Posted at 10.29.2018
I have just lately undertaken students nurse placement in a community medical center in North Wales. I used to be mainly utilized on the health care of the elderly person ward. This ward handled the elderly awaiting or recovering from surgery or awaiting re-housing into good care facilities or their own changed house. Lots of the patients could be considered vulnerable. Normal aging, disease and life experiences had increased the vulnerability of several of the patients and the coping skills of several had been greatly diminished.
In this article, I will examine one of the patients I came into contact with regularly. Relative to the Medical and Midwifery Code of Do (NMC 2008) all titles and placement details will be concealed, and I'll refer to the patient as Mr. A at all times. I am going to discuss Mr. A's medical conditions and how and just why these medical conditions have led Mr. A to be thought to be susceptible, covering physical, interpersonal, mental and environmental factors.
Mr. A was a 67 time old gentleman who was morbidly obese. He previously a BMI of over 40 kg/m2 and was bed bound. He also had to endure Asperger's Syndrome which is a type of autism mainly affecting interpersonal and communication skills. Both of these in addition with being an older person could have resulted in him to be susceptible in various aspects.
Vulnerability is the susceptibility to physical or psychological injury or strike. Vulnerability identifies a person's state of being prone to succumb to manipulation, persuasion or enticement. (Bankoff, et al. 2004). A susceptible adult is person who due to Era, Physical injury, Disability, Disease or Emotional or Developmental disorders is unlikely to have the ability to give their own basic necessities of life; they could also have an increased risk of injury or injury. This might include, but is not necessarily limited to parents who have a home in long-term care and attention facilities such as nursing homes, adult family homes, boarding homes, helped living facilities or those who acquire health care or other assistance in providing for the basic requirements of life while surviving in their own home.
Roper, Logan and Tierney(1980) released a medical model outlining 12 activities of everyday living that are necessary to a person basic needs, a few of which are essential such as breathing, eating and taking in yet others which improve the standard of living such as work and play and expressing sexuality. When a person becomes old, frail, sick and immobile they may be reliant on others to help them with the 12 ADLs. This may cause people feeling vulnerable.
Fernandez LS et al (2002) suggests that impaired physical ability to move, diminished sensory understanding, chronic health issues, and sociable and economic restrictions can cause vulnerability of older people to disasters such as falls or accidents. Frail elderly with serious physical, cognitive, financial, and psycho-social problems are at especially high risk. Mr. A was 67 and according to the Geriatric Pharmacology Research Group in Newcastle upon Tyne, 'The frail elderly are individuals, over 65 years, dependent on others for activities of everyday living, and frequently in institutional care and attention'. Much like Mr. A, he was 67 yrs. old and was reliant on carers for many if not absolutely all of the actions of Daily Living. He was also in institutional look after pressure sores. Because of many of these items Mr. A would be classed as frail older.
Mr A's problem with weight was the primary cause of his hospitalisation, he stated he previously weight consistently put on more and more weight over the years. He experienced very in charge of his putting on weight but was unwilling to do anything about any of it even though he was classed as morbidly obese. Over weight is a medical condition in which extra body excess fat has gathered to the magnitude that it may have an adverse influence on health, resulting in reduced life expectancy and/or increased health problems. Body mass index (BMI), a way of measuring which compares weight and height, identifies people as overweight when their BMI is between 25 kg/m2 and 30 kg/m2, and obese when it is higher than 30 kg/m2.
Mr. A's fatness led him to be largely bedbound and incapable of retaining his health, his home or personal cleanliness. When Mr A was residing in his own house region nurses would regularly come in to have a tendency to his pressure sores. Pressure sores are lesions to the skin triggered by many factors such as unrelieved pressure and friction. These pressure sores were the consequence of Mr A being struggling to move so constantly needing to stay in the same position and therefore having unrelieved pressure on different parts of his body. As Mr. A was bedbound he cannot have a tendency to his own housekeeping and his house became so untidy the region nurses found it too much care for him in the chaotic environment so referenced him to a community clinic. While he was in a community hospital a council funded cleaning team planned his house in order for him to be discharged back to a workable house.
Another reason that region nurses were finding Mr. A hard to manage was that he suffered from Aspergers Symptoms and would often be ambitious with the district nurses. Aspergers syndrome is a kind of autism that is characterized by difficulties in cultural conversation, along with constrained and repetitive patterns of behaviour and pursuits. It is different from other autisms as sufferer's linguistic and cognitive development are often fine and develop well. The exact reason behind Aspergers is unknown. There is no single treatment but interventions are used to boost sufferer's symptoms and functions. The primary treatment used is behavioural therapy, focusing on the specific insufficiency of the individual. These have a tendency to contain poor communication skills, obsessive or repetitive regimens, and physical clumsiness. Most individuals improve over time, but difficulties with communication, social modification and independent living can exist and continue into adulthood. Some individuals with Aspergers syndrome may become angry and ambitious, either to themselves or to other people.
Sometimes when a person with Aspergers feels angry, they can not easily pause and think of alternate strategies to handle the situation. 'The rapidity and depth of anger, often in response to a comparatively trivial event, can be extreme and can get so intense, they may go into a blind trend and struggling to see the impulses indicating that it might be appropriate to stop. ' (Attwood, 2006).
At the community clinic Mr. A would often get hostile or rude when more than one nurse would be in the area. If he experienced he wasn't being listened to not being involved enough he'd become very agitated and begin shouting. The nurses needed this into consideration and ensured Mr. A was included at all times with anything taking place in his room. I feel this problem may have led Mr. A to inadvertently isolate himself from people and people to him. When people do not understand something they may take a negative method of it. Mr. A's outbursts could have offended some individuals and lead them to detach themselves. This might quite possibly be because of the fact they didn't understand or know about the problem and 'fear of the unfamiliar contributes to negativity in a few circumstances'. (Campbell, 2006)
A person who is vulnerable to isolation or communal pressure may be considered as experiencing cultural vulnerability. When people become isolated scheduled to condition or reduced ability to move they may find it hard to access essential services. Mr. A possessed employment translating literature from various overseas languages into British. He do this from his laptop every day so when he was transferred to hospital he kept his laptop at home. This made his feel low at all times as he said he previously no goal to his day. The medical personnel through Multi Disciplinary Team meetings examined his situation and made a decision to let him have his laptop sent to the hospital along with web connection and experienced his mail moved, this all to permit him to continue to work which enhanced his feeling greatly for the remainder of his stay. He reported he was much happier at the city hospital now that he could continue along with his day to day life.
Mr. A also said he felt isolated scheduled to his fatness. As people time, they often become more vulnerable, their social circumstances especially impact their health. Much like Mr A, credited to his overweight he was restricted to his bed and this impacted on his interpersonal circumstances. It limited anything he wanted to do socially, for example, he cannot venture out of the home, and may only find small ways of interacting with society. One of these ways was through his online job; this allowed him to have interaction through the internet without having to leave his foundation. This acquired both a negative and positive side. Though it allowed Mr. A to interact with people, all be it practically, that was important in developing his public skills it performed however mean he didn't have to go therefore made little effort in changing his lifestyle.
Mr. A's lifestyle choices were undoubtedly the primary cause of his hospitalization. He refused to try to diet at a healthcare facility and stated he previously always been this way, never attempting to diet. Family would bring in unhealthy food for him; these were advised against achieving this but made no try to stop. A dietician emerged to evaluate Mr. A and an idea was made but not caught up to by Mr. A. He was also offered physiotherapy by means of help to start doing small moves with his legs and arms daily but he declined. This weight problem made him vulnerable to a variety of illnesses; one in particular that had been managed at a healthcare facility was his pressure sores. In clinic a special bed was necessary to allow for his weight and relieve his pressure sores, along with bariatric chair, wheelchairs and hoists.
Mr. A's weight and incapability to go made him literally vulnerable. Lots of the elderly are admitted to hospital due to something caused by a physical vulnerability. A physical vulnerability is when a person has an increased risk of injury. E. g. easily brakes bones, has reduced durability, reduced motion or dexterity. Many of the patients in the community hospital have there been because of this of such vulnerability and got suffered injuries resulting from falls. Some got reduced ability to move which supposed they needed assistance in performing a number of daily responsibilities such as getting in and out of bed, preparing foods and eating them, doing housework, dressing, and doing personal hygiene.
According to Holden and Smeeding sixteen percent of older people need help with at least one of the conditions. Elderly folks subject to two or more of the five they considered "insecure"; those facing three or more were considered "extremely insecure. " Those people who are totally reliant on social services for success are already economically and socially marginalized and require additional support all the time. Mr. A needed assist with all activities, he was washed, dressed up, fed, and cared for all by nurses and carers. He stated that because he cannot do anything for himself he previously no quality of life locally hospital and even though he was bedbound at home as well, he does have home comforts and possessed developed methods of reaching things he needed and desired, such as a 'pik-stick'.
These new environment may have made Mr. A feel environmentally Vulnerable. Environmental vulnerability is when a person suffers reduced quality of life caused by exterior conditions and surroundings. The copy to the community hospital was a major change of environment for Mr. A as he had to get used to new surroundings, new methods, and new people so that he has limited activity he explained he all the new goings on made him feel somewhat helpless as all he could do was press the bell and hang on if he needed something. This was understandable and it was explained to Mr A in great fine detail the goings on, exercises and design of a healthcare facility to try and overcome his worries. Brubaker (1987) says of how having a significant lifestyle change such as having to come to clinic for an extended time period can make the patient feel as if there dignity is being taken away from them. This was visible with Mr. A. When he was first admitted to clinic, he resisted being washed on many occasion. This might have been due to there being many new nurses and carers that he was not used to. He may have felt shy and undignified having to be washed in his medical center bed my many different workers. This was overcome by causing sure his door was always finished, windows and curtains shut, nurses and carers would also present themselves, ask for consent and discuss Mr. A through the procedure, all to make him feel convenient. This seemed to cease his concerns and he began to allow the staff to clean him on a daily basis.
One major concern of Mr. A's was the time it got from when he pressed the bell in the hospital or the disaster bell in his house to enough time a nurse or carer surely got to him. He'd panic during this time period which impacted greatly on his emotional well being leaving him psychologically prone. Psychological Vulnerability is when someone is vulnerable to emotional or behavioural damage. While Mr. A was in the community hospital calming and rest techniques were trained to him to overcome his anxiousness. He was taught yoga breathing techniques and mentioned he found this particularly beneficial. Every time he began to feel restless and worried he could now use these new techniques which take his mind of the worry and keep him quiet. While I was working at the hospital I saw a huge change in Mr. A's behavior in conditions of anxiousness. He became significantly less aggressive when needing to wait for a nurse.
There have been many older residents at the city hospital that suffered many types of mental health vulnerability. Lots of the frail seniors who had experienced comes lost their confidence completely. One female patient told me that she didn't want to go home as she didn't feel she could manage. She didn't feel safe in her home but would not want to move to a personal home. This must be a very distressing time which is hard to reassure patients in this attitude.
Through the MDT meetings it was chosen that Mr. A would need to visit a personal home as it could not be safe for him to go back home. Mr. A felt he would not enjoy being in home and was completely opposed to the idea. However, three employees from the domestic home emerged to speak to Mr. A, he was taken up to view the home home and his room, the Doctors and Nurses at the city clinic spoke to Mr. A at span and offered him time for you to tone his questions and concerns. With time Mr. A appeared to come around to the idea and appreciate it was the best option for him and by the finish of my college student location Mr. A told me he was looking forward to moving from the community hospital and in to the personal home.
I have layed out Mr. A's conditions and exactly how he was affected by physical, psychological, sociological and environmental vulnerability. In the seven weeks I was in the community clinic alot was done to conquer Mr A's vulnerability and re-merge him into society.
Community hospitals are made to reduce the hazards to people who are vulnerable to communal, physical, environmental and emotional injury. Hospitals have special floors, showers, seating and beds. They have got controlled heating, light, diets, they encourage connections between patients and with tourists (at times during the day) thus lowering social isolation. Highly trained staff keep an eye on and review patients regularly to ensure they are simply getting the best care and the support needed to leave hospital also to prevent their come back. This all minimises the risk of patients sense vulnerable and helps them to truly have a fast restoration and rehabilitation.