Understanding Client Care 1
Identify relevant groups in need of healthcare.
Physical: People that can’t more or less take care of themselves. Physical needs are washing, eating, drinking, swallowing, walking, dressing and mobility.
Psychological: Psychological issues could be mild, like worries of daily living that can be overwhelming, to serious mental illnesses.
Emotional: People suffering from loneliness or more difficult ones like recent bereavement represent emotional problems.
Spiritual: People having difficulties at being at one with themselves or not being concern with god or religion.
Health: People affected by chronic illnesses, young and old.
Cognitive: People suffering from mental illnesses like anxiety, depression, manic depressive, schizophrenia, dementia, Alzheimer.
Dysphasia: People having problems expressing themselves, their needs.
Sensory loss: People losing hear, sight, and touch.
Maslow’s hierarchy of needs is a theory in psychology proposed by Abraham Maslow (Maslow, 1943) and organises all the human needs in a certain order and covering all the above needs.
Discuss the care needs of your chosen client in terms of physical, emotional, social, psychological and spiritual.
Kate is 81 years old and she had a stroke at 78. Kate suffered severe damage following the stroke; her left side was badly touched.
Her arm and both legs are paralysed.
Her speech was affected partially and her ability to read and write was lost.
Weakness of her both legs and left arm (paralysis)
Weakness of the face
Feelings like numbness, pins and needles
Balance problems
Fatigue
Loss of field of vision to one side
Coordination difficulties
To assess her, the healthcare team used the model of 12 Activities of Daily Living in order to create a care plan especially for her and to understand the level of assistance she needs.
The stroke team has members of different professions like:
Doctors
Nurses
Physiotherapists
Speech and Language Therapists
Occupational Therapists
Clinical Psychologists
Social Workers
Dieticians
Opticians (vision)
Kate and her family and friends are very important members of the team
To help Kate getting as much as possible to a normal life and achieve the best level of independence the team needed to work together. They try to help her with:
Relearning abilities and skills
Learning new skills
Adapting to the limitation caused by stroke
Finding social, emotional and practical support at home and in the community.
Kate needs assistance as her level of disability is high and she needs care with all the activities. Kate has also Parkinson disease and the hand that is better is also shaking sometimes.
Kate’s needs are
Physiological:
Dressing
Washing, grooming
Balance and mobility
Use of the arm and hand
Food
Elimination
Psychological:
Worrying about her limitations
Depression.
Memory impairment (light)
Emotional:
Feeling away from her house, family and friends – sadness, loneliness,
Self esteem
Well-being and happiness
Social:
Feeling of belonging
Friends
Activities
Interaction
Spiritual:
She believes in God and this is helping her to find acceptance of her situation. Her faith was sometimes shaken after the accident and she may need spiritual reassurance from time to time.
The care plan will vary from person to person depending on the symptoms. Different members of the team are working with Kate to improve abilities in all the necessary areas.
Immediately after her accident the stroke team was trying to understand Kate lifestyle before the stroke and spoke to her and to the members of her family. All team members worked together with Kate to help her regain her life and enjoy thinks she liked before the stroke. It is very important that Kate puts in a big effort in working with the team in order to reach a superior recuperation. Rehabilitation is an ongoing process and for some may take many years. Kate stroke was very serious and she needed a long-term care facility to provide therapy and skilled nursing care.
In Kate’s case the team indicated a 45 minutes of therapy every day of the week for as long as it is needed and included physiotherapy, occupational therapy, clinical psychology, speech and language therapy and nutrition.
– Discuss the level of assistance required to meet the needs identified.
Paralysis and lack of movement
The Physiotherapists and Occupational Therapists assessed Kate’s ability to move and recommended passive exercises to help her immobility. Passive motion is important to keep flexible joints and prevent joint contracture. Joint contracture happens when there are changes in the structure of the soft tissue such as cramp or reduction of muscles and tendons that restrict movement. It is important for Kate to perform passive range of motion even if she has experienced total paralysis on one site and both legs because a contracture can influence her skin breakdown, irritation of the tissues, pain, it can decrease the blood flow, and prevent her from moving a limb if muscle function does return. Joint contractures also interfere with activities of daily living such as washing under one’s arm, pulling clothing over a contracted elbow or knee, or cleaning the fingernails of a contracted hand.
Swallowing difficulties
Dysphagia is the medical term for difficulties swallowing. Sometimes Kate has problems with drinking or eating as she sometimes may choke or cough. Due to brain damage caused by stroke, eating and drinking may be difficult, as the muscles of chewing and swallowing may be weakened especially in the early stages.
The Speech and Language Therapist provided Kate with special swallowing therapy and advice to help her eat and drink safely. The SLT taught her how to sit correctly and proper eating methods to prevent food and drink from getting into her windpipe. The healthcare assistants are trained to use all the methods suggested by the therapist and help Kate.
Nutrition
A dietician advised her to make sure she was getting the best nutrition to help her recover. The nutritionist or dietician made sure that her dietary needs are met by assessing her nutritional requirements, monitoring what food she ate and educating her on the type of food and drink more appropriate for her needs.
Weight can change after a stroke so it is important that Kate is paying attention to her diet. A healthy balanced diet may help you prevent another stroke. Kate has type II diabetes, high cholesterol and high blood pressure and she needs to follow a diet plan.
Communication Difficulties
After a stroke has problems communicating with others because she cannot find the right words to express her fully and sometimes when she is tired her speech may become slurred and difficult to understand because the nerves and muscles of speech have been damaged. The Speech and Language Therapist also showed her family and friends ways of communicating with her which made it easier to get the message across.
Visual Problems
Stroke caused Kate blurred vision on her left side and this causes difficulty with balance, co-ordination or recognising familiar things or people. The physiotherapist and Occupational Therapist helped with movement and with exercises to compensate for areas of blurred vision. A psychologist helped you with problems like recognising things and people. Now after a long time, Kate regained her vision and has no problems with recognising people. An ophthalmologist recommended glasses to help her vision.
Emotional Problems
After the stroke Kate was challenged with depression – many people experience intense spells of crying and feel hopeless and withdrawn from social activities. After a while she also experienced uncontrolled feelings of anxiety – anxiety attacks. These were caused by the change in her life from the stroke.
Feelings of anger, despair, frustration and grief are all normal for people who have had a stroke. The changes of life that follow a stroke like changes to relationships, work and dealing with the loss of abilities and confidence can lead to anxiety and depression.
Both depression and anxiety are treated with the help of psychological therapies that helped her to understand and cope with these feelings.
Dealing with day-to-day activities
The problems with movement, coordination and perception after a stroke can make it difficult to perform everyday tasks like washing, dressing, eating and moving.
Kate has difficulty with all daily activities. The role of the care team is find ways to make them easier.
Mobility – Kate cannot walk or stand she needs a wheelchair and she is transferred from bed to chair with the hoist. The occupational therapist advised about the use of a wheelchair. The healthcare assistant is helping Kate to move from her room to the dining room or to all the other places she needs to be. She can use her right hand but sometimes it is difficult and her hand is also shaking a little from Parkinson. She likes to comb her hair and brush her teeth and this is encouraged by the care assistants to do this as much as she can.
Getting out of chairs/bed – Occupational Therapists can advise on the best types of chairs and mattresses. Kate needs assistance and a hoist to be transferred from her bed or chair.
Dressing – putting on and taking off clothes may be difficult. Occupational therapists advised Kate and the health care assistant on procedures which can make dressing easier, such as putting the weak arm or leg into clothes first. Kate needs the help of the health care assistants with her dressing. Kate is choosing the clothes she likes to wear every day. The healthcare assistant can offer her opinion on what combination would look better on the client but the choice is with the client and personal opinions should never be imposed. Kate is washed every morning and her denture is rinsed and placed into her mouth before breakfast. All her clothes are clean and fresh and the family is informed whenever clothes need to be replaced. Kate is wearing the appropriate clothes for the day and for the night. When she is helped out of her bed she is wearing comfortable shoes. Grooming is a private matter and is done in her room with the door closed or in her bathroom and attention to all details is necessary. Kate likes to brush her hair by herself and when she finishes the healthcare assistant will finish with a touch and make sure that at the back the hair is well brushed. Kate is wearing make up every day as this is her personal choice and she is assisted in this activity. She is always encouraged to take a final look in the mirror before she leaves her room.
Feeding – The healthcare assistant makes sure that Kate is properly positioned in order to eat. In the morning Kate needs help with her porridge she cannot properly use her right arm so early in the morning when it comes to liquidised food or to taking off the skin of the fruits. She is allowed to taste the food and never rushed. The care assistant needs to first obtain Kate’s consent for the procedure and allow her choice of food. We respect her right to dignity and privacy while eating and drinking. Clothing should always be protected. Dietary needs are facilitated. Kate prefers to finish breakfast by herself if she has toast and a tea in a special cup with lead that allows for dribble-free drinking. Kate is always taken to the dining room in her wheelchair to have lunch and she is trying to eat by herself using utensils with thick handles, a non-slip mats which prevent the plate from moving around the table. The team is always encouraging Kate to be independent. Sometimes she may need partial assistance and discrete encouragement.
Bladder and Bowel Control – Incontinence
It is common for people to have difficulty controlling their bladder or bowel after a stroke. This is known as incontinence. Occasionally after the stroke Kate had a tube inserted to help drain the bladder. When it was needed this was done every now and then rather than inserted for long periods of time. Kate regained this control almost completely after a while. Now Kate needs help to use the commode and two health care assistants will transfer her on the commode from bed or from her wheelchair using a hoist. The rare days when her bowel control is not good she needs to be assisted with her toileting, her pad need changing immediately and with the help of two people she will be washed and cleaned in her bed, being rolled to her side and supported. Dignity towels are used and only the part that needs washing is left uncovered. The doors should be closed the curtains are drawn when necessary and the minimum amount of people should be in the room.
Washing and bathing/showering
This is a very intimate procedure and it can be viewed as an invasion of one’s private space if assistance is necessary. We need to be aware of this and respect the dignity, privacy, independence and empowerment of the person. The healthcare assistant needs to be aware of the client’s reactions all the time. Kate needs assistance with her washing and every morning she is bed washed with the help of two carers. To empower Kate and maintain her self-esteem, Kate is given all the information about the procedure before its starting and she is given choice and options and in this way she can have control of the situation as much as possible and she feels her feeling and choices are appreciated. The attitude of the carer should always be non-discriminatory and they should always strive to meet any needs that the person has. Effective communication and confidentiality are always to be kept.
Social skills
It is very important for people to take part in social activities, to form friendships and this helps maintain a good morale and self-esteem. Care settings should always organise social events and activities for the residents. Social skills should be developed to help learn new skills and have a different outlook. Activities help people keep an active mind and give a feeling of realization. All activities and events organised should be discussed with the residents as everyone has different interests and personality. Attention needs to be paid to different personalities that may prefer peace and quiet, to study or read and that may feel these events are too noisy for them. The healthcare assistant should always respect the client wish and also to encourage him/her to find new interest and to participate and mix in such activities or to start new courses.
Kate was a very active person all her life and the stroke had a big effect on her and her lifestyle. She felt anxious, depressed, frustrated, and angry. A psychologist was helping Kate to overcome these feelings. We need to look at her social activities and she needs stimulation and involvement in social groups. This will bust her positive self –image and encourage her participation. Now Kate is feeling better from the emotional perspective with fewer days of depression. The occupational therapists are organising a variety of activities for her and other residents in the hospice, painting, bowling, singing, art therapy. Kate is always interested in taking part in such activities and events. She really wants to be active and develop/use her skills. She is taking part in the skittles games; she is making and decorating Christmas cakes, taking part in art classes, taking part in events organised with outside people and sometimes her family is there too.
Discuss the prevention of pressure sores and identify the hygiene needs of your chosen client.
A pressure sore is where the skin broke down and fluid is leaking. Usually the areas prone to pressure sores are those where the skin is tin and is covering a protuberant bone, like the occipital bones, the shoulders, elbows, wrists, knees, ankles, sacrum, feet, and face. Healthy people, mobile, that have a healthy diet and hydrate well, do not have pressure sores. Prevention is better than cure and this is why regular exercise, proper fluid intake, proper diet are the most important factors for any prevention. Alternating Pressure and Low Air Loss Mattresses are used for patient with no mobility to help prevent the pressure sores.
It is important to assess the risk of pressure sore. The skin integrity needs to be discretely checked when the person is undressing.
Observe:
Redness of the skin
Mattress
Bed clothing should be light, with no wrinkles
Pad changed regularly
Two hours turning
Good hydration
Nutritious diet
Regular exercises
Physiotherapy
Massage, use of cream
Sleep and food patterns,
Continence bed covers,
Keep the person pain free,
Constantly observe the person.