Concept of Individualised Care: Geriatric Case Study

Concept of Individualised Care: Geriatric Case Study Explain what is meant by the term individualised care. Discuss, using examples from a second practice placement, how one individual patients /clients needs were met using this approach. An essay Introduction The traditional way of trying to assess if a particular treatment or the clinical condition of a patient has changed, is by running blood tests, clinical evaluation, and other laboratory tests. While these measures undeniably give us certain levels of information about a patient, they tell us virtually nothing about the disease process from a personal and social context. (Higginson et al 2001). No illness exists in a vacuum. This essay is a discussion of the concept of individualised care with particular reference to my recent placement on a geriatric ward. I am going to discuss the case of Mrs.J., a 83 yr. old lady. Mrs J has been on the ward for two weeks. She was originally admitted with a chest infection. She was very ill at the time of admission and it was not easy to get a history from her. We could only establish that she lived on her own and had been found by a neighbour who had called her General Practitioner who had then arranged her admission. Her chest infection was treated and she responded reasonably quickly. As she became more lucid, it became obvious that Mrs.J. had had a mild stroke leaving her with an expressive dysphasia. It was not possible to ascertain whether these changes had been present for a long time or had just come on, as she had not seen the General Practitioner for nine months prior to this admission. We also discovered that Mrs.J. had developed a mild form of Type II diabetes mellitus as she was putting out small but constant levels of sugar in her urine and her blood sugar levels were mildly elevated. In brief, her care plan called for her to mobilise with the physiotherapist, to receive speech therapy for her dysphasia, to see the dietician for advice regarding her dietary control of her Type II diabetes mellitus and to see the social work team for assessment for discharge as it was considered unlikely that she would actually be sufficiently self-caring to be able to discharge to her home. The nursing profession, almost by definition, is a very personal and interactive profession. (Yura et al 1998) In order to provide good individualised care there must be a number of interactions in place. The nurse must have a good understanding of the medical elements of the case and also have a good knowledge of the patient both as a person and of all their circumstances. (Meleis 1991) This helps to allow the formulation of good individualised care without making any inappropriate decisions that may be based on an incomplete understanding of the situation.(Holzemer et al. 1994) The case of Mrs.J. is complicated because of her expressive dysphasia. In a nursing context the â€Å"interpersonal processes† that are necessary to establish rapport and empathy were made very much more difficult. (Platt et al 1999). The verbal and motor cues that are a vital part of this essential process were not there by virtue of her cerebro-vascular accident, and it made proper and meaningful conversation very much more difficult. (Carpenito 1997). It was not helped by the fact that she did not appear to have any close relative that we could use to get information. It was not simply a matter therefore of deciding what was medically the best for her, but in order to try to engage with her on the level of empowerment and education, we had to try very hard to understand her feelings and situation in order to provide individualised care. (Woolhead et al 2004) If we try to apply the Roper Logan Tierney model of nursing care (Roper et al 1983) to Mrs.J.’s situation of needing dietary advice for her newly diagnosed Type II diabetes mellitus, the aim would be to try to provide individualised care and to take into account the degree to which the problems of her inability to communicate actually interferes with the other activities of daily living. (Howe et al. 2003). It is in this respect that the concept of individualised care becomes clearly apparent. For the average patient., it may simply be appropriate to fill out a dietetic referral slip and let the dietetic department do the rest. If we wish to fully implement the concept of individualised care, then we would need to establish that Mrs.J. needed and understood why she needed dietetic advice, that she could adequately understand what was being said, (Kuhse et al. 2001), and also make sure that the dieticians were fully aware of all aspects of the situation when they were able to visit her and give advice. (Newell et al 1992) This approach allows us to make an assessment of both the positive and negative aspects of the decision. We can also make an assessment of whether Mrs.J. would eventually be in a position to take responsibility for her own diabetic (or dietary) care in the long run. (Marks-Moran et al 1996) In individualised care, it is important to be as empathetic as possible to the patients needs. One must appreciate the fact that, in this particular case, the imposition of a diet may be seen by the patient as yet another (iatrogenic) restriction imposed upon an already severely restricted lifestyle. Generally speaking, concordance and explanation are better than dogma and enforced compliance (Marinker 1997). Another important aspect of individualised care, is the process of reflection (Gibbs 1998). It is generally comparatively easy to make clinical decisions, but the key to ensuring that they are actually the correct decisions for that individual patient, is to reflect upon them and consider all of the aspects of that particular patient’s case, which may not have actually been impinging upon the original decision making process. (Taylor 2000). For example, it is almost certainly the correct decision to invoke the help of the dietician to assist Mrs.J. in managing her Type II diabetes mellitus. It is however, possible that, upon reflection, Mrs.J. might not be able to adequately manage her diet because her motor problems now preclude her from going independently to the shops, and the person who buys her food for her may have absolutely no idea of the basic concepts behind the maintenance of a regular and restricted sugar intake. Conclusions and Discussion Mrs.J. ‘s case fortunately did have a comparatively happy ending. She accepted the dietician’s advice and proved to be remarkably adept at both managing and manipulating her dietary needs.(Carr et al 2001). It became apparent that part of her confusional state and her dysphasia, was actually due to her hyperglycaemia. As her hyperglycaemia improved and her blood sugar levels returned to more normal levels she rapidly became more communicative. The interpersonal interactions that we referred to earlier, then became both easier and certainly more meaningful. (Stowers et al. 1999). Mrs.J. improved to the point where she was well enough to allow discharge to warden assisted accommodation. Her warden came onto the ward to learn how to help manage the dietary considerations and was able to speak at length to the dietitian. I would like to think that the warden left the hospital as empowered and educated as Mrs.J. was. References Carpenito LJ. 1997 Nursing diagnosis. Application to clinical practice. 7th edition. Philadelphia: Lippincott Company, 1997. Carr AJ, Higginson IJ. 2001 Are quality of life measures patient centred? BMJ Vol18 Issue 42 2001 Gibbs, G (1988) Learning by doing: A guide to Teaching and Learning methods EMU Oxford Brookes University, Oxford. 1988 Higginson and Carr 2001 Measuring quality of life: Using quality of life measures in the clinical setting BMJ, May 2001; 322: 1297 1300. Holzemer W, Tallberg M, et al, editors. 1994 Informatics: the infrastructure for quality assessment improvement in nursing. Proceedings of the 5th international nursing informatics symposium post-conference; 1994 June 24–25; Austin, Texas. San Francisco: UC Nursing Press, 1994. Howe and Anderson 2003 Involving patients in medical education BMJ, Aug 2003; 327: 326 328. Kuhse Singer 2001 A companion to bioethics ISBN: 063123019X Pub Date 05 July 2001 Marinker M.1997 From compliance to concordance: achieving shared goals in medicine taking. BMJ 1997;314:747–8. Marks-Moran Rose 1996 Reconstructing Nursing: Beyond Art and Science London: Balliere Tindall October, 1996 Meleis A. 1991 Theoretical thinking: development and progress. 2nd edition. Philadelphia: Lippincott Company, 1991. Newell and Simon. 1992 Human Problem Solving. Prentice-Hall, Englewood Cliffs: 1992. Platt, FW Gordon GH 1999 Field Guide to the Difficult Patient Interview 1999 Lippincott Williams and Wilkins, pp 250 ISBN 0 7817 2044 3 London: Macmillian Press 1999 Roper Logan Tierney 1983 Using a model for nursing Edinburgh: Churchill Livingstone Stowers K, Hughes RA, Carr AJ.1999 Information exchange between patients and health professionals: consultation styles of rheumatologists and nurse practitioners. Arthritis Rheum 1999; 42(suppl): 388S. Taylor. B. J (2000) Reflective Practice: A Guide for Nurses and Midwives. Buckingham: Open University Press. Buckingham 2000 Woolhead G, Calnan M, Dieppe P, et al. 2004 Dignity in older age: what do older people in the United Kingdom think? Age Ageing 2004;33:165–70. Yura H, Walsh M. 1998 The nursing process. Assessing, planning, implementing, evaluating. 5th edition. Norwalk, CT: Appleton Lange, 1998. PDG Word count 1,562 Muhammad Rafiq Azam Architect: Case Study Muhammad Rafiq Azam Architect: Case Study Table of Contents (Jump to) Introduction Analysis Climatic condition Architectural theory Clients Culture Materials Discussion Conclusion References Book resources Internet resources Introduction: The purpose of indicting this particular essay is to understand architecture via language especially in term of vocabulary, grammatical structure; both physical and intellectual. Through certain arrangement, it carries message and communicates meanings. Rafiq Azam had been chosen as the target of analysis of self and architecture. Muhammad Rafiq Azam is an award-winning architect. He is also a globally acclaimed architect of vernacular architecture from Bangladesh. Shatotto is an architectural studio led by Rafiq Azam, which specialized in architectural aesthetics inspired by lush, riverine landscape of Bengal delta, and ancient architecture heritage of particular region. South Water Garden is a project by Shatotto which was being executed by Shatotto under the lead of Rafiq Azam. It was an apartment building project which located at United Nations Road, Baridhara diplomatic zone, Dhaka, Bangladesh. It is a region not much an exception in term of green. A lake and a narrow strip of green patch on the west of the plot is a fortune. The built area of particular project is about 33600 square feet and had been cost about 576000 US dollar. The particular project was owned by South Breeze Housing and had been completed in 2007. Analysis: In analyzing and theorizing the south water garden imbued architecture quality in term of climatic condition, architecture theory and factors of client, culture and material as well, the analysis depicted that: In term of climatic condition: Apparently, Dhaka undergoes a drastically scorching climate, which characterized as wet, hot and humid climate as it has been categorized under koppen climate classification. Dhaka has been determined as it possess of tropical savanna climate as well. Furthermore, the particular city also has a distinct monsoonal season. In order to design a responsive building, Rafiq Azam had to take account into Dhaka’s climatic conditions as premise. First and foremost, the orientation of building sun screening faà §ade in response to climatic condition of Dhaka is necessarily required in order to reach the standard thermal comfort level in accord to human comfort. Via the analyzing of South water Garden buildings’ plan orientation and building configuration as well, it was obviously to identified and figured out that Rafiq Azam’s intention on creating a parallel configuration. Via the particular array and permutations, the parallel respective building’s blocks tend to act as protective screen in against to direct exposure to summer solstice and winter solstice during the noon. Conclusively, the southern block aids to shade the northern block during the winter solstice, in contrary, the northern block aids to shelter southern block during summer solstice. The incorporation of two hundred square feet of green patch in front of the building on the east road and utilization of large tree and lake on the west as cooling device for the apartment buildings create a balanced interrelation with building configuration in opposing the unstable climatic conditions of Dhaka. Simple interior is connected to beautiful lake and large trees on the west, enabling the south east summer breeze flowing via the entire house. Apart from that, the intention of respective parallel blocks also enables itself to achieve optimal light density for residents’ daily activities. Therefore, sun path effects had been considered as primarily factor as it contributed much i nfluences on building’s comfortability to live. Tactics of Orifice consideration in response to prevailing wind and summer breeze is also a mean to achieve optimal cross ventilation in order to fulfill the human comfort level. The south east and east prevailing wind flow through the house, simultaneously drifting away the heat that gained inside the apartment aid to create a cozy atmosphere inside the apartment buildings. In term of architectural theory: South Water Garden is designed based on phenomenological architecture. Preliminary, looking deep into Dhaka geographical situation as the land characterized with tropical vegetation and moist soils in the primarily was currently being destructed as these all were replaced by construction of multi-storeys building and other real estate developments. Traffic congestion and industrial waste has drastically resulted the deteriorating of air and water pollution. Hence, the regional biodiversity was being demolished. The opposing current aspect of philosophy create trend of creating green in order to preserving extinction of it stimulates local architects to take step into phenomenological architecture especially Rafiq Azam. In response to the particular environment’s situation, an intention of retention among the green and originality of Dhaka’s elemental human experiences, natural features were incorporating into the South Water Garden design in order to create a building design which is concretely defined as â€Å"the place† Dhaka, as well as the South Water Garden residents’ experiences among Dhaka’s originality coincidentally take place in the building. In ground floor plan, Rafiq Azam arranged interior spaces in a simple functional way in order to emphasize on the connectivity between building interior and exterior. By achieving this, he’s skillfully utilizing natural elements such as lake and large trees on the west as transition space that gradually emanating to the surrounding. In contrary, this condition facilitated particular permutation and arrangements of design maneuvering away from abstractions of science and its neutral objectivity as well. In the orizing Rafiq’s architecture via analyzing of South Water Garden roof plan, the imbued intention of connectivity between roof and ground is being emphasized through the two roof tops design of South Water Garden. Incorporation of green living at roof tops is to respond natural elements of rear plot. The continuity of roof tops green to west ground natural features enhances the interrelation of both which then established a strong connectivity among them. Apart from that, the both roof tops of the apartment buildings were created in a way that evidently displays the quality of human experiences of green living as the community green of roof tops which encompassing lawns and bushes subtlety embracing the residents into a sense of Mother Nature. A small pavilion was located poetically at the midst of green community which formed a strong desire toward the nature. This scheme then transformed into a subtropical architectural vocabulary which addressing Rafiq Aza’s concern on shortage of green space in Dhaka. In term of clients Rafiq Azam had been assigned to work with an area of seven thousand five hundred square feet plot. This was a project that formed through the deal between landowner and developer. They both agreed to divide the land in an equal two pieces respectively to construct two six storied buildings of two thousand eight hundred square feet floor area each in order to share equally each. In looking deep into this particular condition, Rafiq Azam’s consideration on requirement that insisted by the clients also influenced much of the design. The clients insisted to put the design into a challenge in terms of creating open green space. In respond to client’s requirement, Rafiq Azam suggested to take forty square feet over seven thousand five hundred square feet from the plot impartially which placing along with eight feet gap of two building respectively, five feet road set back as per rule in order to create a two hundred square feet of green patch in front of the building on the e ast road. This is quite emphasizing of direct residents’ experience toward the buildings as well as the intimacy of natural elements with the users was being created. In term of culture: The richest heritage is formed in neighboring region and lesser developed civilization, as South Water Garden which is located at United Nations Road, Baridhara diplomatic zone. In response to this condition, the arrangement of South Water Garden with no boundary wall notion delivers a more friendly approach toward the local residents. Little pews are placed which delivered a token of respect for pedestrians and community living around. The creation of small pavilion on the roof tops enables gatherings and roof party to be occurred among the neighborhood, which cordially implement the building language co-relation to achieve a hormonal atmosphere amidst the environment. In term of materials: Major buildings in Dhaka, Bangladesh had used brick and concrete as construction materials as these are the most responsive materials to Dhaka’s subtropical climate. In response to surrounding context, exposed brick and concrete are majorly being utilized as construction materials in South Water Garden Apartment. Moreover, the utilization of exposed as cast structural beam and column exterior with terracotta brick in fill is also an approach to subtropical climate of Dhaka that being intended by Rafiq Azam. The selection of materials is quite responsive to human comfort level. Discussion: Rafiq Azam architecture is quite based on experience of space and sensory properties of building materials. This might due to his childhood experiences. By acknowledging that most of the architectural production in Dhaka are dominated on quantitative which driven by profitable motives, he realized that most architect’s keen of sensibility towards a social, ecological and conceptual content is minimized. Growing up in a city which is excessively illustrates segregation of individual architecture as a singular building in a schmooze of materials such as glass, metal, and concrete, there are probably no initiative in thinking much, especially ways of creating an urban which ensemble of various kinds of spaces, which from private to communal, and from hard to green conditions. It was no hard to imagine that with all types of buildings and spatial arrangements coming out of a calculus of market dynamics and borrowed style of architecture. This strictly constricted the architects un til only left with the privilege of addressing buildings with windows. Additionally, Bangladesh has a unique relationship with water, and their sensibilities to its bounty and destruction are a tangible part of the national psyche. The Bangla axiom paanir opor naam jion (water is another life) aptly demonstrate this psychological architecture and the determinative influences of the more than fifty trans-boundary rivers between India and Myanmar, with all their hydrological, social, economic, and political ramifications. With Azams strong impression towards all the impact in his childhood, little wonder then that water bodies are a constant architectural features for Rafiq Azam which is giving out the unrestricted and exposure kind of mood towards the whole city. And his desire to revitalize nostalgia is as ubiquitous in his designs as the water itself in Bangladesh. In his architectural theory, his building is not compendious as the locality, in contrary; it ought to be encompassing of local concretely characteristics or atmosphere which being illustrated via the use of material substances, shape, texture, and color. For instances, the use of cast structural beam and column exterior with terracotta brick in fill is simple way of approach toward subtropical climate of Dhaka as well as the materiality of intimate locality experiences. The consideration of human sensory experiences of building materials is obviously demonstrated through the human comfort responses’ design. In the means of creating spaces, Rafiq Azam allows certain spaces with identical functions to embody a different architectural quality in accord with the local unique characteristics in term of culture and environment conditions. For instances, the local gathering culture was being incorporated into South Water Garden’s roof tops design as the roof pavilion was being created for roof top party. Rafiq Azam attempts to implement his architecture return to things, somehow maneuvering away from abstractions of science and its neutral objectivity. By achieving this, he tries to make things priory happens to be conveys it unique conversations with its place the relevant topic. His design then becomes settlement of different scales in contrasting with surrounding other components. The paths between these subsequently create the Rafiq’s design become secondary defining characteristics of place. The distinction between these conditions offers him the step toward the phenomenological approach. For instances, the emphasis of connectivity inside and outside by Rafiq has been vividly proved via the South Water Garden’s design. Both of the roof tops were created as community green which forms a connection between roof and ground. Conclusion References Book resources Rosa M.F., Kazi K.A. Philip Goad. (2013). Rafiq Azam – Architecture for Green Living. Italy: Skira editore S.p.A. Internet Resources http://www.architecturenewsplus.com/projects/2218 http://archpresspk.com/new-version/Rafiq-azam-book.html http://www.worldarchitecture.org/main/winners.asp?winarchive=11thcyclecyc=11 http://archpresspk.com/new-version/architect-rafiq-azam-interview.html