put a

food chart in place.

Depending on the information obtained from the health and dietary histories and

physical examination it maybe deemed useful to carry out blood and urine studies as

these can reflect changes in the metabolism of carbohydrates in the proteins and

fats (DoH 2000)and maybe used to determine the level of vitamins and minerals. The

nurse will , carry out urinalysis routinely which may reveal the presence of glucose

or ketones, (DoH 2000).


Mrs Jones was happy to discuss with the nurse the need to achieve and maintain a

normal bodyweight as this may facilitate lowering of blood pressure (

nurse discussed with the patient that reduction of sodium intake is likely because

excess sodium expands intravascular volume and aggravates hypertension(

the nurse recommend a no salt diet and also discussed with the patient a plan, of

regular exercise a physical activity is also a beneficial strategy to achieve and

maintain a satisfactory weight.

It is essential that Mrs Jones (with consent) and the dietician work together to
agree and ? set an achievable diet plan for both her and her family. Primarily
the dietician will look at Mrs Jones current eating habits, food preferences, allergies
and also family meal patterns.? She will also look at Mrs Jones economic and social
factors such as access to supermarkets and her financial circumstances. This is so
that the dietician can help Mrs Jones to achieve a diet suitable for both her and her

During assessment it was noted that Mrs Jones finds it difficult to eat healthy
as she finds it expensive and time consuming.? Hodder Arnold (2005)
suggests that `people living on a low income often have many demands and
nutrition is not always top priority`.? The department of health (2004) suggests
that coronary heart disease is more prevalent in lower social classes.?  ? 
Mrs Jones states; that due to her busy lifestyle she does not have much time
to prepare and cook healthier meals, so therefore eats cheaper processed
foods . 5

Her diet mainly consists of quick frozen or microwave meals such as chips, burgers
etc. She states that she does occasionally enjoys a full Sunday roast When feeling
emotional or stressed Mrs Jones admits to eating several chocolates, she does not
understand why but believes it??™s a form of comfort and enjoyment.? The dietician
will work closely with her in order to achieve a diet plan, which would not only
benefit her health, help her to lose weight but also include things that she enjoys.

Mrs Jones enjoys socialising and going out for meals with her family, she also
confesses to having a take away at least once a week.? So it is therefore necessary to
include a variety of different foods to enable her to enjoy food and eating out as this
provides her with pleasure.? 

After assessing Mrs Jones current diet, she was advised to make some dietary
changes to enable herself to achieve a healthier lifestyle. Dietary changes are aimed
at eating as well-balanced diet and reducing saturated fats and increasing fibre in
take Mrs Jones was advised to help maintain and reach a healthy weight avoid or
limit her red meat (beef) Avoid processed meats Avoid whole milk and switch to
non-fat milk products Use olive oil or canola oil Remove skin of poultry before
cooking Mrs Jones is currently overweight, so by helping her to achieve a suitable
diet plan, will help her to reduce her weight, it will reduce the strain on her heart and
keep her blood pressure down.

The information provide by the nurse has enabled Mrs Jones to begin and
start her short and long goals to enable a full recovery and prevent another
heart attack. Another area of concern is helping Mrs Jones to control and
lower her blood pressure; this can be achieved through changes in her diet,
reducing her stress levels and by taking medication. Appel et al (1997) have
shown that a diet rich in fruit and vegetables with reduced saturated and total
fats, substantially lower blood pressure.? Mrs Jones understanding and
compliance to these changes are paramount to help her to lower her blood
pressure.? She also has to come to terms with the fact that then medication
for her condition is for life and not just for when she feels unwell.

Before being discharged from hospital she may need to speak to a
pharmacist, who will be able to provide information regarding her medication
and her health.? They will be able to help educate her on what her medication.

Due to Mrs Jones suffering from a (MI) it has caused her to worry and have
concern relating to exercise and mobility. So therefore it may be beneficially
for her to see a physiotherapist, who can introduce an exercise plan suitable
for Mrs Jones and her heart condition.? She was encouraged to take regular
exercise at least three times a week, such as walking or swimming.? This will
help to reduce her blood pressure, weight and increase the fitness of the
heart muscle.? 

The national service framework suggests that ?????™ Physical activity will help
reduce the risk of another heart attack by 25%`.? The Government is engaged
in a wide range of projects to promote physical activity, set out in Choosing
Activity (2005). These include action through the National Healthy Programme, the
Local Exercise Action Pilots, and training primary care professionals in the use of
pedometers as a motivational tool.

After discharge Mrs Jones will be able to benefit from a number of exercise facilities
in her community, such as leisure clubs, sports centres and swimming pools.
Patients can participate at a reduced cost Active Leisure (2009).? Mrs Jones is
prepared to heed the advice she has been given by the different members of
staff.? She feels prepared, educated and keen to change her lifestyle, enabling her to
achieve better health in the future.

In conclusion this essay has looked into maximising the health of Mrs Jones and
helping her to prevent another heart attack. It has looked at the necessarily life style
changes, relating to her health such as her diet. Mrs Jones has been assessed as a
holistic being, and all aspects of her life influence her health and well being.? It is
important to remember a persons needs and not just there illness.? This essay has
looked at a systematic approach to care and the health care professionals who help to
provide specialist advice and support to help maximise patient??™s health.? Health
promotion and education are paramount to reduce deaths from coronary heart

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