Nursing_Synopsis

The Impact of Mr. Jones Adjusting to an illness is often a difficult and timely process, with each person adjusting at a different rate. It would appear Mr. Jones is in the first stage of illness, according to Chitty and Black. Since illness is individualized to the person experiencing it, it would be reasonable to understand that through the five stages each person progresses at their own rate, some faster, some slower. Mr. Jones appears to be stuck in the first stage because according to the scenario he had discontinued his medication several days prior to the accident. Stage I in the stages of Illness, according to Chitty and Black, is Disbelief and Denial. In this stage, a person often has difficulty accepting the signs and symptoms of the illness and instead uses a defense mechanism, such as denial to avoid dealing with the signs and symptoms, instead just ignoring them. Mr. Jones is a 48 year old man with a family & is sole supporter of the family, he most likely is feeling that he is young and healthy and ignoring his blood pressure and denying its existence is easier than taking the prescribed medication and making life adjustments to feel better. Mr. Jones’ culture is that of Native American. According to Hendrix, Native Americans history is one of intergenerational oppression, repression, anger and grief since the time when America became colonized. Also, Native American culture typically dictates illness as disequilibrium between the physical, mental, social and spiritual person and family. Mr. Jones’ is a member of the Baptist, which is a form of Christianity. The basic broad philosophy of Christianity includes love of God and fellow man, goodness, compassion, forgiveness, selflessness for the community were added to Indian beliefs and did not replace them according to Hendrix, and although Mr. Jones is from the area, his elderly mother and sister live nearby, they do not live in the immediate area and familial support is from his wife and three children. As a patient Mr. Jones would most likely be cooperative in the beginning of the hospital stay. Initially he would most likely accept treatment, but after 4 days he would most likely become more agitated and frustrated being confined and he would most likely begin to refuse pain medication in an effort to appear that he was feeling better and should be considered for release. Mr. Jones appears to have both an internal and external locus of control. Internally he feels like he has control over his hypertension issue, combined with his stage of denial would explain why he discontinued his hypertension medications, but in his present hospitalization for the motor vehicle accident, the locus was external and it was something that happened to him based on an outside factor or chance, his perception of his overall health is that he is well and he will be able to have control over his injuries if he can get out of the hospital and back to his family and job, according to Ruthig and Allery. The impact of the hospitalization for the motor vehicle accident would be huge for Mr. Jones and his family. Mr. Jones is the sole financial source for his family; he also employs two other individuals that he may feel are dependant on him to provide for their own families. Mr. Jones would most likely benefit most from some crisis intervention. A crisis is the breakdown of a person’s usual level of functioning due to a precipitating event. The trilogy definition, according to Kanel has three parts consisting of the precipitating event, subjective distress, and inability to cope. The purpose of the actual intervention is to have the individual in crisis to increase functioning at the end of the crisis event. Crisis is an acute phase of stress and is individualized to the person experiencing it based on their perception of events. For Mr. Jones and the nursing staff it is going to be paramount to develop a rapport and allow Mr. Jones to talk about the accident and his responsibilities that he is presently unable to manage while hospitalized. The nurse may be able to assist in decreasing his stress by offering some alternatives to him while he is in the hospital, for example, perhaps Mr. Jones could assess calls and send his associates to those calls appropriately. By managing some of his business from his hospital bed, it may allow Mr. Jones the feeling of some control back and release his feeling of helplessness, it will also allow him to continue to have some financial income while he is hospitalized. It would also be prudent for the nurse to get an approximate timeline for Mr. Jones’ hospitalization. This would allow Mr. Jones and his family to plan and explore options for assistance from relatives, that are not in the area, but do live nearby, to possibly make the trip for familial support. Also, by including the patient in the plan of care, it may increase his compliance with treatment and decrease his agitation. This would also give the nursing staff an opportunity to educate him on his hypertension and the long-term effect neglect would have on him and his family both physically and emotionally. At the end of the crisis, the optimal goal would be for Mr. Jones to continue his healing process and follow medical advice concerning his neglected hypertension. This would prove to be a successful intervention for Mr. Jones if he would continue managing his hypertension and wounds after discharge with medical compliance. Internal stressors, according to Chitty and Black, are the stress that an individual carries and owns; they are partially responsible for a persons stress level and are created by that individual. Internal stressors can include diet and nutrition, exercise, posture – related to his plumbing career, rhythm and pacing – not taking the time to relax, or even go to church because he “is always on call”, personal psychology, spirituality, sexual fulfillment, personal interests, beliefs, expectations, perception, non-compliance with medication. External stressors are the stressors that come from the outside world or environment. In Mr. Jones’ case these external stressors include the car accident, the immobility related to injuries, the loss of income, loneliness, noise from the hospital, tests, medications, meals, temperature, staff, waiting, unknowing, confinement, lack of sleep, car damage, uncomfortable bed, test results, and healing time. Per Chitty and Black, interpersonal sources of stress are those that individuals incur with others related to demands placed or conflicts. In Mr. Jones’ case these could include, his wife, his children, his employees, his mother, his sister, the nurses, the doctors, other medical and non-medical staff working with the hospital, the car insurance company, and the billing department. All of these stressors, internal, external, or interpersonal, whether actual or perceived by Mr. Jones pose a threat to his balance and can increase his stress in his current condition, increasing his anxiety and possibly increasing his reluctance to compliance with his medical care. Since Mr. Jones is the primary financial supporter for his family, it is realistic that the family may also be incurring stress. Mrs. Jones and her family may be feeling stress over being separated from Mr. Jones. Other stress may include disruption of schedules, uncertainty in his prognosis and the effect it will have long term on the family. Since Mrs. Jones will have to drive to visit her husband in the hospital and does not drive out of her immediate area, traveling back and forth to the hospital could be a stress. The dominant member of the family is incapacitated; the decisions for day to day life will be left to Mrs. Jones. This may be difficult for her, the children, along with Mr. Jones, not only is she taking on an unfamiliar role, but she will most likely be worried about her husband’s response to those decisions. The family could also be feeling a financial stress, they live paycheck to paycheck and Mr. Jones’ hospitalization will be decreasing the incoming money, and incurring bills due to hospitalization. A family is a system that is open and dynamic. It is often the most important social system for any individual, according to Papadopoulos. Within each family is a hierarchy of sort, each member has defining roles within the family structure and plays that part to balance each other for a whole. As situations occur in a family often roles must be exchanged, preparation and expectation of those changes allow the family to prepare and adjust, but in the case of Mr. Jones and his family, the motor vehicle accident was unanticipated and a surprise. The families in their usual roles are sent in to upheaval and disarray as each member’s role is redefined to cope with the current situation. In the hierarchy of this family Mr. Jones is the dominant figure with his family relying on him to not only support them financially, but to make all the decisions regarding family and the business. Mrs. Jones is more passive and quiet. The roles of the children are not specifically defined in the case above, but there are children that will be affected due to the change, each differently as the youngest, age four, may struggle with not understanding what happened to Mr. Jones, but fearful of the outcome that Mr. Jones may not come back. The two older children, age fifteen and ten, may find their roles require more independent from their parents, as both children may be expected to help with chores and activities that are unfamiliar to them. While Mrs. Jones may struggle with the complete upheaval from making only minor decisions, but now making most of the decisions for not only herself, but her family in every aspect including the finances. This family is going to undergo a complete role change. Each family member is coping with the fear and anxiety of what the potential outcome of the accident could have been, they are most likely suffering some separation anxiety and certainly fear of the unknown. Since the family lived paycheck to paycheck there is not only fear with Mr. Jones prognosis, but with what the financial impact could be on all of them. Mr. Jones is most likely frustrated and angry realizing that he is unable to control all the events unfolding around him, while his wife may be struggling with trying to keep the family system intact. Each child could possibly be feeling fear and anxiety, and possibly some anger and resentment over the roles each will have to now resume. The potential outcomes for this family could be amazing or devastating depending on how each person interpersonal contributions are displayed and accepted by the other family members. As a nurse it is important to realize that Mr. Jones does not exist in a vacuum. Mr. Jones, much like most people, has a family and a network of people that rely on him and him on them. As Mr. Jones’ nurse the most crucial step for this family is going to be explanation and reassurance, along with suggestions for resources that may assist them. As with Mr. Jones this family needs to understand the extent of Mr. Jones injuries, the severity and the potential prognosis. This family has been thrown in complete upheaval and may need this explained multiple times. The family as a whole will need to understand a time line of events for Mr. Jones and what to expect for length of stay and care after hospitalization. It will be paramount to include Mrs. Jones in all aspects of her husband’s care as well as encouraging her in her abilities to handle life at home. Encouraging the children to help Mrs. Jones with some tasks around the house and allowing her the time to pursue avenues that may assist the family. Since the family is most likely ill prepared for such an event, resource such as financial assistance and community assistance will be important for her to know, including how to access services that she and her family may qualify for. This family, as well as the patient will need continued encouragement and positive feedback through the hospitalization. Summary An accident is an undesirable and unfortunate event. It can occur to anyone at anytime and have positive and/or negative effects on those it touches. As a nurse we face families in crisis regularly. It is prudent to remember that care for a patient is paramount, but most patients do not exist in a bubble and there will be those surrounding them that are also affected. With holistic nursing the picture of care includes the patient and those affected by the situation. The family, biological or not is a close union and needs to be addressed to provide additional comfort for the patient. The social system surrounding the patient can aid or hinder recovery, and since, as the nurse, our goal is to assist the patient to healing and achieving the highest quality of functioning, it is imperative to include all aspects of the patient in to their plan of care. References Chitty, K. & Black, B. (2010). Professional Nursing: Concepts and Challenges (6th Ed.). Maryland Heights, MO: Saunders, Elsevier, Inc. Hendrix, L. (2001) Health and Health Care of American Indian and Alaska Native Elders. In: Yeo G (ed). Ethnic Specific Modules of the Curriculum in Enthnogeriatrics. Rockville, MD: Bureau of Health Professions, HRSA, US DHHS. Retrieved from: http://www.stanford.edu/group/ethnoger/americanindian.html Kanel, K. (2007). A Guide to Crisis Intervention (3rd Ed.). Bellmont, CA: Brooks/ Cole, Cengage Learning. Papadopoulos, L. (1995). The impact of illness on the family and the family's impact on illness. Counselling Psychology Quarterly, 8(1), 27-34. Retrieved from CINAHL Plus with Full Text database. Ruthig, JC & Allery, A. (2008). Native American Elders’ Health Congruence. The Role of Gender and Corresponding Functional Well-being, Hospital Admissions, and Social Engagement. J Health Psychol November 2008 vol. 13 no. 8 1072-108. Retrieved from: http://hpq.sagepub.com/content/13/8/1072.full.pdf+html Warne, D. (2009). The State of Indigenous American Series. Ten Indian Health Policay Challenges for the New Administration in 2009. Retrieved from: http://find.galegroup.com.prx-01.lirn.net/gps/infomark.do'contentSet=IAC-Documents&type=retrieve&tabID=T002&prodId=IPS&docId=A198415834&retrieveFormat=PDF&userGroupName=lirn_crevc&version=1.0&isMultiPage=false&noOfPages=17&source=gale&infoPage=infoMarkPage