My essay is based on competencies associated with Nursing Associate Domain 2 person-centered approaches to care and competency 3 which is supporting individuals to maintain their identity and self-esteem using person-centered values that include individuality, independence, privacy, partnership, choice, dignity, respects and rights. I will be using the Roper Logan Tierney Nursing Model (Holland et al.,2008). Its theory is based on the 12 activities of daily living to enhance the quality of life, elimination is one of them.
I have used a person-centered approach to make sure that the patient feels valued. As defined by the NHS England (2013), care centred focuses on the “needs, convenience and choices of people and their families and carers”. I will demonstrate how I have learned and developed new skills that can improve my practice in the future. I have maintained confidentiality and anonymity throughout my essay in order to protect the identity of the patient, family, healthcare setting and professionals involved according to Nursing and Midwifery Council (The Code, NMC, 2015). Patient A is a 58-year-old gentleman who attended the TWOC clinic (Trial without a catheter) with his wife.
The clinic is run by Clinical Nurses Specialists in urology. His information was shared in the Multi-disciplinary meeting among the pool of consultants and specialist nurses after he had suffered multiple episodes of urinary retention and infections. He was therefore, referred to the clinic for the nurses to make an assessment taking into consideration all his actual and potential problems. He was asked to come to the clinic early in the morning for the nurses to make an assessment and based on the information and data they would collect; a care plan will be devised.
He states that he was currently unable to pass urine fully. He has a weak, slow urinary stream, frequent and pain when urinating. He was unable to sleep because he needed to wake up during the night to urinate (nocturia). Blood was often present in his urine (haematuria) and he would often get urinary tract infections. He recalled his past medical history when he was diagnosed with a large prostate last year. According to (Barry et al.1992), men who suffer from large prostate develop symptoms of: incomplete bladder emptying, frequency, intermittency, urgency, weak urinary stream, hesitancy and nocturia.
He had Transurethral Resection of Prostate (TURP) done after his diagnosis. TURP is a surgical procedure which consist in the removal of part of the prostate gland that presses down on the urethra, to treat symptoms of enlarged prostate. He continued saying that, unfortunately, soon after his procedure he ended up bleeding, for which he had to undergo another surgery. He was discharged from the hospital with an indwelling catheter in situ for weeks.
An appointment was made to remove it and to re-train his bladder to function again, which was successfully done in an outpatient setting. But this did not last long and he ended up in A and E with urinary retention and infection. He was immediately catheterised as he could not pass urine. He was sent home with an indwelling urinary catheter. Having heard the medical history of the patient, the nurses explained how they will be carrying out the assessment.
For instance, his catheter would be removed. He would be given a jug to measure the urine output and was asked to drink plenty of fluids. He had to record all the inputs and outputs on a fluid balance sheet.
The nurses would assess how much he could manage to empty his bladder without a catheter and then his bladder would be scanned to see how much urine was left. After all the assessment would be completed, the Urology specialist nurses devised a care plan together with the patient as they had to find out what intervention would best suits to solve the actual problem of the patient. The patient was asked to fill up a questionnaire, regarding his psychological and psychosocial aspects were all taken into account. This is done in order to identify all the care needs that will meet his lifestyle, choices, work life, sexuality, sleeping, socialising, mobility, eating and drinking, in other words the activities of living.