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Question: Discuss About The Chronic And Complex Care Nursing Patients? Answer: Introduction Guiding principles on management and treatment of patients with chronic and complex conditions are all important for healthcare providers, the patients and their caretakers, to understanding the guiding principles in the management of chronic and complex decisions. Nursing plans in this setting must be in tandem with these guiding principles which include the need for advocacy, healthcare coaching, self-management and empowerment (Cramm Nieboer, 2013). This presentation will thus entail the highlights of the main guidelines on the developing of nursing plans in chronic and complex care setting and their different ways of improving health outcomes of patients. The discussion also focuses of highlighting the nursing plan for a patient presenting with COPD exacerbations and further, the situations at which the nurses can find opportunities to collaborate with other members of the interdisciplinary team in carrying out the nursing plan. Nursing Plan Guiding Principles in Chronic Complex Conditions Self-management and Empowerment The nursing plan drawn in caring for patients in chronic and complex care must include actions that will enhance self-management and empowerment, on the part of the patient. Self-management in this regard refers to the patients ability in conjunction with the healthcare professionals, their family members and the community, to manage the signs and symptoms of the condition, the treatment involved, necessary changes in lifestyle, and its psychosocial, spiritual and even cultural consequences (Cramm Nieboer, 2013). The nursing plan should therefore include the facilitation of the patient to pursue optimal self-management where they are can monitor their chronic and complex illness develop and engage behavioral, emotional and even cognitive strategies that can help them sustain the quality of life that is satisfactory. Among the specific actions on self-management include facilitating the patient directly or through the family to be able to move, eat and even do grooming on their own ( Sonola et al, 2013). The interdisciplinary team should ensure that as the patients medical needs are managed, and that the patient is also gaining abilities to support themselves through specialized therapies such as occupational therapy, physiotherapy and respiratory therapy. The nursing plan should include a modification of the patients hospital and home environment including empowerment approaches so that it is healthy enough for the patient to be safe (Elder, 2017). It can also help in preventing factors which trigger the elevated levels of a condition, a case of COPD exacerbation. Health Coaching Health coaching as guideline should be carried out with the intention of ensuring collaborative approach in improving the health outcomes of a patient under chronic and/or complex care. Nursing plans should thus factor in the need for health coaching of patients and their caretakers on different aspects of their complex and chronic condition (Sciarra, 2012). The nurse thus has to ensure that they focus on coaching patients and their caretakers using the health promotion approach. The nurse through the interdisciplinary team members recognizes and provides necessary informational needs for health coaching (Straughair, 2011). The sessions for this engagement can take a formal or even an informal approach on convenience basis. The nurse can focus on coaching the patient and their family members on personal hygiene, pain management, exercise, treatment procedure and medication, sexuality, meal-time management among others (Schitz et al, 2016). It is necessary that nurses and members of t he interdisciplinary team identify particular coaching moments where the patients seem to present like they have some knowledge deficiency and address them adequately. The different members of the interdisciplinary team have specific areas of professionalism and therefore they should be facilitated to coach the patient and their caretakers on each informational need in regard to the management of their health condition. Advocacy In The Collaborative Management of The Patient and Her Family It is necessary that nursing plans incorporate advocacy for patients and their caretakers rights. According to Sonola et al (2013) advocating for patient safety and health in chronic and complex care is a crucial requirement in nursing practice. The multidisciplinary team including family members has the responsibility to advocate for the rights of the patient and each other in their quest to provide a collaborated care. Under advocacy, providing culturally appropriate care that considers equity and/or social justice is important (Schitz et al, 2016). Advocacy also requires that the collaborating team members in patient care should in their nursing plan identify and also explain different policies and practices which can infringe patient and familys rights. They should further provide information on policies, plans, particular guidelines on what the patients can do where these rights have been compromised (Sciarra, 2012). There is need to ensure that ethical considerations are fully complied with in the provision of patient care in complex and chronic management settings. Access to appropriate healthcare for patients with chronic and complex conditions is paramount. The multidisciplinary team including the social workers in the community, the family and home-nurses should ensure that the patient accesses medication when necessary (Sonola et al, 2013). The nurse should facilitate the continuity of care making sure that there is both connected and/or coherent care for the patient by the interdisciplinary team. The continuity of care helps in ensuring that at each stage of disease management, every member of the interdisciplinary team is able to advocate for the rights of the patient and those of their families The Role of a Registered Nurse, Nursing Planning Nursing Interventions for Patients with COPD Exacerbation. Managing Imbalanced Nutrition COPD patients may present with imbalanced nutrition while under care. At this point, the patients body has insufficient nutrients that can meet metabolic needs. Managing imbalanced nutrition in complex and chronic care units is in line with the guideline that emphasizes the need for healthcare and support (Parikh et al, 2016). Among COPD patients, imbalanced nutrition can be caused by dyspnea and the production of sputum. It is also caused by nausea, side effects of medications, anorexia, recurrent vomiting and fatigue. To address imbalanced nutrition, it is important for the dietician within the interdisciplinary team to determine the patients and/or caretakers understanding of nutritional needs (Lau et al, 2017). The approach will enable the dietician to determine their informational needs so as to effectively teach and coach them regarding the same. An evaluation of patients dietary habits including the recent food intake is necessary to confirm the extent of eating difficulty the patient has been experiencing. Determination of the patients weight and their size to inform on the BMI can inform nutritional options for the patient. The nurse should auscultate the patients bowel to check any decrease in gastric motility as this indicates low fluid intake, poor food choice and hypoxemia. The expectorated secretions by the patient should be immediately removed as they bring about noxious smells and negative altering their appetite while at the same time bringing about nausea and increased difficulty in breathing (Jan, 2013). Sufficient rest time should be allowed before mealtime to minimize any fatigue while eating. Lastly, the respiratory therapist should avail supplemental oxygen during mealtime to lower dyspnea and that might reduce the patients energy needed for eating. Ineffective Airway Clearance Intervention COPD presents with difficulties in breathing and therefore a nursing plan must involve the management of ineffective airway clearance. The patent should be encouraged to rid respiratory tract secretions and unblock the airway (Kuharic et al, 2015). The nurse with the assistance with the respiratory therapist will auscultate the patients breath sounds in order to determine any crackles, wheezes and rhonchi (Parikh et al, 2016). Usually, the presence if moist crackles indicate that the patient should be treated for bronchitis. Expiratory wheezes on the other hand indicate the need for treatment for emphysema. There is need for the patient to be assisted to maintain a comfortable position and their head elevated so as to enhance respiration. The nurse can let the patient have her arms and/or legs supported using pillows to reduce fatigue while enabling chest expansion (Fromer, 2011). Any air pollutants should be removed to avoid re-triggering of the acute level of COPD in the critical c are setting and at home after discharge. A respiratory therapist should advice the patent to practice pursed-lip exercises and/or abdominal breath exercises (Ides et al, 2011). These will help Angela to cope with dyspnea while minimizing the chances of air-trapping as is the characteristic of COPD. They should confirm whether the patients cough is characteristically hacking, moist, or persistent, in order to assist her improve the effort for effectiveness (Kuharic et al, 2015). The approach is important especially understanding that while the cough might be persistent it could be ineffective. Chest percussion is important in ensuring effective clearance of the airway (Lau et al, 2017). Hydration is important also as it will boost expectoration by reducing Audit viscosity of secretions. In this regard, patient needs to be given about 3000mL each day according to her cardiac tolerance as determined by the respiratory therapist. Managing Knowledge Deficiency Management of a patients and/or the caretakers knowledge deficiency is important in chronic and complex care for COPD according to the guiding principle on teaching and coaching. The nurse will identify a patients knowledge deficiency from going through their request forms, the misconceptions the patients present with, and a poor way of following instructions (Jan, 2013). Particularly on COPD, it is important for the nurse to explain the whole disease process to the patient and make repeated messages to emphasize the different messages on the disease and self-care (Cramm Nieboer, 2013). The patient should take part in the discussion actively where possible as well as the family members. This can be through question and answer sessions that are free of anxiety. Particular concern should be focused on breathing exercises, their importance, effective coughing, and prevention of factors that bring about COPD exacerbations (Chin, 2017). Breathing exercises can enable the patient to have improved respiration muscle strength and also prevent small-airway-collapse. As a result, the patient will have minimal or no dyspnea. Dental care and/or oral care are imperative in caring for patients with COPD as it helps in preventing bacterial growth and multiplication that can bring about pulmonary infections. The interdisciplinary team under the nurse should be able to outline and explain the different factors that trigger exacerbations of COPD so that the patient and the family are able to avoid them. Some of them include fine pollen grains, extreme temperatures, cigarette smoke, dry air, aerosol sprays among others. It is thus important that the patient be taught and coached on the effects of smoking and encouraged to cease the behavior as it aggravates COPD. The teachings should be directed also at the need to adhere to medication and participation in follow-up care. Angela who is the patient in the case study should be encouraged to go for regular sputum culture analysis and chest x-rays (Jan, 2013). These tests are very important considering that therapeutic regimen can be altered depending on their results. A respiratory therapist can feed the patient with information on side effects of different medications used including any adverse reactions so that they understand when to request for a change of the medication regimen. Collaboration Opportunities with Inter-disciplinary Team Care Coordination One collaboration opportunity is at the point of managing the COPD patients ineffective airway clearance. A respiratory therapist will be needed to ensure that the patients respiration is managed professionally and dyspnea is minimized. They will provide and control mechanical ventilation means for the patient, incentive spirometry, and also recommend and administer respiratory medication (Kuharic et al, 2015). The therapist will intubate the patient and even facilitate bronchoscopy procedures. The respiratory therapist will also offer pulmonary hygiene and also do necessary chest physiotherapy to minimize the chances of cardiac arrests. Secondly, it will be important for the nurse to collaborate with a specialized occupational therapist in the management of COPD patients. The therapists task will be to support, coach and educate the patient in regard to movement. The occupational therapist can assess the COPD patient, organize and implement interventions that will enable the patient achieve independence in doing routine activities like walking, eating, and grooming (Jan, 2013). The nurse should collaborate with the occupational therapist especially in assessing and recommending modifications to be done both within the critical care clinic and at Angelas own home. A further opportunity will be where there will be need for managing imbalanced nutrition. The dietician in this case will be the most appropriate for collaboration to help the patient with meal-time management (Fromer, 2011). The dietician thus will assess the patient, organize interventions, implement them and then evaluate them to ensure that the patient gets sufficient dietary needs. On the other hand, the dietician should teach the patient and her caretaker on the necessary dietary requirements within the hospital and when discharged (Chin, 2017). A dietician must thus be fully incorporated in patient teaching, coaching, assessment and advice on balanced nutrition. Conclusion In conclusion, it is important for healthcare providers, the patients and their caretaker to understanding the guiding principles in the management of chronic and complex decisions. The discussion above highlights the main guidelines on the developing of nursing plans in chronic and complex care setting and their different ways of improving health outcomes of patients. 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