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QUESTION
Congestive heart failure
title page, double spaced, 1inch margins, page numbered, header, citations, reference page.
There is a chart on the file that the one you have to use for the care plan the chart and the paper together will be 8 page if its more its ok.
This is the web for the care plan http://www.nandanursingdiagnosislist.org/NUR303 Essentials of Nursing Practice
Guidelines for Course Paper/Project
Paper/Project is worth 10% of overall course grade.
Paper/Project is due ______11/01/2020__________.
Students will choose or be assigned a topic/disorder from the list below in which to complete a scholarly paper.
Students will choose a nursing theorist from the list below and base their nursing care plan from the concepts identified within the framework of the nursing theorists’ model or philosophy applicable to the chosen patient disorder.
Paper should be a minimum of 8 pages and must follow APA format 7th edition (ie: title page, double spaced, 1inch margins, page numbered, header, citations, reference page). Please adhere to the student Honor Code in an effort to maintain the integrity of your work and avoid plagiarism.
Paper should include at least the following, but is not limited to:
Introduction
- Epidemiology:
- Include current statistics on disease distribution
- Risk factors
- Definitions & background data
Pathophysiology
- Review of normal system anatomy and physiology (brief statement)
- Functional changes associated with disease process:
- clinical presentation
- disease progression
Current trends in care/treatment: may include research currently being done; what’s new on the horizon to improve patient outcomes.
Cultural Sensitive Care for at least one cultural/religious groups.
Relevance of Nursing Theorist’s Model
- Apply nursing theorist’s model
- Choose One nursing theorist
- Rationale for choosing nursing theorist specific to assigned disorder
- Rationale why nursing theorist’s model or philosophy is appropriate to use as a framework for developing the Nursing Care Plan
Nursing Care Plan (see template attached) you can use the template for the nursing care plan. Go to the NANDA website.
- Case study including assessment findings.
- Nursing diagnosis
- Minimum of three
- One of the three must be teaching related (health promotion)
- Nursing goal (must be measurable)
- One long term goal (The client will…… by……)
- At least one short term goal (The client will….. by…..)
- Nursing interventions
- Minimum of three per nursing diagnosis
- Rationale specific to each intervention
Topics/Disorders Nursing Theorists
- Congestive Heart Failure 1. Jean Watson
NUR303 Essentials of Nursing Practice
NURSING DIAGNOSIS
(NANDA APPROVED)
EXPECTED OUTCOME
(Measurable Goal)
NURSING INTERVENTIONS
(What do you plan to do?)
RATIONALE
(Why are you doing this?)
Watson’s philosophy and theory of transpersonal caring Danny G. Willis, Danielle M. Leone-Sheehan* Jean Watson (1940–Present) “We are the light in institutional darkness, and in this model we get to return to the light of our humanity.” (Jean Watson, 2012) Credentials and background of the theorist Margaret Jean Harman Watson, PhD, RN, AHN-BC, FAAN, was born and grew up in the small town of Welch, West Virginia. The youngest of eight children, she was surrounded by an extended family–community environment. Watson attended high school in West Virginia and the Lewis Gale School of Nursing in Roanoke, Virginia. After graduation in 1961, she married Douglas Watson and moved to his native state of Colorado. Douglas, whom Watson describes as her physical and spiritual partner, and her best friend, died in 1998. She has two grown daughters, Jennifer and Julie, and five grandchildren. Jean lives in Boulder, Colorado. After moving to Colorado, Watson continued her nursing education at the University of Colorado. She earned a baccalaureate degree in nursing in 1964, a master’s degree in 1966, and a doctorate in educational psychology and counseling in 1973. After completing her doctorate, she joined the School of Nursing faculty at the University of Colorado Health Sciences Center, serving in both faculty and administrative positions. In 1981 and 1982, she pursued international sabbatical studies in New Zealand, Australia, India, Thailand, and Taiwan; in 2005, she took a sabbatical for a walking pilgrimage in the Spanish El Camino. In the 1980s, Watson and her colleagues established the Center for Human Caring at the University of Colorado, the nation’s first interdisciplinary center using human caring knowledge for clinical practice, scholarship, administration, and leadership (Watson, 1986). At the center, Watson and others sponsored clinical, educational, and community scholarship activities with national and international scholars in residence, as well as with international colleagues around the world, in Australia, Brazil, Canada, Korea, Japan, New Zealand, the United Kingdom, Scandinavia, Thailand, and Venezuela, among others. The Watson Caring Science evolved and the Watson Caring Science Institute (WCSI) was established from groundwork laid by the Center for Human Caring. WCSI exists as a nonprofit organization devoted to advancing caring science in Global World Caring Science programs and projects. The Watson Caring Science Center established at the University of Colorado is an interdisciplinary center for nurses and health professionals. This center is operationally and philosophically aligned with WCSI in partnership. In line with the University of Colorado initiatives in Watson Caring Science, the Watson Endowed Chair in Caring Science was recently established at the University of Colorado (Watson, personal communication, April 6, 2016). At the University of Colorado School of Nursing, Watson served as chairperson and assistant dean of the undergraduate program, implementing the nursing PhD program, and served as director of the PhD program from 1978 to 1981. Watson was Dean of the University of Colorado School of Nursing and Associate Director of Nursing Practice at the University Hospital from 1983 to 1990. As dean, she developed a postbaccalaureate nursing curriculum in human caring, health, and healing that led to a Nursing Doctorate (ND), a clinical doctorate that became the Doctor of Nursing Practice (DNP) in 2005. Watson has been active in many community programs, such as founder and member of the Board of Boulder County Hospice, and numerous other area health care facilities. Watson has received research and education federal grants, numerous university and private grants, and extramural funding for faculty and administrative projects and scholarships in human caring. She received numerous honors and awards from national and international universities and organizations, including honorary degrees, appointed positions of leadership, and honoraria for her ongoing work and service. She has received 13 honorary degrees, nine from international universities, including Göteborg University in Sweden, Luton University in London, and the University of Montreal in Quebec, Canada. In 2015 she received an honorary doctorate from Erciyes University in Kayseri, Turkey (Watson, personal communication, April 6, 2016). In 1993 she received the National League for Nursing (NLN) Martha E. Rogers Award. From 1993 to 1996, Watson served on the Executive Committee and Governing Board for the NLN, and she served as president from 1995 to 1996. In 1997 the NLN awarded her an honorary lifetime holistic nurse certificate. The University of Colorado School of Nursing honored Watson as a distinguished professor in 1992; Watson was recognized in 1998 as a Distinguished Nurse Scholar by New York University and in 1999 received the Fetzer Institute’s national Norman Cousins Award in recognition of her commitment to developing, maintaining, and exemplifying relationship-centered care practices (Watson, personal communication, August 14, 2000). In 1999 Watson assumed the Murchison-Scoville Endowed Chair of Caring Science at the University of Colorado. In 2015 she received the Helene Hildebrand Center of Compassionate Care in Medicine Award from Notre Dame University as well as an award from the Academy of Integrative Healing Medicine. In 2016 she was honored by the United Nations via the Nightingale Global Health Initiative 60th session on Commission of Women. Also in 2016 she was Honorary Chair Emerita of the International Society for Caring and Peace in Japan (Watson, personal communication, April 6, 2016). Watson has served as a Distinguished and Endowed Lecturer at national universities, including Boston College, Catholic University, Adelphi University, Columbia University–Teachers College, State University of New York, and at universities in numerous foreign countries. Her international activities include an International Kellogg Fellowship in Australia (1982), a Fulbright Research and Lecture Award in Sweden and other parts of Scandinavia (1991), and a lecture tour in the United Kingdom (1993). Watson has been involved in international projects and received invitations to New Zealand, India, Thailand, Taiwan, Israel, Japan, Venezuela, and Korea. She is featured in at least 20 nationally distributed audiotapes, videotapes, and CDs on nursing theory, a few of which are listed in Points for Further Study at the end of the chapter. Jean Watson has authored 11 books, shared authorship of 9 books, and published countless articles in nursing and interdisciplinary journals. The following publications reflect the evolution of her theory of caring. Her first book, Nursing: The Philosophy and Science of Caring (1979), was reprinted in 1985 and translated into Korean and French. Yalom’s 11 curative factors stimulated Watson to use 10 carative factors as the organizing framework for her book (Watson, 1979), “central to nursing” (p. 9), and a moral ideal. Watson’s early work embraced 10 carative factors but evolved to include “caritas,” making explicit connections between caring and love in the 2008 revised edition of this seminal text. Her second book, Nursing: Human Science and Human Care—A Theory of Nursing (1985) reprinted in 1988 and 1999, addressed her conceptual and philosophical problems in nursing. Her second book has been translated into Chinese, German, Japanese, Korean, Swedish, Norwegian, and Danish. Her third book, Postmodern Nursing and Beyond (1999), presented a model to bring nursing practice into the 21st century. Watson describes two personal life-altering events that contributed to her writing. In 1997 she experienced an accidental injury that resulted in the loss of her left eye, and soon after, in 1998, her husband died. Watson states that she has “attempted to integrate these wounds into my life and work. One of the gifts through the suffering was the privilege of experiencing and receiving my own theory through the care from my husband and loving nurse friends and colleagues” (Watson, personal communication, August 31, 2000). This third book has been translated into Portuguese and Japanese. Instruments for Assessing and Measuring Caring in Nursing and Health Sciences (2002), her fourth book, comprises a collection of 21 instruments to assess and measure caring and received the American Journal of Nursing Book of the Year Award. Her fifth book, Caring Science as Sacred Science (2005), describes her personal journey to enhance understanding about caring science, spiritual practice, the concept and practice of care, and caring-healing work. In this book, she leads the reader through thought-provoking experiences and the sacredness of nursing by emphasizing deep inner reflection and personal growth, communication skills, use of self-transpersonal growth, and attention to both caring science and healing through forgiveness, gratitude, and surrender. It received the American Journal of Nursing 2005 Book of the Year Award. Recent books include Measuring Caring: International Research on Caritas as Healing (Nelson & Watson, 2011); Creating a Caring Science Curriculum (Hills & Watson, 2011); Human Caring Science: A Theory of Nursing (Watson, 2012); and Caring Science, Mindful Practice: Implementing Watson’s Human Caring Theory (Sitzman & Watson, 2013). Theoretical sources Watson’s work has been called a philosophy, blueprint, ethic, paradigm, worldview, treatise, conceptual model, framework, and theory (Watson, 1996). Watson (1988) defines theory as “an imaginative grouping of knowledge, ideas, and experience that are represented symbolically and seek to illuminate a given phenomenon” (p. 1). She draws on the Latin meaning of theory “to see” and concludes, “It (Human Science) is a theory because it helps me ‘to see’ more broadly (clearly)” (p. 1). Watson acknowledges a phenomenological, existential, and spiritual orientation from the sciences and humanities as well as philosophical and intellectual guidance from feminist theory, metaphysics, phenomenology, quantum physics, wisdom traditions, perennial philosophy, and Buddhism (Watson, 1995, 1997, 1999, 2005, 2008, 2012). She cites as background for her theory nursing philosophies and theorists, including Nightingale, Henderson, Leininger, Peplau, Rogers, and Newman and the work of Gadow, a nursing philosopher and health care ethicist (Watson, 1985, 1997, 2005, 2012). Watson attributes her emphasis on the interpersonal and transpersonal qualities of congruence, empathy, and warmth to Carl Rogers and more recent writers of transpersonal psychology. Watson points out that Carl Rogers’s phenomenological approach, with his view that nurses are not here to manipulate and control others but rather to understand, was profoundly influential at a time when “clinicalization” (therapeutic control and manipulation of the patient) was considered the norm (Watson, personal communication, August 31, 2000). In her book, Caring Science as Sacred Science, Watson (2005) describes the wisdom of French philosopher Emmanuael Levinas (1969) and Danish philosopher Knud Løgstrup (1995) as foundational to her work. Watson’s main concepts include the 10 carative factors (see Major Concepts & Definitions box and Table 7.1) and the transpersonal healing and transpersonal caring relationship, caring moment, caring occasion, caring healing modalities, caring consciousness, caring consciousness energy, and phenomenal file/unitary consciousness. Watson expanded the carative factors to caritas, and offered a translation of the original carative factors into clinical caritas processes that suggested open ways they could be considered (see Table 7.1). TABLE 7.1 Carative Factors and Caritas Processes Carative Factors Caritas Processes “The formation of a humanistic-altruistic system of values” “The instillation of faith-hope” “The cultivation of sensitivity to one’s self and to others” “Development of a helping-trust relationship”; became “development of a helping-trusting, human caring relation” (in the 2004 Watson website) “The promotion and acceptance of the expression of positive and negative feelings” “The systematic use of the scientific problem solving method for decision making”; became “systematic use of a creative problem solving caring process” (in the 2004 Watson website) “The promotion of transpersonal teaching-learning” “The provision of supportive, protective, and (or) corrective mental, physical, societal, and spiritual environment” “The assistance with gratification of human needs” “The allowance for existential-phenomenological forces”; became “allowance for existential-phenomenological-spiritual forces” (in the 2004 Watson website) “Practice of loving-kindness and equanimity within the context of caring consciousness” “Being authentically present and enabling and sustaining the deep belief system and subjective life-world of self and one being cared for” “Cultivation of one’s own spiritual practices and transpersonal self, going beyond the ego self” “Developing and sustaining a helping trusting authentic caring relationship” “Being present to, and supportive of, the expression of positive and negative feelings as a connection with deeper spirit and self and the one-being-cared for” “Creative use of self and all ways of knowing as part of the caring process; to engage in the artistry of caring-healing practices” “Engaging in genuine teaching-learning experience that attends to unity of being and meaning, attempting to stay within others’ frame of reference” “Creating healing environment at all levels (physical as well as nonphysical, subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity, and peace are potentiated)” “Assisting with basic needs, with an intentional caring consciousness, administering ‘human care essentials,’ which potentiate alignment of mind body spirit, wholeness, and unity of being in all aspects of care” “Opening and attending to spiritual-mysterious and existential dimensions of one’s own life-death; soul care for self and the one-being-cared for” Modified from Watson, J. (1979). Nursing: The philosophy and science of caring (pp. 9–10). Boston: Little, Brown (carative factors), and Watson, J. (2008) Nursing: The philosophy and science of caring. Revised & Updated Edition. Boulder, CO: University Press of Colorado (caritas processes). Watson (1999) describes a “transpersonal caring relationship” as foundational to her theory; it is a “special kind of human care relationship—a union with another person—high regard for the whole person and their being-in-the-world” (p. 63). Development and maintenance of the transpersonal relationship is actualized through the application of the 10 caritas processes that guide the relationship and set the foundation for the caring-loving relationship essential to nursing practice (Watson, 2008). MAJOR CONCEPTS & DEFINITIONS Ten Caritas Processes Watson originally based her theory for nursing practice on 10 carative factors. Since the initial publication of the theory, the factors have evolved into what are now described as the 10 caritas processes that include a decidedly spiritual dimension and overt evocation of love and caring (Watson, 2008). One essential shift from carative to caritas is the explication of Caritas Consciousness, defined as “an awareness and intentionality” that forms the foundation for the caritas nurse (Watson, 2008, p. 43). (See Table 7.1 for the original carative factors and for caritas process interpretation.) 1. Cultivating the practice of loving-kindness and equanimity toward self and other as foundational to caritas consciousness. Humanistic and altruistic values are learned early in life but can be influenced greatly by nurse educators and clinical experience. This process can be defined as satisfaction through giving and extension of the sense of self and an increased understanding of the impact of love and caring on self and other (Watson, 2008). 2. Being authentically present: Enabling, sustaining, and honoring the faith, hope, and deep belief system and the inner-subjective world of self/other. This process, incorporating humanistic and altruistic values, facilitates the promotion of holistic nursing care and positive health within the patient population. It also describes the nurse’s role in developing effective nurse-patient interrelationships and in promoting wellness by helping the patient adopt health-seeking behaviors (Watson, 2008). 3. Cultivation of one’s own spiritual practices and transpersonal self, going beyond ego-self. The recognition of feelings leads to self-actualization through self-acceptance for both the nurse and patient. As nurses acknowledge their sensitivity and feelings, they become more genuine, authentic, and sensitive to others. The nurse also goes beyond feelings in a lifelong exploration of personal values and belief systems with the goal of increased mindfulness in caring actions (Watson, 2008). 4. Development and sustaining a helping-trust caring relationship. The development of a helping-trust relationship between the nurse and patient is crucial for transpersonal caring. A trusting relationship promotes and accepts the expression of both positive and negative feelings. It involves congruence, empathy, nonpossessive warmth, and effective communication. Congruence involves being real, honest, genuine, and authentic. Empathy is the ability to experience and thereby understand the other person’s perceptions and feelings and to communicate those understandings. Nonpossessive warmth is demonstrated by a moderate speaking volume, a relaxed open posture, and facial expressions that are congruent with other communications. Effective communication has cognitive, affective, and behavior response components (Watson, 2008). 5. Being present to, and supportive of, the expression of positive and negative feelings. The sharing of feelings is a risk-taking experience for both nurse and patient. The nurse must be prepared for either positive or negative feelings. The nurse must recognize that intellectual and emotional understandings of a situation differ (Watson, 2008). 6. Creative use of self and all ways of knowing as part of the caring process; engage in the artistry of caritas nursing. The process of nursing requires application of various ways of knowing, including “creative, intuitive, aesthetic, ethical, personal and even spiritual” (Watson, 2008, p. 107). This process moves most significantly away from a singular perspective on scientific knowledge as essential for nursing practice and calls upon the nurse to use knowledge creatively in practicing caritas nursing (Watson, 2008). 7. Engage in genuine teaching-learning experience that attends to unity of being and subjective meaning—attempting to stay within the other’s frame of reference. This factor is an important concept for nursing in that it separates caring from curing. It allows the patient to be informed and shifts the responsibility for wellness and health to the patient. The nurse facilitates this process with teaching-learning techniques that are designed to enable patients to provide self-care, determine personal needs, and provide opportunities for their personal growth (Watson, 2008). 8. Creating a healing environment at all levels. Nurses must recognize the influence that internal and external environments have on the health and illness of individuals. Concepts relevant to the internal environment include the mental and spiritual well-being and sociocultural beliefs of an individual. In addition to epidemiological variables, other external variables include comfort, privacy, safety, and clean, esthetic surroundings (Watson, 2008). 9. Administering sacred nursing acts of caring-healing by tending to basic human needs. The nurse recognizes the biophysical, psychophysical, psychosocial, and intrapersonal needs of self and patient. Patients must satisfy lower-order needs before attempting to attain higher-order needs. Food, elimination, and ventilation are examples of lower-order biophysical needs, whereas activity, inactivity, and sexuality are considered lower-order psychophysical needs. Achievement and affiliation are higher-order psychosocial needs. Self-actualization is a higher-order intrapersonal-interpersonal need (Watson, 2008). 10. Opening and attending to spiritual/mysterious and existential unknowns of life-death. Watson considers this process the most difficult to understand and can be best understood through her own words. “Our rational minds and modern science do not have all the answers to life and death and all the human conditions we face: thus, we have to be open to unknowns we cannot control, even allowing for what we may consider a ‘miracle’ to enter our life and work. This process also acknowledges that the subjective world of the inner-life experiences of self and other is ultimately a phenomenon, an ineffable mystery, affected by many, many factors that can never be fully explained.” (Watson, 2008, p. 191) Use of empirical evidence Watson’s research into caring incorporates empiricism but emphasizes approaches that begin with nursing phenomena rather than with the natural sciences (Leininger, 1979). For example, she has used human science, empirical phenomenology, and transcendent phenomenology. She has investigated metaphor and poetry to communicate, convey, and elucidate human caring and healing (Watson, 1987, 2005). In her inquiry and writing, she increasingly incorporated her conviction that a sacred relationship exists between humankind and the universe (Watson, 1997, 2005). Major assumptions Watson calls for joining of science with humanities so that nurses have a strong liberal arts background and understand other cultures as a requisite for using caring science and a mind-body-spiritual framework. She believes that study of the humanities expands the mind and enhances thinking skills and personal growth. Watson has compared the status of nursing with the mythological Danaides, who attempted to fill a broken jar with water, only to see water flow through the cracks. She proposed that the study of sciences and humanities was required to seal similar cracks in the scientific basis of nursing knowledge (Watson, 1981, 1997). Watson describes assumptions for a transpersonal caring relationship extending to multidisciplinary practitioners: • Moral commitment, intentionality, and caritas consciousness by the nurse protect, enhance, and potentiate human dignity, wholeness, and healing, thereby allowing a person to create or cocreate his or her own meaning for existence. • The conscious will of the nurse affirms the subjective and spiritual significance of the patient while seeking to sustain caring in the midst of threat and despair—biological, institutional, or otherwise. The result is honoring of an I-thou relationship rather than an I-it relationship. • The nurse seeks to recognize, accurately detect, and connect with the inner condition of spirit of another through genuine presence and by being centered in the caring moment; actions, words, behaviors, cognition, body language, feelings, intuition, thoughts, senses, the energy field, and so forth all contribute to the transpersonal caring connection. • The nurse’s ability to connect with another at this transpersonal spirit-to-spirit level is translated via movements, gestures, facial expressions, procedures, information, touch, sound, verbal expressions, and other scientific, technical, esthetic, and human means of communication, into nursing human art and acts or intentional caring-healing modalities. • The caring-healing modalities within the context of transpersonal caring/caritas consciousness potentiate harmony, wholeness, and unity of being by releasing some of the disharmony—that is, the blocked energy that interferes with natural healing processes; thus the nurse helps another through this process to access the healer within, in the fullest sense of Nightingale’s view of nursing. • Ongoing personal and professional development and spiritual growth, as well as personal spiritual practice, assist the nurse in entering into this deeper level of professional healing practice, allowing for awakening to a transpersonal condition of the world and fuller actualization of the “ontological competencies” necessary at this level of advanced practice of nursing. • The nurse’s own life history, previous experiences, opportunities for focused study, having lived through or experienced various human conditions, and having imagined others’ feelings in various circumstances are valuable teachers for this work; to some degree, the nurse can gain the knowledge and consciousness needed through work with other cultures and study of the humanities (e.g., art, drama, literature, personal story, or narratives of illness or journeys), along with exploration of one’s own values; deep beliefs; and relationship with self, others, and one’s world. • Other facilitators are personal growth experiences such as psychotherapy, transpersonal psychology, meditation, bioenergetics work, and other models for spiritual awakening. • Continuous growth for developing and maturing within a transpersonal caring model is ongoing. The notion of health professionals as wounded healers is acknowledged as part of the necessary growth and compassion called forth within this theory and philosophy (Watson, 2006b). Theoretical assertions Nursing According to Watson (1988), the word nurse is both a noun and a verb. To her, nursing consists of “knowledge, thought, values, philosophy, commitment, and action, with some degree of passion” (p. 53). Nurses are interested in understanding health, illness, and the human experience; promoting and restoring health; and preventing illness. Watson’s theory calls nurses to go beyond procedures, tasks, and techniques in practice, the trim of nursing, in contrast to the core of nursing, those aspects of the nurse-patient relationship resulting in a therapeutic outcome included in the transpersonal caring process (Watson, 2005, 2012). Using the 10 carative factors, the nurse provides care to various patients. Each carative factor and the clinical caritas processes describe how a patient attains or maintains health or dies a peaceful death. Conversely, Watson described curing as a medical term that refers to the elimination of disease (Watson, 1979). As Watson’s work evolved, she increased her focus on the human care process and the transpersonal aspects of caring-healing in a transpersonal caring relationship (1999, 2005). Watson’s evolving work continues to make explicit that humans cannot be treated as objects and that humans cannot be separated from self, other, nature, and the larger universe. Caring-healing is located within a cosmology that is metaphysical and transcendent with the coevolving human in the universe. Personhood (human being) Watson uses interchangeably the terms human being, person, life, personhood, and self. She views the person as “a unity of mind/body/spirit/nature” (1996, p. 147), and she says that “personhood is tied to notions that one’s soul possesses a body that is not confined by objective time and space” (Watson, 1988, p. 45). Watson states, “I make the point to use mind, body, soul or unity within an evolving emergent world view-connectedness of all, sometimes referred to as Unitary Transformative Paradigm-Holographic thinking. It is often considered dualistic because I use the three words ‘mind, body, soul,’ but my intention is to make explicit spirit/metaphysical—which is silent in other models” (Watson, personal communication, April 12, 1994). Health Watson’s (1979) definition of health has evolved. It was originally derived from the World Health Organization as “The positive state of physical, mental, and social well-being with the inclusion of three elements: (1) a high level of overall physical, mental, and social functioning; (2) a general adaptive-maintenance level of daily functioning; (3) the absence of illness (or the presence of efforts that lead to its absence)” (p. 220). Later, she defined health as “unity and harmony within the mind, body, and soul”; associated with the “degree of congruence between the self as perceived and the self as experienced” (Watson, 1988, p. 48). Watson (1988) stated further, “illness is not necessarily disease; [instead it is a] subjective turmoil or disharmony within a person’s inner self or soul at some level of disharmony within the spheres of the person, for example, in the mind, body, and soul, either consciously or unconsciously” (p. 47). “While illness can lead to disease, illness and health are [a] phenomenon that is not necessarily viewed on a continuum. Disease processes can also result from genetic, constitutional vulnerabilities and manifest themselves when disharmony is present. Disease in turn creates more disharmony” (Watson, 1988, p. 48). Environment Watson speaks to the nurse’s role in the environment as “attending to supportive, protective, and/or corrective mental, physical, societal, and spiritual environments” (Watson, 1979, p. 10) in the original carative factors. In later work, a much broader view of environment states: “the caring science is not only for sustaining humanity, but also for sustaining the planet. . . . Belonging is to an infinite universal spirit world of nature and all living things; it is the primordial link of humanity and life itself, across time and space, boundaries and nationalities” (Watson, 2003, p. 305). She says that “healing spaces can be used to help others transcend illness, pain, and suffering,“ emphasizing the environment and person connection: “when the nurse enters the patient’s room, a magnetic field of expectation is created” (Watson, 2003, p. 305). Logical form The theory is presented in a logical form. It contains broad ideas that address health-illness phenomena. Watson’s definition of caring as opposed to curing is to delineate nursing from medicine and classify the body of nursing knowledge as a separate science. Since 1979, the development of the theory has been toward clarifying the person of the nurse and the person of the patient. Another emphasis has been on existential-phenomenological and spiritual factors. Her works (2005) remind us of the “spirit-filled dimensions of caring work and caring knowledge” (p. x). Watson’s theory has foundational support from theorists in other disciplines, such as Carl Rogers, Erikson, and Maslow. She has been adamant that nursing education incorporate holistic knowledge from many disciplines integrating the humanities, arts, and sciences and that the increasingly complex health care systems and patient needs require nurses to have a broad, liberal education (Sakalys & Watson, 1986). Watson incorporated dimensions of a postmodern paradigm shift throughout her theory of transpersonal caring. Her theoretical underpinnings associated with concepts such as steady-state maintenance, adaptation, linear interaction, and problem-based nursing practice were replaced with a postmodern approach, leading to a more holistic, humanistic, open system, wherein harmony, interpretation, and self-transcendence emerge, reflecting a epistemological shift. Application by the nursing community Practice Watson’s theory has been validated in outpatient, inpatient, and community health clinical settings and with various populations, including recent applications with attention to patient care essentials (Pipe et al., 2012), living on a ventilator (Lindahl, 2011), simulating care (Diener & Hobbs, 2012), mothers struggling with mental illness (Blegen, Eriksson, & Bondas, 2014), and women with infertility (Arslan-Ozkan, Okumus, & Buldukoglu, 2014; Ozan, Okumus, & Lash, 2015). Jesse and Alligood (2014) provide examples of the application of Watson’s theory in nursing practice. The Attending Nursing Caring Model (ANCM) exemplifies the application of Watson Caring Science to practice, initially described in Watson and Foster (2003) as an application of theory to practice. The ANCM was a unique pilot project in a Denver children’s hospital that is modeled after the “attending” physician model. However, unlike a medical cure model, the ANCM is concerned with the nursing care model. “It is constructed as a Nursing-Caring Science, theory-guided, evidence based, collaborative practice model for applying it to the conduct and oversight of pain management on a 37-bed, postsurgical unit” (Watson & Foster, 2003, p. 363). Nurses who participate in the project learn about Watson’s caring theory, carative factors, caring consciousness, intentionality, and caring-healing practices. The mission of the ANCM is to have a continuous caring relationship with children in pain and their families. The ANCM is made visible in a caring-healing presence throughout the hospital. The influence and presence of Watson’s theory continues to be applicable and transformative in hospital systems applying for initial and ongoing Magnet status. The list of Caring Science hospitals is growing and continually evolving; examples of those who have achieved this status include Stanford Health (Palo Alto, CA), Brigham and Women’s (Boston, MA), Veterans Administration (District of Columbia), Veterans Administration (Tampa, FL), Memorial Beacon Health (Indiana), Colorado Children’s Hospital (Denver, CO); those in process include Denver Health and Hospitals (Denver, CO) and Craig Rehabilitation Hospital (Denver, CO) (Watson, personal communication, April 6, 2016). (See Watson’s website [http://www.watsoncaringscience.org] for examples of this theory in practice.) Administration and leadership Watson’s theory calls for administrative practices and business models to embrace caring (Watson, 2006a), even in a health care environment of increased acuity levels of hospitalized individuals, short hospital stays, increasing complexity of technology, and rising expectations in the “task” of nursing. These challenges call for solutions that address health care system reform at a deep and ethical level and that enable nurses to follow their own professional practice model rather than short-term solutions, such as increasing numbers of beds, sign-on bonuses, and relocation incentives for nurses. Many hospitals seeking Magnet status are meeting these challenges by using Watson’s theory of human caring for administrative change. Others call for sustaining a professional environment based on the definition of patient care essentials (Pipe et al., 2012). This and other examples of caring administrative practices are described on her website and in her article, “Caring Theory as an Ethical Guide to Administrative and Clinical Practices” (Watson, 2006a). Recent advances in Watson’s theory relevant to administration include an effort toward linking caring science and quantum leadership, which includes the work of Tim Porter O’Grady, Teri Pipe, and Kathy Malloch at Arizona State University (personal communication, April 6, 2016). Education Watson’s writings focus on educating graduate nursing students and providing them with ontological, ethical, and epistemological bases for their practice, along with research directions (Hills & Watson, 2011). Watson’s caring theory has been taught in numerous baccalaureate nursing curricula, including Bellarmine College in Louisville, Kentucky; Indiana State University in Terre Haute; Oklahoma City University; and Florida Atlantic University. In addition, the concepts are used in international nursing programs in Australia, Japan, Brazil, Finland, Saudi Arabia, Sweden, and the United Kingdom, to name a few. At the University of Colorado students can pursue a PhD in nursing with a caring science focus, and the WCSI supports postdoctoral training in caring science. More initiatives are developing in South America and the Middle East (United Arab Emirates). Additional grassroot efforts aim to integrate caring science with nursing educational developments, for example with Mary Jo Kreitzer at the University of Minnesota and Mary Kothian at the University of Arizona. There are pockets of excellent creative caring science nursing programs in the United States: Viterbo University (La Crosse, Wisconsin), Nevada State College (Henderson, Nevada), and Florida Atlantic University (Boca Raton, Florida), which has the longest caring science academic program in the United States (Watson, personal communication, April 6, 2016). Research Qualitative, naturalistic, and phenomenological methods have been identified as particularly relevant to the study of caring and to the development of nursing as a human science (Nelson & Watson, 2011; Watson, 2012). Watson suggests that a combination of qualitative-quantitative inquiry, what is known broadly as mixed-methods design, may be useful for furthering the exploration and testing of the theory (Watson, 2008). There is a growing body of national and international research that tests, expands, and evaluates the theory (DiNapoli et al., 2010; Nelson & Watson, 2011). Smith (2004) published a review of 40 research studies that specifically used Watson’s theory. Mason et al. (2014) presented the results of a mixed-methods pilot study in which Watson’s theory was influential in the development of an intervention aimed at increasing nurse retention and reducing compassion fatigue and moral distress in a surgical trauma intensive care unit. As Watson’s theory advances in the literature, researchers are providing statistical validation supporting the impact of the theory with randomized controlled trials. One such trial provided evidence in support of the efficacy of nursing care guided by Watson’s theory to reduce distress experienced by infertile women (Arslan-Ozkan, Okumus, & Buldukoglu, 2014). Measurement of outcomes associated with Watson’s theory and the application of theory to clinical practice and hospital organizations have been major weak areas of research, with particular focus on survey development. Nelson and Watson (2011) report on studies carried out in seven countries. Nelson and Watson (2011) present eight caring surveys and other research tools for caritas research, such as differences among international perceptions of caring, nurse and patient relationships, and guidelines for hospitals seeking Magnet status. Development of measures to quantify the outcomes of caring science has received significant ongoing attention with the development of the Watson Caritas Patient Score (Brewer & Watson, 2015). Further, Watson is currently working with Press Ganey on a pilot program under way in five health care systems whereby five caritas items are being included in the Press Ganey survey to link the relationship between patients’ experiences of caring and outcomes, beyond problem-focused data (Watson, personal communication, April 6, 2016). A number of PhD dissertations and DNP projects have been conducted since 2013; a search of the Proquest Dissertations and Theses database yielded 29 such publications. A wide range of topics were researched that were grounded in or informed by Watson Caring Science. Topics reflected primarily the domains of nursing education and clinical practice, including, but not limited to, faculty-student caring relationships, caring health care leadership, Watson’s caring theory translation bridging the theory-practice gap, emancipatory nursing experiences, and clinicians’ and patients’ perspectives and experiences of caring, including patient satisfaction. Further development Jean Watson is currently working with more than 20 different countries that are involved in caring science in education, doctoral programs, clinical practice, or clinical care models. There is an ongoing commitment to global programs of caring science, with current work focused on the future unveiling of a formal Watson Caring Science Global Associate network. There are membership commitments from the Middle East, Japan, Italy, South America (Peru), China, and Mexico. Programs, projects, or systems pending are South Africa, Portugal, Spain, Canada (Quebec), Korea, Singapore, Thailand, the Philippines, and Taiwan. Watson envisions Watson Caring Science influencing interdisciplinary realms of knowledge and practice, given that Watson Caring Science and unitary views are universal and transdisciplinary, beyond all health and healing professions, so it can be held as a hopeful paradigm for all health and healing professions and educational and human service programs. The paradigm is a guide toward honoring the whole person, preserving human dignity, and sustaining and evolving human consciousness, humanity, and views and informed moral action toward authentic human caring, healing, and health for self, other, and planet (personal communication, April 6, 2016). On the horizon, Watson is creating a Watson Caring Science World Portal, evolving as a dream network of global programs, projects, and systems networking with one another with their unique programs, able to access a common portal of others’ works, and to have virtual programs/webcasts from different countries sharing their work and helping one another as a resource for the 19 million nurses and midwifes as well as health and healing professions. Other future visions include creating new standards and criteria for hospitals and clinical agencies, including academic programs to be fully and formally credentialed as authentic Watson Caring Science organizations, with new forms of evidence beyond empirics alone, perhaps guided by evidence of new concepts such as “human flourishing”; caring-healing presence, consciousness, intentionality, evidence of caritas processes lived out at multiple levels in systems, and new outcome measures (caritas items). Critique Clarity Watson uses nontechnical, sophisticated, fluid, and evolutionary language to artfully describe her concepts, such as caring-love, and caritas processes and consciousness. Paradoxically, abstract and simple concepts such as caring-love are difficult to practice, yet practicing and experiencing these concepts leads to greater understanding. At times, lengthy phrases and sentences are best understood if read more than once. Watson’s inclusion of metaphors, personal reflections, artwork, and poetry make her concepts more tangible and more esthetically appealing. She has continued to refine her theory and has revised the original carative factors as caritas processes. Critics of Watson’s work have concentrated on her use of undefined or changing/shifting definitions and terms and her focus on the psychosocial rather than the pathophysiological aspects of nursing. Watson (1985) has addressed the critiques of her work in the preface of Nursing: The Philosophy and Science of Caring (1979, 2008), in the preface of Nursing: Human Science and Human Care—A Theory of Nursing (1985, 1988), and in Caring Science as Sacred Science (2005). Simplicity Watson draws on a number of disciplines to formulate her theory. The theory is more about being than about doing, and the nurse must internalize it thoroughly if it is to be actualized in practice. To understand the theory as it is presented, it is best for the reader to be familiar with the broad subject matter. This theory is viewed as complex when the existential-phenomenological nature of her work is considered, particularly for nurses who have a limited liberal arts background. Although some consider her theory complex, many find it easy to understand and to apply in practice. Generality Watson’s theory is best understood as a moral and philosophical basis for nursing. The scope of the theory encompasses broad aspects of health and illness phenomena. In addition, the theory addresses aspects of health promotion, preventing illness, and experiencing peaceful death, thereby increasing its generality. The caritas processes provide guidelines for nurse-patient interactions, an important aspect of patient care. One critique is that the theory does not furnish explicit direction about what to do to achieve authentic caring-healing relationships. Nurses who want concrete guidelines may not feel secure when trying to use this theory alone. Some have suggested that it takes too much time to incorporate the caritas into practice, and some note that Watson’s personal growth emphasis is a quality “that while appealing to some may not appeal to others” (Drummond, 2005, p. 218). Empirical precision Watson describes her theory as descriptive; she acknowledges the evolving nature of the theory and welcomes input from others (Watson, 2012). Although the theory does not lend itself easily to research conducted through traditional scientific methods, recent work focused on intervention development and measurement stretch to validate the theory through quantitative or mixed-method design. In addition to this work, ongoing development with qualitative nursing approaches is appropriate and needed to adequately explore concepts central to the theory. Recent work on measurement reviews a broad array of international studies and provides research guidelines, design recommendations, and instruments for caring research (Nelson & Watson, 2011). Derivable consequences Watson’s theory continues to provide a useful and important metaphysical orientation for the delivery of nursing care (Watson, 2007). Watson’s theoretical concepts, such as use of self, patient-identified needs, the caring process, and the spiritual sense of being human, may help nurses and their patients to find meaning and harmony during a period of increasing complexity. Watson’s rich and varied knowledge of philosophy, the arts, the human sciences, and traditional science and traditions, joined with her prolific ability to communicate, has enabled professionals in many disciplines to share and recognize her work. Summary Jean Watson began developing her theory while she was assistant dean of the undergraduate program at the University of Colorado, and it evolved into planning and implementation of its nursing PhD program. Her first book started as class notes that emerged from teaching in an innovative, integrated curriculum. She became coordinator and director of the PhD program when it began in 1978 and served until 1981. While she was serving as Dean of the University of Colorado, School of Nursing, a postbaccalaureate nursing curriculum in human caring was developed that led to a professional clinical doctoral degree (ND). This curriculum was implemented in 1990 and was later transitioned into the DNP degree. Watson initiated the Center for Human Caring, the nation’s first interdisciplinary center with a commitment to develop and use knowledge of human caring for practice and scholarship. She worked from Yalom’s 11 curative factors to formulate her 10 carative factors. She modified the 10 factors slightly over time and developed the caritas processes, which have a spiritual dimension and use a more fluid and evolutionary language. CASE STUDY A 62-year-old inmate is admitted to this hospital from prison with a complaint of chest pain. The patient is being worked up for possible myocardial infarction and admitted to the cardiac unit. Because the patient is an inmate, while he is in the hospital a prison guard will be posted outside of the patient’s room and the patient will be handcuffed to the bed rail. During the initial assessment, the admission nurse finds the patient to be withdrawn. The nurse discovers the patient has a past medical history significant for abuse of multiple substances. The patient describes how the addictive behaviors led to his incarceration and estrangement from his family. The patient expresses to the nurse interest in meeting with a chaplain while in the hospital. • Describe examples of the how the nurse can provide care to this patient as guided by each of the 10 caritas processes. Critical thinking activities 1. Review the values and beliefs in your own philosophy of person, environment, health, and nursing and compare your beliefs with Watson’s 10 caritas processes. 2. Create a list of caring behaviors in your own nursing practice. Review Measuring Caring: International Research on Caritas as Healing (Nelson & Watson, 2011), and compare your list with the caring behaviors from instruments designed to measure caring included in that text. 3. Plan a time and place to meditate for 10 minutes each week, closing your eyes and listening to quiet music. Reflect on ways to feel compassionate, intentional, calm, and peaceful. Consider ways to incorporate ideas from your reflection into your nursing practice.
| Subject | Nursing | Pages | 32 | Style | APA |
|---|
Answer
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Congestive Heart Failure
Introduction
Heart failure is described as a complex clinical syndrome, which results from structural or functional heart disorder that impairs ejection of blood or ventricular filling; thus, systemic circulation fails to meet the systemic needs. Symptoms of heart failure include decreased exercise tolerance, dyspnea, and fluid retention. Fluid retention is associated with peripheral or pulmonary edema (Malik, Brito, & Chhabra, 2020). Caring for congestive heart failure patients should be holistic in approach and include patient education to improve outcomes.
Epidemiology
About 5.1 million people in the United States clinical present with heart failure. The prevalence of heart failure continues to increase. More than 650,000 new cases of heart failure are diagnosed annually particularly in persons who are more than 65 years of age (Malik et al., 2020). Black men present with the highest rate of incidence of the disease compared to White men. The prevalence of the disease among non-Hispanic Black females and males is 3.8% and 4.5%, respectively, versus 1.8% and 2.7% in non-Hispanic White females and males, respectively (Malik et al., 2020). Mortality is about 50% within 5 years of diagnosis. The 5-year survival for heart failure stage A, B, C and D is 97%, 96%, 75%, and 20%, respectively (Malik et al., 2020).Prevalence of heart failure is greater than 37.7 million globally. Medical costs for caring of patients in the United States are projected to rise from $20.9 billion in 2012 to staggering $53.1 billion by 2030 (Ziaeian & Fonarow, 2016).
Background
Congestive heart failure can be caused by disorders of the myocardium, endocardium, pericardium, vessels, heart valves or metabolic disorders. The most common cause of systolic dysfunction includes coronary heart disease, idiopathic dilated cardiomyopathy, valvular disease, hypertension and coronary heart disease (Malik et al., 2020). Obesity, hypertension, diabetes mellitus, hyperlipidemia, and coronary artery disease are highly prevalent in congestive heart failure patients with preserved ejection function. Hypertension is a major cause of congestive heart failure with preserved ejection fraction. Besides, conditions such as restrictive cardiomyopathy and hypertrophic obstructive cardiomyopathy are associated with significant level of diastolic dysfunction resulting in heart failure with preserved ejection fraction (Malik et al., 2020). Causes of high-output failure include hyperthyroidism, atrioventricular fistulas, pregnancy, beriberi, anemia, multiple myeloma, carcinoid syndrome, polycythemia vera, and Paget disease of bone (Malik et al., 2020).
Common causes of decompensation in a stable patient with congestive with congestive heart failure include sudden changes in weather, lack of physical activity, inappropriate reduction in medications, and excess intake of sodium in the diet. Other important cause of decmpensation includes excess intake of water, emotional crisis, and prolonged physical activity (Malik et al., 2020). Congestive heart failure manifests with numerous symptoms that impairs quality of life. Symptoms include fatigue, dyspnea, fluid retention, and poor exercise tolerance (Ziaeian & Fonarow, 2016).
Pathophysiology
Adaptive mechanisms aimed at maintaining sufficient overall contractile performance of the heart at the normal range becomes maladaptive in the long run. Primary myocardial response to chronically elevated wall-stress is myocyte hypertrophy, due to regeneration and apoptosis (Malik et al., 2020). The process of myocyte hypertrophy results in wall remodeling with reduced cardiac output, leading to a cascade of vascular mechanism and neurohumoral mechanism. Clinical presentations such as decreased renal perfusion and carotid baroreceptor stimulation results in activation of renin-angiotensin-aldosterone system and sympathetic nervous system. Activation of the renin-angiotensin-aldosterone system leads to elevation of the afterload, vasoconstriction, and hemodynamic alterations, elevated preload. Activation of the sympathetic nervous system leads to inotropy and elevated heart rate, resulting to myocardial toxicity (Malik et al., 2020).
B-type natriuretic peptide and atrial natriuretic peptide are released from the ventricles and atria in response to volume expansion or heart chamber pressure. These peptides promote vasodilation and natriuresis. Besides, B-type natriuretic peptide inhibits sodium reabsorption in the proximal convoluted tubule. It also suppresses aldosterone release and suppresses renin (Malik et al., 2020). In patients with congestive heart failure with preserved ejection fraction, there is increased ventricle stiffness and impaired relaxation, leading to dysfunction in diastolic filling of the left ventricle. Patients with left ventricular hypertrophy manifest with a shift of the diastolic-pressure-volume curve to the left resulting in an increase of diastolic pressures that in turn results in increased oxygen demand, increased energy expenditure, and myocardial ischemia. All these mechanisms results in worsening of the left ventricular function and negative remodeling; thus, causing symptoms of heart failure (Malik et al., 2020). Symptoms of congestive heart failure due to excess fluid accumulation include orthopnea, dyspnea, pain from hepatic congestion, abdominal distention from ascites, and edema. Weakness and fatigue that is most pronounced with physical exertion indicates congestive heart failure due to reduction in cardiac output (Malik et al., 2020).
Subacute and acute presentations, in a matter of days to weeks, is characterized by shortness of breath with exertion and/or at rest, paroxysmal nocturnal dyspnea, orthopnea, and right upper-quadrant discomfort as a result of acute hepatic congestion (Malik et al., 2020). Palpitations, without or with lightheadedness, can occur in patients who develop ventricular or atrial tachyarrhythmias. Chronic clinical presentations may vary since anorexia, fatigue, peripheral edema, and abdominal distension may be more pronounced than dyspnea. Anorexia is secondary to factors such as bowel edema, nausea induced by hepatic congestion, and poor perfusion of the splanchnic circulation (Malik et al., 2020). Late stages of congestive heart failure manifest with signs such as pedal edema, tachycardia, abnormal lung sounds, increased jugular venous pressure, and S3 gallop (Inamdar & Inamdar, 2016).
Prognosis
Congestive heart failure is a serious medical condition that is associated with high mortality rate. Mortality rate at 1 year is 22%, while mortality rate for patients who have had the disease for 5 years is 43%. Patients with advanced New York Heart Failure classification report highest mortality rate (Malik et al., 2020). Clinical values including systolic blood pressure <115 mmHg, serum urea >15 mmol/L, SERUM creatinine >2.72 mg/dL, left ventricular ejection fraction <45%, and N-terminal pro-brain natriuretic peptide >986 pg/mL are key predictors of high risk of mortality (Inamdar & Inamdar, 2016). Heart failure that is characterized by systolic dysfunction has mortality rate of 50% over 5 years. Heart failure patients require repeated admissions over the years (Malik et al., 2020).
Current Trends in Care/Treatment
Pharmacotherapy
Beta-blockers, diuretics, angiotensin receptor blockers, angiotensin converting enzyme inhibitors, hydralazine plus nitrate, angiotensin receptor neprilysin inhibitor, aldosterone antagonists, and digoxin are used in management and improvement of symptoms. Angiotensin receptor neprilysin inhibitor should not be administered within 36 hours of administration of a dose of angiotensin converting enzyme inhibitors (Malik et al., 2020). Diuretics include potassium sparing drugs, loop diuretics, and thiazides, which are administered to reduce edema by reducing venous pressure and blood volume (Inamdar & Inamdar, 2016).
Device Therapy
Implantable cardioverter-defibrillator is indicated form secondary and primary prevention of sudden cardiac death. Patents with prolonged QRS duration, reduced left ventricular ejection fraction, and with a sinus rhythm can be managed with cardiac resynchronization therapy with bi-ventricular pacing to improve survival and symptoms. Patients who can be managed with cardiac resynchronization therapy implantation can also be managed with an implantable cardioverter-defibrillator; or receive a combination of the two devices (Malik et al., 2020). Cardiac transplant or a ventricular assist device is reserved for patients with severe disease regardless of all measures (Malik et al., 2020).
Cultural Sensitive Care
Congestive heart failure patients from the African-American community with New York Heart Association functional classification III to IV congestive heart failure and left ventricular ejection fraction <40%, regardless of medical therapy (angiotensin converting enzyme inhibitors, beta-blocker, angiotensin II receptor blockers, diuretics, and aldosterone), should be administered hydralazine plus oral nitrate (Malik et al., 2020). African-Americans reports with highest incidence rates of heart failure, Hispanic and Whites reports with intermediate rates, while Chinese-Americans manifest with lowest incidence rates (Ziaeian & Fonarow, 2016).
Relevance of Jean Watson’s Theory of Human Caring
Dr. Jean Watson developed the Theory of Human Caring that focuses on how nurses care for their patients as well as how caring advancements into better plans so as to promote wellness and health. The other goal is to restore health and prevent illness. The aims are compatible with the goals of treating a congestive heart failure patient. According to Jean Watson’s Theory of Human Caring a disease such as congestive heart failure can be cured; however, the illness may remain since, without caring, health will not be attained. Caring is considered as the essence of nursing and depicts responsiveness between the nurse and the person; the nurse co-participates with the person being provided with care (Gonzalo, 2019). Constant reviews of the nurses’ caring behavior and patient satisfaction help to advance the quality of nursing (Pajnkihar, Štiglic, & Vrbnjak, 2017). Caring should be central to improvement of patient’s experience as endorse Watson’s theory of human caring. Caring includes care about and care for clients. Patient education is necessary for health promotion in patients with congestive heart failure (Pajnkihar, Štiglic, & Vrbnjak, 2017).
Table 1: Nursing Care Plan
NURSING DIAGNOSIS
(NANDA APPROVED)
EXPECTED OUTCOME
(Measurable Goal)
NURSING INTERVENTIONS
(What do you plan to do?)
RATIONALE
(Why are you doing this?)
Decreased cardiac out
· Normal heart rate and rhythm by two months under treatment (Wayne, 2019).
· Patient demonstrates sufficient cardiac out as evidenced by pulse rate and blood pressure as well as rhythm within the normal range for the patient; ability to tolerate physical exertion without symptoms of syncope, dyspnea, or chest pain and strong peripheral pulses by a period of 6 months after commencement of treatment (Wayne, 2019).
· Patient explains precautions and actions for to take for cardiac disease after two weeks of patient education (Wayne, 2019).
· Patient demonstrates dry skin, warm skin, and eupnea with absence of pulmonary crackles by two months of treatment (Wayne, 2019).
· Record volume of intake and output. In acutely ill patients, hourly measurement of urine output is necessary so as to detect decreased urine output (Wayne, 2019).
· Limit sodium intake and fluid intake in patients with increased preload (Wayne, 2019).
· Auscultation of heart sounds. Record rhythm, heart rate, presence of S3 and S4, and lung sounds.
· Reduced cardiac output contributes to reduced perfusion of the kidneys, which results in decreased urine output (Wayne, 2019).
· Sodium and fluid restriction results in decreased extracellular fluid volume as well as reduced demands on the heart (Wayne, 2019).
· New onset of fine crackles in lung bases, tachycardia, and a gallop rhythm demonstrates onset of heart failure. In case the patient develops pulmonary edema it will lead to severe dyspnea and course crackles on inspiration (Wayne, 2019).
Ineffective tissue perfusion
· Display vital signs within the acceptable range, no symptoms of failure, or dysrhythmias/controlled (Vera, 2020).
· Patient will demonstrate behaviors that indicate improved circulation (Vera, 2020).
· Assess the patient for pain intensity using a pain rating scale, for precipitating factors and location of pain (Vera, 2020).
· Assess response to medications every five minutes (Vera, 2020).
· Monitor vital signs, particularly blood pressure and pulse, every five minutes until pain subsides (Vera, 2020).
· Ti identify precipitating factors, intensity, and location of pain to assist with accurate diagnosis (Vera, 2020).
· Assessment of the response determines the effectiveness of the medications and to determine if further interventions are required (Vera, 2020).
· Elevated blood pressure and tachycardia often occur with angina and reflects mechanisms of compensation secondary to sympathetic nervous-stimulation (Vera, 2020).
Deficient knowledge
· Help the patient identify the relationship between ongoing treatment plans and medications to prevention of complications and recurrent episodes within two weeks of hospitalization (Vera, 2020).
· Help the client to initiate necessary behavioral or lifestyle changes within a period of 6 months.
· Help the client to identify own risk/stress factors and various techniques for handling them within a period of 2 weeks of hospitalization (Vera, 2020).
· Review medications, side effects, and purpose of medications. Provide both written and oral instructions (Vera, 2020).
· Recommend taking of diuretics early in the morning (Vera, 2020).
· Provide opportunities for the client to discuss concerns, ask questions, and make necessary lifestyle changes (Vera, 2020).
· Understanding importance of prompt reporting of medication side effects and therapeutic needs can help to prevent occurrence of drug-associated complications. Anxiety may hinder the patient from developing an understanding of details hence written notes may be referred by the patient later (Vera, 2020).
· The rationale is to provide sufficient time for diuretics to impart their action so as to prevent interruption of sleep (Vera, 2020).
· Debilitating and chronicity nature of heart failure often drain supportive capacity and coping abilities of both care providers and the patient, leading to depression (Vera, 2020).
Reference
Gonzalo, A. (Sep 12, 2019). Jean Watson: Theory of Human Caring. https://nurseslabs.com/jean-watsons-philosophy-theory-transpersonal-caring/
Inamdar, A. A., & Inamdar, A. C. (2016). Heart Failure: Diagnosis, Management and Utilization. Journal of clinical medicine, 5(7), 62. https://doi.org/10.3390/jcm5070062
Malik, A., Brito, D., & Chhabra, L. (2020). Congestive heart failure. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430873/
Pajnkihar, M., Štiglic, G., & Vrbnjak, D. (2017). The concept of Watson's carative factors in nursing and their (dis)harmony with patient satisfaction. PeerJ, 5, e2940. https://doi.org/10.7717/peerj.2940.
Vera, M. (Jul 01, 2020). 18 heart failure nursing care plans. https://nurseslabs.com/heart-failure-nursing-care-plans/6/
Wayne, G. (Feb 12, 2019). Ineffective tissue perfusion nursing care plan. Nurseslabs. https://nurseslabs.com/ineffective-tissue-perfusion/
Ziaeian, B., & Fonarow, G. C. (2016). Epidemiology and aetiology of heart failure. Nature reviews. Cardiology, 13(6), 368–378. https://doi.org/10.1038/nrcardio.2016.25
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QUESTION
Week 4 Discusssion
This is a discussion question that I need answered. I need the second portion of the questioned answered thoroughly, both bullet points. I have highlighted it in yellow to show that it is what I need answered. I need this r returned to me completed without any grammatical or punctual errors. The company that I want this question written about is Nissan Motor Corporation.
Choose ONE of the following discussion question options to respond to:
Using Adverse Conditions to a Company's Advantage
- Chakravorti (2010) discusses four methods that corporate innovators use to turn adverse conditions to their advantage. Examine an organization of your choice and briefly discuss how the organization might use one of these methods.
-OR-
Assessing Risk and Reward
- Using the company of your choice, identify an important and difficult decision that they faced. What were the most important risks and the most important rewards of the decision?
- What data, analysis or perspective would you have used to help Sr. Management decide if the rewards outweighed the risks?
| Subject | Business | Pages | 4 | Style | APA |
|---|
Answer
Assessing Risk and Reward
The Nissan Motor Company is one of the leading automobile makers in the world. The Japanese carmaker has primarily enjoyed a successful run, allowing it to enter various regional and international markets such as the United States. However, the changing business environment was not favorable to the company in 2019. Notably, the cooperation recorded losses amounting to 7.8%. The experience pushed the management into making tough decisions, requiring almost all of its North American workforce to go for unpaid leaves.
In late 2019, the company announced that the decline in sales necessitated a two-day unpaid leave for the North American workers. The stated days for the vacation were January 2 and 3rd (Chicago Tribune, 2019). Notably, this move was a crucial decision for the company because of its conflicting impacts. Whereas on the positive side, it could help the firm minimize expenses, it threatened to affect the public perception of the company regarding employee welfare.
The rewards for the decision involved cutting expenses by not paying the workers on leave, which eventually would translate into reduced expenses. Another reward was that the decision could allow the company to optimize performance by evaluating employee performances then developing new milestones. However, on the low side, the company risked affecting its public image and brand name, especially in the North American market. As per Chakravorti (2010), the way an organization treats its employees influences the firm's public perception. Thus, Nissan risked eliciting a negative public perception. With a distorted public image, the company could fail to revive its declining sales.
I would have advised the management of Nissan to utilize the Predictive Analytic perspective in determining the right decision to take. Ideally, the approach tries to predict what might happen in the future if particular decisions or actions are undertaken at the moment (Traymbak & Aggarwal, 2019). Looking at the situation at Nissan, the company needed to develop a goal such as increasing sales. After that, they would have made decisions aimed at realizing the set goal. In this regard, the predicted outcome could give the management an overview of whether more risks existed or significant rewards could be realized.
.
References
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Bertani, A., Di Paola, G., Russo, E., & Tuzzolino, F. (2018). How to describe bivariate data. Journal of thoracic disease, 10(2), 1133.
Palazzolo, D. (2018). Writing in the disciplines: Political science - Four steps for conducting bivariate analysis. University of Richmond Writing Center & WAC Program. https://writing2.richmond.edu/writing/wweb/polisci/bivariate2.html
Sims, R. L. (2000). Bivariate data analysis: A practical guide. Nova Publishers.
Zhang, Z. (2016). Univariate description and bivariate statistical inference: the first step delving into data. Annals of translational medicine, 4(5).