Outcomes:

1. Apply legal and ethical frameworks and evidence based practice principles to explore the complexity of person centred care in the medical-surgical setting.

2. Examine the use of technology to inform person centred nursing care within the medical-surgical setting.

3. Critically discuss communication patterns and process required to inform person safety and quality within the medical-surgical setting

4. Apply cultural awareness principles to develop person centred nursing interventions and discharge planning relevant to the medical-surgical setting

Details This assignment relates to a Molly Mooney In order for you to attempt this assignment you must first familiarize yourself with Molly. You can do this by referring to the video of Molly within your Moodle site titled ‘Molly's conditions' This video gives you some background on Molly and includes relevant information in order to complete the assignment task.

Who is Molly Mooney?

Molly was born in 1944 and is a widower of many years. She lives alone with no assistance. She had 3 children: 1 died at birth, 2 are still living: Michael is a firefighter, David is a Nurse Unit Manager, and neither live close to Molly. Molly has a sister Donna who is 65 years old and lives in UK. Molly is a long time ex-smoker. She stopped after her husband died of a heart attack. After many years of nursing as a GP Practice Nurse she retired. Her passion for nursing is strong and she still likes to be involved in reviewing articles for the Australian Practice Nurse Association.

Whilst in hospital with an exacerbation of her COPD Molly talks in the presented videos in the Moodle site about her multiple co morbidities and medications. Molly experiences many health issues which include; chronic obstructive pulmonary disease (COPD), hypertension (HTN), diabetes type 2, osteoporosis, cervical cancer for which she had a hysterectomy 10 years ago. She also suffers from anxiety.

Her medications include Salbutamol 100mcgs prn, Tiotropium 18mcgs daily via a handihaler, Atenolol 25mgs BD and Alendronate once Weekly 70mg tablet in the morning, Metformin SR 1000mgs daily.

During hospitalisation, Molly's vital signs have been stable. Her last recorded observations were as follows: Blood Pressure - 158/94; Respiration rate - 26 breaths per minute; SPO2 saturation - 94%, Pulse - 92 beats per minute, blood sugar level (BSL) ranges between 4-8mmols post-prandial.

Task

You are the student nurse on the ward caring for Molly. Her admission relates to a moderate exacerbation of COPD. Due to Molly being prescribed prednisone 50 mgs daily for 7 days to manage her exacerbation her diabetes has now become unstable and her BSL is between 10-15mmols post prandial.

- You are to consider Moly's situation, and discuss the nursing care that you would provide to Molly in relation to her COPD and her diabetes.

Although Molly is a retired nurse and keeps up to date she does experience some confusion relating to her medications. In the delivery of nursing care you provide her with medication and she becomes anxious about what all her medications are for.

- Using communication principles how would you explain to Molly about the different medications and provide rationales for their use to reduce her anxiety?

It is now 5 days post admission. Molly has progressed well under you care. The consultant reviews Molly and is happy to send her home. She is managing her medications well now and her BSL, although higher than normal at 8mmols post prandial she is reassured once she stops the prednisone in 2 days this should level out. You are preparing Molly for her discharge home.

- Critically discuss self-management concepts for Molly in regards to her multiple co-morbidities in preparation for her discharge home. Ensure you consider her educational background, her cultural background, and social context.

- Discuss two different types of technology to assist in the patient- centred care of Molly whilst in the hospital and how they will assist in her discharge home so as to ensure safe and continuous management of her complex conditions.

Prior to discharge you chatted to Molly about advanced care planning and advanced care directives. She is a very independent lady and is reluctant to talk about this and make any decisions at this point.

- Analyse and discuss the reasons why Molly may be resistant to the concept of an advanced health directive. What legal and ethical principles in regards to advanced health directives might you discuss further with Molly?