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HOLISTIC NURSING Suggesting that holistic nursing care should be introduced in postgraduate critical care nursing, Lane et al (2005) point out that critical care education is an important aspect of professional development for a critical care nurse. Interdependence between physiological and psychosocial theories and concepts is important for the development of critical care educational programs. A multidisciplinary educational framework provides a deeper understanding of all those factors that contribute to ill health.

To enhance patient care outcomes a strategic framework for research, education, clinical excellence and quality assurance needs to be established. Several creative modalities can offer nurses new perspectives on how to improve patient care. Lane (2005) emphasized on the link between creativity and healing and pointed out that many hospitals have used institutional programs including arts and creativity.

Lane suggests that since nurses have a unique bond with patients, they play a crucial role in bringing creative arts into patient care and gives many recommendations for implementing art media such as music, drawing, dance, writing within the hospital and clinical setting. Patients’ expectations of nursing care including holistic spiritual care using frameworks of humanistic nursing were studied by Davis (2005). he themes important in nursing care according to the patients were identified as ‘good’ and ‘bad’ nursing, surveillance and competence, spiritual care expectations and the concept of time. On considering sociological and managerial aspects of care, Cabana and Jee (2004) suggest that continuity of care has been promoted as an important aspect of health care delivery system. The authors determined that sustained continuity of care on the quality of patient care and conducted a systematic review through Medline search.

The texts of 260 articles on continuity of care and patient care were selected and results indicated that none of the studies documented negative effects of increased SCOC on the quality of care. SCOC has been found to be associated with patient satisfaction, decreased hospitalizations or emergency department visits, improved recognition of preventive services. The authors suggest that sustained continuity of care improves quality of care and this is seen in case of patients with chronic conditions.

Thus all plans to promote such methods of care must target patients with chronic conditions to get maximum impact. The importance of power and status within the nursing profession is also an important determinant of patient care and comprehensively defines patient care provided. Kuokkanen et al (2002) argues that the empowerment ideology has been adopted in the conceptual framework of nursing care, training and management.

The authors examine critical care, long term care and public health nurses’ views on personal qualities and performance in relation to nurse empowerment. This suggests that nurses have a positive image of their empowerment and any ideal model of nursing management emphasizes aspect of nurse empowerment which leads to enhancement in professional competence, nursing education and personnel management defining an interactive power-driven relationship between patients, nurses and other healthcare professionals in a clinical setting.

Another equally important aspect of patient care is maintaining privacy of patient information and confidentiality of all patient records which is a legal as well as social requirement (Erickson and Millar, 2005). As far as administration of medicines is concerned, the following guidelines have been suggested by the Nursing and Midwifery Council (refer to Nursing and Midwifery Council Guidelines for Administration of Medicines, 2002).

The Medical treatment should: * be based, whenever possible, on the patient’s informed consent and awareness of the purpose of the treatment * be clearly written, typed or computer-generated and be indelible * clearly identify the patient for whom the medication is intended * record the weight of the patient on the prescription sheet where the dosage of medication is related to weight * clearly specify the substance to be administered, using its generic or brand name where appropriate and its stated form, together with the strength, dosage, timing, frequency of administration, start and finish dates and route of administration * be signed and dated by the authorised prescriber not be for a substance to which the patient is known to be allergic or otherwise unable to tolerate * in the case of controlled drugs, specify the dosage and the number of dosage units or total course; if in an out-patient or community setting, the prescription should be in the prescriber’s own handwriting; some prescribers are subject to handwriting exemption but the prescription must still be signed and dated by the prescriber. Rationale and Case Study Having discussed the different approaches to patient care, the important aspects of nursing management, and the various theoretical models of patient management, we move on to considering the appropriate nursing approach for a 55 year male patient J. D. suffering from coronary heart disease at the post-operative stage. The patient had coronary artery bypass and showed left ventricular dysfunction.

Coronary artery bypass is applicable and recommended for patients with deteriorated left ventricular functions and in this case, surgery was also carried out as the best alternative. Lifestyle changes in patients with heart disease and the importance of assessment and management in nursing can be emphasized. Shotter (2005) mention that heart failure is a clinical syndrome and is caused by a reduction in the heart’s ability to pump blood around the body. The prevalence of heart failure due to coronary heart disease (CHD) is increasing although overall mortality from CHD is on the decline. More people seem to suffer acute heart attacks and experience residual left ventricular dysfunction. Standards have been set up for treatment of patients with heart failure. The nursing approach for J.

D focuses on lifestyle changes and improving quality of life (QOL) for the patient after surgery. Alm-Roijer et al (2004) argue that better knowledge improves adherence to lifestyle changes and medication in patients with coronary heart disease. Their aim was to investigate if knowledge of risk factors for CHD which were measured by a questionnaire showed any relation to advice to compliance to lifestyle changes to attain treatment goals and adherence to drug therapy. For this study men and women who had a cardiac event were interviewed and 347 patients answered a questionnaire regarding general knowledge of risk factors for CHD, compliance to lifestyle changes to attain treatment goals and adherence to drug therapy.

The authors found significant correlations between general knowledge about risk factors for CHD and compliance to lifestyle changes such as weight, stress management, physical activity, diet, attainment of lipid levels and the likelihood of taking prescribed blood pressure-lowering drugs. The study also found no correlations between blood pressure levels, smoking habits and treatment patterns. The authors concluded that a patient’s general knowledge on health conditions relating to his illness correlated with his behavior with respect to the risk factors concerned and this should be recognized in heart disease preventive programs. Coronary heart disease is one of the leading causes of mortality with 84% of persons dying from this disease.

The secondary preventive measures of this disease include lifestyle modifications, pharmacotherapy as this is important for the elderly patients due to variable impacts on morbidity and mortality rates as well as quality of life. Light to moderate activities are suggested for recovering heart patients, patients are also treated for depression and other adverse psychological conditions that can follow heart disease. Cessation of smoking is also encouraged and aspirin and beta blocker therapy effectively applied. Reduction of low density lipoprotein cholesterol levels has shown substantial reduction in coronary heart disease mortality and nonfatal myocardial infarction rates.

Hypertension revealed as systolic blood pressure elevation should be treated with medical therapies such as diuretics, beta blockers or with newer agents such as angiotensin-converting enzyme inhibitors along with restrictions in sodium intake. Cardiovascular diseases are related to obesity, insulin resistance, type 2 diabetes, weight reduction and glucose control, thus weight loss strategies are emphasized and management of diabetes is recommended through dietary modification, exercise and medications. Depression, social isolation may be seen in older patients with lower socioeconomic status than younger counterparts and this negatively affects participation of older patients in rehabilitation programs or compliance with medical therapy and advice.

Brostrom and Johansson (2005) account that sleep disturbances are prevalent among the elderly and among people with chronic heart failure or CHF affecting all dimensions of the quality of life (QOL). The authors delineated the most common causes of sleep disturbances in patients with CHF and emphasized on the holistic perspectives from which different care actions could be implemented. Sleep disordered breathing and insomnia has been considered as the most common causes of sleep disturbances and occurs in many patients with CHF. Insomnia, which is generally caused by anxiety and stress, leads to negative effects on aspects of the QOL causing daytime sleepiness. When nurses assess and plan the care of patients with CHF, sleep disturbances and their consequences should also be considered.

The requirements for improved sleep with non-pharmacological nursing interventions have been emphasized in such patient care. Strategies to improve quality of life by tackling these subtle physiological, social and psychological issues are considered important. The patient under consideration 55 year old male patient J. D who underwent surgery after being diagnosed with coronary heart disease was placed in critical care unit for a few days following surgery. At the postoperative stage recovery was aimed with a balance of medical and social approaches. Improving the quality of life of the patient seems to be of primary concern and any symptoms of depression or social isolation were subsequently recorded.

The patient was given regular therapy and was informed on various issues on healthcare at this stage and was encouraged to interact with hospital staff on stress management, diet, and physical activity. Conclusion: In this study, we offer a critical reflection of goals set to provide care for a 55 year old CHD patient at the postoperative stage. Considering the different aspects of care we discussed the importance of palliative and whole person care as well as holistic and complementary therapeutic approaches to care. Diagnosis of sleep disturbances and depression and improving quality of life has been suggested as important within the nursing schedule of patient management in postoperative conditions. Providing care, considering spiritual and creative needs of the patients is an important aspect highlighted in the discussion.

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