The topic of this paper is the delivery of nursing care to a patient with a stroke history. The client is a 75-year-old female with severe movement restrictions. At the age of 71, she has suffered a left-sided Cerebral Vascular Accident. Following this event, the client was admitted to the nursing home, where she currently resides. Stroke constitutes the main source of discomfort for the client. In essence, stroke transpires when blood flow in the brain is obstructed. Without the necessary supply of blood, brain cells become damaged and die (Johnson et al., 2016). Effects of a stroke may include disabilities in the side of the body, which is opposite to the affected hemisphere.
Due to health conditions, the client cannot perform basic daily activities, such as personal hygiene, dressing, and elimination, on her own. These needs are facilitated by the nurse staff, which attends to her and controls her condition twenty-four/seven. It should be noted that the client has an extended family, which includes two daughters and a number of grandchildren, all of whom visit her each week. The goal of this assignment is to ascertain the full extent of the client’s needs, the role of the healthcare assistant in meeting them, and the recommendations on improving the quality of care in this case.
Holistic Client’s Needs
Being a stroke survivor, the client has physical limitations, which impair her essential functions. As such she is not able to dress, use the restroom, bathe, and move safely on her own. Considering that the stroke affected only her left hemisphere, the client can move and use her left arm and leg, although they do not allow for much mobility. For instance, she can eat without outside help. Sometimes, she cannot turn herself while she is in bed. Without outside help, the client stays in the same position and may get pressure sores. In practice, in any situation where using the full functionality of the body is necessary, she is dependent on other people.
It should be no surprise that the client has substantial emotional issues. Due to their stroke experience, she experiences anxiety about another blood flow obstruction, which is more likely to happen in patients who have already suffered such a disease (Pei et al., 2016). Being an elderly person, she also expresses concerns about other conditions arising. Therefore, the client needs frequent conversations, which would give her psychological comfort and reassure them of her organism’s ability to resist the ailments.
The client does not feel a lack of social interaction. Her immediate surroundings incorporate patients with similar disabilities and health problems. The client converses with patients and nurses. Her family members make frequent visits on a weekly basis. Moreover, the cellphones enable outside communication. It is possible that being admitted to a nursing home makes her feel isolated from the rest of the world. As a result, there is a definite need for the client to leave the facility with an escort and communicate with close people.
Rehabilitation and Recreational Needs
Being a patient of the nursing home, the client is already undergoing therapy. The nursing staff works on helping the client regain motor abilities. While the process of reactivating the body is underway, the patient experiences anxiety about returning to old leisure activities. The reason for this is that circumstance of the Cerebral Vascular Accident involved her engaging in gardening. Although the client fears suffering another stroke during this activity, gardening remains her primary form of recreation that she needs help to return to.
The client does not express signs of mental decline caused by stroke. Her reasoning abilities are sufficient to correctly solve medical cognitive tests. The client understands when she needs support in daily activities and does not hesitate to call for help. It should be stated that there are some issues with memory, which manifest in the client forgetting where she put her possessions. However, it may also be attributed to her age rather than the brain damage because of the stroke.
The client is a religious woman who follows the Protestant church. She prays daily without disturbing anyone. However, the client’s faith requires that she visit the church once a week. As the client is a devout Christian, attending a church constitutes a need for her. Also, much of her inner strength in fighting the disease stems from her faith. Therefore, helping the client attend church is essential in her willingness to recover from the disease.
Level of Assistance Required
The client’s disability impairs her movement. She receives healthcare assistance throughout the entire day and sometimes at night. The instances where outside help is required encompass getting dressed, being served food, and visiting the restroom. The client also receives assistance when she needs to have a shower. Each time she leaves the room, she is escorted. At night, the client can call the assistant to help her turn around in bed.
The client does not show any cognitive impairment, therefore, no difficulties regarding communication are present. She is able to vocally articulate her needs. The client does need emotional encouragement and assistance to lessen anxiety. Besides her emotional integrity, conversations with the client yield important information concerning her reasoning, signs of unusual behavior, and health changes (NIFAST, 2013).
The client’s disabilities make long walks extremely challenging for her. Therefore, she was provided with a wheelchair. The assistant helps her position herself in the wheelchair, which is used for long walks, going to the church, and attending therapy. The wheelchair itself is manual, but it is always used by the assistant because the client herself is not able to rotate the wheels.
Role of Healthcare Assistant
Clients’ Privacy and Dignity
As all residents of nursing homes, the client has the right to privacy. All visits made by family members transpire without the presence of the personnel, although the client is transported by the assistant to them. Unless the client explicitly asks for support in intimate affairs, such as elimination and bathing, the assistant does not intrude upon her personal space (British Geriatrics Society, 2018). Some activities require exposing the client’s body to the assistant. For example, when making a regular examination of the damaged areas of the body, the assistant is obliged to explain their actions to the client. Understanding why such checks are important is essential in protecting the client’s health. Moreover, the assistant makes sure that no other people are present during these and the windows are closed to minimize any potential discomfort.
The goal of spending time in the nursing home is to foster autonomy with assistance. It is accomplished by allowing the client maximum freedom. As such, she is free to communicate with any people she is willing to. Moreover, no restrictions are placed on her pastime, as long as it is not threatening and cannot lead to the exacerbation of her condition. The assistant does not control the manner of the client’s meal consumption. Furthermore, what he eats is entirely her decision, as she is presented with a choice of meals. The room also has a refrigerator and a microwave so that she could store and heat food. The room can be locked from the inside. The assistant does not restrict the client’s wish to move around the facility.
A feeling of self-confidence is important for a successful recovery. Nursing home residents struggle with the overwhelming sensation that due to their disabilities, they become a burden to other people. At no point is the assistant allowed to articulate the client’s limitations, whether they are physical, mental, or psychological (British Geriatrics Society, 2018). All assistance is done on the basis of the client’s need – unless she asks, the assistant does not intervene with her activities. The client is also assigned voluntary tasks, which she can do on her own. An example includes folding their laundry and washing the dishes. A large part of communication with the client is finding out about her past. By reliving old memories and doing some of the household duties, the client feels more important and confident about herself.
The client is constantly monitored for signs of health deterioration. As most of the client’s movement is done with the use of the wheelchair, the risk of the client’s falling is minimized. The assistant regularly changes the sheaths and controls personal hygiene. In case of an infection, the client is required to limit visiting common areas until the threat of contracting the disease is eliminated. Cameras in corridors monitor for any unusual activity. The assistant makes regular checks of the client’s condition, including physical examinations. Overall, the combination of surveillance, rules, and health control measures constitutes the safety of the client.
Personal information about the client does not escape the nursing home and her family (British Geriatrics Society, 2018). Any mail to the client is not opened by the assistant or other personnel. Her own communication is private, regardless of whether she is visited by the family or is contacted via cellphone. The client cannot be used for research purposes if such endeavors disclose her identity and her consent is not obtained. No interactions with the client can be recorded on camera or a voice recorder. The only way the assistant can take a picture of the client is at her own request. The assistant makes sure that any potential intrusion of confidentiality is immediately reported to the client.
Personally, I think that caring for a stroke survivor has been an eye-opening experience for me. Not only did I learn to monitor for signs of another Cerebral Vascular Accident, but I also saw the value of communication with the patient. In many ways, the ability to recover from an illness is not as physical, as it is mental. Therefore, it is essential to encourage the client and help them feel capable of overcoming the disease (Johnson et al., 2016). Sometimes, something as simple as asking the person about their past or opinion can make them feel better and more empowered. Another important lesson is maintaining self-esteem by delegating some of the household tasks to the client.
The last but nonetheless important lesson is to maintain the balance between assistance and the client’s independence. At first, it was not clear how to perform the duties while respecting her privacy. However, once it was established that the assistant appears only when the client needs them, it became much easier to trespass on her private space. At the same time, it is important to let the client know that she can recover and will be able to perform these tasks herself.
In my opinion, some of the measures taken in the maintenance of the client’s safety are not adequate within the context of the pandemic. First, all personnel of the nursing home ought to be vaccinated. The ease with which the virus spreads makes it possible for elderly clients to contract it and suffer subsequent complications, which may exacerbate their initial condition. It is also important to restrict visits to those who either have already been vaccinated or have proof that they have successfully recovered and have antibodies. Communication with the family is critical for the recovery of the residents, but it should be more strictly regulated.
Another recommendation concerns the way the residents are treated. It is easy to view them as entirely dependent people who constantly require supervision. However, I believe it should become customary to involve the residents in some of the household duties. For instance, if their condition allows, they can change their sheaths themselves or help the assistant measure their health indicators. By performing such simple tasks, the residents will feel useful and more confident, which increases the chance of successful recovery.
British Geriatrics Society (2018) Continence care in residential and nursing homes.
Johnson, W. et al. (2016) ‘Stroke: a global response is needed’, Bulletin of the World Health Organization, 94(9), pp. 634-634A.
NIFAST (2013) Care Skills and Care Support: FETAC Level 5. Dublin: M.H. Gill & Company U. C.
Pei, L. et al. (2016). ‘Factors associated with activities of daily living among the disabled elders with stroke’, International Journal of Nursing Sciences, 3(1), pp. 29-34.