This paper provides an analysis of the case of Mr. C., a 32-year-old patient seeking data about bariatric surgery. The report addresses the clinical manifestations the man shows as well as his health history, noting their possible causes. The work discusses possible health risks associated with obesity and the appropriateness of the surgery in the patient’s case. It also assesses the man’s functional health patterns and concludes by addressing prevention and health promotion opportunities for Mr. C.
Analysis
The signs Mr. C. shows reveal that the patient suffers from obesity. The man’s weight is 134.5 kg while his height is 6”8, meaning that his body mass index (BMI) is about 32,5, which is a sign of obesity. Sleep apnea and high blood pressure are also signs of obesity. Mr. C’s fasting blood glucose is high; it places the patient at risk for vascular disease. The high level of triglycerides increases the man’s risk of heart-related diseases, such as stroke. At the same time, Mr. C. has a low level of HDL, which is good in his condition, as it may decrease his proneness to the conditions presented above.
Mr. C. reports that he was a heavy child even at a young age, which means that his health state may have been at a low level in his childhood. As the collected data shows, the patient is at risk of diseases associated with obesity. They include hypertension, diabetes, heart-related conditions, increased levels of blood sugar, and high levels of cholesterol. It is possible to say that bariatric surgery is an appropriate intervention for Mr. C. This type of intervention can help to eliminate obesity in the patient and decrease the risks associated with it.
Health-perception: The patient is aware of the risks associated with obesity, and is willing to improve his health state. The possible causes for his symptoms may include genetic ones, as he has always been overweight, and the ones associated with his lifestyle, as he is not physically active. It is crucial to continue educating the patient about the disadvantages of his current condition and the opportunities he has for changing it.
Nutritional: Mr. C. tries to reduce his dietary sodium; other information about his daily intake is unavailable. The patient may not be able to control his increased appetite as he wants to undergo bariatric surgery.
Cognitive-perceptional: There is a lack of data about the patient from this perspective. However, Mr. C. strives to learn information about weight loss, which shows that currently, he does not experience learning-related difficulties.
Role-relationship: Mr. C. does not report any information about his family or personal relationships. However, obesity may be caused by behaviors taught by his parents or social groups he belongs to.
Coping-stress tolerance: It is unclear whether Mr. C. can rely on others to address his problems. He may have the habit of using food to manage stressful situations, which results in obesity.
End-stage renal disease (ESRD) is the fifth and last stage of chronic kidney disease. The previous stages are characterized by various levels of glomerular filtration rate (GFR); there are normal, mild, moderate, and severe stages before the end-stage. The GFR level of ESRD is lower than 15 mL/min (Mayo Foundation for Medical Education and Research (MFMER), 2019). The contributing factors include diabetes, polycystic kidney disease, high blood pressure, and recurrent kidney infection.
There are several prevention and health promotion opportunities for individuals living with ESRD. Mr. C. should be educated about the risk of developing ESRD due to high blood pressure and glucose levels (DiMaria, Leonard, & Jewell, 2017). He should aim at eliminating the impact of these factors to restore his health and avoid the deterioration of his renal status. Moreover, Mr. C. should be informed that avoiding the excessive consumption of sodium or potassium can also be an effective preventive measure (DiMaria et al., 2017). For instance, he can reduce chocolate, bananas, nuts, and other similar types of foods in addition to measuring his blood pressure and glucose levels regularly.
The resources available for ESTD patients include ESRD networks and interdisciplinary care clinics. They are available for patients living with the condition and provide support and several types of care following the multidisciplinary approach. For instance, they offer transplant coordination, dietary counseling, advanced care planning strategies, and treatment option educations (Johns, Yee, Smith-Jules, Campbell, & Bauer, 2015). Moreover, they help individuals to obtain needed resources, such as transportation and smart devices. ESRD networks provide help from the social perspective, assisting individuals in return-to-employment issues, and working on improving their living conditions. These factors are crucial for ensuring that all patients can enhance their health state.
Conclusion
The report reveals that bariatric surgery is an appropriate intervention for Mr. C. He is at risk for several conditions, including diabetes, heart-related diseases, and ESRD. It is crucial to educate the patient about the factors contributing to the potential development of ESRD, including high blood pressure and glucose levels, and the consequences it may lead to. The resources available for Mr. C. and other individuals with this disease include ESRD networks and interdisciplinary care clinics.
References
DiMaria, C., Leonard, M., & Jewell, T. (2017). What you need to know about end-stage kidney disease (ESRD). Web.
Johns, T. S., Yee, J., Smith-Jules, T., Campbell, R. C., & Bauer, C. (2015). Interdisciplinary care clinics in chronic kidney disease. BMC Nephrology, 16. Web.
Mayo Foundation for Medical Education and Research (MFMER). (2019). End-stage renal disease. Web.
The Theory Of Comfort In Nursing
Introduction
Throughout times, various nursing theories have emerged within the healthcare industry, and each of them defined nursing and its major elements in its way. Smith and Parker (2015) define nursing theories as “patterns that guide the thinking about nursing” (p. 2).
Different healthcare professionals imply the concepts into their practice intending to improve their performance, the outcomes of the services, and the experience of the patients. The theory of comfort is one of the approaches that I have developed based on previous researches and prior nursing theories that focus on care and an individual’s health. The purpose of this paper is to analyze the emergence of this theory, observe the development of related terminology, look at the implications for the current nursing practices, and evaluate it.
Main body
It is crucial to emphasize the importance of the relationships among the needs of the patients, comfort, and nursing interventions. After analyzing the connection between those areas, I have concluded that the most significant issue is the “whole person outcomes” (Kolcaba, 1994, p. 1178). Comfort, in turn, serves as the holistic outcome for the whole person, which implies that applying comfort principles can bring favorable results to the nursing practices (Kolcaba, 1994). The analysis of the theories by Orlando, Henderson, and Paterson, and Zderad moved me to distinguish three types of comfort, which are relief, ease, and transcendence (Smith & Parker, 2015).
The next point of theorizing was to determine the contexts in which the primary element of my method could be applied. Consequently, different types of comfort can be experienced within physical, psychospiritual, sociocultural, and environmental contexts (Smith & Parker, 2015). After a more precise investigation of those aspects, I came up with the comfort theory, where comfort becomes an outcome of intentional nursing care.
The term comfort itself, despite common beliefs, has a complicated and unique nature. As far as comfort lies in the core of my theory, I had to analyze the existing definitions and see if I need to come up with a distinct explanation. In one of my first articles about the comfort theory, I have investigated six different meanings of this concept (Kolcaba & Kolcaba, 1991). Among them, there were such descriptions as “the relief from discomfort,” “the state of peaceful contentment,” and “whatever makes life easy and pleasurable” (Kolcaba & Kolcaba, 1991, p. 1302).
The final definition of comfort for my nursing theory is “the satisfaction of the basic human needs for relief, ease or transcendence arising from health care situations that are stressful” (Kolcaba, 1994, p. 1178). Therefore, the use of comfort within my theory is based on previous research and literature reviews from prior approaches and concepts.
It has been more than 20 years since the emergence of the theory of comfort, and nursing professionals keep applying the elements of this theory to practice. The nurses can measure a patient’s comfort through questionnaires and verbal rating scales, which makes the theory’s use convenient and practical (Boudiab & Kolcaba, 2015). Besides, healthcare organizations gradually integrate comfort theory into the electronic records of the patients because it gives a possibility to see the bigger picture and better understand the individual’s needs (Boudiab & Kolcaba, 2015).
The theory of comfort is rapidly integrating modern nursing practices. Comfort, with careful implementation of its concept and an emphasis on holistic care, can not only improve the patients’ experience but “enhance the team’s satisfaction and morale” (Boudiab & Kolcaba, 2015, p. 278). Therefore, one can argue that the comfort concept offers a proper approach and adds value to the caring activities.
Conclusion
In conclusion, after a thorough analysis and various concepts and terms offered by different nursing theories, I have concluded that comfort plays an integral role in the care system. The theory of comfort provides a holistic approach to healthcare practices, enhancing the experiences, broadening the spectrum of patients, and improving the general image of a healthcare facility. Further implementation within different organizations and evaluation of the theory’s concepts and outcomes have a possibility of modifying the bases of comfort concept and its future applications.
References
Boudiab, L. D., & Kolcaba, K. (2015). Comfort theory: Unraveling the complexities of veterans’ health care needs. Advances in Nursing Science, 38(4), 270-278.
Kolcaba, K. Y. (1994). A theory of holistic comfort for nursing. Journal of Advanced Nursing, 19(6), 1178-1184.
Kolcaba, K. Y., & Kolcaba, R. J. (1991). An analysis of the concept of comfort. Journal of Advanced Nursing, 16(11), 1301-1310.
Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice (4th ed.). Philadelphia, PA: FA Davis Company.
Healthcare Strategies When Treating Readmitted Patients
Research Problem/Purpose
Hospitals use the rate at which patients are readmitted as a measure of the quality of care provided. However, it is not known how healthcare workers change their provision of care strategies when dealing with readmitted patients, and thus this scenario presents a nursing problem. Therefore, the purpose of this article was to “determine how healthcare workers shift their care strategies when treating readmitted patients” (Pennathur & Ayres, 2018, p. 1).
The researchers placed the study problem within the context of existing healthcare knowledge by reviewing the available literature on the subject to identify gaps that can be filled using this research. The study will solve a problem relevant to nursing because the issue of readmission is associated with negative patient outcomes and it might be indicative of inherent challenges that nurses face, such as poor communication and inefficient patient education during discharge.
Review of the Literature
The researchers conducted an extensive literature review by highlighting some of the undying issues associated with patient readmissions. For example, the researchers noted that the extent to which readmissions affect the quality of care provided to patients is not clear. On the one side, readmissions are associated with poor quality care services. On the other hand, Pennathur and Ayres (2018) cited other studies that had not established a positive correlation between readmission and poor quality care services.
The authors also cited other studies that had concluded that readmissions lead to poor patient outcomes because readmitted patients are exposed to infections in the hospital setup. The majority of the references used in this article are current. Out of the 71 sources used for referencing, only 4 were over 10 years old by 2014 based on their date of publication. Most sources had been published within 5 years by the time the article was published in 2014.
Theoretical Framework
The authors identified the grounded theoretical framework as the chosen framework for the study. This framework was appropriate for the study because it guided the sample size selection based on its established protocols. For instance, the researchers “stopped recruitment for specific roles, when a preliminary examination of successive interview responses indicated data saturation according to grounded theory protocols” (Pennathur & Ayres, 2018, p. 2). In addition, the research drew on other disciplines apart from nursing theory because it targeted healthcare workers in general including nurses.
Variables/Hypotheses/Questions/Assumptions
The research questions as stated in the article are “when treating a readmitted patient, do healthcare workers shift their care strategies significantly? What are the characteristics of the care strategy shifts, and what insights do they provide about patient care for a readmitted patient?” (Pennathur & Ayres, 2018, p. 2).
Therefore, the research questions are clearly stated in the article. The independent variable in the research question is readmitted patients, while the dependent variables are care strategies that healthcare workers use when dealing with readmitted patients. The variables are not clearly defined for the reader to understand the researchers’ interpretation of the same. Therefore, the reader has to find the variables in the course of reading the article’s contents. However, the dependent variable is concrete and measurable.
Methodology
The qualitative study design was used in this study. The inductive reasoning in this study is that the researchers would develop codes and analyze responses from healthcare workers based on how they shift their care strategies when dealing with readmitted patients. Using this approach, the researchers would approach the data without any preconceived hypotheses about the data, and thus specific observations are analyzed to guide the development of codes, themes, patterns, and theory. 34 healthcare workers (15 males and 19 females) were selected for this study. The study population was strictly restricted to healthcare workers operating in different care units in an academic center and tertiary-care hospital.
The case sampling method was used and thus there was no application of the inclusion/exclusion criterion. Therefore, given the nature of case sampling, the researchers did not choose a probability or non-probability sample as it was not necessary. Both the independent and dependent variables were tested by interviewing the selected participants to understand their thoughts on readmissions and how they changed their process of care when addressing such cases.
The measurement tools used in this study (face-to-face or telephone semi-structured interviews) are highly credible. To address ethical issues, all the participants provided verbal consent, and the University of Iowa Institutional Review Board and the Nursing Research Review Committee approved the study. Consent and delinking the participants’ identifiers from the data were the only ethical consideration necessary for this study.
Data Analysis
Data were analyzed inductively using the grounded theory approach. As such, the researchers coded data to generate patterns and themes. Categories, sub-categories, and final themes “were generated using the constant comparative framework of the grounded theory approach” (Pennathur & Ayres, 2018, p. 3). The results were presented using charts to capture how the participants shifted their approach to care when dealing with hospitalized patients. The data were classified into three different themes – shifts in assessment, shifts in information, and shifts in communication patterns. The researchers also explained their findings to support what had been presented in the charts.
In the results, participants reported that they “became more conservative in their assessment of the clinical condition of a readmitted patient” (Pennathur & Ayres, 2018, p. 1). In other words, healthcare workers become more careful and are likely to follow protocols when dealing with cases of readmission. This finding is linked to the dependent variable that sought to establish how healthcare workers shift their care approach when dealing with readmitted patients.
Summary/Conclusions, Implications, and Recommendations
One of the strengths of this study is that it followed the protocols of qualitative research. The authors have stated the theory upon which they based their methodology and approach to the study questions. The article is well-structured with clear titles to allow the reader to interact and follow the flow of the content. However, as a weakness, the population sample is too small for the generalization of the results. In addition, the study was conducted in two healthcare facilities, which limits the generalizability of the results. Therefore, the researchers cannot generalize the findings to other populations as explained under the weakness sentence.
The significance of the study findings and conclusions in my personal nursing is that I should be careful when handling patients by ensuring that I follow protocols as a way of guaranteeing quality service and avoid unnecessary readmissions. For the nursing profession, nurses, in general, should be concerned with the quality care that they offer to patients on the first admission. This approach would ensure positive patient outcomes and reduce the burden of care that is associated with avoidable readmissions.
Reference
Pennathur, P. R., & Ayres, B. S. (2018). A qualitative investigation of healthcare workers’ strategies in response to readmissions. BMC Health Services Research, 18(138), 1-13. Web.