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NUR3005 The Role Of Nurses For The Disease Prevention

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Course Code: NUR3005
University: Monash University

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Question:
Demonstrates knowledge base. Follows up on points raised in  introduction. Some depth and detail in knowledge of patho and issues in chronic illness or ageing, but not adequately related to the topic. readings relevant to the subject, uses indicative texts identified 

Answer:
Introduction
Chronic diseases are illnesses that persist for more than three months (González et al.,  2014).  The diseases are mostly associated with elderly people or people with health damaging habits such as tobacco smoking and excessive consumption of alcohol. Some of the most common chronic illness include arthritis, stroke, cancer, obesity and plague among others. Due to the nature of the illness and the duration that they take, it is vital that the patient is placed under constant monitoring especially when the disease seams to advance.  The care that is provided to the patient should focus on prevention of further infections and self-management while administering the curative intervention. Furthermore, it is vital to initiate a personal centered care for the patient patients suffering from chronic diseases.  Person Centered nursing approach concentrates on the personal needs and wants of the patient (Schwind, et al., 2014).  The nursing practice gives attention to the desires and goals of the patient.  When using person concentrated approach the medical practitioners put the needs and the wants of the patients higher than other identified priorities. The practice requires the nurses to go beyond just knowing the medical history of the patient. For the practice to be effective, the nurse should develop interest in knowing the patient as an individual in order to provide care that is meaning full to the patient. Furthermore, the nurse should be responsive to promote not only physical but also emotional comfort (Hebblethwaite, 2013). The nurse is also expected to emphasize on the freedom of choice and this is accompanied with respecting of the needs, values and personal preferences of the patient. The operation of the nursing practice in such an environment requires that the nurse develop a fostering trusting and care giving relationships with the patient. Furthermore, as the nurses will spend most of the time with the patient during this time it is paramount for the nurse also to involve the friends and family members of the patient as much as possible.
 Like many other nursing interventions, person centered care also come with its own set of principles. The principles that govern the practice of person centered nursing care include valuing people, understanding relationships, anatomy and the environment. The principals are tuned to ensure that the nurse makes use of the value assessment process to help in the identification of the areas that may need to be improved so that they can find means of addressing them (Hamza & Willoughby, 2014). The autonomy principle requires that the nurse respects the choices made by the patient while the Life experience principle dictates that the nurse should show understanding of the patients past, presents day experiences and also the future of hopes of the patient and share in them. However, it is also vital to understand the relationship between the nurse, the patient and the relatives (Douglas, Brush, & Bourgeois, 2018). Furthermore it is also vital to pay attention to the relationship between the service provided and the user and also between different staffing levels. Other author’s summaries all the properties of person centered health care in five main points. The first point is summarized as individualism while in the second point they highlight issues of rights. Since the rights of the patient are paramount, it is included in the third point while the fourth and the last point talk about privacy and independence respectively (Wu, Bathje, Kalibatseva, Sung, Leong & Collins-Eaglin, 2017).  All the nursing activities that revolve around the provision of person centered nursing services are not just aimed at making the patient comfortable but has medical aspect which are the key aspects of the nursing practice. The medical aspects involve disease prevention. Furthermore the practice should promote self-management in the patients.  The most vital part of the interventions is passing of important information to the patient. In most cases, it depends on the relationship that has been established with between the patients.  The process should be done in a manner that the patient understands and so as to enable them to make informed decision (Kolanowski, Haitsma, Penrod, Hill & Yevchak, 2015).  The nurses therefore have a vital role to play in person centered health care. This paper analyses the role of nursing practitioners in delivering inter-professional person centered care.
Role of Patient care
Nurses are caregivers to patients with chronic health problems like those suffering from long-term diseases such as diabetes. The roles played by nurses under this category helps in managing the physical needs of the patient, prevention of invasion of other opportunistic illnesses and in the treatment process of the condition (Baker, Drane, Chambers, & Lindqvist 2018). There are many other stakeholders in the process of treatment of a chronic disease who rely on nurses to make decisions on the nature of the therapy to adapt in the process.  Some of the main participants of nurses in such kind of process include observation and monitoring of the day to day developments the patient undergoes. For instance, patients who have diabetes are vulnerable to sudden clinical deterioration that may lead to worse conditions like cardiac arrest and sudden death. Nurses are entrusted with the role of monitoring events in the patient’s life that may lead to such abrupt events.  
Another major role of nurses in this area includes the recording of the observations made on the patient. Other players in the management of a critical diabetic patient like the doctors rely on the information the nurses’ record about the progress of the patient’s stay in the healthcare facility (Bennett, Hauck, Radford, & Bindahneem, 2016). The nurses act as the bridge between diabetes patients and doctors. It is the role of nurses to listen and record the events from the patient’s perspective, and use the information to explain the progress to medical doctors in medicine languages that patients could not manage (Ebrahimi, Sadeghian, Seyedfatemi, & Mohammadi 2017). The nurses have to be able to understand the words or the type of communication the patient uses and pass the information to doctors in the words that the doctors understand best.
The services offered to patients by nurses extend beyond just administration of medicine. Nurses monitor the progress of patients throughout their treatment process and advice doctors accordingly. Additionally, it is the work of nurses to give pieces of advice to the family and the members of the fourth estate of the patient on what to do (Chilton & Pires-Yfantouda 2015). The nurses; roles may prove to be difficult in this situation mostly when there are misunderstandings between the medical team and the family of the patient; it is the responsibility of the available nurse to balance the situation.  In such a case, nurses provide holistic care for patients, psychosocial, spiritual, cultural, and developmental guidance to the patient.
It should be noted that some health conditions rely heavily on other emotional factors rather than the actual medication to realize improvements (Coulson, Galenza, Bratt, Foisy-Doll, & Haase 2015). For instance, a patient who has suffered diabetes for an extended period and tended to give up in the fight against the disease may require more of psychological approach than just drug administration. This role is generally played by the nurses mostly in less advanced healthcare facilities that lack psychologists.  
Patient Advocacy
Nurses are required by law and the policies governing their job to always act in the interest of the patient at all times and at whatever possible cost (MIN, SEUNGWAN, YOUNG, & MYOUNGSOON 2014). It should be noted that the actions of nurses may be perceived otherwise mostly by the family members of the patient. During the treatment process, patients are always vulnerable and unable to protect their dignity given that they may not be able to comprehend the events during the treatment process (Grant, Goldman, LeGrow, MacMillan, van Soeren, & Kitto 2016). The entire medical team, the patient and the family of the patient entrust the nurse to fight for the patient in every stage of the treatment process. With this, the patient’s confidential information is believed to be in safe hands with the nurse.
An illustration by Naegle,  Nursing Care in Alcohol and Drug User Treatment Facilities  (2015) indicates that patients have the right to quality health care regardless of their financial status and their positions in society. It is the nurses who understand the reasons of the patients and know when the rights are violated. It is the responsibility of nurses to make sure the interests and the rights of patients, mostly in acute medical acre like diabetic ones are upheld and treated with dignity.  Nurses are the representative of the patient in the meetings where a patient’s treatment processes are discussed and decided on. Being the health practitioner closest to the patient, the nurse always understands what happens to the patients, and in most cases, they tend to see things as the patients. This is a significant role played by this group of health practitioners (Wetherill, Chancellor, Beachy, & Shadid 2018). It may seem very unethical for medical teams to discuss and make decisions regarding a patient who is not in the meeting and is not represented. Nurses help bridge this gap by acting the representative of the patient’s team. Nurses achieve this role by updating both the medical team and the patient’s family on the developments of the patient’s treatment process.
Care Planning.
Nurses are the members of the medical team who have most pieces of information about the patient than other health practitioners. The nurses associate closely with the patients and are familiar with the individual patient’s condition regarding progress and response to the already administered medication (Walton-Roberts, Bhutani, & Kaur 2017). In this regard, nurses need to think critically when accessing and handling the patient records to be able to think critically on behalf of the patients who are sometimes unconscious and may not comprehend what is going on during his or her treatment process.
The decisions regarding the treatment process of a patient are made solely by other health professionals such as doctors and specialists. Such decisions are made based on the pieces of information and guidance provided by the concerned nurse (Sørensen, Bæk, Kallestrup, & Carlsson 2017). It is the responsibility of the related nurse to provide accurate information on the observations he or she has made on the progress of the patient, the accuracy of such information plays a significant role in the effectiveness of the treatment plan adopted by the doctors and relevant specialists. To some extent, it is the role of nurses to plan the care and treatment administered on a patient given that the decision made by the decision makes depend on the information provided by the nurse in charge of the patient (Pinsonneault, Addas, Qian, Dakshinamoorthy, & Tamblyn 2017). It is for this reason that nurses are expected to act in the best interest of the patient as they are the members of the medical team who are more familiar with the affairs of the patient than any other member of that decision-making team.
Escalation of care
Nurses play an important role in making sure the attention of a patient in a facility is enhanced if the patient’s condition worsens. The observations, measurement and responsive actions taken at early stages of the patient’s stay at the facility may help prevent any further complications that can lead to cardiac arrest or death (Fairchild, Bayer, Green, Colgrove, Kilgore, Sweeney, & Varma 2018). Escalation procedures and protocols are aimed at providing timely assistance to the patient mostly when deterioration is detected. There are escalation protocols that need to be followed whenever an inpatient is handled. The contracts should address the following as in the above case.

Increasing the frequency of observations of the patient’s condition. This means that the observations need to be taken more regularly to detect the slightest change possible.
The intervention of other senior practitioners to help monitor the patient.
If the condition continues to worsen, then there is the need to review the medical team that handles him.
The patient is served with some special facilities so helpful in assisting and managing the condition.
At some points, the patient may be transferred to another higher level facility with better types of equipment for enhanced care.

Patient Education and General Support
 Chronic diseases like diabetes are challenging to manage, and their treatment can take some considerably long time. It should be noted that such treatment processes take place inside a hospital or healthcare facility but at times may extend after the patient has been discharged from the health facility (Kangovi, Mitra, Grande, Hairong Huo, Smith, & Long, 2017). Diseases like diabetic are sensitive to small environmental aspects, and changes in environment experienced during discharge from hospital after an extended stay in the facility (Mollerup, Harboe, & Johansen 2016). With such realities accompanied by the weakened immune system in the patient, the victims of such diseases are vulnerable to invasion of other opportunistic illnesses that take advantage of the weak defense mechanism of the body.  
Based on the above factors, the patients need to be educated on some possible occurrences after they are discharged from the medical care provided in the hospital. To start with, it is the responsibility of the nurses to educate the patients and their families on the condition of the patient and make them understand and accept the situation as it is (Grace, Innes, Joffe, East, Coutts, & Nancarrow 2017).  This realization helps in reducing stigmatization of the affected patients; this argument comes from the fact that victims are subjected to stigmatization mostly by people who are ignorant of the situation. By educating the family members and the related members of the public, the patient would not go through the psychological torture associated with stigmatization.
Another educational role played by nurses is the need to make the patient and the family know what to expect when they leave the hospital to avoid unnecessary tension on the patient’s health. According to illustration done by Hamric, Schwarz, Cohen, and Mahon (2018), it should be noted that the patient there are adjustments on a diabetic patient’s health conditions when he or she leaves the hospital. Such changes may be positive or negative, and the family or caregivers should know the course of action to take in cases of such events.
Responsiveness to Changing Patient’s Needs
 There are always a series of notable events that precede some of the adverse health conditions such as cardiac arrest and unexpected death. Such events can still be noticed, acted upon, and the death prevented. Studies show that most of the sudden deaths occur since the previous events go unnoticed and not acted upon appropriately.  The recognition and responses help in ensuring that the adverse medical conditions are detected and acted upon as first as possible (Fairchild, Bayer, Green, Colgrove, Kilgore, Sweeney, & Varma 2018). The response includes appropriate and timely treatment to the sensed conditions. The National Consensus Statement: Essential Elements for Recognising and Responding to Clinical Deterioration (ACSQHC) states that recognition should follow the A-G assessment but other considerations may include other methods simple activities that can be achieved by the family members.
Conclusions 
In conclusion, nurses play an essential role in the person centered care is essential in the recovery process from terminal illnesses. The medical nurses find themselves right at the center of the interventions. The role that the nurses play in this process is vital and is governed by a sets of principles. In health facilities located in the rural areas with inadequate number of doctors, nurses double up to perform some roles that were initially meant for doctors and other specialists. In such cases where the nurse assumes all the medical roles on a patient, the decisions regarding the method of medication applied on a patient with cute medical conditions are made by the nurses. Past studies have indicated that the decisions made by such nurses acting as the doctors are some times more effective than the decisions made by doctors themselves. This reality has been contributed to the fact that nurses carry out assessments on patients by them, they do not rely on secondary like other specialists. In cases where a nurse who handle a diabetes patient comes from the locality, such nurses double up to reference point in the village. The community depends largely on such medical nurses for medical information concerning various health hazards and the preventions. Even after discharge of a diabetic patient, such local nurses create time to offer extensive services to the patients. This level of flexibility among nurses makes them the most suitable members of medical team to take care of ailing members of the community. It should be understood that the process of making personal observations on patients make nurses more experienced in handling delicate cases of the same magnitude in future. 
It is important for the nurses to take into consideration the patient’s desires and wants as well as preferences in this process as the approach use in the intervention is based solemly on the patient. It is therefore vital that the nurses strive to have an understanding with the patient as this will make it easy for the nurse to pass information to the patient. Passing information to the patient should be done in a manner that the patent fully comprehends the information to ensure that he or she makes informed decisions. 
References
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