What Are Effective Nursing Models for Improving Asthma Care?
Paper II: Planning care through a nursing model paper
The purpose of this paper is to demonstrate your ability to plan care through a nursing model. After you have chosen a nursing model (from section III or IV of textbook), provide a thorough description of the “nuts and bolts” of that model. Then you should select a client that you are caring for at your clinical site (or an interesting acquaintance).
Describe all the steps of the nursing process (assessment [should be detailed], planning, nursing diagnoses (3), implementation, and evaluation) as they are done when following the model.
Planning Care Through a Nursing Model
Various nursing care models are applied in care to organize how nurses are assigned to provide patients with holistic care. Different settings, patient needs, and circumstances differ in the nursing model used. One among the many nursing models is the theory of Goal Attainment developed in the early 1960s by Imogene King (Toth-Bos et al., 2020). The purpose of this paper is to describe concepts of this model and its application in the management of a patient with asthma.
The King`s Theory of Goal Attainment
The model majorly describes dynamic, interpersonal relationship patient develops and grow to attain certain life goals (Adib-Hajbaghery & Tahmouresi, 2018). According to Toth-Bos et al. (2020), the model has three major systems: personal, interpersonal, and social. The concepts for the personal system are self, body image, growth and development, perception, time, and space. On the other hand, interpersonal concepts include communication, interaction, stress, role, and transactions. Social systems involve comprehensive interactions involving groups in society such as organizations, decision-making, status, and power.
According to King, a human being is referred to as a social being who is sentient and rational. Human beings can choose, think, make decisions, perceive, and set goals that affect their health. Furthermore, humans have three basic fundamental needs: the need for health information; the need for care when seeking to prevent illness, and the need for care when he or she is unable to care for themselves. To meet the needs of humans, nurses are vital as part of the environment. According to the theory of Goal Attainment, nursing is defined as a process of action, reaction, and interaction requiring nurses to constantly communicate with clients and share information surrounding a nursing situation (Toth-Bos et al., 2020). Through interaction, the nurse and client perceive each other’s situation as they communicate, set goals, explore means, and make an agreement on how to achieve goals together. Action majorly elucidates the sequence of behavior involving mental and physical activity while the reaction is among the sequences of behavior described in the action (Adib-Hajbaghery & Tahmouresi, 2018). Through action, reaction, and interaction, nurses` major goals are to help individuals to maintain their health to function in their roles as required. Fulfilling the goals requires nurses to monitor, care for the sick, maintain and restore the health of the injured, sick, and dying. Furthermore, nurses interpret the information in the nursing process to plan, implement, and evaluate nursing care. Besides, King had assumptions and major concepts of the model.
The following are assumptions of the model
- Nursing focuses on caring for human beings
- Nursing health care aims at achieving the well-being of individuals and groups.
- Human beings constantly interact with their environment.
- Patients and nurses often communicate, set goals together, and formulate actions to achieve the goals set. The same assumption applies to the nursing process.
- The world is perceived as a complete person by the patient allowing them to make transactions with individuals and things in the environment.
- The transactions made by individuals are a representation of life situations encountered and perceived by an individual. It also represents the situations an individual enters as an active participant with changes made based on the experiences (Toth-Bos et al., 2020).
Major concepts and sub-concepts of the King`s Model
- The nursing process involves actions, reactions, and interaction, allowing the nurse and patient to communicate regarding a situation, identify concerns/problems, set goals, and explore actions of accomplishing the goals.
- Health is a dynamic experience that requires constant adjustment to stressors and situations in the external and internal environment through using available resources to achieve high potential standards.
- The background to human interaction is the environment. Both external and internal environment. Nurses form part of the human environment.
- As social beings, humans are sentient and rational. Humans can communicate their actions, perceptions, thoughts, and belief using language. Furthermore, humans can set goals, think, make decisions, feel, choose between alternatives, and devise means of achieving goals.
- If role conflict is experienced by either patient, nurse, or both, stress in the nurse-patient interaction will occur.
- Making transactions in nurse-patient interaction enhances growth and development.
King further detailed the information about the nursing process in the Goal Attainment model. The detailed steps of the nursing process are assessment, nursing diagnosis, planning, implementation, and evaluation. According to the model, assessment occurs during an interaction between the nurse and the client. The nurse uses special knowledge and skills to gather more information from the patient who provides knowledge of their experience or concerns during the interaction (Toth-Bos et al., 2020). The nurse collects detailed data from the patient including personal information, growth and development, self-perception, and state of the patient`s health. Effective communication is key during the assessment process to enable the collection, interpretation, and translation of the information to make meaning. After the assessment, the information collected is used to formulate the nursing diagnosis. This is based on the problems, concerns, and disturbances that prompted the patient to seek assistance. The nursing diagnosis provides a short statement of the problem, related factors, and evidence upon which the diagnosis is made. The information from the nursing diagnosis is key to coming up with a nursing care plan. The care plan is formulated through the participation of other healthcare providers who set goals and devise the means to achieve the goals. Patient participation is encouraged in this process to help in making decisions to achieve goals. The actual activities aimed at achieving the goals are done in the implementation phase. Finally, the evaluation phase helps in determining whether or not the goals set were achieved. Because of the detailed information about the model, I applied this model in the care of a patient who had an interesting case as detailed hereafter.
The patient was known as asthmatic for several years; however, he was not using his inhaler properly which made him have several episodes of an acute attacks. This last attack was life-threatening and he risked losing his life due to the severity of the presentation. His presentation and clinical summary and interventions are well elaborated below. However, learning a few things about asthma is important. Asthma is a chronic airway inflammatory condition that is characterized by airway narrowing due to inflammation, bronchospasm, and mucus hypersecretion (Villa-Roel et al., 2018). Exposure to triggers and allergens such as pollen, house dust, and mites trigger a hypersensitivity reaction that leads to clinical signs and symptom. Infection and smoking are other triggers of an acute attack. Common clinical signs include chest pain, cough, difficulty in breathing, wheezing, shortness of breath, chest tightness, cyanosis, tachycardia, tachypnea, use of accessory muscles for breathing, and in worst care loss of consciousness. Management of asthma is complex and involves long-term follow-up and patient education. Bronchodilators are often used to relieve symptoms; however, the mainstream management is prevention through avoiding exposure to the allergen. Preventing future attacks requires the active participation of patients and close family members in the management. Healthcare providers are also important. A summary of the plan of care is provided subsequently.
Plan of Care
Name: Mr. J.N
Age: 52 years
Occupation: high-school teacher
Chief complaint: cough, chest pain, difficulty in breathing, loss of consciousness.
History of presenting complaint: the patient J.N, a 52-year-old Caucasian was brought into the emergency department by his wife and son. He was diagnosed with asthma when he was 15 years and has been on follow-up for acute exacerbations. He had lost consciousness when he came in but later regained it. The wife and son reported that he had complained of chest pain, cough, and difficulty breathing moments before he went unconscious. The episodes came after he arrived home late and was exposed to house mites and pollen in the compound. Cough was productive and could barely complete sentences. He often forgets to use his inhaler. This is the third episode of presenting with the same symptoms in one month. He also smokes cigarettes. Does not attend any self-care groups and most of the time he doesn’t know what to do to alleviate his symptoms.
Allergy: he was allergic to house dust which often triggers his asthma attack
Current Medication: Inhaled albuterol 2 puffs when needed.
- Congestive heart failure
- Diabetes mellitus type 2
- Pulmonary pneumonia
Review of systems
Constitutional symptoms: he reported fatigue, anxiety, and fever.
Cardiovascular: he reported palpitations, chest pain, cough, and difficulty in breathing.
Gastrointestinal: he denied nausea, vomiting, abdominal pain, diarrhea, or constipation.
Genitourinary: denies dysuria, burning sensation on urination, urgency, increased frequency, or hesitancy.
Skin: he reported itchiness. Denied bruising or bleeding.
Vital signs: temperature 99.7 F, respiratory rate 31 breaths/min, pulse rate 112 beats/min, oxygen saturation 85% on room air, pain level 5/10, blood pressure 134/89 mmHg
Mouth: pursed lips breathing and central cyanosis present. Clear and moist oropharynx
Nose: nasal flaring.
Eyes: wears glasses. No conjunctival bleeding. Pupil round, equal, and reactive to light.
Cardiovascular: hyperactive precordium, apex beat at the fifth intercostal space mid-clavicular line. Pulse with a regular rhythm, the rate increased at 112 beats/min, normal volume, and palpable pulses bilaterally. S1 S2 heard. No murmurs.
Respiratory: chest moves with respiration, use of intercostal muscles with intercostal recession. Expiratory wheezes on auscultation. Resonance on percussion.
Abdominal: abdomen moving with respiration, no swelling, tenderness, distention, or palpable masses.
Neurological: oriented and alert.
Skin: warm, intact, and dry.
Summary of the Assessment.
J.N is a 52-year-old male, known asthmatic patient since he was 15, and has been on management using albuterol. He complains of chest pain, cough, difficulty in breathing, and loss of consciousness. On physical examination, he has nasal flaring, tachycardia, tachypnoea, central cyanosis, and pursed-lip breathing, and uses accessory muscles for breathing. There is an evident lack of knowledge about the disease
- Ineffective breathing pattern related to swelling and spasm of the bronchial tubes in response to inhaled irritants as evidenced by cough, cyanosis, use of accessory muscles, nasal flaring, tachypnoea, and dyspnea.
- Ineffective airway clearance related to bronchospasm as evidenced by wheezing, chest tightness, cough, cyanosis, and dyspnea.
- Anxiety related to hypoxia and change in health status as evidenced by tachycardia, dyspnea, tachypnea, and restlessness.
- Deficient knowledge related to the chronicity of the disease and lack of information as evidenced by ineffective self-care
Planning of Care
- To improve oxygen saturation to 100%
- To maintain optimal breathing pattern evidenced by the absence of dyspnea, relaxed breathing, and normal respiratory rate
- To improve knowledge about triggers and how to avoid them.
- To improve knowledge on signs and symptoms of acute asthma exacerbation
- To engage the patient in the treatment plan and during decision-making.
- Patient and family to verbalize knowledge of the disease, its management, and community resources to help in coping with the chronic disease.
- To prevent future exacerbations of asthma and lead a life free from frequent attacks.
- Start oxygen and monitor vitals
- Help the patient to elevate the head of the bed. This promotes maximum lung expansion and assists in breathing.
- Educate the patient about triggers for asthma such as house dust, mite, and pollen, and how to avoid the triggers.
- Educate the patient on how to use the inhaler appropriately and when to use it.
- Administer medications to relieve bronchospasm.
- Assess the client’s level of anxiety
- Encourage the patient to take a deep breathing and coughing exercise to help in expectorating excess secretions and clear the airway.
- Discuss with J.N the need to use his medications properly to prevent exacerbations
- Discuss with J.N the need to stop smoking cigarettes or coming near the smoking area.
- Discuss with the patient and wife the danger signs of asthma that may lead to ineffective breathing.
- Educate J.N about the signs and symptoms of acute asthma attacks and how to use family during an attack.
- Encourage J.N to have his pulse oximeter to constantly measure his oxygen saturation to enable him to access prompt care.
- The patient put on high-flow oxygen
- The patient demonstrates how to use the inhaler appropriately
- N understands that triggers to exacerbations are dust, pollen, and infections.
- N agrees to his medications regularly
- N learns to take deep breathing and cough exercise to clear the airway.
- Teach J.N how to use a pulse oximeter to monitor oxygen saturation.
- N and his family attended classes to improve their knowledge of asthma presentation and management strategies.
- N verbalized the importance of using his medications to prevent asthma exacerbations.
- Ns wife verbalized understanding of the impending signs of danger of asthma and rush J.N to the nearest facility.
- N verbalized understanding of the importance of raising the head of the bed and demonstrate how to do it. This will help him attain efficient breathing.
- N demonstrated how to use the inhaler appropriately while the wife promised to help him in using the inhaler when needed.
- N verbalized the risks of smoking cigarette and how cigarette affects his recovery. He promised to stop smoking.
- JN verbalized the importance of attending the clinic and sticking to follow-up for the long-term management of his condition.
- N verbalized the signs and symptoms of an asthma attack and the importance of involving family members for help during such occasions.
- Ns oxygen saturation improved as evident in the pulse oximeter.
- N was able to purchase a pulse oximeter and demonstrated how to use it to measure his oxygen saturation. His wife accepted to help him assess oxygen saturation and act appropriately.
- N and his family verbalized their knowledge about asthma, and its management, and joined a community group to help J.N to gather more information about his condition and help effectively manage symptoms.
- N`s major concerns were ineffective breathing patterns, ineffective airway clearance, anxiety, and deficient knowledge. My team members and I worked with J.N and his family to set goals, devise ways of reaching goals, and come up with solutions to his problems. J.N now understands the stem of his problem. He now understands he needs to use his inhaler regularly. He also verbalizes the allergies and triggers of an asthma attack such as pollen, house dust, and infections. He understands the signs and symptoms of his condition and appreciates the vital role family can help to alleviate his symptoms and help in the recovery process. He also understands the importance of checking his oxygen saturation regularly especially when the signs and symptoms start.
Final summary and discharge notes
- N presented to the clinic in an unstable state burdened by ineffective breathing patterns, anxiety, ineffective airway clearance, and deficient knowledge. His symptoms have since improved through the active involvement of the patient, family, and attending healthcare providers. He has completed his treatment involving oxygen saturation and other medications that alleviate bronchospasm and other symptoms. He understands the triggers of an asthma attack and appreciates the importance of avoiding triggers to an asthma attack. He understands the signs and symptoms very well.
- He will continue with follow-ups in the clinic for further education and manage his symptoms. He will also attend other clinics to address his other health concerns. He will also continue attending services held by the community self-care group to learn more and help him in the long-term management of his condition. He will notify the family about any impending signs and symptoms as the family members help him to access health care providers. He will continue to adopt more mechanisms for preventing infective breathing. He will also stop smoking cigarettes or coming near smoking areas to prevent exacerbations of symptoms.
Critiquing the Theory of Goal Attainment.
Using King`s theory of Goal attainment offers some advantages. First, the patient is allowed to take an active part in his/her care to attain good health. For instance, J.N was allowed to communicate with the nurse and other healthcare providers regarding his care and how to alleviate the symptoms and prevent future attacks. Besides, this theory provides a logical sequence of events nurses undertake while caring for patients (Toth-Bos et al., 2020). The concepts of the theory are also easy to follow. Furthermore, these concepts are clearly defined and have been used in several pieces of research thus helping in building knowledge of the nursing profession.
The theory has some noticeable limitations that have limited its application in some nursing situations. There is no clear explanation of the use of the theory in communities, large groups, and families. Despite concerns about the healthcare of groups, King emphasizes a dyadic relationship in her discussion (Toth-Bos et al., 2020). Another limitation is evident when King regards patients and nurses as strangers; however, she expects the strangers to work together towards the attainment of health goals; such practice may impair the clarity of information and information sharing.
King`s theory of Goal Attainment has contributed to the vast knowledge in nursing and enhanced the development of the nursing profession. The theory focuses on strengthening the nurse-patient relationship through effective communication and setting goals to attain health. Using this model, nurses have continuously improved the outcomes of the patient through the active participation of patients in their care. Patients feel motivated to be involved directly to make decisions rather than being instructed on what to do. Furthermore, the theory allows nurses to think critically during patient interaction and come up with goals and interventions that will aid in attaining the goal. Therefore, this theory is the pioneer to improving population health through interactive engagement while addressing other health-related services to improve health outcomes.
Adib-Hajbaghery, M., & Tahmouresi, M. (2018). Nurse–patient relationship based on the imogene king’s theory of goal attainment. Nursing and Midwifery Studies, 7(3), 141. https://doi.org/10.4103/nms.nms_10_17
Toth-Bos, A., Wisse, B., & Farago, K. (2020). The interactive effect of goal attainment and goal importance on acculturation and well-being. Frontiers in Psychology, 11, 704. https://doi.org/10.3389/fpsyg.2020.00704
Villa-Roel, C., Voaklander, B., Ospina, M. B., Nikel, T., Campbell, S., & Rowe, B. H. (2018). Effectiveness of written action plans for acute asthma: A systematic review. The Journal of Asthma: Official Journal of the Association for the Care of Asthma, 55(2), 188–195. https://doi.org/10.1080/02770903.2017.1318142