Nursing Diagnosis
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The nursing diagnosis that several members of the Orlov family have been diagnosed with, risk-prone health behavior, can be defined as impaired ability to modify lifestyle / behavior in a manner that improves health status. (Ackley, 2014). Jakub, as mentioned earlier, has particularly alarming sexual behavior. His job at the casino may not be making matters any better, since it gives him exposure to these people that he can have sexual intercourse with. Emil also has this problem, from his frequent short term relationships, to his fondness of fast foods. Darius also has an issue with seeking medical attention in relation to his bulging discs that cause him back pains. The house that the Orlov family lives in, a four bedroom split level home, may not work in his best interests since he will be required to climb multiple staircases regularly.

Recommended nursing interventions

It is clear that all family members are unwilling, or incapable of taking those actions which will improve their health status. In view of this, nursing intervention is necessary. It is recommended that since all members are highly literate, the nurse in question should start by assisting in making decisions about their health improvement. This will include suggestions on how they can better manage their health. Emil should be advised to desist from too many sexual relations, and ensure to use protection any time he does. Jakub should avoid going to places that he usually picks up his sex partners. He should also try as much as possible to use protection when having sex, and additionally, see a counsellor or psychologist to sort out his gender confusion issues. Darius is also in need of intervention, and should be advised to seek medical attention as soon as possible any advice from the doctor should then be implemented to the letter. (Carpetino-Moyet, 2008)

This exercise would then be followed by asking the client to choose one area they feel they should focus on. This will be then be used initially to make progress, and build confidence in the client that they can succeed in overcoming the issues they face. The caregiver should then be able to provide the tools that the client may need to implement that decision. To make the client in charge of the process, the care giver should strive to provide as much information as may be needed by the client. They can ask about any areas that the client feels are not clear, and oblige by clarifying any such issues. (Carpetino-Moyet, 2008)

Readiness to change, and understanding should be assessed, since they are instrumental in determining the success of the intervention in the long run. This assessment can be done by getting from the client, how important he or she thinks the change in behavior is. If they view this as important and high priority, they are likely to implement changes. If not, they are as likely to fail, at least to initiate the change in behavior themselves. Equally important is the confidence levels of the client that they will actually succeed in making the change. Low confidence can be strengthened by encouraging the client to make the change, while stressing the dangers associated with not changing.(Carpetino-Moyet, 2008)

The last leg of the intervention involves participating in creating goals for the exercise. These goals should be as realistic as possible, as the level of enthusiasm and confidence will grow with success. Failure to achieve these goals will lead to the person losing faith and even abandoning the whole exercise altogether. Once goals have been set, the caregiver should come up with a monitoring schedule, and gradually lengthen it as conditions dictate – high level of success will enable the caregiver to be only checking on the patient after a considerable amount of time. At this juncture too, the caregiver should use any resources at the client’s disposal – support groups. These may include church membership, or community organization, family and friends, and include them as much as possible in the plan, to the extent that he client is comfortable with their inclusion in the process. (Doenges, 2008)

For this process to be successful, some things are necessary. For example, the willingness of the participants to engage is of utmost importance – Jakub, or Emil, who live alone, particularly need more dedication to be able to commit to this. Before the whole process starts, the caregiver will have received the clients’ perceptions about health, and use this information to build a plan that will be successful. Any misperceptions should be aligned with what is necessary to help them lead a healthier life, with provision of more information and expert advice. (Doenges, 2008). Education on health matters for all affected will also help the clients very much as they begin their recovery and be able to control themselves, with the support resources’ help. (Scain, 2013)

The caregiver should also promote free communication as much as possible, so that the clients can share their fears, perceptions and goals honestly. This is very important if the plan is eventually going to work. The caregiver should also pay particular attention to the influence cultural beliefs, norms and values may have on the clients. As first generational immigrants, the Orlovs are likely to have a different set of cultural practices, which may inform some of the issues they are currently having.

The Orlovs, being Polish, have a great emphasis on religion and family values, in addition to close community ties. The caregiver can emphasize the importance of these ties with the two brothers, Emil and Jakub, since they will provide invaluable support as they try to enact changes in their lives. (Carpetino-Moyet, 2008)

The interventions discussed above are appropriate, given the family demographics, culture and socioeconomic factors at play, the Darius and his wife live in a close-knit community, which will provide additional help for the caregiver in the implementation and monitoring phase of the plan. His wife will also come in handy, and is likely to help Darius keep doctors’ appointments, take medicine, and exercise. While the decision to change is personal, these effects will obviously make it easier.

Emil does not enjoy the same family or community advantage that his father does, neither does his brother, Jakub. For them, the plan’s emphasis on open communication and several ways of checking on, and building confidence will be important. The monitoring intervals in their cases will be frequent, so that any weaknesses in terms of low confidence or lack of strong convictions about the necessity to change will be caught early and be rectified.

Possible outcomes

The implementation of the intervention plan outlined above is expected to bring about profound changes in the way the clients will live, and attend to their health. The level of information shared with the clients will mean that they, and the people around them, will come out more enlightened about the need to take care of their health. Teaching is one of the focus points of the plan, and the clients should therefore be empowered in such a way that at the completion of the plan, they will not be suffering from the inability to effect changes that will improve their health status.(Friedman, 2003)

It is also expected that the plan will lead to change in behavior as agreed in the initial stages. This behavioral change will be a sign of the client’s progression, in being able to overcome those behaviors that had initially led them to being diagnosed with risk prone health behavior. This will be accompanied by an understanding of the new health status, and a strong willingness to continue in the new path thus set. In all these expected outcomes, it is expected that the support networks available will be helpful in helping them cope with the changes in their lives.

Evaluation of outcomes

An evaluation of the outcomes will be considered against the expectations. The confidence exhibited by the clients in changing, and their willingness to do so will be a key part of the evaluation. This will also be considered against the tangible benefits that have come about as a result of this intervention, Additionally, their ability to use, together with others involved, the information that has been given to them by the caregiver will be a vote of confidence in their progression to being able to modify their behavior in the interests of their health, and the well-being of all those around them. (Friedman, 2003)

For example, Darius should, at the end of this intervention, be able to seek medical attention for any issues he has, and take greater care of his health. Jakub, on the other hand, should now be able to seek help for his sex issues. He should also be able to desist from going where he goes to pick up sexual partners randomly, Emil should be able to avoid changing relationships as he does, and have a responsible and safe sex life.

References

Ackley, J. B. (2014). Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care. Maryland Heights: Mosby Elseiver.

Carpetino-Moyet, L. J. (2008). Nursing Diagnosis: Application to Clinical Practice. Philadelphia: Wolters Kluwer/ Lippincott Williams and Wilkins.

Doenges, M. E. (2008). Diagnoses, Prioritized Interventions, and Rationales. Nurses' Pocket Guide, 112-115.

Friedman, M. M. (2003). Family nursing research, theory & practice . Upper Saddle River: 2003.

Scain, F. M. (2013). Accuracy of nursing interventions for patients with type 2 Diabetes Mellitus in outpatient consultation. Scielo, Vol32 No. 2.

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