Leaving a Nursing Heart Print in Neurosurgical Patients and Families · · 2018-02-02Leaving a...
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2/22/2017 1 Leaving a Nursing Heart Print in Neurosurgical Patients and Families AHS-NNI Neuroscience Forum 2017 18 February 2017 Aisyah Nasir Senior Staff Nurse Khoo Teck Puat Hospital o To illustrate how to develop relationships between nurses and family members of neurosurgical patients o To analyze the factors relating to caregiver’s burdens when caring for patients with neurosurgical conditions o To design a process that nurses could use to build caregiver’s resilience when caring for these patients Objectives
Transcript of Leaving a Nursing Heart Print in Neurosurgical Patients and Families · · 2018-02-02Leaving a...
2/22/2017
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Leaving a Nursing Heart Print in Neurosurgical Patients and Families
AHS-NNI Neuroscience Forum 2017
18 February 2017
Aisyah NasirSenior Staff Nurse
Khoo Teck Puat Hospital
o To illustrate how to develop relationships between nurses and
family members of neurosurgical patients
o To analyze the factors relating to caregiver’s burdens when
caring for patients with neurosurgical conditions
o To design a process that nurses could use to build
caregiver’s resilience when caring for these patients
Objectives
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0
5
10
15
20
25
3029.7
19.416.7
6.8
% of Total Deaths
75%
25%
Stroke
Ischemic Hemorrhagic
Statistics
(Ministry of Health, 2015)
o Largest cause of long-term physical disability in Singapore
and with a rapidly ageing population, the burden of stroke is
expected to increase, posing challenges to the healthcare
system and society
o Brain injury, due to its uncertainty of recovery, presents
dramatic life altering changes to most families
Stroke
(MOH, 2015)
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o The families play certain role
in the rehabilitation of their
loved ones
o This process begins in acute
care
o Meeting the emotional and informational needs of families is
essential to helping them adapt in the aftermath of brain
injury
Caregiver Stress in Stroke
Survivors
(Camak, 2015)
Research on Caregiver Burden
on Stroke Patients
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Research on Caregiver Burden
on Stroke Patients
Research on Caregiver Burden
on Stroke Patients
(Kumar et. al., 2015)
(Costa et. Al., 2015)
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Factors affecting families
coping with pressure
Chaotic work environment
Fragmented delivery system
Patient acuity limited nurses’
abilities to care for families
(Yetman, 2008)
o Mr. ABC, 53 years old Malay man
o Found unresponsive by wife and
diagnosed with massive intracerebral
haemorrhage
o Underwent EVD insertion and
decompressive craniectomy
o Bed-bound, on NGT feeding and with
a tracheostomy
o Signed “Do Not Resuscitate” (DNR) from SICU
o Stepped down to general ward
o Attempted to wean off tracheostomy once but failed
o Wife unable to cope with patient on tracheostomy
o Wife refused to take patient home
Case Study
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Nurse
oEager to assist
patient to recover
oHeavy work load
due to frequent
monitoring and
nursing care
oFaced with
family’s emotional
baggage
Patient
o Communication
problems
o Expressive
aphasia
o Memory Loss
o One-sided
Neglect
o Confuse
o Dependent
Family
o Stress
o Unable to cope
with stroke
o Denial
o Guilt
o Suffering
o Financial
Problems
What we face when
encountered such cases
Actual eventPerceived event
Fire on the Stove
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• The ability to adapt to adverse conditions while maintaining a
sense of purpose, balance, and positive mental and physical
wellbeing
• The power to cope with adversity and adapt to challenges or
change
Resilience
(Limardi, Stievano, Rocco, Vellone, & Alvaro, 2016)
Building Caregiver Resilience
Utilizing
the
nursing
process
(Marriner & Tellez, 1983)
Assessment
Diagnosis
PlanningImplementation
Evaluation
Nursing
Heart
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Identify the stressor:
oView families as “one more patient”
oHow involved is the family in caring for the patient
oWhat aspects of care are particularly challenging
oHow does this admission affect their daily lives:
Time travel to the hospital
Time lost from work
Less time with other
children
Expenses
Building Caregiver Resilience:
Assessment
Building Caregiver Resilience:
Assessment
Our case study:
o Anxious
Fear of the unknown
o Sole bread winner of the family
o Have to juggle between patient care
and work
o Not confident in bringing patient home
who has a tracheostomy
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Building Caregiver Resilience:
Diagnosis
Utilize the assessment data gathered and interpret the
findings
Diagnosis of family response to patient's
condition
“unable to cope” with the
situation
Building Caregiver Resilience:
Diagnosis
Our case study:
o Ineffective coping related to newly
diagnosed illness
o Patient is unable to wean off
tracheostomy as he has excessive
sputum
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Building Caregiver Resilience:
Planning
Create an action plan:
o Set realistic goals
o Educate family on all of the equipment being used on the
patient
o Provide social support in the form of support groups,
counselors
o Refer to the rehabilitation team to assess rehab potential
Building Caregiver Resilience:
Planning
Our case study:
o Engage wife early in the care activities
o Aim to reduce frequency of suctioning
by managing the secretion
o Plan to wean off tracheostomy once
secretion decreases
o Initiate caregiver training to wife while
awaiting for arrival of maid
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Follow through the care plan that was developed:
oReached out proactively to families
oOccupy family with care activities
oUse social “chitchat” to get to know the family
oInclude family in the
patient’s care
oUpdate family actively
on relevant information
oEngage family in their
emotional needs
Building Caregiver Resilience:
Implementation
Building Caregiver Resilience:
Implementation (cont.)
Follow through the care plan
that was developed:
oAssess and identify signs of
family’s inability to cope
oMake a collaborative decision
with medical team if patient is
at risk of not being cared for at
home
oContinue caregiver training
until family is competent
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Follow through the care plan that was developed:
o Document appropriately any sign of caregiver stress or any
unusual behavior elicited by family
o Encourage family to take breaks
o Provide family with contact number for clarification if they
have questions or want to check on the patient
Building Caregiver Resilience:
Implementation (cont.)
Our case study:
o Weaning of tracheostomy was
successful
o Wife was motivated to stay with patient
and participated in care
o Caregiver training was completed over 1
week
o Maid application was successful but can
only arrive in 2 weeks time
o Transitional care nurse was activated for
follow up care while waiting for maid
Building Caregiver Resilience:
Implementation
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Determine whether the goals set in the care plan have
been met:
oAssess family’s coping ability at home with follow up call
oFeedback to the transitional care nurses of any assistance
required by the family
Building Caregiver Resilience:
Evaluation
Building Caregiver Resilience:
Evaluation
Our case study:
o Wife claimed transitional care (TC) was
helpful
o 2 weeks later the maid arrived and
provided care
o TC stepped down
o Home nursing foundation was applied
for continuity of care and regular home
visits
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Why healthcare professionals
have to build caregiver
resilience
Better patient outcomes
Shorter length of stay
Prevent readmissions
Patient and family will be
more satisfied
Reduce cost for family and
hospital
(Limardi, et. al. , 2016)
Summary
AssessmentView family as “one more patient” and assess their coping ability
DiagnosisDiagnose family response to patient condition
PlanningSet realistic goals
ImplementationCarry out the action plan and include families in patient care
EvaluationAssess the coping ability and follow up with the family upon discharge
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o Being a caregiver is meaningful, but takes a toll
o Important role for professionals besides caring for the
patients, is to build resilience in caregivers
o With professional support, resilient caregiver will assist in
patient’s wellness and recovery, and prevent readmission
o Building resilience leaves a Nursing Heart Print in patients
and families
Take home messages
Ang, S., Tin, A., Pavitar, G., Ng, W., Lee, K., & Lim, L. et al. (2013). A Qualitative Study into Stroke Caregivers’ Educational Needs
-- Perspectives of Caregivers and Healthcare Professionals. Proceedings Of Singapore Healthcare, 22(3), 166-174.
http://dx.doi.org/10.1177/201010581302200303
Camak, D. J. (2015). Addressing the burden of stroke caregivers: a literature review. Journal Of Clinical Nursing, 24(17/18), 2376-
2382. doi:10.1111/jocn.12884
Costa, T., Costa, K., Martins, K., Fernandes, M., & Brito, S. (2015). Burden over family caregivers of elderly people with stroke.
Escola Anna Nery - Revista De Enfermagem, 19(2). http://dx.doi.org/10.5935/1414-8145.20150048
Kumar, R., Kaur, S., & K, R. (2015). Burden and Coping Strategies in Caregivers of Stroke Survivors. Journal Of Neurology And
Neuroscience, 06(s1). http://dx.doi.org/10.21767/2171-6625.s10005
Limardi, S., Stievano, A., Rocco, G., Vellone, E., & Alvaro, R. (2016). Caregiver resilience in palliative care: a research protocol.
Journal Of Advanced Nursing, 72(2), 421-433. doi:10.1111/jan.12829
Marriner, A., & Tellez, A. (1983). The nursing process: A scientific approach to nursing care. Mexico: El Manual Moderno.
Ministry of Health (2015). Principal Causes of Death. Ministry of Health. Retrieved 15 February 2017, from
https://www.moh.gov.sg/content/moh_web/home/statistics/Health_Facts_Singapore/Principal_Causes_of_Death.html
Yetman, L. (2008). Neuroscience nurses caring for family members of patients with acquired brain injury in acute ward settings:
nursing defensively in a double bind. Canadian Journal Of Neuroscience Nursing, 30(4), 26-33.
References
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o Adj. Asst. Prof Eugene Yang Wei Ren
o ADN Velusamy Poomkothammal
o Dr. Ronald Tan
o NM Guo Hui
o NM Cherie Koh
o ANC Sangeetha Sodimani
o Neurosurgery Specialist Nurse Chua Shu Ting
o Department of Neurosurgery
o Nursing Administration
o Colleagues of Ward B86
Acknowledgement
THANK YOU
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