Role of nurse,family and patient in adult patient care

Prepared by:
M.Vijayarani.Bsc.(N).R.N.R.M

ROLE OF NURSE FAMILY AND PATIENT IN ADULT PATIENT CARE

INTRODUCTION:

The word “NURSE “originated from the Latin word “NUTRIX” meaning “TO NOURISH”. Nurse assumes a number of roles when they provide care to client. The roles required at a specific time depend on the needs of the client and aspects of the particular environment.

DEFINITION:

1) According to Virgiena Handerson (one of the first modern nurse) " The unique function of the nurse is to assist the individual, sick, or well, in the performance of those activities contributing to health or its recovery (or to peaceful deatyh0that he would perform unaided if he had the necessary strength, will or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible".

2) The International council of nurses published a full definition in 1987,followed by shorter, more succinct version in 2002,"Nursing encompasses autonomous and collaborative care of individual of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.”

DEFINITION OF ADULT HEALTH NURSE:

“A Nurse who has received additional education and training in the primary health care of adults.”

MEANING OF ADULT NURSING:

Adult nursing involves caring for adults, both sick and well, not only ion the hospital environment but also in the community setting. An inherent part of the role of an adult nurse is the promotion of health through education, the prevention of disease, and the care, substance and rehabilitation of adults undergoing diagnostic and therapeutic regimens. Clearly the role of the nurse helping and caring for adults is both challenging and diverse.

GOALS OF ADULT HEALTH NURSING:

Determines responses to health problems, level of wellness, and needs for assistance.
Provides physical care, emotional care, teaching, guidance and counseling.
Interventions aimed at assisting the client to meet own needs.

AIMS OF NURSING IN ADULT PATIENT CARE:

• To promote health
  
• To prevent illness
  
• To restore health
  
• To facilitate coping with disability or death.

To meet these aims the nurse uses knowledge, skills and critical thinking to give care in a variety of the traditional and expanding nursing roles. To provide knowledgeable care the nurse uses cognitive, technical, inter personal, and ethical, legal competencies essential to nurse in practice.

GENERAL DISCRIPTION OF ADULT HEALTH NURSE:

Adult nurses provide medical care to and support the recovery of patients suffering from acute and long-term illness, diseases such as diabetes or arthritis or those requiring surgery.

They focus on the needs of the patient rather than the illness or condition.
They promote good health and well being through the education.
Adult nurses plan and carryout case within a multidisciplinary team but are curing a specific disease, although treatment skills that promote physical healing are important to care givers.

The adult nurse addresses the holistic health care needs of the client including measures to restore emotional, spiritual, and social well being.
The nurse helps the client and family to set goals and meet those goals a minimal cost of time and energy.

The role as a caregiver is the role of nurse.
Gaining the trust and confidence of each patient is an important role of nurses.
In all the cases nurses needs to establish a good relationship with the patient and their relatives.

• Duties of nurses include the following
  
• Preparing care plans
  
• Implementing plans through tasks such as preparing patients for surgeries,

• wound treatment and monitoring pulse, blood pressure and temperature.
  
• Observing and recording the conditions of patient.
  
• Checking and recording the conditions of patients.
  
• Setting up drips and blood transfusion.
  
• Assisting with tests and evaluating.
  
• Carrying out routine investigations.
  
• Responding quickly to emergencies.
  
• Organizing staff and workloads.
  
• Teaching skills to student and junior nurses.
  
• Maintaining patient records.
  
• Making ethical decisions related to current and confidentiality.
  

ROLE OF NURSE IN ADULT PATIENT CARE:

ROLE:

A role is a set of expected behaviors associated with an individual status or position, which includes behaviors, rights and responsibilities.

Nurses often carry out several roles concurrently, not exclusively of one another. The contemporary nurse functions in the interrelated roles of caregiver, clinical and ethical decision maker, protector and client advocate, rehabilitator, comforter, communicator, and teacher.

1) CARE GIVER:
· As a caregiver, the nurse helps the client regain health through the healing process. Healing is more than just the main point of contact for patients.

· Adult nurses who work mainly in the hospitals have traditionally included those activities that assist the client’s dignity.

· The required nursing actions may involve full care for the completely dependent client, partial care for the partially dependent client, and supportive educative care to assist clients in their highest possible level of health and wellness.

· Caregiver encompasses the physical, psychosocial, developmental, and cultural and spiritual levels.

· The nursing process provides nurses with a framework for providing care.

· A nurse may provide care directly or delegate it to other caregivers.

2) CLINICAL DECISION MAKER:

· To provide effective care, the nurse uses critical thinking skills throughout the nursing process.

· Before understanding any nursing action, wheather it is assessing the clients condition, giving care, or evaluating the results of the care, the nurse plans the action by deciding the best approach for each client. The nurse makes these decisions alone or in collaboration with the client and family.

3) ADVOCATE:

· Adult nurse also assist clients in exercising their rights and help them speak up for themselves. The promotion of human or legal rights and serving of care of all patients based on the belief that patients have the rights to make informed decisions about their own health and lives.

· A client advocate acts to protect the client.

· The nurse may also defend client’s rights in a general way by speaking out against policies or actions that might endanger client’s well being or conflict with their rights.

4) PROTECTOR:
· As a protector the nurse helps to maintain a safe environment for the client from possible adverse effects of diagnostic or treatment measures. Confirming that a client doesn’t have an allergy to a medicine and providing immunization against disease in a community based practice are examples of the nurses protective.
5) COMMUNICATOR:

· The role of communicator is central to all other nursing roles.

· Nursing involves communication with clients and families, other nurses and health care professionals, resourse persons, and the community.

· Without clear communication it is impossible to give care effectively, make decisions with clients and families, protect with clients from threats to well being, coordinate and manage client care, assist client in rehabilitation, offer comfort or teach.

· In the role of communicator nurses identify clients problems and then communicate these verbally or in writing to other members of the health team.

· The nurse must be able to communicate clearly and accurately in order for a clients health care needs to be met.


6) COMFORTER:

· The role of comforter, caring for the client as a person, is a traditional and historical one in nursing and has continued to be important, as nurses have assumed new roles.

· Because nursing care must be directed to the whole person rather than simply the body, comfort and emotional support often help give the client strength to recover.

· While carrying out nursing activities, nurses can provide comfort by demonstrating care for the client as an individual with unique feelings and needs.
· As comforter, nurses should help the client reach therapeutic goals rather than encourage emotional or physical independence.

7) TEACHER:

· As a teacher nurse must helps clients learn about their health and the health care procedures they need to perform to restore or maintain their health.

· The nurse assess the clients learning needs and readiness to learn, sets specific learning goals in conjunction with the client, enacts teaching strategies and measures learning.

· As teacher, the client, the nurse explains to client’s concepts and facts about health, demonstrates procedures such as self-care activities, determines that the client fully understands reinforces learning or client behaviour, and evaluates progress in learning.

· It involves providing emotional, intellectual and psychological support.

· The nurse counsels primarily healthy individuals with normal adjustment difficulties and focus on helping the person develops new attitudes, feelings and behaviour by encouraging the client to look at alternative behaviour, recognize the choices, and develop a sense of control.

9) CHANGE AGENT:

· Nurses who function in the role of change agent recognize the change is a complex process.

· The change agent is proactive (take the initiative to make things happen) rather than reactive (responding to after they have happened).

· The nurse acts as a change agent when assisting others, that is a client, to make modifications in their own behaviour.

· Nurses also often act to changes in a system, such as clinical care, if it is not helping a client return to health.


10) LEADER:

· The assertive, self-confident practice of nursing when providing care, effective change, and functioning with groups.

· A leader influences others to work together to accomplish a specific goal.

· The leader role can be employed at different levels: individual, client, family, and groups of clients, colleagues or community.

· The nurse criticizes the leadership process in a variety of circumstances: when assisting a single patient and or family to make changes in their health related behaviour.

· When assisting groups or communities to alter their health practices, and when assisting groups of nurses or other health care professionals to affect the actions of patients, groups of patients, communities with regard to the achievement of desirable health behaviors.

11) REHABILITATION:

· Rehabilitation is the process by which individuals return to maximum levels of functioning after illness, accidents, or other disabling events, frequently clients experience physical or emotional impairments that change their lives and the nurse help-s them adapt as fully possible.

· Rehabilitation and restorative care activities range from teaching clients to walk with crutches to helping clients cope with lifestyles often associated with chronic illness.

12) MANAGER:

• The term manager in this discussion means the person who co-ordinates human and material resources in providing care to clients,.human resources include
  Ø Client
  Ø The nurse
  Ø The family or significant others
  Ø Professional colleagues
  Ø Support groups
  Ø Research groups
  Material resources include equipment and supplies.
  
  
• The nurse manages the nursing care of individuals, families and communities.
  
• Managing requires knowledge about organizational structure and dynamics, authority and accountability, leadership, change theory, advocacy, delegation, and supervision and evaluation.

13) CASE MANAGER:

• As a care manager, the nurse coordinates the activities of other members of the health care team, such as nutritionist and physical therapists, when managing a group of clients care.
  
• In addition, nurse must also manage their own time and the resource of the practice settings.
  
• As managers, nurses coordinate and delegate care responsibilities and supervise other health care workers.

14) TEAM MEMBER:

• A vital role of the nurse is that of the nurse is that of team members. The nurse doesn’t function in isolation but rather work with other members of the health care team.
  
• Collaboration requires the nurse to use effective interpersonal skills and promotes continuity of care.

15) RESOURSE PERSON:

• The nurse function as a recourse person by providing skilled intervention and information.
  
• Identifying recourses and making referrals as needed also fall under the auspices of this role.
  
• Nurses must consider the client strength as well as availability of resources, including physical, intellectual, economic, social, and environmental factors.

16) RESEARCH CONSIDERATION:

Nurses often use research to improve client care .In a clinical area, nurse’s needs to

• Have some awareness of the process and language of research.
  
• Be sensitive to issues related to protecting the rights of human subjects.

• Participate in the identification of significant researchable consumer of research findings.

• Be a discriminating consumer of research findings.
  

17) EXPANDED CAREIER ROLE:

Nurses are fulfilling expanded career roles, such as those of nurse practioners, clinical nurse specialist. Nurse midwife, nurse educator, nurse researcher, and anesthetist, all of which wallow greater independence and autonomy.

18) ROLE IN DIFFERENT HEALTH CARE SETTINGS:

Although many nurses are direct care providers, others role include manager of other members of the health care team providing patient care , administrator ,nurse practitioner ,clinical nurse specialist, patient educator ,in – service and researcher .Nurses play different roles in different centers like.

• Primary care centers
  
• Ambulatory care centers and clinics
  
• Home health care
  
• Long term care facilities specialized care centers and settings

• Day care centers

• Mental health canters rural health centers

• Industry
  
• Homeless shelters
  
• Rehabilitation centers
  
• Healthcare services for care givers and end of life care.

• Respice care
  
• Hospice care
  
• Health care agencies (voluntary agencies)
  
• Eg, alcoholic Anonymous
  
• Cancer and support groups
  
• Parish nursing
  
• Government agencies.

ROLE OF FAMILY IN ADULT PATIENT CARE:

A person illness affects not only the person who is ill but also the family or significant others.

Acute illness may place sudden demands on family. The family should be able to cope with the changes that occur in the family include the following:

• Role changes
• Task reassignment and increased demands on time.
• Increased stress due to anxiety about the illness
• Financial problems
• Loneliness as result of separation and pending loss.
• Changes in social custom.

The family should have a basic understanding of the disease, its treatment and personal care.

Families should be able to cope using the known and behaviors to help them to manage and adapt to the problem.

The family plays an important role in both the development and management of disease condition.

Doubts and issues or misconceptions related to the disease should be clarified with the health care professionals.

Family should know the importance of affection and love etc during illness.
The families if offers remedies and advice, it will take over those roles that the

person is no longer capable of and it will provide the care necessary until recovery or for long term support.

Emotional support from family and friends are essential.

Family members are expected to assist patient in difficulties.

A willing member of the family can be allowed to assist with aspects of nursing care is comforting to the patient as well as to the relatives.

The family is expected to provide a supporting environment for the patient.

The family should understand the need for the assistance and help the patient.

The family should try to fix in support of the ill member, meal preparation and chauffeuring the children around varied work schedules.

Family influences the lives of one another.

The family structure, functioning, and relative position in the society significantly influence the health and ability to respond to health problems.

The family structure, functioning, and relative position in the society significantly influence the health and ability to respond to health problems.

In some cases, the terminally ill may be taken home and the family becomes responsible for his care until death occurs.

Family members are important to chronically ill clients. They may help the management of the chronic illness. This collaboration should be initiated under the direction of the health care team at diagnosis to prevent difficulties later.

Families are an important factor in the client’s response to health problem and in the ability to cope.

Families are not only being kept abreast of the therapeutic plan, but also actively participate in the planning and implementation of the care.

Family experiences a crisis or a crisis-producing event, they attempt to gather their recourses to deal with the demands created by the situation.

Too many visitors may tire the patients and the relatives and families should understand it.

The family should actively participate in the health education.

Also family has an important role in prevention of high-risk diseases in the patient.

Patient family plays a vital role in carrying about restrictions and plans in the patients.eg.diabetes patients should follow strict sugar free diet.

Discharge plans must include both the patient and family and should be taught clearly to the item before discharge or transfer.

ROLE OF PATIENT IN ADULT PATIENT CARE:

1. Patient is the good source of information about illness.

2. Patient is not a passive recipient of care he is an active participant.

3. Patient should be cooperative with the treatment.

4. Patient must be given information about his care to make choices or manage their conditions.

5. Patients are the key player in the decision making in the patient care. Patient plays a decision maker role with skill in tools of the function.

6. Chronically ill individuals must learn to live with the course of chronic illness.

7. Part of the task also involves developing a personal identity that includes the chronic illness and life style changes in necessities.

8. Maintaining interpersonal relationships with the health team members.

9. Patients can clarify the misbelieves and doubts regarding the treatment and procedures with the adult health nurse.

10. Patient’s cooperation is very important in assessment, planning, implementation, and evaluation.

11. Patient also participates actively in the patient and family teaching programmes.

12. Giving consent for surgeries and diagnostic procedures is also an important role.

13. Patient is expected to move the health team members towards the goals of potential well-being.

14. With the level of knowledge, skill and confidence patient can develop the self-management capacity so that he could be targeted towards the quality improvement care.

15. More effective care processes and interventions are to be planned to make the patients function in expanded role.

SUMMARY:

Thus the comprehensive care of adult patient not only involves the care of nurse towards the patient but also the participation of patient and family is important for improvement of the patient towards his potential well being.

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