Testimonials: Abdellah's real!
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Testimonial #1
by Group E's Amelisa Melendres
Cases of amputation are very
common in my workplace. Most of these patients have Diabetes Mellitus – Type 2,
with poor control of blood sugar, poor circulation (especially in their lower
limbs) with wounds and ulcers that are not healing, which are always the cause
of a Below-the-knee (BKA) or Above-the-knee (AKA) amputations. In relation to
this, I will be citing an example of a patient’s case using the model of Faye
G. Abdellah’s Theory of 21 Nursing Problems, which is a patient-centered
approach.
Mr. Smith, 68 years old, has had DM-T2 for 30 years. He is on regular insulin that he takes every meal, and a long acting one that he takes at bedtime. Aside from this, he also maintains an oral hypoglycemic that is taken twice a day with meals. He is a smoker (1 pack of cigarettes a day) and drinks at least 5 beers a day. Additionally, he loves eating junk foods and drinking soda/pop, and in spite of his regular insulin injections, his blood sugar level always sits between 12-18 mmol/L. He is 5’4” and weighs 80 kgs. To complicate the situation, he also has ulcers affecting his right foot, specifically the great, 2nd and 3rd toes. He said it started with a small blister a few months ago from wearing tight shoes that progressed to a non-healing wound. It has purulent drainage, foul odor, and with noticeable tissue necrosis around the edges. He also stated that his Right foot has no sensation and somehow has affected his mobility. He has been in and out of the hospital for 2 months, receiving IV antibiotics, treatments and dressing changes for his wound but his condition has not improved. After a series of surgical consults, the doctors convinced him to do a below-the-knee amputation to save the remaining leg’s function to which the patient agreed and consented. Mr. Smith and his wife are separated and he lives alone. His children are not actively participating in his care since admission due to busy work schedules and refused to attend family meetings whenever they are called for one. The day of the operation came and Mr. Smith had his right lower leg amputated with no post-operative complications. Day 1 post-op, Mr. Smith has been mobilizing and transferring to the wheelchair with the help of the physiotherapists. Days went on, he has been very cooperative with his rehabilitation and has been diligent with his muscle strengthening exercises in preparation for his prosthesis. Moreover, a dietician has been closely monitoring him and he has started adhering to a healthy diet plan, which apparently resulted to a drop in his blood sugar to acceptable level (6-8 mmol/L), and had quit smoking and drinking with the motivation of the nursing staff through series of education and health teaching. Despite the non-involvement of his family with his treatment plan, Mr. Smith is determined to get back on his feet and be useful again in the community by organizing a support group for amputees. Mr. Smith was also referred to a mental health counselor to help him address issues he might encounter when coping with stressful situations.
Nursing Care Plan for Mr. Smith
References List:
NANDA. (2012). The complete list of NANDA nursing diagnosis for 2012-2014, with 16 new diagnoses. Retrieved from: http://www.kc-courses.com/fundamentals/week2process/nanda2012.pdf
Testimonial #2
by Group E's Kristine Caren Onato
References List:
Testimonial #3
by Group E's Pamela Pantalan
In our institution, since we are accredited with the Joint
Commission International and Central Board for Health Institution all the care
is based on the local and international standards. Different clinical audit teams are coming
more often to the department to ensure that the highest quality of care is
being rendered. And to ensure quality care, the nurses are required to take the
weekly lectures and continuing educations. Our Hospital has a lot of key
performance indicators, some indicators that are applicable to the nursing
department are Hand Hygiene Compliance, Documentation Compliance, and
Compliance to the International Patient Safety Goals 1-6 to search for the
opportunities for improvements. Our prime focus is the patient and its safety.
In summation, what we are doing right now, we owe it all to the nursing theories.
Testimonial #4
by Group E's Ada Fatima Fuego Megraso
Testimonial #1
by Group E's Amelisa Melendres
Cases of amputation are very
common in my workplace. Most of these patients have Diabetes Mellitus – Type 2,
with poor control of blood sugar, poor circulation (especially in their lower
limbs) with wounds and ulcers that are not healing, which are always the cause
of a Below-the-knee (BKA) or Above-the-knee (AKA) amputations. In relation to
this, I will be citing an example of a patient’s case using the model of Faye
G. Abdellah’s Theory of 21 Nursing Problems, which is a patient-centered
approach. Mr. Smith, 68 years old, has had DM-T2 for 30 years. He is on regular insulin that he takes every meal, and a long acting one that he takes at bedtime. Aside from this, he also maintains an oral hypoglycemic that is taken twice a day with meals. He is a smoker (1 pack of cigarettes a day) and drinks at least 5 beers a day. Additionally, he loves eating junk foods and drinking soda/pop, and in spite of his regular insulin injections, his blood sugar level always sits between 12-18 mmol/L. He is 5’4” and weighs 80 kgs. To complicate the situation, he also has ulcers affecting his right foot, specifically the great, 2nd and 3rd toes. He said it started with a small blister a few months ago from wearing tight shoes that progressed to a non-healing wound. It has purulent drainage, foul odor, and with noticeable tissue necrosis around the edges. He also stated that his Right foot has no sensation and somehow has affected his mobility. He has been in and out of the hospital for 2 months, receiving IV antibiotics, treatments and dressing changes for his wound but his condition has not improved. After a series of surgical consults, the doctors convinced him to do a below-the-knee amputation to save the remaining leg’s function to which the patient agreed and consented. Mr. Smith and his wife are separated and he lives alone. His children are not actively participating in his care since admission due to busy work schedules and refused to attend family meetings whenever they are called for one. The day of the operation came and Mr. Smith had his right lower leg amputated with no post-operative complications. Day 1 post-op, Mr. Smith has been mobilizing and transferring to the wheelchair with the help of the physiotherapists. Days went on, he has been very cooperative with his rehabilitation and has been diligent with his muscle strengthening exercises in preparation for his prosthesis. Moreover, a dietician has been closely monitoring him and he has started adhering to a healthy diet plan, which apparently resulted to a drop in his blood sugar to acceptable level (6-8 mmol/L), and had quit smoking and drinking with the motivation of the nursing staff through series of education and health teaching. Despite the non-involvement of his family with his treatment plan, Mr. Smith is determined to get back on his feet and be useful again in the community by organizing a support group for amputees. Mr. Smith was also referred to a mental health counselor to help him address issues he might encounter when coping with stressful situations.
Nursing Care Plan for Mr. Smith
ASSESSMENT
|
NURSING
DIAGNOSIS
|
PLANNING
|
IMPLEMENTATION
|
EVALUATION
|
Subjective:
“
I smoke and drink and I love McDonalds, chips, and pop”
Objective:
-Pt.
is always out for smoke several times a day.
-Noted
junk foods (chips and pop) at the bedside which the pt. ordered from a nearby
store.
|
-Ineffective
health management
-Risk
for unstable blood glucose level
|
After
health teaching, pt. will be able to discuss the harmful effects of smoking,
drinking and junk food consumption. Pt. will participate in dietary
modification.
After
health teaching, pt. will be able to modify lifestyle changes and to
demonstrate knowledge of acceptable blood sugar level. Pt. will be able to
properly use a glucometer.
|
-
Established rapport.
-
Discussed with pt. the negative effects of smoking, drinking, and junk foods.
Provided booklets of information regarding smoking cessation. Referred pt. to
a dietician and conducted health teaching on healthy and recommended diets.
Provided
health teaching on low, normal, and high blood sugar levels, their signs and
symptoms, and their effects to the body. Demonstrated the proper use of
glucometer for blood glucose monitoring.
|
Pt.
discussed the harmful effects of smoking, drinking, and junk food. Pt.
adhered to a healthy diet plan. Pt. verbalized willingness to quit smoking
and drinking and have enrolled in a smoking cessation program and “alcohol
anonymous” support group.
Pt.
demonstrated knowledge on the use of glucometer, and is able to discuss the
effects of low, normal, and high blood glucose level in the body and their
signs and symptoms.
|
Objective:
Right
below-the-knee amputation.
|
Risk
for fall r/t to loss of right lower limb secondary to amputation
|
After
health teaching, pt. will demonstrate effective self-transfer and the proper
use of ambulatory aid.
|
With
the help of the physiotherapists, demonstrated self-transfer and the proper
use of ambulatory aid.
|
Pt.
demonstrated safe self-transfer from bed to wheelchair and vice versa.
Demonstrated proper use of 2-wheeled walker with leg prosthesis on.
|
Objective:
-Pt.
is separated from his wife and lives alone.
-Pt.’s
children not involved in care and refused attendance in family meetings.
|
Risk
for ineffective relationship.
|
-After
series of health teaching, pt. will verbalize understanding of effective
coping mechanism.
|
-Discussed
with pt. the effective techniques of coping.
-Referred
pt. to a mental health counselor to help him address issues of coping with
stressful situation.
|
-Pt.
demonstrated effective coping techniques with the intention of organizing a
support group for amputees.
-Pt.
seeks advice of mental health counselor when confronted with stress.
|
References List:
NANDA. (2012). The complete list of NANDA nursing diagnosis for 2012-2014, with 16 new diagnoses. Retrieved from: http://www.kc-courses.com/fundamentals/week2process/nanda2012.pdf
NANDA. (2015). Nursing diagnosis list for 2015-2017. Retrieved from: https://health-conditions.com/nanda-nursing-diagnosis-list-2015-2017/
Testimonial #2
by Group E's Kristine Caren Onato
"Nursing is based on an art and science
that mould the attitudes, intellectual competencies, and technical skills of
the individual nurse into the desire and ability to help people, sick or well,
cope with their health needs" –Abdellah. As a nurse for eleven years,
Abdellah has taught me in so many ways towards patient care as well as my
patients have experienced her theories through my service. I deeply appreciate
her studies and compassion when it comes to patient care. Growth to one’s
professionalism has molded her inspiring works through nursing, not just me but
to all the nursing students and nurses handling the newborn, sick, well and
dying human beings. This is not just a call for duty but a service which comprises
the best attitude and competencies in judgment and critical thinking because
the patient’s life is involved. Medical science has been a challenging
industry. Nurses are expected to do the right thing at all times but nurses are
not perfect and failure is possible. Abdellah’s nursing theory is of big help to
the nurse towards performing nursing care which helps in preserving life.
My experiences will be shared below as my past
patients will be known anonymously. These experiences are comprised of the 10 steps to identify the client’s problems
and 11 nursing skills.
1.
Learn to know the patient and observation of
health status.
Years 2002 until 2006 are my years of nursing education. I was taught by my
instructors on how to observe and establish rapport with patients whom I handled
for the first time. Assessment which included direct observation helped me in
engaging my patients in conversations and knowing them more.
2.
Sort out relevant and significant data, and
skills of communication. During these years of study I was assigned to take care of actual
patients. Also, I had to do research regarding their medical conditions. I have
handled these cases very well because of the effectiveness of my patient interactions
and I involved the families in the research too. I was able to sort out the
gathered data from both my patients and their significant others
3.
Make generalizations about available data in
relation to similar nursing problems presented by other patients and
application of knowledge. I had difficulty with comprehension during my college years.
Good thing was that there was always help available from my professors,
doctors, licensed health workers and classmates. They made me understand the
cases, find solutions to my problems and answer my questions. Thus, it was
easier for me to apply it in the clinical setting and discuss/present the
research in class.
4.
Identify the therapeutic plan and, teaching of
patients and families. Year 2006 after passing my licensure exams for
Philippine boards, I started my nursing profession as a volunteer nurse. I had
an indigent patient who had TB that progressed to his bone and was admitted for
almost three months by the day I handled him. He got the TB from his mother.
The patient was in a depressing state and
was physically incapable of performing self-care. I, as his nurse, cared for
him in a day to day basis. I utilized therapeutic interventions, shared
information and teaching strategies with my patient and his mother. Doing all
of these, I was able to build a trusting relationship with them and helped them
understand the disease process by presenting it in a simple way.
5.
Test generalizations with the patient and make
additional generalizations, and planning and organization of work. Year 2007, I had a patient who was rushed to
the hospital due to strong uterine contractions, persistent abdominal pain and
continuous vaginal bleeding. Another ward nurse placed the medication, Cytotec,
vaginally since the patient was diagnosed with threatened abortion. Suddenly,
her husband shouted and went to the nursing station. He said that the patient
was very pale and with cold extremities. By that moment I knew that the
patient’s status was deteriorating and she was rushed to the delivery room and
was pronounced dead late that afternoon during my shift. This had an impact on
all the staff. This brought about more organized staffing assignment, testing
generalizations and planning the workload. There was a stress on prioritization
and the use of right judgment and all available resources.
6.
Validate the patient’s conclusions about his
nursing problems and use of resource materials. Year 2008, I had a patient who was regularly
admitted with complaints of non-healing wounds which started as simple scratches.
The patient had a consistent elevated blood sugar level and a series of tests
were done also which were conclusive of diabetes. Queries that the patient had
regarding his conditions were validated with the use of health resources
including the patient’s history and laboratory results.
7.
Continue to observe and evaluate the patient
over a period of time to identify any attitudes and clues affecting his
behavior and use of personnel resources. Year 2009, I had the same patient who was
already diagnosed with DM type 2 and was obese for the past years of his life.
Evaluating the patient for the past two years was necessary for him to control
his blood sugar levels with medication compliance and proper diet. Personnel resources
from the restaurant where the patient usually stays were made aware of his
special diet. Assurance of good compliance from both personnel and patient
himself for his diet recommendation helped the patient in controlling his
diabetes.
8.
Explore the patient’s and family’s reaction to
the therapeutic plan and involve them in the plan, and problem-solving. Year 2010, I had a post CABG patient who was
admitted in the telemetry ward with dry healing chest wound. The patient was a known
chain smoker and with the support of his relatives he finally quit smoking. The
advices given by the family to stop the bad habit helped the patient to solve
this problem. However, the patient failed to use the incentive spirometry daily
and presented a lot of excuses. I gave the patient and the family an Incentive
spirometry manual which helped with their enlightenment of the uses of this
respiratory tool. The patient tried his best and for the first time he met
level 500 then the succeeding days he was able to meet level 1000 and more.
9.
Identify how the nurses feels about the
patient’s nursing problems and direction of work of others. Year
2011, I had a patient who was positive for HIV. He developed a grade IV sacral
sore. I coordinated the care with the wound team and the attending physician.
We made goals and monitored if the doctor’s orders were met and were updated.
After a month, the patient’s sacral sore improved from stage II to stage I. With
proper coordination and collaboration with the health care team and directing
others to work with me like turning the patient every two hours, we were able
to achieve our goals and solve the nursing problems.
10.
Discuss and develop a comprehensive nursing
care plan, and therapeutic use of the self. Year 2012, I had a patient who was post
surgical tracheostomy for six months already. The balloon was accidentally cut
by my colleague during the patient’s bath. I developed a nursing care plan
immediately together with my charge nurse and my colleague. We held the patient’s
continuous feeding via nasogastric tube and relayed the case to the physician
on duty. All anticoagulants were held and the patient was kept on NPO except
for medications. The next day, the patient was due for a change in tracheostomy.
I helped and encouraged my colleague to discuss the incident that happened with
the relatives. This minimized my colleague’s and the relatives’ fears as well
with regards to the tracheostomy.
The succeeding years of my service from year 2013 and up to the present
have established in me a sense of independence. Currently, I am able to
practice my nursing profession with minimal assistance from my colleagues, I am
a good resource person because of my experience, and I have the initiative to
do what is expected of me within the scope of my nursing practice and hospital
protocols. These are Abdellah’s theories that worked in my nursing profession.
Abdellah formulated a theory that is essential for the patient, the
health team and especially for the nurses. She has inspired a lot of nurses who
make up a big part in the health care system. As I have learned Abdellah’s
theory of 21 problems in the nursing process, my fears in performing my role as
a nurse independently were lessened. These examples that I have shared are
proofs of Faye Abdellah’s theory in application. Following the guidelines set
by Abdellah allowed me to become competent nurse, to uphold safe nursing
practices and patient safety. I acknowledge Faye Glenn Abdellah for her theory and
her other major contributions to nursing. References List:
Abdellah, F.G. The federal role in nursing
education. Nursing outlook. 1987, 35(5),224-225.
Abdellah, F.G. Public policy impacting on
nursing care of older adults .In E.M. Baines (Ed.), perspectives on
gerontological nursing. Newbury, CA: Sage publications. 1991.
Abdellah, F.G., & Levine, E. Preparing
nursing research for the 21st century. New York: Springer. 1994.
Abdellah, F.G., Beland, I.L., Martin, A.,
&Matheney, R.V. Patient-centered approaches to nursing (2nd ed.). New York:
Mac Millan. 1968.
Abdellah, F.G. Evolution of nursing as a
profession: perspective on manpower development. International Nursing Review,
1972); 19, 3..
Abdellah, F.G.). The nature of nursing
science. In L.H. Nicholl (Ed.), perspectives on nursing theory. Boston:
Little, Brown, 1986.
George Julia B. Nursing theories: The base of
professional nursing practice 3rd edition. Norwalk, CN: Appleton and Lange;
1990.
by Group E's Pamela Pantalan
For almost seven years in ICU, mainly we are assisting the patient
in achieving their basic needs, act as an advocate and educator. The moment you
stepped into the patient’s cubicle you start assessing and recognizing your
patients need using the ADPIE (assessment, diagnosis, planning, intervention
and evaluation). Like for example assisting them to provide oxygenation, eat,
elimination, mobilize and some other basic needs. You also start to plan what
you’re going to do for 12 hours shift to help your patient and decide on the
appropriate interventions applicable to the case of your patient. In case that
your interventions are not working according to your goals then it can be
change later. In planning for the interventions aside from independent nursing
care, it can also be multidisciplinary like for example doctors, respiratory
therapist or social worker can be involved in giving care. The shifts are
design either 8 hours or 12 hours shift to ensure that the care is continually
given.
In summation, what we are doing right now, we owe it all to the nursing theories.
Testimonial #4
by Group E's Ada Fatima Fuego Megraso
Faye Abdellah’s typology of 21
nursing problems, her identification and classification of solving specific
problems, inspiring quotations and aspirations of becoming a best version of
herself, as a Nurse working in the community and with community for almost 6
years, her legacy has a great impact in the application of nursing care with
the goal focuses on health promotion and disease prevention.
To attain these goals, in relation
with her theory on the “11 nursing skills that a nurse should possess”,
we strengthen our foundation in promoting health which begins within ourselves.
As health care providers (Barangay Health Workers, Midwives, Nurses and
Doctors) empowered through orientations, seminars, updates, workshops, and
research with the collaborative approach of tapping our local officials I
believe that unless we do not have the knowledge, we cannot find the confidence
in applying the skills we do not actually possess. The glow of knowledge
radiates, extending the relevance of awareness and care to the community (sick
and well) especially to the marginalized group and vulnerable population.
“We cannot wait
for the world to change…Those of us with intelligence, purpose, and vision must
take the lead and change the world. Let us move forward together.” - Faye
Abdellah. In her very inspiring quotation, I can see ourselves, as the
front-liners of health, not limited to the degree of educational attainment but
the willingness to consider knowledge as the fundamental instrument in bringing
the community towards better health outcomes.
For almost 6 years under the
Department of Health I have been randomly assigned in different areas of Bislig
City, Surigao Del Sur, having 102,786 population , (24) Barangay with (38)
Barangay Health Stations including Rural Depressed and Geographically Isolated
Depressed Area. My duty is to help in
the implementation of the DOH programs: Maternal - Child Health &
Nutrition, National Immunization Program, Filaria/Malaria & Dengue Program,
Schistosomiasis Programs, National Tuberculosis Program, Leprosy, Youth and
Development Health Program, Aging Population, Non-communicable Diseases, STI
and other Infectious Diseases, AIDS prevention, STH, etc.
Her
typology of 21 nursing problems considering: 1.) Biological, sociological and
emotional needs of the patient 2.) Types of interpersonal relationship between
the nurse and the patient, and 3) Common elements of patients care, were
incorporated in the 3 major health programs under the Department of Health.
These are my experiences in using the Nursing process:
1.) Maternal - Child Health &Nutrition
: 1st trimester- 3rd trimester- labor and delivery
-postpartum care
a.)
Promotion of health: “tutok sa buntis”, health teaching on
nutritional status/diet, physiologic and emotional needs, personal hygiene and
verbalization of feelings
b.)
Prevention of complications: prompt referral of high
risk-pregnancy cases, complete history taking, BP and FBS monitoring, Ultrasound,
U/A and Hgb exam, 2 blood donors and a big NO to home delivery
c.)
Rehabilitation: UnangYakap, Post-postpartum visit:
Personal Hygiene, Nutritional status, Supplementation (FeS04 and Vit.A) Child Health Nutrition: Promotion
and prevention: Teaching mothers on newborn care (cord care &
exclusive Breastfeeding ), Newborn Screening, Immunization, Supplementation
(Iron, Micro-nutrients,Vit.A, iodine) , OPerationTimbang, GarantisadongPambata
and Deworming Rehabilitation: Monthly weight monitoring and
feeding programs for malnourished
children.
2.)
National TB Program and TB in children
a.)Promotion
of health & prevention: lectures on TB and Leprosy awareness,
personal hygiene, cough etiquette, healthy lifestyle activities (exercise,
avoid exposure to alcohol, smoking and crowded places), sputum exam for TB
symptomatic
b.)
Prevention of disease
re-occurrence TB-MDR: “tutok gamutan” adherence to medication and
nutritional status/diet TB in
children: mantoux test, nutritional status/diet b.) Rehabilitation:
healthy lifestyle and diet
3.)
Non-communicable Diseases (Hypertension, Diabetes, Goiter and Cancer)
a.)
Promotion of health and
Prevention: healthy lifestyle and non-com
disease awareness (exercise, avoid alcohol) anti-smoking individual counseling
and diet
b.)
Rehabilitation:
healthy lifestyle, diet and adherence to physical rehab through “CBRMP”
(Community-Based Rehabilitation Management Program) provision of equipment to
enhance good circulation, nerve function, anti-varicose, body balance and
posture, lumbar stretching, fat burner and detoxification machines or Diabetes,
stroke patients, with fractures, scoliosis and etc.
And like Abdellah says to her interview in Image
“Those Yale students were just
brilliant challenged me to explain why they were required to follow procedure
without questioning the science behind them.” Those were the words I have
always been hearing from our City Health Officer that before program
implementation there should always be a re-evaluation, research and critic on
application of practice before applying it in the field to prevent further complications
to the recipients. Serving the well and sick, not only
facilitating them with their health care needs but by comprehensive, facilitative
and pro-active health care providers-community interaction approach. Emphasize
to them the importance of maintaining external and internal environment in balance.
Healthcare Providers assist in health sustenance, reaching out health care
services even to the most under privileged places with the goal “All for health
towards health for all” 2016-2022 until the community can truly adapt with the evidences
of improved health seeking behavior and for the members of the community to
become independent.
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