AN ESSAY ON THE PRINCIPLES OF EVIDENCE-BASED & PERSON-CENTRED CARE PLAN
Table of Contents
The present essay would attempt to create a care plan that would benefit patient with postoperative wound infections. With the considerations of evidence-based practices and proper person-centric attributes, this essay would attempt to assess all the necessary and relevant areas within the disciplines of nursing (Gethin, Probst, Stryja, Christiansen & Price, 2020). With a proper elaboration of risk factors and pathophysiology, the study assessment would attempt to consider the comprehensive post-operative assessments to comprehend how that could possibly help the patient with identifying the potential underlying complications while developing a care plan that could be effective in providing treatments properly. With proper justification, the care plan would be further elevated.
Some of the most effective risk factors for a patient with post-operative wound infection are-if the patient is an elderly adult, having medical complications or diseases could increase the risk factor, weak immunity system, prolonged preoperative stay, infection at remote site, even overweight and malnutrition (Li, Renick, Senkowsky, Nair & Tang, 2020). The complex process of postoperative wound infection, is a complex process where the load and the virulence of the intruding microbes often predisposed by genetic factors where it is conducted by prime and pre-triggered host immune inflammatory response o pathogen. The localised excavation of the skin where under the soft skin, the invasion of the pathogenic organism causes the infection (Sandy-Hodgetts, Ousey & Howse, 2017).
Post-operative assessments of surgical patients commence during peri-operative period where the involvement of health professionals is consistent (Stryja et al. 2020). With the involvement of accurate monitoring and repeatedly consistent clinical assessments, where identifying surgical complications are required to be recognised immediately and accurately.
Development and risk factors of wound dehiscence
One of the major complications that has high risks of occurring amongst the patients who underwent surgical procedures are infection or wound dehiscence. It is a complication that could lead to a wide range of clinical complications (Judson, 2019). The development of wound dehiscence occurs when the wound opens up or the sutures are not performed properly and it open prematurely, leaving the wound open and prone a series of subsequent complications such as bacterial infections, further deterioration of the incision or the wound complications and making the entire aspect of operations an unsuccessful and vain performance (Harris, 2021). The total serration of the recently cut wounds could lead the patient’s life at risk, meaning it could lead to wound evisceration where it causes a massive medical emergency. In cases of a stomach operations, if the patient experiences a wound dehiscence, that could potentially lead to the development of open wounds and internal organs sticking out, making the entire situation extremely vulnerable and pit everything in clinical crisis (Gethin, Probst, Stryja, Christiansen & Price, 2020). No matter how successful the operation is, if the wound dehiscence occurs, it puts the patient in even a vulnerable patient.
One nursing assessment in post-operative wound infection
After then patient is being reported as someone who is currently experiencing a wound dehiscence and that the GP or the RN and all the other medical professionals are well informed, the primary responsibilities of the RN would be to conduct a proper assessment where reviews of fever, or any sort of purulent discharge from the open wounds are occurring are mot are to be monitored (Fernandes-Taylor et al. 2017). Taking care of how the wound could possibly heal, comprehending how deep the wound is, considering what kind of operation has been performed, and performing a continual holistic assessment of the patient where the factors that could possibly heal the wound and several suitable interventions are to be altered and administered accordingly for better outcomes. Making sure that the restitch or sutures are performed the second time with skilled medical professional and the involvement of competency is consistent (Ellis, 2020). Considering active management, the moment wound infection is suspected would help the RN to have a credible control over the entire situation. Making sure that the RN is collecting sound swabs for culture and sensitivity analysis and is duly sending them to the lab to effectively analyse and clinically assess and comprehend the wounds. Based on the suspected pathogen and comprehending the same would allow the RN to effectively commence the assessment process and take effective decisions, suitable for the patient (Ding, Lin, Marshall & Gillespie, 2017).
Risk mitigating care plan
|Care plan actions||Rationales|
|Conducting the assessment and comprehending the existence or identifying the common cause of the infection (Gethin, Probst, Stryja, Christiansen & Price, 2020)||The mentioned factors would possibly represent the body’s first line of defence and would potentially provide the RN with indications of the infections (Sandy-Hodgetts, Ousey & Howse, 2017).|
|Assessing to comprehend the presence of the infectious processes in the membrane or mucous (Nilsson, Gruen & Myles, 2020)||Arising signs and symptoms such as swelling and tenderness, pain etc.|
|Monitoring WBC effectively||Increasing WBC, the body’s count indicating the body’s ability to combat foreign pathogens whereas low white blood counts indicating severe risks of further infection, post-surgery (Stryja et al. 2020).|
|Checking the patient’s immunization history and all sorts of medical history in general||Insufficient immunization in that patient’s body would make the RN extra aware and would allow them to take decisions accordingly to treat the patient and mitigate the risks of infections (Moody, Nicholls, Shamji, Bridge, Dhanju & Singh, 2018)|
|Assessing body temperature, monitoring all the organs systems and checking up on the wounds or the injury at all time (Li, Nylander, Smith, Han & Gunnar, 2018)||Signs of infections would be detected; inflammatory response will be recognised and development of the internal would be analysed|
|Monitoring the fluid intake and assessing the urine output||Thinking out secretions. Would prevent stasis of urine from frequent diluting and emptying process of bladder, something that could be detrimental for the patients’ recovery.|
|Cleaning and checking for any sorts of cross-contamination or further infection and finding any indication of massive wound dehiscence||Will indicate any sorts of potential risks and infection and would immediately shed light upon them to create awareness amongst the RNs and they would take the clinical decisions, accordingly (Li, Renick, Senkowsky, Nair & Tang, 2020)|
Justification of the plan
Although all the actions mentioned above that are to be conducted and perform by the registered nurse, they have associated rationale to potentially clarify why and how important it is for the nurses to perform those actions and include them into their care plans (Judson, 2019). The aspect of staying cautious under such as stressful environment and comprehending the weightage of the situation would be the first priority of the RN and having these steps that are mentioned in the care plan for a patient who has a possibility of getting post-operative wound infections or possibly have developed one already would help them effectively receive the necessary treatments and care services suitable for their immediate recoveries (Harris, 2021). Having the RN directly involved and performing these aspects of their clinical disciplines while considering the evidences available at their disposal and developing the plan extremely patient-centric would help them primarily focus on their patients and would be able to participate in the clinical decision-making proves, where the possibilities of positive outcomes would gradually increase (Gethin, Probst, Stryja, Christiansen & Price, 2020).
As a RN within the disciplines of clinical process, I have experienced several critical and considerably grave situations for patients immediately after they have received their surgeries (Fernandes-Taylor et al. 2017). I personally felt cautious and at the same time responsible where making sure that I do everything I could possibly do has been my first priority. Analysis what is going wrong and what is wrong and comprehending the dichotomy of both good and bad have helped me to effectively analyse the overall situation and assess accordingly (Ellis, 2020). With all the clinical experience and all the social and professional skills I analysed and attempted to comprehend the situation to effectively come up with the best suitable solutions. Based on the action plan solution, I continued to execute all the necessary actions required for the possible improvement of the situations (Ding, Lin, Marshall & Gillespie, 2017).
The essay has considered all the possible indication and health monitoring assessment process to effectively analyse and evaluate the possible complications that a patient could experience who recently underwent a surgical procedure (Sandy-Hodgetts, Ousey & Howse, 2017). With that, the development of an action care plan has been conducted and how evidence-based practices could possibly help then RN to effectively perform and conduct all the clinical actions while taking relevant decision and execute them effectively has been a consistent aspect of the entire discussion of the essay.
Ding, S., Lin, F., Marshall, A. P., & Gillespie, B. M. (2017). Nurses’ practice in preventing postoperative wound infections: an observational study. Journal of wound care, 26(1), 28-37. Retrieved from: https://www.magonlinelibrary.com/doi/abs/10.12968/jowc.2017.26.1.28
Ellis, P. (2020). Principles of care planning. Patient Assessment and Care Planning in Nursing, 90. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=5kS8DwAAQBAJ&oi=fnd&pg=PA90&dq=THE+PRINCIPLES+OF+EVIDENCE-BASED+and+PERSON-CENTRED+CARE+PLAN+OF+post+operative+wound+infection&ots=BN2NmExOLx&sig=TMY3ewaE_06hUymWtC9cptaLgK8#v=onepage&q&f=false
Fernandes-Taylor, S., Gunter, R. L., Bennett, K. M., Awoyinka, L., Rahman, S., Greenberg, C. C., & Kent, K. C. (2017). Feasibility of implementing a patient-centered postoperative wound monitoring program using smartphone images: a pilot protocol. JMIR research protocols, 6(2), e26. Retrieved from: https://www.researchprotocols.org/2017/2/e26?utm_source=TrendMD&utm_medium=cpc&utm_campaign=JMIR_TrendMD_0
Gethin, G., Probst, S., Stryja, J., Christiansen, N., & Price, P. (2020). Evidence for person-centred care in chronic wound care: A systematic review and recommendations for practice. Journal of wound care, 29(Sup9b), S1-S22. Retrieved from: https://www.magonlinelibrary.com/doi/abs/10.12968/jowc.2020.29.Sup9b.S1
Harris, M. (2021). Understanding Person-Centred Care for Nursing Associates. SAGE. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=fbryDwAAQBAJ&oi=fnd&pg=PP1&dq=THE+PRINCIPLES+OF+EVIDENCE-BASED+and+PERSON-CENTRED+CARE+PLAN+OF+post+operative+wound+infection&ots=7h5IgiX1CF&sig=J4Lj3KQoWUTRGS2mJoUepEecGUU#v=onepage&q&f=false
Judson, R. T. (2019). Management of surgical wounds. Textbook of Surgery, 45-48. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1002/9781119468189.ch6
Li, S., Renick, P., Senkowsky, J., Nair, A., & Tang, L. (2020). Diagnostics for Wound Infections. Advances in Wound Care. Retrieved from: https://www.liebertpub.com/doi/abs/10.1089/wound.2019.1103
Li, X., Nylander, W., Smith, T., Han, S., & Gunnar, W. (2018). Risk factors and predictive model development of thirty-day post-operative surgical site infection in the veterans administration surgical population. Surgical infections, 19(3), 278-285. Retrieved from: https://www.liebertpub.com/doi/abs/10.1089/sur.2017.283
Moody, L., Nicholls, B., Shamji, H., Bridge, E., Dhanju, S., & Singh, S. (2018). The person-centred care guideline: from principle to practice. Journal of Patient Experience, 5(4), 282-288. Retrieved from: https://journals.sagepub.com/doi/full/10.1177/2374373518765792
Nilsson, U., Gruen, R., & Myles, P. S. (2020). Postoperative recovery: the importance of the team. Anaesthesia, 75, e158-e164. Retrieved from: https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.14869
Sandy-Hodgetts, K., Ousey, K., & Howse, E. (2017). Top ten tips: management of surgical wound dehiscence. Wounds International, 8(1), 11-15. Retrieved from: http://eprints.hud.ac.uk/id/eprint/31374/3/Sandy-Hodgetts%20K%20Ousey%20K%20and%20Howse%20K%20(2017)%20Wounds%20International.pdf
Stryja, J., Sandy-Hodgetts, K., Collier, M., Moser, C., Ousey, K., Probst, S., … & Xuereb, D. (2020). Surgical site infection: Prevention and management across health-care sectors. Journal of wound care, 29(Sup2b), S1-S72. Retrieved from: https://www.magonlinelibrary.com/doi/abs/10.12968/jowc.2020.29.Sup2b.S1
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