Keith Rischer - Step 3: Recognizing Holistic Care

2016 Keith Rischerwwwkeithrncomstep 3 Recognizing Holistic Care

Recognizing Holistic Care involves integrating compassion, empathy, engagement, and presence in the provision of healthcare. It emphasizes caring for the whole person—physical, emotional, and spiritual—and involves identifying educational and psychosocial needs, determining priorities, and planning comprehensive care strategies.

This case study presents John Gates, a 59-year-old male with longstanding diabetes type II and hypertension, experiencing neurological symptoms consistent with stroke. As the nurse responsible for his care, it’s essential to interpret relevant social and personal history data, identify psychosocial concerns, and develop interventions rooted in holistic nursing principles to optimize outcomes and support patient-centered care.

Paper For Above instruction

John Gates’ presentation with sudden-onset neurological deficits signifies a medical emergency consistent with ischemic stroke, especially given his history of poorly controlled diabetes and hypertension. To provide holistic care, the nurse must synthesize his clinical data with social, emotional, and spiritual factors influencing his health behaviors and recovery potential.

Relevant data from John’s social history include his living situation with his wife in a rural community, his active involvement in his hardware store, and recent health behaviors such as inconsistent blood glucose checks, smoking cessation efforts with nicotine patches, and recent complaints of irregular heartbeats and foot pain. These elements are clinically significant because they influence both disease management and psychosocial well-being.

His irregular heartbeats suggest possible atrial fibrillation, a common stroke risk factor, compounded by his hypertension and obesity (BMI 33.9). His inconsistent blood glucose monitoring indicates poor diabetes control, heightening the risk of further vascular events. His foot pain might signify peripheral neuropathy or infection, complicating his recovery and mobility.

His social situation, including his active work life and frustration over neurological deficits, implicates potential psychosocial concerns such as altered self-image, dependence, or anxiety related to his health status. The wife's role as caregiver and their rural setting could limit access to healthcare resources, further impacting his care.

Psychosocial concerns identified include potential anxiety, fear of disability, frustration due to communication difficulties, and possible feelings of dependence or helplessness. These factors can significantly influence his motivation for treatment adherence and participation in rehab.

Such psychosocial issues could contribute to disease progression by mediating stress responses, impacting medication adherence, or leading to unhealthy behaviors. For example, emotional distress can hinder blood pressure and glucose control, increasing stroke risk or impairing recovery.

Primary nursing priorities should focus on addressing these psychosocial concerns and supporting holistic healing. These include emotional support to manage fear and anxiety, spiritual care to foster hope and meaning, and education tailored to improving disease management and lifestyle modifications.

Interventions should encompass:

• Care/Comfort: Ensuring physical comfort and pain management, monitoring neurological status, and promoting a safe environment.
• Emotional: Providing reassurance, active listening, and assessing emotional well-being. Facilitating communication strategies given speech deficits.
• Spiritual: Respecting spiritual beliefs, offering presence, and referring to chaplaincy services if desired by the patient.

Therapeutic communication principles such as active listening, empathy, validation, and open-ended questions are essential to encourage dialogue with John and his family, fostering trust and understanding.

Educational priorities include teaching about stroke warning signs, importance of blood pressure and blood glucose control, smoking cessation, foot care, and medication adherence to prevent recurrent events. Tailoring education to his literacy, learning style, and cultural beliefs ensures greater engagement.

Additional healthcare team members—such as speech-language pathologists, physical therapists, social workers, and spiritual care providers—are vital in addressing psychosocial, functional, and spiritual needs, creating a multidisciplinary support network.

Currently, John is likely experiencing fear, anxiety, frustration, and possibly helplessness due to his neurological deficits and hospitalization. Acknowledging these feelings compassionately is crucial.

Engaging personally with the patient involves demonstrating genuine concern, maintaining eye contact, providing reassurance, and involving him in decision-making to affirm his dignity and personhood.

References

• American Stroke Association. (2020). Understanding stroke: Risk factors and prevention. Circulation, 142(11), e256-e273.
• Briggs, M. (2018). Holistic nursing: A handbook for practice. Pearson.
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• Kutlubaev, M. A., et al. (2020). Psychological distress after stroke: Prevalence and impact on recovery. Stroke Research and Treatment, 2020, 1-10.
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• World Health Organization. (2019). Risk factors for cardiovascular disease. WHO Report.