+ Praxis Patient Empowerment Post-Cerebrovascular Accident Allison Deighton NURS 484 Saginaw Valley State University

+ Scenario N.R. is an 81-year-old male brought to the emergency care center (ECC) with the chief complaint of right sided-weakness. Upon arrival, N.R.’s wife who is 82-years old and daughter who is 56-years old accompany him. N.R. is a full code and vital signs upon arrival are blood pressure 162/95, heart rate of 78, respiratory rate of 25 and oxygen saturation 100% on 2L per nasal cannula. The pertinent medical history given upon arrival was hypertension, depression, and former smoker. The assessment displayed the evidence of alert and oriented mental status, right-sided weakness in both extremities, dysphasia and agitation. The rest of the assessment and lab values were within normal limits. A CT scan showed a middle cerebral artery (MCA) clot and an angiogram was done with TPA injected into clot in MCA. Improvement was seen in NIHSS (Score of 8) upon arrival to the neurological med-surg unit. N.R. was in my care four days after admission. N.R. was still experiencing significant right-sided weakness, dysphasia and dysphagia. N.R. and wife both state that N.R. is normally active and is feeling powerless in this situation. He becomes frustrated easily with speech and physical therapy.

+ Clinical Challenge Clinical Challenge—Patient empowerment NANDA Diagnoses Self-care deficit r/t right-sided weakness aeb inability to care for self without total assistance from staff Impaired verbal communication r/t dysphasia aeb inability to communicate needs effectively to staff and family

+ Decision Making Process Examine the whole situation and tackle which problem, either mentally, emotionally or physically, that was impacted the care most N.R.’s frustration and lack of motivation was contributing to his feeling of powerlessness and need for patient empowerment. Self-care deficit—inability to care for himself with assistance Impaired communication—inability to communicate needs

+ Care Provided (NIC) Self-Care Deficit NIC—Self-care assistance with bathing and hygiene NIC—Nutritional counseling Purred foods Swallowing evaluation with speech therapy Impaired Communication NIC—Active listening NIC—Anxiety reduction Slow speech and encouragement

+ Outcomes Obtained (NOC) Self-Care Deficit NOC—Self care of activities of daily living Use left side of body for support to achieve goals Ambulation from bed to chair Feeding himself Impaired Communication NOC—Communication Progress made with dysphasia Slow speech to reduce slur

+ Nursing Literature McGilton et al (2012) Patient-centered communication intervention Facilitate interaction with patients Reduce agitation Kirpershock et al (2011) Promote high self-efficacy Improve quality of life Increased mood

+ Personal Learning Use of interdisciplinary care for greatest outcomes Patient empowerment Consistent encouragement Promote high quality of life

+ Concerns In N.R.’s case, I lacked ethnic or religious concerns that would impact care In other cases… Lack of social support Religious concerns regarding care plan

+ References Korpershoek, C., Van der Bijl, J., & Hafsteinsdottir, T. B. (2011). Self-efficacy And Its Influence On Recovery Of Patients With Stroke: A Systematic Review. Journal of Advanced Nursing, 67(9), Mcgilton, K. S., Sorin-Peters, R., Sidani, S., Boscart, V., Fox, M., & Rochon, E. (2012). Patient-centered communication intervention study to evaluate nurse-patient interactions in complex continuing care. BMC Geriatrics, 12(1), 61. Wilkinson, J. M., & Ahern, N. R. (2011). Nursing Diagnosis Handbook (9th ed.). Upper Saddle River, N.J.: Pearson/Prentice Hall.