Mr. P is an elderly patient suffering from heart failure (HF) and edema. It is difficult for him to manage the condition independently and, living only with his wife, whose psychological state became negatively affected by the patient’s multimorbidity, he does not have a lot of support sources. The spouses find themselves in a complicated financial situation. Additionally, the patient expresses a will to die. For this reason, it is not enough to focus just on the physical side of the disease. It is possible to say that a holistic approach to nursing care will befit the given case well.
Holistic nursing refers to the definition of human well-being that is beyond the absence of disease. According to Peterson-Burch, Reuter-Rice, and Barr (2017), “it is the recognition, cultivation, and integration of dynamic, multidimensional levels of satisfaction and an overall sense of peace in daily functioning” (p. 4). Therefore, to promote wellness in Mr. P, a nurse should strive to empower the patient and improve his social support system and other aspects of the environment in which he currently lives.
The shortness of breath is one of the most common HF symptoms reported by hospitalized patients. Thus, during the treatment, the nurse must aim “to alleviate both the physical and emotional symptoms of breathlessness and optimise outcome” (Riley, 2015, p. 123). For instance, during the onset of acute HF symptoms, it is possible to involve an occupational therapist, who will help Mr. P to keep exertion to a minimum, and to teach him some relaxation techniques that will allow reducing stress. As for the long-term treatment, the suggested plan may include adjustments in nutrition, physical activity, and intake of medicines. Since Mr. P failed to comply with similar recommendations before, education should become a central intervention element.
To be effective, patient education for the elderly should follow a few guidelines. Marcus (2014) states that health practitioners must provide information in small amounts to facilitate comprehension, strive to improve patients’ problem-solving skills and encourage them to obtain necessary evidence regarding their diseases independently. During the course of education, it is important to give both the patient and his wife a chance to ask questions and express their concerns. Moreover, it is observed that the establishment of trustful and meaningful relationships with patients and families assists in minimizing anxiety, which is regarded as a major factor inhibiting the building of health literacy (Marcus, 2014). It is possible to say that such a method will assist in motivating Mr. P to adhere to the treatment plan better.
The instruction plan should cover a few areas. First of all, as a patient with HF, Mr. P must be advised “to strictly comply with a heart-healthy diet, including sodium control” and “taught to follow fluid restrictions” (Pi & Hu, 2016, p. 388). Additionally, since the patient is not compliant with the prescribed medication regimen, the given problem must be carefully referred to and discussed during the education. The nurse should also emphasize the importance of Mr. P’s wife in controlling and developing the patient’s self-management skills. It should be stressed that better adherence will ultimately help reduce excess treatment expenditures as well. Lastly, both Mr. P and his wife can be recommended to attend some physical exercising activities such as Yoga or Tai Chi as they may be helpful in “routine disease management, prevention of fluid retention, and improve the quality of life” for the patient with HF (Pi & Hu, 2016, p. 388). Such activities allow developing stress coping mechanisms. Moreover, by attending group classes, the patient will get a chance to expand his social circle and support system.
The main problem identified in the case study was the lack of motivation to comply with prescriptions and treatment plans. It led to the aggravation of the patient’s condition and adversely impacted his family as well. The proposed education method and content can potentially help eliminate the current barriers to better self-management and may allow improving the overall patient outcomes and the quality of life.
Marcus, C. (2014). Strategies for improving the quality of verbal patient and family education: A review of the literature and creation of the EDUCATE model. Health Psychology and Behavioral Medicine, 2(1), 482-495.
Peterson-Burch, F., Reuter-Rice, K., & Barr, T. L. (2017). Rethinking recovery: Incorporating holistic nursing perspectives in post-stroke care. Holistic Nursing Practice, 31(1), 3-6.
Pi, H.-Y., & Hu, X. (2016). Nursing care in old patients with heart failure: Current status and future perspectives. Journal of Geriatric Cardiology, 13(5), 387-390.
Riley, J. (2015). The key roles for the nurse in acute heart failure management. Cardiac Failure Review, 1(2), 123-127.