Introduction
Recreational water activities are beneficial for the health and well-being of individuals of different age groups. Swimming is known for its positive influence on muscle strength, cardiovascular health, and maintaining a normal BMI. This activity also helps to relieve stress, which is of particular importance for older adults. Given the impact of water activities on physiological and psychological states, such a form of therapy as aquatic therapy was developed and became widely used (Nakashima et al., 2018). Swimming is known for its ability to improve the quality of life (Nakashima et al., 2018). Adaptive devices are designed to facilitate swimming for patients with partial paralysis. Additionally, adapted swimming programs provide patients, such as Mr. Brown, with an opportunity to exercise in a water environment. During adaptive swimming, trained professionals supervise and assist individuals with disabilities. Overall, the prospects of patients with paralysis to obtain cardio and aerobic exercise are restricted. On the contrary, swimming is an activity that allows patients to exercise.
Although initially criticized, the nursing process became the foundation of professional nursing practice. The notion can be defined as a systematic approach to clinical practice based on a sequence of steps. The nursing process steps are assessment, diagnosis, planning, implementation, and evaluation (Peate, 2009). Assessment refers to the process of gathering and analyzing data about a patient; upon this data, a nurse is supposed to produce a clinical judgment. Following the assessment process, a nurse sets appropriate goals for a patient, which are achieved according to a care plan. Subsequently, the care plan is implemented into practice, and its effects are continuously evaluated. The use of the nursing process is significant in the care due to its ability to increase the quality of care and patient satisfaction (Peate, 2009). The method provides nurses with a structured and effective framework upon which they can base their clinical practice.
During the completion of the assignment, the concepts of the nursing process and activities of living will be investigated and applied to a practical situation. The primary goal is to develop a plan for an activity that would align with the patient’s needs and possibilities, adhering to professional and ethical standards of nursing. In order to achieve the primary goal, several secondary ones also should be established. The patient’s health state and its implications will be analyzed in-depth to select an adequate setting and timing, ensuring that patient satisfaction and experience after the activity are high. Practicing planning, assessment, and implementation competencies is another important goal.
Planning
Mr. Brown is a senior man experiencing long-term stroke complications. As a result of the medical condition, the client developed hemiplegia, which is not severe and does not restrict Mr. Brown’s mobility. Hence, the stroke did not affect his daily living activities to an extreme degree since the man does not need assistance in major aspects of his routine (Morton and Morgan, 2009). Given that he experiences hemiplegia, his needs and daily activities should be adjusted accordingly. For instance, in lying and sleeping positions, the patient should be supported with pillows correctly, depending on whether he is positioned on his affected, unaffected sides, or back. One of the nurse’s essential responsibilities is to educate the client about the adjustments and limitations hemiplegia entails. Thus, hemiplegia patient education should be incorporated into the plan of care. Considering that Mr. Brown does not need assistance in his daily living activities, the role of a nurse is narrowed.
The client has a relatively high level of functional independence despite his age and the stroke, which allows him greater autonomy and represents a good start for enhancing it through the rehabilitation process. Mr. Brow’s ability to perform daily living activities safely and autonomously is sufficient, as he does not have mobility problems. The HCA is supposed to apply the functional independence measurement to determine independence level with more precision. Communication is a significant aspect of independence that might be lacking in the client’s case as he developed dysarthria following stroke. During a consultation with Mr. Brow, respect for his decision and autonomy should be accentuated.
The services provided to Mr. Brown are supposed to align with the high standards of care and dignity. It is important to instruct the team members on the intricacies of communication with the client in the planning phase. For instance, the care providers ought to be informed that, in contradictory situations, the client has the final say, and his values constitute the basis for the decision-making process. However, in case Mr. Brown’s instructions contradict the safety measures, team members should contact the supervisor and request permission to comply with the client’s requirements.
Increased attention should be paid to swimmers with hemiplegia as in moderate or severe cases, they are not able to swim autonomously. Hence, assisted swimming could be optimal in Mr. Brow’s case, and an instructor could help him not lose balance in the water. An aquatic therapy specialist should be contacted to facilitate the activity. The specialist could also involve the patient in aquatic exercises, further increasing the health benefits of the visit to the pool. Additionally, such swimming equipment as a raft for Mr. Brow to lean on would help control the body’s weight while leaving arms and legs free to move. Regarding transportation, particularly considering that the client transfers with a rollator’s help, a vehicle to transport the client to the indoor swimming pool needs to be organized. The vehicle should be spacious enough to fit the rollator.
The activity is supposed to take place in the late afternoon, or according to Mr. Brow’s preferences. The indoor swimming pool is appropriately equipped to facilitate access to people with disabilities. The facility has an exercise and hydrotherapy swimming pool that is equipped with disabled access swimming pool ladders. Furthermore, the pool has slopped entry, which allows individuals to enter the water body gradually. Besides adjustments that concern the pool directly, the building itself also meets the accessibility standards. Several parking spaces are adjacent to the building so that Mr. Brown will not have to cover a sizable distance. A curb ramp connects parking and sidewalk, leading to a firm route to the building entrance, which is easily seen. The entrance door can be opened without effort as it is auto sliding. The building also has large enough toilets with grab bars. Washroom accessories and dispensers are automatic and thus easy to use for Mr. Brown. Overall, the selected indoor pool corresponds to the accessibility standards to a sufficient extent.
Client Care
Given that water is a hazardous environment and swimming entails some risks, it was instrumental to ensure that Mr. Brown used the equipment correctly. Although the swimming pool has the necessary accessibility equipment, the client’s entry and exit from the water were accompanied by the HCA to avoid slipping or losing balance. Other equipment (a raft) was needed to facilitate the client’s movements in the water so that a correct position (torso on the raft with legs and arms free to move) could have been maintained. Nevertheless, the use of this equipment was optional, as Mr. Brown’s swimming skills were adequate to maintain him floating on his own. During the activity, the safe practice was also ensured by constant care and attention: the client was not left in the water without supervision, even for a moment. The safe practice became the foundation of Mr. Brown’s visit to the swimming pool.
During the visit, non-verbal and verbal communication was employed to ensure the client’s safety, satisfaction, and well-being. In terms of non-verbal communication, positive cues such as open body language, measured eye contact, and friendly facial expressions were used with the client and other team members to create a warm ambiance. In terms of verbal communication, appropriate tone and pitch, encouragements, humor, responsiveness, and politeness were constantly present. A safe environment was maintained by assessing and reducing risks associated with the activity. For instance, slipping or tripping hazards (wet, poorly maintained floors) were promptly identified, and the necessary help was provided to the client to overcome them. Mr. Brown’s diminished ability to convey information heightened the risk of injury following miscommunication, so that additional attention was paid to the client’s body language. Considering Mr. Brown’s age and consequent vulnerability, selecting an appropriate amount of exercise and time spent in the water was also a part of maintaining safety.
The client’s verbal and non-verbal behavior was observed to detect his needs. Mr. Brown’s eye contact, tone and color of skin, facial expression, body language, and general behavior served as a basis for the decision-making process combined with wishes expressed directly via verbal communication (Peate, 2009). For example, dryness of lips conveyed the client’s dehydration and was a signal to act, although the need for water was not stated straightforwardly. Mr. Brown’s independence was prompted by providing him with the decision-making power. The client’s opinion regarding different aspects of the activity was systematically requested and served as a departure point for decision-making. Additionally, Mr. Brown was encouraged to communicate with other people at the indoor pool. Providing opportunities to interact with other visitors was an instrumental part of the activity that allowed the client to fulfill his need to socialize with people besides the HCA and staff members.
Mr. Brown’s dignity was maintained through the freedom to choose, privacy, and recognizing his individuality. The client’s freedom to chose was expressed by involving him in the decisions regarding his care, the activity’s timing, and the risks associated with it (Social Care Institute for Excellence [SCIE], no date). Mr. Brown’s privacy at the pool was of high priority; for instance, it was protected by holding discussions with the client about his physiological state discretely, without exposing him to other pool visitors. The client’s individuality was recognized through “little things,” by addressing Mr. Brown the way he prefers and being interested in his stories and opinions (SCIE, no date). The activity and all the necessary details linked to it was reported in the monthly activity report and directly to the supervisor. The client’s confidentiality was maintained by following organizational security and patient policies, keeping confidential patient information out of the public eye, and disposing of it safely with the help of a shredder.
Evaluation and Reflection
According to Mr. Brown’s feedback, he greatly enjoyed the visit to the indoor pool. The client appreciated thoughtfulness and attention from the staff – swimming is one of his preferred activities. The client included attention to detail, gentleness, genuine interest, a high level of organization, and the activity’s selection into the positive sides of the experience. Nevertheless, he described the noise level, amount of people, and lack of time at the pool as the visit’s downsides. Overall, the activity went well: Mr. Brown was visibly excited and enthusiastic about swimming after a long time spent in a hospital. Nurse-patient interactions were void of communication breakdowns as well as the communication between the staff. The detailed planning and organization allowed escaping unexpected troubles, and since the pool was adequately equipped for people with disabilities, Mr. Brown was unrestricted in his mobility, as transferring it was safe and prompt. On the other hand, during the weekend, the pool seemed somewhat overcrowded and noisy. The activity positively impacted the client, satisfying his need for exercise, which has been absent from his activities of living during considerable time.
The client care could be improved by personalization, implementing more physical activities in daily routine, allowing clients greater freedom, particularly taking risks, and a greater degree of meaningful communication with personnel. In nursing homes, individuals’ sense of identity and authenticity are at risk of being lost – clients are treated uniformly, without recognizing their personal differences. Furthermore, boredom and isolation are another challenges in such institutions. In cases when clients can engage in physical activities, they are beneficial not only for their health but also mental wellness. More extensive and personalized communication with the staff could help the nursing home residents overcome the sense of isolation. Generally, the nursing process was instrumental in providing appropriate client care: it allowed effectively prepare, plan, organize, and effectuate the discussed activity. A systematic approach to nursing practice and the provision of care helped to increase its quality and guarantee clients’ higher levels of satisfaction.
References
Morton, T. and Morgan, M. (2009) ‘Examining how personalised care planning can help patients with long term conditions’, Nursing Times, 17 September. Web.
Nakashima, M. et al. (2018) ‘Optimizing simulation of arm stroke in freestyle for swimmers with hemiplegia’, Mechanical Engineering Journal, 5(1), pp.1-13.
Peate, I. (2009) Nursing care and the activities of living. 2nd edn. Hoboken: Wiley-Blackwell.
Social Care Institute for Excellence. (no date) Dignity in care: the dignity factors. Web.