Journal ten000hzlegend's Journal: REFLECTIONS
Demonstrate a basic knowledge of professional regulation
---
Through this I have learned to act professionally when deciding a patients best course of treatment, taking into regard their present condition and well-being along with their own wishes and independence in how their treatment proceeds
Demonstrate a basic knowledge of self regulation
---
This entails me to act responsibly under any circumstance regarding a patients well-being, also taking into account my own views on a particular treatment and how those views may conflict with professional guidelines but must not over-rule them under any circumstances
Recognise and acknowledge limitations of own abilities
---
Through this I have gained insight on how best to accomodate a patients needs without risking their immediate health in any way, this also helps me gain valuable practice and referral to new treatments being administered by a higher grade nurse or equivalent
Recognise situations that require referral on to a registered practitioner
---
In a ward situation, I have realised the importance of recording and referring any abnormal signs and results from a patient immediately onto their doctor, charge nurse or available member of staff. Not only does this give the patient assurance in their condition and encouragement but also allows no delay in further treatment if deterioration occurs in the patient i.e if cardiac arrest is imminent
Demonstrate respect for patient confidentiality
---
Through this I have learned to treat the patient as an individual and not as a name on the check list, regardless of their personal attitude towards staff or own emotional and physical state, this entails giving them as much privacy as requested
Identify ethical issues in day to day practice
---
Through this I have found it necessary to not only treat the person with as much respect I would give someone out-with hospital, but to disregard their physical conditional as much as possible and deliver a content of service and treatment that they would expect of themselves and agree wholly to, whether or not they agree to treatment is up to them and not for me to judge upon or forcefully change
Demonstrate and identify key issues in relevant legislation relating to mental health
---
My observed ward held a number of mentally unwell patients at any time, therefore it was necessary to research and relate their condition in regards to their treatment and also relate to them on a personal level
Demonstrate and identify key issues in relevant legislation relating to children
---
Not observed in the workplace as all patients I cared for were above 18
A willingness to accept responsibility for their actions
---
Through this I have realised that a patients recuperation could falter and possibly be threatened by any professional misconduct, accidental or otherwise, willingness to own up to any faults or flaws in my own work and treatment administered to patients can correct the situation with the help of others without further setbacks or negative consequences
Punctuality
---
Through my own mistakes in punctuality, I have realised that a nurses day must run to a set plan, it is important for the patients that would be in my care that they are included in each of my tasks, they could possibly miss out or be delayed in receiving a wash, personal grooming and more immediate concerns such as drug administration, each can have a knock on effect, disrupting the ward flow and disrupting not only the staff, but the patients welfare
Respect For Colleagues
---
Through this I have learned that because of a wards structure, nurses operate alongside each other and must trust one an-others instructions, advice and records pertaining to patients, any disruption for instance, two members of staff who refuse to talk, can prove troublesome in helping the patients and communicating information to doctors, secondary care team staff and visitors, who require up to date information and need staff to be able to work alongside one another to enable a smooth running of the ward. Any trouble must be talked over privately and any issues, stamped out and agreed upon to maintain efficiency
Truthfulness
---
I have been working in a Cardiac And Recuperation Ward, as such, it is a high risk ward. It is important in every single case to record and present information that will used by the higher care team accurately, any deviations or mistakes could cost the patient perhaps a delay in their administration or prescribed care plan. When faced with visitors who require information, moral stances must go to one side and they must be told their relatives or friends condition with accuracy and with a reasonable forecast in their condition
Attendance
---
From my own irregular attendance, I have came to discover how disruptive even a day here and there off working in the ward can be, any long term plans cannot be followed through both on nursing and patient sides and most notably, how a ward is staffed and ran with the acceptable number of people, any less than a full compliment can cause considerable distress to other members of staff as they have to try and do basically two jobs at once
Enthusiasm For The Role
---
In my abilities as an observer of the ward, I found that general nursing and auxiliary nursing entails a great deal of motivation beyond the need to work, nurses cannot find themselves stagnating in their career and must at all times, even under pressure, put all concentration and focus on their job, if they do not, patients and staff around them suffer
A willingness to seek supervised practical help to aid professional development
---
Through this I have gained insight on how best to accomodate a patients needs without risking their immediate health in any way, this also helps me gain valuable practice and referral to new treatments being administered by a higher grade nurse or equivalent, and also allows me to put that experience and observation into practice straight away
Understand the possible barriers to communication
---
I have realised the possible embarrassment that people may have if they lose the powers of speech or motor control, I have gained valuable lessons in how to communicate effectively with people through any means they know and not discriminate towards them because of their disability, loss of speech or prolonged degradation of speech can result from a number of factors, so it is important to find these and deal with it accordingly
Demonstrate Sensitivity In Interactions With Patients
---
Throughout my time in the ward, I have came to the realisation that patients are individuals, therefore they have not only a physical side to treat but their emotional well-being must not be hampered in any way, in a situation that requires privacy, perhaps washing and toilet functions, the patient must be asked if they require any assistance and privacy must be ensured at all times, this enables them to put trust in their nurse. Also, a nurse must not in any way ask the patients for information that does not correspond to the short and long term care plan without due reason and with permission from the patient first
Acknowledge the boundaries of a professional care relationship
---
As a nurse, I am expected to retain my professional role at all times during my work, therefore I am not in any position to offer off-hand or negative comments towards patients, neither is it within my role to speak freely about conditions or people within the ward
Contribute to measures to ensure the privacy of the patient
---
Through this I have learned that a patient under my care must always be ensured of their privacy, this is achieved by asking them whether they require privacy to be with family members, friends etc... or are receiving treatment in their bed and require the curtains pulled around them and so on
Contribute to measures to ensure the dignity of the patient
---
Through this I have learned that patients must at all times retain overall rights to their "personal space", this means for example, requesting assistance in washing and toiletry functions and consultations with their doctor and care team, all this must be under strictest confidentiality, either in conversation or in action i.e going to the toilet and ensuring they are not seen by anyone else, are not spoke about negatively by anyone else and are comfortable enough in their position without further embarrassment or hassle
Understand the importance of patient empowerment
---
Patient empowerment allows the individual to decide and be made aware of all choices and alternatives in relation to their time in the ward, interactions with the care team and their care plan. Any decisions that are initially suggested to them must be made clear and agreed upon wholly, this relates to a patient with full mental grasp, alternatives for patients with some mental degradation can be placed with relatives, close friends or higher consultants who feel a particular course of action is best for them
Understand the need for the care worker to operate as an advocate for the patient in certain situations
---
As I worked in a cardiac ward, the number of patients who experienced some cognitive difficulties ensured that their appropriate care worker made decisions on their behalf and got their own good, these decisions are made on solid facts from records and consultations with other care team members in regards to further recuperation
Demonstrate fairness and sensitivity when responding to patients from diverse circumstances
---
Through this I have learned to accomodate a patients individual decisions and choices no matter what their background, sexual orientation or religious beliefs, these make no impact in providing the most constructive plans regarding their recuperation
Recognise the needs of patients whose lives are affected by disability
---
Through this I have came to respect and realise the full extent that a persons disability can affect their life and how they are able to lead a full life without hindrance
Demonstrate an awareness of assessment strategies to guide collection of data for assessing patients
---
In the cardiac ward, there are many forms of data that are needed for long-term planning for a patient, along with my case study, I researched forms of data collection including basic blood pressure results, diabetes results, electrocardiograms and heart sensor ultrasounds, these enabled me to get a full grasp of what planning takes place for each part of a persons physical ailment and also taking into account secondary care team members who may wish to perform stamina and mobility assessments, diet checks and future housing assessments if required
The ability to discuss the prioritisation of care needs
---
From this I have learned that a patients needs are not uniform and are subject to a number of physical and mental assessments, these include whether or not they are able to mobilise when required, able to feed and administer drugs themselves and so on... all these can have a knock on effect of the overall care plan so the most important needs need addressed first
Awareness of the need to re-assess patients as necessary
---
Through this I have discovered that a patients condition can fluctuate over time, this allows for the care team to constantly forecast changes and refinements to their on-going treatment without fear of treatment becoming necessary or providing too little for the patient etc...
Inclusion of physical, psychological, social and spiritual needs of patients
---
I have realised in my time in the ward environment that a holistic approach to patient care is important as each particular need needs to be addressed, not just their physical condition
The ability to identify care needs based on the assessment of a patient
---
Through this I have learned that a patient may exhibit certain conditions within the hospital environment and just not the initial symptoms, these must be picked up on and treated accordingly
Effective communication skills
---
A nurses role must include providing accurate and up to date information to care teams, patients and visitors without error and without hesitation to provide information when it may be vital to a patients recovery
Maintaining Confidentiality
---
The data protection act of 1999 ensures ward staff and patients alike of absolute non-disclosure of information pertaining to their condition, treatment, whereabouts and so on, these issues must be in place and acted upon by nursing staff at all times
Effective observational skills
---
Through this I have learned that a nurse must also be adequately equipped to observe any changes in a patients manually i.e without blood pressure machines, pulse monitors etc... these small signs that may appear could have negative consequences later for a patient if no action or no warning is given by a nurse
Taking physiological measurements
---
My time spent in cardiac and college has allowed me to equip myself with intermediate skills to observing patients and taking measurements, using manual aids such as blood pressure pads and electronic equipment such as electrocardiograms, these are also complimented by visual cues such as increased respiration, changes of skin tone, pulse rates, breathing rate etc...
Safe practice in moving and handling
---
I have trained in safe moving and handling and I have learned later on that it is essential for both nurse and patient to observe and follow these procedures as to cause no long-term injury or cause accidental injury to a patient who for example may be very frail and requires alot of assistance when moving
Essential first aid and emergency procedures
---
In a ward setting, patients may exhibit abnormal signs at any time, may pass out or fall, causing sometimes bad injury, basic first aid training will help the majority of these cases
Safe practice in administration of medicines
---
Through this I have learned that particular drug types, if mistakenly given to the wrong patient, can have adverse effects on their condition, they may be allergic to certain drugs etc... so all drug output must be checked twice over with doctors and charge nurse before final administration
Meeting emotional needs
---
Through this I have learned that a patient must be treated as an entire individual as emotional unwellness can have a detrimental effect on their physical recuperation, this can be achieved by having them speak to a hospital councillor or simply taking time to speak to a member of staff if they request
Meeting physical needs
---
Every patient must be treated with the same amount and level of care as expected from the nurse, this includes evaluating and detecting any signs of physical discomfort if not given by the patient and correcting them accordingly in any situation
Nervous System
---
Question Two
---
Johnson's Model Of Care broke ground in such that the affliction was taken out as part of the priority and the patient themselves was treated individually as the most important aspect of improving their condition. Because of Thomas' co-operation with care staff but steadfast refusal to exercise in his own time, the Johnson model was theorised to incorporate behavioural change over a period of time, resulting in an equilibrium where the patient believe they are suited to their environment, Thomas' progress has stagnated i.e he does not progress in developing mobility comparable to what it was before the road accident and the final notes include an idea for alteration in coping with a wheelchair bound patient. The theory consists of a behavioural system comprising of seven sub-systems
Attachment - Inevitable closeness to those who care and help
Achievement - Realising Thomas' own goals and successfully reaching them
Aggressive Tendencies - Faltering at those goals, resulting in aggression at himself
Dependance - If reliance on others is needed for physical and mental support
Sexual Needs
Ingestive Systems
Eliminative Qualities
---
The Henderson Care And Nursing Model integrates the nurse as the "second person" in a patients recuperation, they are at every stage of treatment and recovery so therefore, for example, the nurse is a patients arms, mobility, therapist, carer, communicator etc... and this in turn allows the patient full independence even when their physical and mental state does not allow them on their own
The model incorporates four belief systems
Physiological - The patient has the necessities of day to day living such as normal respiration, plentiful nourishment, ability to regularly discharge waste and alter their position when required and when in distress, full rest and relaxation, changes of clothes when needed, the ability to change their surroundings to suit them and so on
Sociological - All actions undertaken by a patient must further not only their treatment but must also be undertaken to allow accomplishment in themselves
Spiritual - That the patient has full rights and freedom to practice their religious beliefs and this does not become a hindrance to their recuperation
Psychological - Every part of a patients recuperation can have negative effects on that person if it fails, it can cause relapses of trust, attitudes towards carers and their own self-confidence
---
Question Three
---
In regard to Thomas' physical health, the spinal injuries received, in whatever scale, are always very dangerous due to the spines intolerance to prolonged pressure and strain, Thomas's may find that he can regain mobility from a wheelchair but loss or degradation of some motor control.
His accident and long-term rehabilitation may have brought some loss of memory, the unwillingness to perform tasks may be related to Thomas possibly being unable to remember simple things, an example includes preparing a meal or dressing correctly.
Prolonged absence from work may find him under continued pressure to return and at the same time, further his recuperation, perhaps leading to more stress which could hinder his recuperation
---
Question Four
---
With Thomas' apparent refusal to take up regular rehabilitation exercises, he would be best helped by a recuperative care program, this provides Thomas with a trained physiotherapy worker, regular monitoring with his social worker and a pre-planned set of goals, each focusing first on regaining full mobility, exercise to build on what motor control is being improved, diet management, medical treatment when necessary, a full course on day to day task management and planning for any modifications to his home. Encouragement through each of these stages is recommended as much as possible with the aid of family members and friends, as Thomas has difficulty maintaining regular mobility exercises, feeling as if he is failing etc... Independent living can be achieved from house modifications, grip bars, walk in washing facilities, lowering of switches, wheelchair ramps if needed and emergency contact cords
---
Question Five
---
As Thomas refuses to commit to exercise plans, this is may be a sign of sudden but prolonged in-confidence within himself, before the accident he kept fit and was no doubt proud of his physical activities so the mental block of beginning from scratch the basic skills he used before without conscious effort is now enough to almost completely hinder his progress in physically recuperating.
Thomas' refusal to see his children is also a sign of his in-confidence and his "shattered" self-image, it may be that without the added encouragement of his children, he will find that trying to set goals, for example, 100% walking function will be hard alone, it may also be he does not want his children to see their father in such a immobile state because as before, he was at a peak physically.
As Thomas spends more time voluntary immobile, his body will suitably react and "intensify" his condition. If Thomas begins to try and reach a more mobile way of life, his body may be dormant, loss of sensory and motor function will accelerate leading to possible limits to how fully mobile he could be, it is vital for him to begin recuperation of his physical abilities as soon as possible.
---
Through this I have learned to act professionally when deciding a patients best course of treatment, taking into regard their present condition and well-being along with their own wishes and independence in how their treatment proceeds
Demonstrate a basic knowledge of self regulation
---
This entails me to act responsibly under any circumstance regarding a patients well-being, also taking into account my own views on a particular treatment and how those views may conflict with professional guidelines but must not over-rule them under any circumstances
Recognise and acknowledge limitations of own abilities
---
Through this I have gained insight on how best to accomodate a patients needs without risking their immediate health in any way, this also helps me gain valuable practice and referral to new treatments being administered by a higher grade nurse or equivalent
Recognise situations that require referral on to a registered practitioner
---
In a ward situation, I have realised the importance of recording and referring any abnormal signs and results from a patient immediately onto their doctor, charge nurse or available member of staff. Not only does this give the patient assurance in their condition and encouragement but also allows no delay in further treatment if deterioration occurs in the patient i.e if cardiac arrest is imminent
Demonstrate respect for patient confidentiality
---
Through this I have learned to treat the patient as an individual and not as a name on the check list, regardless of their personal attitude towards staff or own emotional and physical state, this entails giving them as much privacy as requested
Identify ethical issues in day to day practice
---
Through this I have found it necessary to not only treat the person with as much respect I would give someone out-with hospital, but to disregard their physical conditional as much as possible and deliver a content of service and treatment that they would expect of themselves and agree wholly to, whether or not they agree to treatment is up to them and not for me to judge upon or forcefully change
Demonstrate and identify key issues in relevant legislation relating to mental health
---
My observed ward held a number of mentally unwell patients at any time, therefore it was necessary to research and relate their condition in regards to their treatment and also relate to them on a personal level
Demonstrate and identify key issues in relevant legislation relating to children
---
Not observed in the workplace as all patients I cared for were above 18
A willingness to accept responsibility for their actions
---
Through this I have realised that a patients recuperation could falter and possibly be threatened by any professional misconduct, accidental or otherwise, willingness to own up to any faults or flaws in my own work and treatment administered to patients can correct the situation with the help of others without further setbacks or negative consequences
Punctuality
---
Through my own mistakes in punctuality, I have realised that a nurses day must run to a set plan, it is important for the patients that would be in my care that they are included in each of my tasks, they could possibly miss out or be delayed in receiving a wash, personal grooming and more immediate concerns such as drug administration, each can have a knock on effect, disrupting the ward flow and disrupting not only the staff, but the patients welfare
Respect For Colleagues
---
Through this I have learned that because of a wards structure, nurses operate alongside each other and must trust one an-others instructions, advice and records pertaining to patients, any disruption for instance, two members of staff who refuse to talk, can prove troublesome in helping the patients and communicating information to doctors, secondary care team staff and visitors, who require up to date information and need staff to be able to work alongside one another to enable a smooth running of the ward. Any trouble must be talked over privately and any issues, stamped out and agreed upon to maintain efficiency
Truthfulness
---
I have been working in a Cardiac And Recuperation Ward, as such, it is a high risk ward. It is important in every single case to record and present information that will used by the higher care team accurately, any deviations or mistakes could cost the patient perhaps a delay in their administration or prescribed care plan. When faced with visitors who require information, moral stances must go to one side and they must be told their relatives or friends condition with accuracy and with a reasonable forecast in their condition
Attendance
---
From my own irregular attendance, I have came to discover how disruptive even a day here and there off working in the ward can be, any long term plans cannot be followed through both on nursing and patient sides and most notably, how a ward is staffed and ran with the acceptable number of people, any less than a full compliment can cause considerable distress to other members of staff as they have to try and do basically two jobs at once
Enthusiasm For The Role
---
In my abilities as an observer of the ward, I found that general nursing and auxiliary nursing entails a great deal of motivation beyond the need to work, nurses cannot find themselves stagnating in their career and must at all times, even under pressure, put all concentration and focus on their job, if they do not, patients and staff around them suffer
A willingness to seek supervised practical help to aid professional development
---
Through this I have gained insight on how best to accomodate a patients needs without risking their immediate health in any way, this also helps me gain valuable practice and referral to new treatments being administered by a higher grade nurse or equivalent, and also allows me to put that experience and observation into practice straight away
Understand the possible barriers to communication
---
I have realised the possible embarrassment that people may have if they lose the powers of speech or motor control, I have gained valuable lessons in how to communicate effectively with people through any means they know and not discriminate towards them because of their disability, loss of speech or prolonged degradation of speech can result from a number of factors, so it is important to find these and deal with it accordingly
Demonstrate Sensitivity In Interactions With Patients
---
Throughout my time in the ward, I have came to the realisation that patients are individuals, therefore they have not only a physical side to treat but their emotional well-being must not be hampered in any way, in a situation that requires privacy, perhaps washing and toilet functions, the patient must be asked if they require any assistance and privacy must be ensured at all times, this enables them to put trust in their nurse. Also, a nurse must not in any way ask the patients for information that does not correspond to the short and long term care plan without due reason and with permission from the patient first
Acknowledge the boundaries of a professional care relationship
---
As a nurse, I am expected to retain my professional role at all times during my work, therefore I am not in any position to offer off-hand or negative comments towards patients, neither is it within my role to speak freely about conditions or people within the ward
Contribute to measures to ensure the privacy of the patient
---
Through this I have learned that a patient under my care must always be ensured of their privacy, this is achieved by asking them whether they require privacy to be with family members, friends etc... or are receiving treatment in their bed and require the curtains pulled around them and so on
Contribute to measures to ensure the dignity of the patient
---
Through this I have learned that patients must at all times retain overall rights to their "personal space", this means for example, requesting assistance in washing and toiletry functions and consultations with their doctor and care team, all this must be under strictest confidentiality, either in conversation or in action i.e going to the toilet and ensuring they are not seen by anyone else, are not spoke about negatively by anyone else and are comfortable enough in their position without further embarrassment or hassle
Understand the importance of patient empowerment
---
Patient empowerment allows the individual to decide and be made aware of all choices and alternatives in relation to their time in the ward, interactions with the care team and their care plan. Any decisions that are initially suggested to them must be made clear and agreed upon wholly, this relates to a patient with full mental grasp, alternatives for patients with some mental degradation can be placed with relatives, close friends or higher consultants who feel a particular course of action is best for them
Understand the need for the care worker to operate as an advocate for the patient in certain situations
---
As I worked in a cardiac ward, the number of patients who experienced some cognitive difficulties ensured that their appropriate care worker made decisions on their behalf and got their own good, these decisions are made on solid facts from records and consultations with other care team members in regards to further recuperation
Demonstrate fairness and sensitivity when responding to patients from diverse circumstances
---
Through this I have learned to accomodate a patients individual decisions and choices no matter what their background, sexual orientation or religious beliefs, these make no impact in providing the most constructive plans regarding their recuperation
Recognise the needs of patients whose lives are affected by disability
---
Through this I have came to respect and realise the full extent that a persons disability can affect their life and how they are able to lead a full life without hindrance
Demonstrate an awareness of assessment strategies to guide collection of data for assessing patients
---
In the cardiac ward, there are many forms of data that are needed for long-term planning for a patient, along with my case study, I researched forms of data collection including basic blood pressure results, diabetes results, electrocardiograms and heart sensor ultrasounds, these enabled me to get a full grasp of what planning takes place for each part of a persons physical ailment and also taking into account secondary care team members who may wish to perform stamina and mobility assessments, diet checks and future housing assessments if required
The ability to discuss the prioritisation of care needs
---
From this I have learned that a patients needs are not uniform and are subject to a number of physical and mental assessments, these include whether or not they are able to mobilise when required, able to feed and administer drugs themselves and so on... all these can have a knock on effect of the overall care plan so the most important needs need addressed first
Awareness of the need to re-assess patients as necessary
---
Through this I have discovered that a patients condition can fluctuate over time, this allows for the care team to constantly forecast changes and refinements to their on-going treatment without fear of treatment becoming necessary or providing too little for the patient etc...
Inclusion of physical, psychological, social and spiritual needs of patients
---
I have realised in my time in the ward environment that a holistic approach to patient care is important as each particular need needs to be addressed, not just their physical condition
The ability to identify care needs based on the assessment of a patient
---
Through this I have learned that a patient may exhibit certain conditions within the hospital environment and just not the initial symptoms, these must be picked up on and treated accordingly
Effective communication skills
---
A nurses role must include providing accurate and up to date information to care teams, patients and visitors without error and without hesitation to provide information when it may be vital to a patients recovery
Maintaining Confidentiality
---
The data protection act of 1999 ensures ward staff and patients alike of absolute non-disclosure of information pertaining to their condition, treatment, whereabouts and so on, these issues must be in place and acted upon by nursing staff at all times
Effective observational skills
---
Through this I have learned that a nurse must also be adequately equipped to observe any changes in a patients manually i.e without blood pressure machines, pulse monitors etc... these small signs that may appear could have negative consequences later for a patient if no action or no warning is given by a nurse
Taking physiological measurements
---
My time spent in cardiac and college has allowed me to equip myself with intermediate skills to observing patients and taking measurements, using manual aids such as blood pressure pads and electronic equipment such as electrocardiograms, these are also complimented by visual cues such as increased respiration, changes of skin tone, pulse rates, breathing rate etc...
Safe practice in moving and handling
---
I have trained in safe moving and handling and I have learned later on that it is essential for both nurse and patient to observe and follow these procedures as to cause no long-term injury or cause accidental injury to a patient who for example may be very frail and requires alot of assistance when moving
Essential first aid and emergency procedures
---
In a ward setting, patients may exhibit abnormal signs at any time, may pass out or fall, causing sometimes bad injury, basic first aid training will help the majority of these cases
Safe practice in administration of medicines
---
Through this I have learned that particular drug types, if mistakenly given to the wrong patient, can have adverse effects on their condition, they may be allergic to certain drugs etc... so all drug output must be checked twice over with doctors and charge nurse before final administration
Meeting emotional needs
---
Through this I have learned that a patient must be treated as an entire individual as emotional unwellness can have a detrimental effect on their physical recuperation, this can be achieved by having them speak to a hospital councillor or simply taking time to speak to a member of staff if they request
Meeting physical needs
---
Every patient must be treated with the same amount and level of care as expected from the nurse, this includes evaluating and detecting any signs of physical discomfort if not given by the patient and correcting them accordingly in any situation
Nervous System
---
Question Two
---
Johnson's Model Of Care broke ground in such that the affliction was taken out as part of the priority and the patient themselves was treated individually as the most important aspect of improving their condition. Because of Thomas' co-operation with care staff but steadfast refusal to exercise in his own time, the Johnson model was theorised to incorporate behavioural change over a period of time, resulting in an equilibrium where the patient believe they are suited to their environment, Thomas' progress has stagnated i.e he does not progress in developing mobility comparable to what it was before the road accident and the final notes include an idea for alteration in coping with a wheelchair bound patient. The theory consists of a behavioural system comprising of seven sub-systems
Attachment - Inevitable closeness to those who care and help
Achievement - Realising Thomas' own goals and successfully reaching them
Aggressive Tendencies - Faltering at those goals, resulting in aggression at himself
Dependance - If reliance on others is needed for physical and mental support
Sexual Needs
Ingestive Systems
Eliminative Qualities
---
The Henderson Care And Nursing Model integrates the nurse as the "second person" in a patients recuperation, they are at every stage of treatment and recovery so therefore, for example, the nurse is a patients arms, mobility, therapist, carer, communicator etc... and this in turn allows the patient full independence even when their physical and mental state does not allow them on their own
The model incorporates four belief systems
Physiological - The patient has the necessities of day to day living such as normal respiration, plentiful nourishment, ability to regularly discharge waste and alter their position when required and when in distress, full rest and relaxation, changes of clothes when needed, the ability to change their surroundings to suit them and so on
Sociological - All actions undertaken by a patient must further not only their treatment but must also be undertaken to allow accomplishment in themselves
Spiritual - That the patient has full rights and freedom to practice their religious beliefs and this does not become a hindrance to their recuperation
Psychological - Every part of a patients recuperation can have negative effects on that person if it fails, it can cause relapses of trust, attitudes towards carers and their own self-confidence
---
Question Three
---
In regard to Thomas' physical health, the spinal injuries received, in whatever scale, are always very dangerous due to the spines intolerance to prolonged pressure and strain, Thomas's may find that he can regain mobility from a wheelchair but loss or degradation of some motor control.
His accident and long-term rehabilitation may have brought some loss of memory, the unwillingness to perform tasks may be related to Thomas possibly being unable to remember simple things, an example includes preparing a meal or dressing correctly.
Prolonged absence from work may find him under continued pressure to return and at the same time, further his recuperation, perhaps leading to more stress which could hinder his recuperation
---
Question Four
---
With Thomas' apparent refusal to take up regular rehabilitation exercises, he would be best helped by a recuperative care program, this provides Thomas with a trained physiotherapy worker, regular monitoring with his social worker and a pre-planned set of goals, each focusing first on regaining full mobility, exercise to build on what motor control is being improved, diet management, medical treatment when necessary, a full course on day to day task management and planning for any modifications to his home. Encouragement through each of these stages is recommended as much as possible with the aid of family members and friends, as Thomas has difficulty maintaining regular mobility exercises, feeling as if he is failing etc... Independent living can be achieved from house modifications, grip bars, walk in washing facilities, lowering of switches, wheelchair ramps if needed and emergency contact cords
---
Question Five
---
As Thomas refuses to commit to exercise plans, this is may be a sign of sudden but prolonged in-confidence within himself, before the accident he kept fit and was no doubt proud of his physical activities so the mental block of beginning from scratch the basic skills he used before without conscious effort is now enough to almost completely hinder his progress in physically recuperating.
Thomas' refusal to see his children is also a sign of his in-confidence and his "shattered" self-image, it may be that without the added encouragement of his children, he will find that trying to set goals, for example, 100% walking function will be hard alone, it may also be he does not want his children to see their father in such a immobile state because as before, he was at a peak physically.
As Thomas spends more time voluntary immobile, his body will suitably react and "intensify" his condition. If Thomas begins to try and reach a more mobile way of life, his body may be dormant, loss of sensory and motor function will accelerate leading to possible limits to how fully mobile he could be, it is vital for him to begin recuperation of his physical abilities as soon as possible.
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