NURS1102 : Primary Health Care

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NURS1102 : Primary Health Care

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NURS1102 : Primary Health Care

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Course Code: NURS1102
University: The University Of Newcastle

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Country: Australia


This is a  case study report, and does not require an introduction and conclusion. Use the following headings to structure your assignment.
1. GPN health assessment 
Provide an overview of the general practice nurses role and the 707 health assessment for people aged 75 years and older. Access the MBS benefit paid for this specific health assessment. Present the aims of the 707 health assessment and identify Mr Pitman’s risk factors based on his physical, psychological and social functions.
2. Activities of Daily Living 
 Explore the incidence and causes of falls in older people. Discuss deficits relating to Mr Pitman’s activities of daily living (eating, bathing, dressing, toileting/continence, mobility/transferring). Provide one paragraph on each and describe how these may impact his overall health. Support your findings with evidence from the academic literature (eg Applying the Roper-Logan-Tierney Model in Practice (ebook available via library)
3. Nursing Care Recommendations and Rational
Discuss recommendations that the GPN could provide Mr Pitman so that his ADL needs are met in his home environment. Consider home care options and referral pathways that are available to Mr Pitman. For example, explore the options that an Aged Care Assessment Team (ACAT) (https://www.myagedcare.gov.au/) and Department of Veterans Affairs  (https://www.dva.gov.au/) can provide. Also explore the services available through the multidisciplinary team at his own superclinic and those available to him in his community. Provide rationales for your recommendations and support these with evidence from academic literature and Government websites.


GPN Health Assessment:
The MBS is an acronym that stands for the Medicare Benefit Schedule. It basically comprises of a schedule that is meant to provide a critical assessment of health to the patients. Primarily the MBS- 701, 703, 705, 707 and 715 schemes are available for a wide range of clients ranging from children and the elderly group to the indigenous or the Torres Islander inhabitants. On critically analyzing the case study, it can be said that the MBS scheme 707 would be implied in order to access the physical health condition of 83 year old Mr. Pittman. The assessment would involve thoroughly examining the physical, physiological and mental status of the patient. Depending upon the various scores on the evaluation scale, interventions would be designed to proceed with the treatment and decision to recommend home based nursing care. The MBS 707 aims to provide care to a wide target group of audience that include, over all screening of the physical health of individuals aged 45 and above, assessment of the clients aged 45 and above who are prone to developing Diabetes in accordance to the Australian Diabetes risk assessment and screening tool, assessing individuals who are vulnerable to develop a chronic disease. The MBS 707 also provides a health assessment to clients who require palliative care or are victims of long term sickness, mental or physical disability, immigrants requiring special cognitive and developmental care with respect to mental health, indigenous clients and clients who have initially served at the Australian Defense force (“MBS online – Medicare Health Assessments: MBS Items 701-707 and 715”, 2018). The MBS 707 scheme can only be availed by the target audience listed above. The process is an initiative taken by the Australian government in order to provide assistance to the elderly patients who are almost at the terminal phase of life. The process comprises of an extensive evaluation of the patient by the Primary Physician for about 60 minutes and the thorough screening of the physical, social and psychological behavioral pattern so as to design an intervention or introduce a preventive care. The health assessment schedule comprises of the basic tools of evaluation which are stated below (“MBS and health assessments – Australian Government Department of Human Services”, 2018):

Thorough examination of the pulse-rate, blood pressure and the breathing rhythm
Complete evaluation of the ongoing medication
Developing a clear assessment about the client’s continence
An evaluation about the patient’s social status clearly depicting the paid or the non-paid health services used by the patient and whether the patient is responsible for providing care to another member within the family
A thorough psychological evaluation, examining the mood types of the patient and the cognitive behavior
A clear examination about the vaccination and the immunization status of the client in order to understand whether or not the client is susceptible to develop influenza, tetanus or Pneumococcus
A clear evaluation about the client’s physical condition and the ability to perform daily chores and also record if there had been any incidences of fall within the last 3 months
The evaluation can be supposedly availed by any eligible patient who fulfills the above mentioned criteria once in every twelve months.

In case of MBS 707, a benefit of 100% is paid to the patient and the amount considered is approximately $268.80 dollars (“MBS and health assessments – Australian Government Department of Human Services”, 2018). On thoroughly analyzing the case study risk factors such as cognitive impairment, anxiety, sleep disorder, fluctuating blood pressure, poor locomotor coordination can be identified as the risk factors with Mr. Pitman.
Activities of daily living:
The concept of Activities of daily living came into existence at the Benjamin Rose hospital situated at Cleveland in the year 1950 by Sidney Katz and his team (Liu et al., 2013). The Activities of Daily Living primarily constitutes of the five daily activities that is expected to be fulfilled by every individual and the activities include, eating, bathing, dressing, toilet and mobility. Studies reveal that the ability of an individual to perform the above mentioned activities independently is considered as a determinant factor to measure the condition of physical fitness and accordingly interventions are designed. Additionally, it is also stated that the incidence of impaired ability to carry out activities of daily living is confined to patients post injury, the elderly group of patients and the infants who need support because of not being self-sufficient to perform the duties alone. In relation to the case study, it can be correctly said that Mr. Pitman suffered an injury after he tipped over the mat placed in front of the bathroom and fell down. Studies state that on an average there are more than 4,75000 incidences of fall in the elderly group every year globally (Doherty-King et al., 2014). On analyzing the seriousness of the situation, it can be said that the old-age patients suffer an injury caused due to fall as the most common injury. Studies reveal that about 50% of the injuries in the elderly resulting due to fall causes bruises, lacerations and in acute cases might light to a fracture or bone dislocation. Also, it has been mentioned that falls could cause brain injury due to the hurting of the head. Scientific literatures also reveal that there are primarily six causes that increases the risk of incidence of fall in the elderly people (Engelhart et al., 2014). The reasons can be listed as, Vision problems, weaker muscles, lower blood pressure, side effects of medications, insufficient physical exercise and Vestibular dysfunction. All these causes increase the risk pertaining to the possibility of imbalance and fall in the elderly. The physiological functions are found to be impaired with the onset of 50 years of age, however the incidence of fall is found to be more common in women than in men (Mubashir et al.,2013). On analyzing the case study it can be said that Mr. Pitman is finding it extremely difficult to manage the activities of daily living, such as movement, reheating the meals brought by his friends and daughter, changing his clothes and approaching the washroom to wash himself or to urinate or defecate. The factors significantly point out towards the fact that he requires assistance with the activities of daily living. The assistance that would be provided to him would comply with the guidelines of RLT model of nursing. The three aspects that must be considered before assisting a patient with the activities of daily living comprises of critically considering the safety, comfort and dignity and esteem of the patient (Fairbrother et al., 2016). The RLT model evaluates the ability of the patient to perform activities based on biological, environmental, sociocultural, psychological and politico-economical activities and accordingly record the score based on which interventions are devised (Williams, 2015).
Nursing professionals must allow the patients to eat on their own. It is important to let the patient feed themselves independently or else it would give rise to possible situations when the patient has no will to do anything on their own (Gulanick & Myers, 2013). The nurse should take care of the temperature of the food, the quality and assist with things such as maybe cutting a whole fruit to slices so that it is easier for Mr. Pitman to eat. But feeding should be encouraged independently.
Bathing and Dressing:
While bathing the nursing professional must first make sure about the basic amenities such as checking the temperature of the water that would be used by the patient to bathe. The second consideration would be to check if the razor blades are clean and then proceed with shaving the patient as per the requirement. It is important to ensure that the patient feels comfortable in the presence of the nurse and the personal traits of the patients must be addressed in order to make them feel positive (Karlsson et al.,2013). Incidences might occur when the patient likes to take a shower for a longer period of time or maybe thrice a day or maybe there is a patients who likes to wear her makeup often, however on not being able to perform these activities alone, the patients often hesitate to speak up. The nurses should assure that it is perfectly okay to lead life the according to their desire. While dressing up the patient, it is important to ask the patient about their preference so as to make them feel comfortable also, if the dress requires fastening belts that it should be made sure that it is not uncomfortable for the patients. Toe-nails or finger nails should be properly trimmed with clippers straight across so as to avoid any probability of causing skin injury. These factors should be kept in mind while assisting Mr. Pitman with bathing or dressing up as per the daily routine.
Nursing professionals should assist the patients while walking to the washroom and provide support while they are using it. Use of catheter should be avoided unless the patient is disabled. Patients should be asked about whether they wish to use the washroom frequently so as to avoid any uncomfortable situation. The nurse should make Mr. Pitman use the washroom so as to promote movement in the patient and elicit a will for a quick recovery. Care should be taken to keep the washroom floor dry so as to avoid any incidence of fall (McKenna et al., 2014).
On account of the medications taken, the patients experience side effects in terms of dizziness and sometimes blurred vision that makes it difficult to sense the environment that causes fall. The nurses should make sure that the patient is placed in a bright environment with proper lighting and restricted sharp edges or wooden furniture than can cause a fall (Milos et al., 2014). Care should be taken to ensure that the floor is not spilled with water or the patient does not trip over rug (Orive et al.,2015). In case of Mr. Pitman care should be taken to place items of regular use in close reach of him and the patient must be assisted while walking to the washroom by the nurse with the use of a walker device. Wheel chair mobility should be avoided unless the patient is disables so as to ensure the patient tries to move in need. These factors would help in assisting Mr. Pitman with his daily activities to a significant extent and help him in attaining a speedy recovery.
Nursing Care Recommendations and Rational:
On closely examining the condition of Mr. Pitman as is evident from the case study, it can be stated that the physical condition of Mr. Pitman is degrading day by day and he requires major help with the activities of daily living. The Aged care assessment team would assist the patient with the option of home nursing care so as to facilitate him with the daily chores such as changing his clothes, moving to the washroom, helping him reheat things and other such activities (Soar, 2013). The assessment of the daily living activities of Mt. Pitman would first be assessed in terms of the score on various ADL activities and mood scales and then the process would involve consulting the primary care physician to go ahead with the designed aid. Primary care providers should understand the responsibility and functions of the GPN’s and in turn the GPN’s must recommend the primary care providers to facilitate proper communication between homes and the GPN’s. The GPN’s could take up assessments to visit and share latest knowledge and skills to the primary care providers and relatives. Mr.Pitman could explore the services provided by the ‘Aged care Assessment Team’ (Ungar et al.,2013). It’s a team of highly professional care givers who are determined to cater to the needs of elderly people and support them in every possible way. The best aspect of ACAT is that they provide both low level and high level care free of cost. There is a special program for veterans which Mr.Pitman could avail which is exclusively an initiative of the Australian government for the war veterans. Under this compensation scheme, the Australian government provides for the services at home, financial support and medical programs so as to help the veterans with their health related problems. The Repatriation also provides, support in terms of providing home based care and other entitlements that the veterans are obliged to receive on behalf of the government. The providence are all covered under the acts of Defence Service Homes Act which was passed in the year 1918, Providence of military rehabilitation and compensation act that was passed in the year 2004, Safety, compensation and rehabilitation act that was passed in the year 1988, Veterans Entitlements Act which was passed in the year 1986 and the War and Graves Act that was passed in the year 1980 (Soar, 2013). Mr. Pitman is also entitles to avail a number of community programs that are designed for senior patients like him which includes, homecare assistance, respite assistance, transportation and mobility help, senior card that offers a wide range of discount on a number of items, programs designed to support patients with Dementia and a range of information services. Community based non-governmental services can also be availed by Mr. Pitman which comprises of aged care facilities and support organizations to take care of the aged patients (Halcom, 2017). Lastly, the neighborhood where Mr. Pitman is staying in could work together to provide him some support in terms of visiting him and sharing a meal with him. It would promote a speedy recovery as a positive and friendly atmosphere and good conversation help in avoiding traits of depression or harboring feelings of being alone.
Doherty?King, B., Yoon, J. Y., Pecanac, K., Brown, R., & Mahoney, J. (2014). Frequency and duration of nursing care related to older patient mobility. Journal of Nursing Scholarship, 46(1), 20-27.
Engelhart, D., Pasma, J. H., Schouten, A. C., Meskers, C. G., Maier, A. B., Mergner, T., & van der Kooij, H. (2014). Impaired standing balance in elderly: a new engineering method helps to unravel causes and effects. Journal of the American Medical Directors Association, 15(3), 227-e1.
Fairbrother, G., Cashin, A., Conway, M. R., Symes, M. A., & Graham, I. (2016). Evidence based nursing and midwifery practice in a regional Australian healthcare setting: Behaviours, skills and barriers. Collegian, 23(1), 29-37.
Gulanick, M., & Myers, J. L. (2013). Nursing Care Plans-E-Book: Nursing Diagnosis and Intervention. Elsevier Health Sciences.
Halcomb, E. (2017). Nursing in general practice. An Introduction to Community and Primary Health Care, 317.
Karlsson, M. K., Magnusson, H., von Schewelov, T., & Rosengren, B. E. (2013). Prevention of falls in the elderly—a review. Osteoporosis International, 24(3), 747-762.
Liu, Y. E., Norman, I. J., & While, A. E. (2013). Nurses’ attitudes towards older people: A systematic review. International Journal of Nursing Studies, 50(9), 1271-1282.
MBS and health assessments – Australian Government Department of Human Services. (2018). Retrieved from https://www.humanservices.gov.au/organisations/health-professionals/subjects/mbs-and-health-assessments
MBS online – Medicare Health Assessments: MBS Items 701-707 and 715. (2018). Retrieved from https://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-MedicareHealthAssessments
McKenna, H., Pajnkihar, M., & Murphy, F. (2014). Fundamentals of Nursing Models, Theories and Practice, with Wiley E-Text. John Wiley & Sons.
Milos, V., Bondesson, Å., Magnusson, M., Jakobsson, U., Westerlund, T., & Midlöv, P. (2014). Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care. BMC geriatrics, 14(1), 40.
Mubashir, M., Shao, L., & Seed, L. (2013). A survey on fall detection: Principles and approaches. Neurocomputing, 100, 144-152.
Orive, M., Aguirre, U., García?Gutiérrez, S., Las Hayas, C., Bilbao, A., González, N., … & Quintana, J. M. (2015). Changes in health?related quality of life and activities of daily living after hip fracture because of a fall in elderly patients: a prospective cohort study. International journal of clinical practice, 69(4), 491-500.
Soar, J. (2013). Aging issues and policies in Australia. Global aging issues and policies: understanding the importance of comprehending and studying the aging process. Charles C. Thomas Publisher Ltd, Springfield, IL. United States, 295-311.
Ungar, A., Rafanelli, M., Iacomelli, I., Brunetti, M. A., Ceccofiglio, A., Tesi, F., & Marchionni, N. (2013). Fall prevention in the elderly. Clinical Cases in mineral and bone metabolism, 10(2), 91.
Williams, B. C. (2015). The Roper-Logan-Tierney model of nursing: A framework to complement the nursing process. Nursing2018, 45(3), 24-26.

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