Introduction
The nursing process is universal, applicable in both the medical and mental health fields, and following the same steps regardless of the specialty. Critical reasoning, client-centered treatments, goal-oriented activities, evidence-based (EB) practice recommendations, and nursing instincts are all essential components of the nursing process, as described by Toney-Butler and Thayer (2022). Integrating holistic and scientific postulates lays the groundwork for treatment that is both empathetic and of high quality. Assessment is the initial stage, and it requires the use of critical judgment skills together with the collection of both subjective and objective evidence. Care planning for a client named Mr. Mark Noble is shown in this essay via the use of the nursing process and nursing concepts. Note that in order to protect patient privacy and adhere to the Code of the Nursing and Midwifery Council [NMC], the name “M” will be used throughout this paper as a pseudonym (NMC, 2018). Each step of the ADPIE process will be explained below to show how clinical principles and peer-reviewed research play a role in informing choices and actions.
Case Scenario
The case scenario of the above-named service user is as indicated herein. Patient Mark Noble is a male patient who is a 68-year-old man who was admitted to the hospital’s dementia organic unit in January 2023. The patient was found by police wandering on the street so confused and in very poor condition. Patient M has a diagnosis of Lewdy body dementia, enlarged prostate, history of aggression, self-neglect, depression and falls. Mr. M is now divorced with one child who lives in Canada, so basically Mr. M has been living by himself since the patient’s condition deteriorated during the COVID-19 pandemic. Unable to do anything for himself and was malnourished so he could not even stand on his feet. He was aggressive to others, risk to himself because he once attempted to commit suicide.
ADPIE Process
Assessment and Initial Care Planning
After identifying the desired outcomes, nurses and patients collaborate to develop a nursing care plan supported by research and evidence. Assessment, the first step of ADPIE, is essential (Lapteva et al., 2021). The possible concerns with depression and falls in Mr. M were evaluated in two stages. The head nurse and Mr. M. had a brief discussion first (noting that he is divorced). The nurse made use of inspirational interviewing techniques to learn about his feelings and thoughts regarding memory loss and violence. In this case, the nurse may get a sense of Mr. M’s awareness of the problem and his readiness to take action based on the results (Kaltman and Tankersley, 2020). The use of talk therapy not only makes these realizations possible, but also promotes a team-based method of treatment (Tolchin et al., 2020). In the event of a fall risk, this drives nurse-patient interaction and relapse prevention in the future.
Mr. M’s forgetfulness, Lewy body dementia, enlarged prostate, history of aggressiveness, self-neglect, anxiety, and falls are all factors that need an in-person examination by a nurse. The one-on-one interaction between the nurse and the patient is characteristic of the nurse-patient therapeutic relationship. Faith and trust are fostered via mutual respect in the nurse-patient therapeutic alliance, which allows the nurse to accurately assess the patient’s physical and emotional requirements with the use of nursing skills, as stated by Appiah et al. (2023). This evaluation led to the discovery of his former spouse’s divorce and the whereabouts of his Canadian-based child.
Risk assessment refers to the process of identifying and analyzing elements that may compromise a patient’s therapy. Jo, Park, and Ryu (2020) state that single people who do not have a partner are at a higher risk of falling. Having lost his wife to divorce and his sole child to Canada, Mr. M now lives alone. As such, Poe et al. (2018) argue that the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) should be used in identifying fall risks in patients with acute health problems. The device should be used if a patient has been diagnosed with a high risk of falls as indicated in Mr. M (Andrews et al., 2022). For instance, a patient with a history of additional co-morbidities in the prior half year before readmission should be quickly treated with appropriate intervention according to the tool’s first strategy (Andrews et al., 2022). A fall risk assessment should be conducted by a qualified nurse if any of the aforementioned requirements are not met.
Diagnosis
Diagnosis is the second step in the ADPIE nursing process for whole-person care. Mr. M’s dementia care requires consideration of his mental, physical, environmental, and emotional states (Stolldorf et al., 2020). Holistic nursing simplifies care by taking into account the whole person and teaching them how to take better care of themselves. Here, nurses provide an auditing tool for the next stage of the assessment process (Francisco, 2023). The purpose of this audit tool is to conduct an objective screening for aggressive tendencies. The National Institute for Health and Care Excellence (NICE) suggests this test as a cheap and reliable way to screen for and diagnose aggressive behaviors (NICE, 2018). This is a brief procedure that may pave the way for more person-centered care, thus, encouraging communication.
The same dialogue may be used to evaluate whether Mr. M is actually experiencing memory problems, as has been stated. This may be done in combination with clinically significant measurements owing to the use of objective techniques like the audit and the mini mental state examination (MMSE) (NICE, 2018). Broad signals concerning Mr. M’s concerns may be assessed and processed through a supportive clinical interview throughout the evaluation procedure, leading to more accurate diagnoses. Throughout the patient-nurse conversation, it became evident that Mr. M spends a great lot of his time bewildered, angry, and perplexed. Based on the information provided, one may conclude that the audit showed that he was excessively depressed; hence, health-damaging.
The clinical interview suggested that Mr. M. was experiencing memory lapses more often than usual, and his high MMSE score corroborated this finding, suggesting that he was suffering from severe depression (Stolldorf et al., 2020). Mr. M has Lewy body dementia and an enlarged prostate, which suggest that Alzheimer disease (AD) is the most probable cause of his dementia (MacDonald, Shah and Tousi, 2022). Despite the lack of a definitive test, Mr. M’s appearance is consistent with this diagnosis being established clinically. ADPIE planning was started after the diagnosis, as will be seen below.
Planning
Clinical nursing practice relies heavily on the planning of care. An all-encompassing approach is required for successful planning. Care for the patients as a whole is what is meant by the term “holistic” (Frisch and Rabinowitsch, 2019). According to Frisch and Rabinowitsch (2019), a patient’s well-being involves more than just meeting their medical requirements; it also involves attending to their mental, spiritual, and emotional well-being, as well as their social needs. According to the code of conducts for registered nurses, the first step in providing holistic care is to develop a deep familiarity with each patient’s unique situation and goals for treatment (NMC, 2018). Holistic nursing conceptual frameworks take into account the cumulative effects of an individual’s life circumstances, including their physical, mental, and spiritual health, as well as their immediate surroundings and social context.
Care planning entails formulating objectives to guarantee achievement of these objectives via delivery of high-quality care. In order to improve patient governance and provide high-quality healthcare, nurses should set goals in accordance with Henderson’s Nursing Need Theory. These goals should be case-specific, measurable through nursing processes, achievable within the allotted time frame for nursing practice, and realistic (Fernandes et al., 2019). For optimal recovery following hospitalization, the idea suggests that nurses should stress the value of patient autonomy. Therefore, the nursing team recognized the significance of being capable of implementing supportive structures for Mr. M’s condition, both in the short and the long terms. The nursing team discovered Mr. M to be hard to communicate to due to his aggression, but with the support of his child who lives in Canada, they were able to make progress.
Secondly, at the conclusion of the nursing shift, Mr. M should be able to identify at least four coping methods that he may use to lessen his uncertainty and hostility. Throughout his time in the hospital, the nurse has planned to use healthy coping mechanisms. The nurse may, for instance, do the forced swim test (FST), which has been shown to provoke severe, unavoidable stress in people with mental illnesses (Armario, 2021). After 4 days, Mr. M. will feel more at ease emotionally. When he is in the hospital and after he is released, he will take his medicine exactly as prescribed by his doctors. This objective will guarantee the creation of a framework that promotes enhanced self-care.
The third goal is to deal with the potential legal and ethical problems that may arise from treating Mr. M. Among them are aspects of a social and cultural nature, as well as issues of mental capacity and medical compatibility, and adherence. Dementia care and treatment also has to include patients’ capacity for sound decisions (NHS, 2019). The UK Mental Capacity Act of 2017 allows Mr. M to reject medicine if he has the mental ability to do so (NHS, 2019). However, Mr. M does not have the mental ability to resist treatments due to his memory loss. In order to make choices that are in the patient’s best interests, the nurse may include a multidisciplinary team consisting of the psychiatric doctor, a pharmacist, and a proxy, in this instance the child who is in Canada (Silverman, 2020). This is a long-term objective, since it may take some time for the Child to travel from Canada to begin receiving educational therapy for his father’s care.
Additionally, a person’s mental health is profoundly impacted by the culture in which they are immersed. According to Saltzman et al. (2020), a person’s cultural relevance is reflected in their delusions, psychotic symptoms, intrusive thoughts, and phobias. Cultural stigma has a significant role in the development of mental health issues, particularly in the emergence of behavioral disorders like suicide attempts (Furnham and Swami, 2018). When it comes to stigma, different cultures have different perspectives on what constitutes a healthy mind. Hence, Mr. M’s cultural dynamics will be determined with the aid of the Child in Canada, allowing for more effective treatment options to be provided.
Implementation and Intervention
The last step of the ADPIE process that was used to improve Mr. M’s health was implementation. To put the aforementioned care plan into action, Mr. M and his child should determine which aspects of self-care he may have forgotten due to his memory loss and disorientation. Mr. M was assigned a caregiver to assist him with his medication management as part of the non-pharmaceutical implementation. The consequences of memory loss and confusion are mitigated via a combination of dietary and physical changes. To help Mr. M remember to take his medicine and deal with the stresses in his life that may be contributing to his forgetfulness, he is provided with coping strategies. To support with Mr. M’s memory recovery, the government and nursing advocates should arrange for the child to be flown in for his father’s rehabilitation and for proxy purposes.
Pharmaceutical interventions are performed with the assistance of a specialized physician. An understanding of how various medications function is crucial, as noted by Karttunen et al. (2019). Cholinesterase inhibitors are the first line of drug therapy for dementia and AD (Hussein et al., 2018). This drug works by preventing the enzyme responsible for breaking down acetylcholine, a neurotransmitter that is crucial for mental processing (Hussein et al., 2018). For example, donepezil works by preventing the breakdown of acetylcholine, leading to normalized cognitive performance (Hussein et al., 2018). Mr. M is to take 5 mg of Aricept qHS at first, and then increase to 10 mg qDay after 4 to 6 weeks at night (Donepezil (Rx), 2020). For a severe case like Mr. M’s, the dose is effective.
Evaluation
After the nursing intervention, the intended outcomes are reassessed. By four days, Mr. M should have found a good rhythm with his dementia, with just occasional bouts of forgetfulness. The patient was able to recognize coping methods and mechanisms by the conclusion of the nursing shift, and he agreed to the care plans to decrease the frequency with which he forgets. Seeing a patient who has been listening to music nonstop for four days is also indicative of successful coping (Silverman, 2020). Her dementia treatment up until discharge will be evaluated as part of the long-term objective. To facilitate the assessment of all the items on the above list, a checklist with percentage progress and standard score was made for Mr. M. In addition, an MMSE was utilized to assess the extent of cognitive impairment in relation to the intended outcomes. According to the NICE’s recommendations for the management of mental health conditions, the objectives and strategies are revised for those with scores below the mean.
Conclusion
In conclusion, the foregoing summary of Mr. M’s first care serves as an illustration of how the ADPIE process may be utilized to methodically approach the care of individuals, even those with complicated and co-morbid diseases. Nurses may utilize ADPIE to organize their thoughts as they examine a patient’s symptoms in order to develop EB practice and person-centered strategies for diagnosis, treatment, and evaluation. The procedure is one that must be conducted in the correct order, and as Mr. M’s example shows, it may be used to address more than one problem simultaneously. In fact, this method may be useful for minimizing the risks of diagnostic clouding when dealing with patients who have long-term diseases and have many symptoms or concerns.
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