Applying Orem's Theory to Care for Patients with Neurogenic Bladder

This assignment will critically discuss the nurse’s role in assessment and care planning for a patient in a case study. Confidentiality which is required by the NMC (Nursing Midwifery Council, 2008) and the Data protection Act (1998) will not be broken through out the assignment because the case study used is a scenario not a fictional character. The care plan will focus on Jean’s incontinence needs using The Roper, Logan and Tierney model (2000).

The analysis of this domain will focus on my nursing practice. It is clearly demonstrated throughout appendix 1(patient feedback), appendix 2 (reflective dairy) and appendix 5 (career poster). Evidence-based practice is a requirement of all registered nurses to act safely and effectively NMC (2010). Appendix 2 shows that patient had acute incontinence and urethra injury. It was essential to recognize the patient’ needs and keep hydration balanced which had a profoundly positive effect on his health and well-being. Dehydration is the topic that I have been passionate about during my training, through both academic work and practice. Having noticed gaps in my knowledge and have witnessed poor care relating to dehydration, I made this my dissertation topic. I have conducted thorough research to find the best available evidence to inform of my own practice and improve the service. My critical analysis and action plan will be addressed by appendix 1, 2, and 5.

This reflection case study will be discussing urinary continence management using Gibbs reflective framework (Gibbs,1988). This will include what is urinary incontinence management, the pathophysiology of urinary incontinence after stroke, how continence affect patient and current clinical practice and the role of the nurse and multi-disciplinary team within continence management. Also using the evidence based research and national guidelines.

For nurses, (P) on 2 South caring for patients with urinary catheters, will education, on the importance and proper use of a nurse -driven indwelling catheter removal protocol (I), change knowledge on the use of the nurse driven protocol, as compared to knowledge before receiving an education, (C), as evidenced by (O), change in knowledge in the use of the nurse -driven indwelling catheter removal protocol, and CAUTI rates as evidenced by, pre and posttest scores and CAUTI audits after three months? The project will utilize a

When I started my placement , Mrs . X who was suffering from Parkinsonism and dementia was on Indwelling urinary catheter for the management of urinary incontinence. Adhering to the results from the literature review I planned for initiating several steps to control incontinence in Mrs. X. My mentor was always with me with full support and guidelines. Fluid management was the first step started. An input output chart was kept and well maintained. Then steps wre also taken to manage constipation. Exercises were the last method practiced and the final result was really appreciable as she got a great reduction in the incontinence rate.

Also another serious complication of CAUTI is BSI (Blood stream infections) that can be fatal if not caught and treated promptly. “The Clinical Performance of Quality Health Care, along with Joint Commission” offers standards and objectives for facilities to assess measure and improve their standards at the lowest cost possible. The database covers nursing care and education, along with guidelines on prevention. Moreover the JCAHO regulatory standards for catheterized patients are explained and the documentation that is expected when JCAHO inspections are rendered in a facility. The source “Stop orders to reduce inappropriate urinary catheterization in hospitalized patients” states that by following standard precautions with every patient these infections can be prevented. . Also the source explored whether catheters should be used at all in an effort to decrease the incidence of CAUTI’s. Intermittent catheterizations along with supra-pubic were explored with a decreased incidence of bacteria being present in the bladder afterwards. The source “Strategies to prevent catheter-associated urinary tract infections in acute care hospitals” offered ways of cleansing and disinfecting the skin before insertion to reduce the risk of infection. Many CAUTI’s are linked to bacteria harboring in or around the site at insertion. By using not only aseptic technique but also cleansing the skin with chlorhexadine can decrease he incidence of infection

First, neurological disorders can occur, as seen with Alzheimer’s disease and Parkinson’s disease, which can lead to neurogenic bladder (“Neurology/Neurogenic Bladder,” 2017). Next, physiological disorders can occur as seen with enlarged prostate in men or shortening of the urethra in women (Jaipaul, 2017). Anticipating the above changes appropriately will aid in understanding what leads to urinary retention in older adults, the resulting need of catheterizations, and the CAUTIs that can follow. Having a foundation to build on, it would be beneficial to explore what nurses can do prevent urinary tract infections in patients who require catheterization.

Hooton, T., Bradley, S., Cardenas, D., Colgan, R., Geerlings, S., Rice, J., Nicolle, L. (2010).

Nursing research offers the scientific foundation for the practice of the profession. “In order for nursing to be at the forefront of knowledge generation and address societal issues and health care, nursing research must be relevant to health and illness situations, scientifically rigorous, and readily translatable into practice and health policy”(Potempa & Tilden, 2004). Catheter associated urinary tract infections (CA-UTIs), accounts for almost 40% of all nosocomial infections, which result in increased morbidity, mortality, and costs and, it is one of the most common health care- associated infections in acute care area. The study existed in this paper discourses the influence of the 2008 nonpayment policy of the Centers for Medicare and Medicaid Services (CMS) on catheter-associated urinary tract infections (CAUTIs) from the viewpoint of infection preventionists.

The patient and their families must be aware of the infection, the source of infection, signs and symptoms, treatments, and measures to apply at home to decrease their risk of receiving an infection. Because geriatric patients are incontinent they may need a catheter in place to help remove their urine. Nurses must perform aseptic technique, wearing proper gloves when inserting or removing device. Another way to help reduce the risk of elderly urinary tract infections would be to avoid or remove catheter soon as possible. Once patients are cleared for discharge they must be aware of the steps to take to insure proper bladder

According to the evidence based research done by Overton Brooks VA Medical Center “implement a bladder retraining trial in compliance with the NPSG to prevent CAUTIs. The goal was to decrease infection risk by decreasing the length of time catheters were in use and reinsertions. Decreasing reinsertion rates not only reduces infection risk but also decreases post-op length of stay, saving money and resources.” (Shreveport, 2013).The way I would share with my employment would be to have in service education for all staffs and share the information about normal bladder function. Also instruct nurses to teach patients to have voiding schedule that incorporates regular delay of voiding by using interruption and relaxation techniques, self-monitoring,

This essay aims to explore the importance of utilising evidence based care while working with clients and other health care providers to form a professional and reliable nursing team. This essay also aims to focus and evaluate a qualitative article entitled “Patient experiences of bladder problems following stroke” selected from the Nursing Standard. The assignment will adopt a systematic approach to expose the strengths and weaknesses of the chosen qualitative research article. I found this topic quite intriguing after undertaking a clinical placement in a stroke unit and learnt that many people suffered in silence as they found urinary incontinence embarrassing to live with as

The importance of nursing theory to practice of nursing should not be overlooked or underrated. That is because, it’s understanding and application are essential in enhancing patient 's care, improving communication between nurses, providing education’ and guidance in research, (Robert T. Croyle (2005). It is equally important to know that currently, there are many theories that guide the practice of nursing. Two of the most prominent ones will be compared and will form the subject of this this discussion.

In order to find the patients baseline an assessment of functionality is needed for comparison. When assessing a patient it is important to pay attention to the abilities of activities of daily living regularly. An assumption of Orem’s Self-Care Deficit Theory is that a person’s knowledge of potential health problems is needed for promoting self- care behaviors (Nursingtheory.org, 2013).

interpret the results of diagnostic and laboratory examinations undergone by our client and identify the corresponding nursing considerations;