B721 Nursing

Question 1
Identify and apply an appropriate professional, legal or ethical framework to critical discuss how you address the issues of responsibility and accountability as a nurse caring for Joe. 
(Q1 Safe Effective Person Centred Care
Define Person Centred Care
NMC CODE
Definition of accountability and responsibility
Definition of legal & ethical four principles NMC code 2015 (4Ps)Legal
Health and Social Care Act 2012 work Laws 
Equality Act consent & confidentiality 

Question 2:
a)present a critical discussion of the pathophysiology of Asthma, looking at the normal and altered pathophysiology.
Q2A
(1)Asthma
Definition of Respiratory System; Normal VS Abnormal
Their Symptoms
Defferential  diagnosis 
A topic VS non Atopic
Occupational Asthma

b)Critically discuss a psychosocial factor that may impact on Joe.
Q2B
Psychosocial Factor
Occupation < sick zero hours
Language barrier
Immigration – support network
Smoking- Health impact
Cultural acceptability of smoking in France

Question 3:

a)Identify and critically discuss the clinical reasoning and systematic assesement process within person centred care with reference to the scenario.
b)Choose one relevant issue that is presented in the scenario to critically examine how you would deliver safe and effective care.

Question 1. Safe Effective Person Centered Care

Asthma is a chronic lung disease that inflames and narrows the air way of the lungs, due to which the concerned person suffers from respiratory distress, irritability of the respiratory tract, coughing, chest tightness. If left untreated may lead to death. According to Hackett (2012) patients suffering from occupational asthma may face non- compliance, anger or frustration due to his incapability.

Other psychological effects of Asthma may include depression, emotional depression. Acute Asthma can lead to professional loss which may again lewd to psychosocial issues in the patient (Asher and Pearce 2014).  

In order to manage Asthma, the nursing care plan should focus mainly on the management of the hypersensitivity reaction, controlling of the allergens that may trigger asthma, maintenance of the patency of the airways and preventing the occurrence of the reversible complications (Hackett 2012).

In order to manage the anxiety of the patient like Joe, it is important for the nurse to provide emotional support to the client. It is essential to provide a holistic care to the Asthma patient. In order to accomplish that nurse should abide by certain nursing ethical or legal frame work (Groves 2014).

The nurse should be able to conduct a patient centered care.

Patient centered care- A patient centered care is the type of care, where the health status of an individual is the driving force behind all the decisions taken and  patients are also involved in the decision making process. The health care providers provide care to the patient not only from the clinical perspective but also form spiritual, mental, financial and social perspective (Ritz et al.2013).  

NMC code– The nurse in charge of Joe should abide by the nursing and the midwifery code of conduct while planning care for JOE. The NMC codes would help a nurse ton understand how the dignity of the patient should be maintained, how to practice a safe and a quality care (Groves 2014).

Accountability refers to the fact that a nurse is answerable for her activities to oneself and is considered as an essential component of nursing practice.

A nurse is entitled to take the responsibility of her patient and should go beyond his conventional practice to provide a patient centered care(Groves 2014).

4 principles of NMC code are-

1. To treat every person as individual entity and to uphold their integrity and dignity.
2. A nurse should be able to listen to the patient and should be able to respond to their preferences and concerns (Groves 2014).
3. A nurse should be able to address the physical, social and the psychological requirements of the patient.
4. To meet the interest of the patient at its need.  

In this case Joe needs proper education about Asthma for its self management, which aligns with the NMC codes. According to the code number 3 Joe also requires proper psychosocial as he had been through an emotional turmoil (Amelink et al.2014).

According to the Health and Social Care Act 2012, it is necessary to look after the mental health alongside physical health. Hence it is the duty of the nurse to give a comprehensive care to Joe, which would include physical assessment alongside mental health.

One of the codes of nursing standard refers to the maintenance of equality, integrity and confidentiality of the patient. In this context, Joe might not want to share his clinical disability with anybody else. In such a case, it is essential for the nurse to maintain the dignity and the integrity of the patient.

Q. 2A Pathophysiology of Asthma

The breathing airways narrows during an Asthma attack which interferes with the normal air movement through the respiratory tract. It has to be kept in mind that asthma only involves the bronchial tubes and not the alveoli (Doeing and Solway 2013). Unlike the normal condition, excess mucus is secreted in the respiratory tract as an inflammatory response, during an Asthma attack, which causes the respiratory distress (Killeen and Skora 2013).

The symptoms of Asthma includes fast and shallow breaths, prolonged cough, chest tightness, inability to stop coughing, low sounding whistle while breathing (Killeen and Skora 2013).

Normally the clinical hallmark of Asthma is reversibility and wheezing. It should be kept in mind that any disease that causes disruption of airflow through the respiratory tract cause wheezing, but patients with Asthma should have a history of allergy or past attacks of dyspnea on exposure to allergens (Miravitlles et al.2012). Diseases like chronic bronchitis, cardiogenic pulmonary edema, pulmonary emphysema also shows wheezing, but is not related to exposure to allergens.

Atopic Asthma may be referred to the type of Asthma that requires history of allergen exposure and are mainly termed as extrinsic asthma (Pekkanen et al.2012).

Non atopic asthma shows no clinical evidence of IgE mediated allergy on exposure to the environmental allergens (Pekkanen et al.2012). In case of non atopic asthma, the IgE is produced against any unknown auto-antigen or viral particles (Kuhl and Hanania 2012).

In this case study, it is evident that Joe suffers from atopic asthma, as it can be already seen that Joe is a chain smoker, and excessive smoking increases the symptoms (Malinovschi, et al.2012).

Occupational asthma is a type of asthma that is mainly found in the workplaces due to the exposure to environmental allergens like smoke, dust, asbestos particles and pollens (Tarlo and Lemiere 2014). The case study has already provided with the fact that Joe works in a construction company. Hence it is obvious that he gets exposed to many obnoxious chemicals, dusts and fumes that can trigger the asthmatic symptoms (Lemière, et al.2013).

Q. 2B Psychosocial factors

Asthma is associated with significant morbidity and mortality, which is not only associated with poor socioeconomic conditions but also due to a number of psychosocial factors like disease denial, inability to cope and anxiety. These psychosocial factors are the possible reasons that results in irregular checkups, noncompliance with medications and poor levels of asthma management in patients at a high risk (Ritz et al. 2013). In Joe’s case the psychosocial factor is anxiety. Significant level of stress or anxiety can induce asthma attacks, resulting in frequent attacks and makes the control of the attacks very difficult. Anxiety results in physiological changes that induce the attacks. Anxiety triggers the release of histamines or leukotrienes, which causes narrowing of the airway (Li et al. 2015). Moreover, during anxiety attacks, individuals forget to take their asthma medications, which further adds to the severity of the problem.

A zero hour contract is a contract, where the employees are hired at short notice and their pay depends on the number of hours they spent working. Zero hour contracts do not include sick leaves and those who take sick leaves are not paid. Reports revealed that individuals on zero hour contract suffered from poor physical and mental health (Bender and Theodossiou 2017). Joe worked on a zero hour contract, which significantly affected his health.

Language barrier plays a very important role in the proper administration in healthcare systems. Language barriers is a challenging issue faced by the healthcare system as it prevents the provision of high quality and effective care to patients (van Panhuis et al. 2014). Joe is an immigrant of France and as a result he faces problems with the understanding of the medication and the healthcare system.

A poor immigration support network also affects the health of immigrants. These immigrants work in poor wage jobs and do not get health insurance coverage from the workplace. As a result, these immigrants have poor access to various healthcare service programs (Martinez et al. 2015). Joe is an immigrant from France and he also works for long hours at a poor wage.

Smoking is harmful for the respiratory system. Smoking of tobacco results in the settling of irritating substances on the moist lining in the airways, which in turn triggers asthma attacks. The hair like projections called cilia in the airways are damaged by tobacco smoke. Cigarette smoke also increases the mucus formations by the lungs. Thus, the cumulative effect of damaged cilia and increased mucus and other harmful substances in the airways induces the asthmatic attacks. Cigarette smokers have narrow bronchial tubes, which results from inflammation and scarring. These in turn causes breathing problems in the individuals. Individuals with asthma who indulge in smoking suffer from breathing problems, coughing and wheezing (Carsin et al. 2016). Joe is also a smoker and smokes 4 cigarettes regularly.

The French are significantly inclined to smoking. The smoking rates in France has increased to 60% and is considered to be the tobacco haven. Reports reveal that 47 billion cigarettes are smoked in France every year. France is considered the smokiest country of the World. Smoking is a part of culture in France, where the young generation engage themselves in smoking from a very early age. Restrictions have been introduced but very little effort is put forth to enforce the restrictions (Peretti-Watel et al. 2014).

Q. 3. Clinical reasoning and Systematic Assessment

Systematic assessment process for asthma includes determining a brief history of the patient in order to identify the risk factors, determining the socioeconomic status and ethnicity in order to provide effective person centered care. The next step includes clinical examinations in order to diagnose and assess the severity of asthma. Finally management or intervention strategies are provided, which include oxygen therapy, non-invasive positive pressure ventilation (NIPPV), inhaled or intravenous bronchodialters and systemic corticosteroids (Restrepo et al. 2015).

The Roper Logan Tierney Model for nursing is often termed as ADLs or ALs. This is because this theory of nursing care is based on the “activities of daily living” or ADL. This theory helps to assess the life of a patient and how it has undergone changes as a result of illness, admissions to hospitals or injury. The activities of living are : maintainance of a safe environment, breathing, communication, elimination, eating and drinking, washing and dressing, temperature control, working or playing, mobilization, sleeping, death and sexuality (Williams 2017).

Nursing process assessment is one of the five phases, where the nurse obtains information about the patient regarding physiological, sociological, psychological and spiritual status.

Among the 12 AL assessment, communication is the one that is applicable in this case. This is because Joe being a French is finding extremely hard to understand the suggestions provided by the nurse practitioner in the English language.

Person centered care can be defined as a way by which the patients or clients who are using the healthcare services are considered to be equal partners in the planning, development and monitoring of care, so that their personal needs are met (Olsson et al. 2013). Clinical reasoning is the process with the help of which the nurses collect information, process it and understand the patient problem in order to provide implementations. It also involves evaluation of the outcomes, reflecting and learning from experiences (Alfaro-LeFevre 2015).

One relevant issue in this case is the language barrier that prevents in providing safe and effective care. Joe is finding it difficult to understand how and when to use the inhaler. His father acts as an interpreter, which can pose a problem. Other problems include his inability to translate medical terminologies, medication use and purpose. Moreover, he suffers from work aggravated asthma, since his symptoms increases during work (Purokivi et al. 2014). Interventions for him could include the use of interpreters who can stay with him during his working hours and enable him to use proper medications. Moreover, the use of personal protective equipments like inhalers can reduce the severity of the attacks and are safe and effective.

Reference List

Alfaro-LeFevre, R., 2015. Critical Thinking, Clinical Reasoning, and Clinical Judgment E-Book: A Practical Approach. Elsevier Health Sciences.

Amelink, M., Hashimoto, S., Spinhoven, P., Pasma, H.R., Sterk, P.J., Bel, E.H. and ten Brinke, A., 2014. Anxiety, depression and personality traits in severe, prednisone-dependent asthma. Respiratory medicine, 108(3), pp.438-444.

Asher, I. and Pearce, N., 2014. Global burden of asthma among children. The international journal of tuberculosis and lung disease, 18(11), pp.1269-1278.

Bender, K.A. and Theodossiou, I., 2017. The Unintended Consequences of Flexicurity: The Health Consequences of Flexible Employment. Review of Income and Wealth.

Carsin, A., Mazenq, J., Ilstad, A., Dubus, J.C., Chanez, P. and Gras, D., 2016. Bronchial epithelium in children: A key player in asthma. European Respiratory Review, 25(140), pp.158-169.

Doeing, D.C. and Solway, J., 2013. Airway smooth muscle in the pathophysiology and treatment of asthma. Journal of applied physiology, 114(7), pp.834-843.

Groves, W., 2014. Professional practice skills for nurses. Nursing standard, 29(1), pp.51-59.

Hackett, T.L., 2012. Epithelial–mesenchymal transition in the pathophysiology of airway remodelling in asthma. Current opinion in allergy and clinical immunology, 12(1), pp.53-59.

Killeen, K. and Skora, E., 2013. Pathophysiology, diagnosis, and clinical assessment of asthma in the adult. Nursing Clinics, 48(1), pp.11-23.

Kuhl, K. and Hanania, N.A., 2012. Targeting IgE in asthma. Current opinion in pulmonary medicine, 18(1), pp.1-5.

Lemière, C., Boulet, L.P., Chaboillez, S., Forget, A., Chiry, S., Villeneuve, H., Prince, P., Maghni, K., Kennedy, W.A. and Blais, L., 2013. Work-exacerbated asthma and occupational asthma: do they really differ?. Journal of Allergy and Clinical Immunology, 131(3), pp.704-710.

Li, H.L., He, X.L., Liang, B.M., Zhang, H.P., Wang, Y. and Wang, G., 2015, November. Anxiety but not depression symptoms are associated with greater perceived dyspnea in asthma during bronchoconstriction. In Allergy and asthma proceedings (Vol. 36, No. 6, pp. 447-457). OceanSide Publications, Inc.

Malinovschi, A., Backer, V., Harving, H. and Porsbjerg, C., 2012. The value of exhaled nitric oxide to identify asthma in smoking patients with asthma-like symptoms. Respiratory medicine, 106(6), pp.794-801.

Martinez, O., Wu, E., Sandfort, T., Dodge, B., Carballo-Dieguez, A., Pinto, R., Rhodes, S., Moya, E. and Chavez-Baray, S., 2015. Evaluating the impact of immigration policies on health status among undocumented immigrants: a systematic review. Journal of Immigrant and Minority Health, 17(3), pp.947-970.

Miravitlles, M., Andreu, I., Romero, Y., Sitjar, S., Altés, A. and Anton, E., 2012. Difficulties in differential diagnosis of COPD and asthma in primary care. Br J Gen Pract, 62(595), pp.e68-e75.

Olsson, L.E., Jakobsson Ung, E., Swedberg, K. and Ekman, I., 2013. Efficacy of person?centred care as an intervention in controlled trials–a systematic review. Journal of clinical nursing, 22(3-4), pp.456-465.

Pekkanen, J., Lampi, J., Genuneit, J., Hartikainen, A.L. and Järvelin, M.R., 2012. Analyzing atopic and non-atopic asthma. European journal of epidemiology, 27(4), pp.281-286.

Peretti-Watel, P., Legleye, S., Guignard, R. and Beck, F., 2014. Cigarette smoking as a stigma: Evidence from France. International Journal of Drug Policy, 25(2), pp.282-290.

Purokivi, M., Sauni, R., Hannu, T., Harju, T., Jaakkola, M., Karjalainen, J., Kilpeläinen, M., Karvala, K., Malmberg, P., Nieminen, E.M. and Pallasaho, P., 2014. Work aggravated asthma. Duodecim; laaketieteellinen aikakauskirja, 130(17), pp.1691-1698.

Restrepo, R.D., Tate, A., Gardner, D.D., Wittnebel, L.D., Wettstein, R. and Khusid, F., 2015. Current approaches to the assessment and treatment of acute severe asthma. Indian Journal of Respiratory Care, 4(1), p.521.

Ritz, T., Meuret, A.E., Trueba, A.F., Fritzsche, A. and von Leupoldt, A., 2013. Psychosocial factors and behavioral medicine interventions in asthma. Journal of consulting and clinical psychology, 81(2), p.231.

Ritz, T., Meuret, A.E., Trueba, A.F., Fritzsche, A. and von Leupoldt, A., 2013. Psychosocial factors and behavioral medicine interventions in asthma. Journal of consulting and clinical psychology, 81(2), p.231.

Tarlo, S.M. and Lemiere, C., 2014. Occupational asthma. New England Journal of Medicine, 370(7), pp.640-649.

van Panhuis, W.G., Paul, P., Emerson, C., Grefenstette, J., Wilder, R., Herbst, A.J., Heymann, D. and Burke, D.S., 2014. A systematic review of barriers to data sharing in public health. BMC Public Health, 14(1), p.1144.

Wenzel, S.E., 2012. Asthma phenotypes: the evolution from clinical to molecular approaches. Nature medicine, 18(5), pp.716-725.

Williams, B.C., 2017. The Roper-Logan-Tierney model of nursing. Nursing2017 Critical Care, 12(1), pp.17-20.