Emma Gee is an occupational therapist who lives an active lifestyle when started to experience back pain, headaches, and clumsiness weeks after she returned from holidays (overseas) in April 2005. She was admitted to hospital and diagnosed with an arteriovenous malformation (AVM), a knot of blood vessels in her brainstem that caused paralysis on the left side of her body. The neurosurgeon discovered that Emma’s AVM is likely to burst at any moment and needed to be removed urgently. In consultation with other neurosurgeons, Emma agrees to have it removed and undergo the surgery on June 2005. However, after the surgery, the surgeon suspects that Emma is still bleeding inside and organize another operation to remove the remaining AVM and drain the blood that is pooling in her brain. Due to a complicated brain operation, it placed Emma Gee to an induced coma for 6 days (Gee 2016). This paper will focus on how Strength- Based Nursing Care (SBNC) enhanced Emma’s journey throughout her recovery while she was in the hospital and a nursing care plan was developed during her transition point to relearn walking in collaboration with the multidisciplinary team.
SBNC is an approach to care promoting empowerment, self-efficacy, and hope that focuses on the inner and outer strengths of the patient and family (Gottlieb 2014). As a nurse, it is my responsibility to identify Emma and her family’s strength to empower them to take control over their lives and their health care decisions for a better health outcome. By guiding Emma and her family to focus on what will work well for them and assist them to positively deal with the issues and minimize deficits (Gottlieb 2014). As a nurse, it is my responsibility as well to focus on Emma’s health and facilitate healing using the SBNC approach. Good collaboration with Emma and her family will facilitate alleviation of their suffering by drawing upon their inner and outer strengths to adapt life’s challenges and to live with purpose and meaningful life (Gottlieb 2014).
Meet Emma Gee
It is essential to have a discussion with Emma, her family and myself in relation to Emma’s care, decision making, and recovery. Part of the discussions will be about Emma’s experience recovering from a stroke, how she developed resilience despite the terrifying experienced she had during her recovery process and setting up goals that best for Emma’s needs.
As a nurse, my role is to promote a collaborative partnership with Emma by listening attentively to what she wants to say (Gottlieb 2013). To encourage her to share her experience without judgment by placing her story in a context to identify strengths and weaknesses to assist Emma to utilize these elements to function at her highest level of recovery. Engaging Emma in the process of reflection, what’s happening in her life and what the future will be is important. It allows Emma to have the autonomy to take control over her health and to encourage her to actively participate in planning about her own care. Having a mutual relationship with Emma and trust each other’s ability to contribute to the process for setting up goals is the key to achieve the desirable objectives (Gottlieb 2013).
The process of collaborative partnership allows all parties to actively involved in setting up goals for Emma’s care and recovery by working together in finding solutions that are best for Emma’s needs. My role as a nurse is to provide all the necessary information about Emma’s health conditions and expertise that aligns with her capability and understanding so that both of us can participate fully as partners. The goals are jointly determined according to Emma’s capability that is manageable and meaningful to her (Gottlieb 2014).
Promoting a collaborative partnership facilitates empowerment for Emma to be involved in planning and decision making of her own care (The Royal Melbourne Hospital 2014). The concept of patient empowerment involves patient’s education to have a better understanding of their condition to enhance self-confidence and determination to make their own decisions (Chen et.al 2016).
It is essential to understand and be aware that suffering may arise during Emma’s health care and therefore promoting resilience is a key to improve mental health and quality of life (Sadler et. al 2016). Resilience is the ability to adapt and cope with illness and other adversities in life i.e. stress, trauma and tragedy (The American Psychological Association cited in Southwick et. al 2014; Sadler et.al 2016). Stroke often cause severe and lasting disability that can lead to a loss of independence whether it be physical, emotional and cognition (National Stroke Association 2018). The development of resilience plays a vital role in promoting adjustment after stroke. Therefore, it is an important aspect to promote resilience in Emma’s recovery to improve health outcomes (Sadler et.al 2016).
In caring for Emma and her family, identifying their strengths and abilities to cope with stress and crisis is crucial to alleviate their pain and suffering. Working together with Emma and her family to identify and develop family strengths help family members to enhance family functioning and resilience. The strengths-based nursing care (SBNC) approach focuses on the inner and outer strengths of the patients and families to assist them to positively deal with issues and deficits by promoting empowerment, self-efficacy, and hope (Gottlieb 2014). In the SBNC approach, nurses assist families and influence their views and opinions instead of looking at what factors contribute to family problems (Sittner, Hudson & Defrain, 2007).
In identifying family strengths, it is ideal to implement various strategies that promote a holistic approach to all members of the family and these are the Australian Family Nursing Assessment Guide (AFSNA) and a common approach.
The AFSNA is one of the strategies that we can use to involve Emma and her family in relation to her care in identifying and developing their strengths to enhance family functioning and resilience (Patterson, cited in Smith & Ford 2013). The AFSNA is developed in a form of questions from the nine qualities of family strengths namely: togetherness, sharing activities, affection, support, communication, acceptance, commitment, resilience and spiritual wellbeing. The questions are formatted that suits to children, young people and families. This assessment tool can be used to initiate a conversation among all members of the family that needs support and encouragement including the patient in identifying their strengths to cope with life’s adversities. Recognizing family strengths strengthen family relationships and demonstrate a better understanding of the needs and hopes of the whole family (Smith & Ford 2013).
The Common Approach
The common approach is another strategy that we can use to engage Emma and her family in relation to her care. The focus of the common approach is prevention and it’s a flexible way of working with every individual involved to have quality conversations with patients and their families about all aspects of their wellbeing. There are six aspects of well-being in the common approach that includes a positive sense of culture and identity, material basics, healthy, loved and safe, participating and learning (ARACY 2018; ADSS 2018). It encourages to work in partnership with family members to focus on identifying their strengths by placing the patient at the center of the conversation and at the same time considering all aspects of family’s circumstances (ARACY 2018; ADSS 2018).
Focus on the Relationships
Establishing trust and good relationship with Emma and her family can lead to better health outcomes and improve health care services. A good relationship between patient, family and healthcare professionals allow everyone to connect and be comfortable to discuss issues and needs that will result in a better outcome for all who are involved in care. The study shows that having that bond and connection with the nurse, patient, and family reinforce positive views of their health status that influence patients’ health outcomes (Ong et.al 1995).
Forming a positive relationship with Emma and her family through therapeutic communication allows me to understand the situation, their needs, and concerns. It is important to place the patient’s interest at the centre in addressing the care and being straightforward and honest to all who are involved. By providing all the necessary information and assistance according to their needs to have a better understanding that benefits to the patient’s wellbeing and family (Kourkouta & Papathanasiou 2014).
Patient and family-centered care approach allows me to know what the family needs and preferences in terms of care by providing appropriate information and evidence to reach an agreement with the patient and family to deliver health care services effectively. The information should be tailored and meeting the needs of the patient and family including their healthcare rights and role to improve patient and family health literacy. The application of patient and family-centered care is based on sharing information, partnering, respect, and negotiation that can leads to better health outcomes (Kuo et.al 2012; Department of Health 2014).
Transition point: relearn to walk
It is essential to understand Emma and her family’s conditions, needs and concerns to integrate a care plan using the identified strengths to relearn to walk in collaboration with the multidisciplinary team to improve quality of life.
The Shared Wellbeing Assessment Tool Plan (SWAT)
The SWAT plan is designed by the Strong Families Safe Kids initiative in Tasmania for healthcare professionals as a tool to use in developing and understanding patient’s current situation, especially for young adults to identify their strengths and needs to provide an appropriate level of care based on the patient’s current conditions. The feature of SWAT plan is to identify the patient’s strengths and needs against the six domains of wellbeing (DoE DHHS 2018).
What’s going well?
Emma has a strong family support throughout her recovery process where her father gave up working as a medical professional, so he can attend to Emma’s care (Gee 2016). This features that Emma and her family value the importance of family relationship and support each other in times of difficulties which shows on the loved and a safe section on the wheel of wellbeing (ARACY 2018).
Emma is actively participating in her care despite her disability using the identified strengths in the participation section on the wheel of wellbeing (ARACY 2018).
What needs to improve?
Emma’s goal of care is to relearn to walk from a stroke. Regaining Emma’s ability to walk after a stroke is important and that greater improvement in walking is possible to facilitate independence. Walking is the effect of post stroke that can lead to a loss of independence though it will improve over time through rehabilitation (National Stroke Association 2018).
What are we going to do?
We are going to utilize Emma’s identified strengths in formulating her care plan to establish her goal of care to relearn to walk is vital. By involving the multidisciplinary team, Emma, and her family in relation to planning and setting goals to improve Emma’s ability to walk. Through family support and nursing interventions, it helps the patient to achieve goals that are set for them to function well in day to day living and to improve quality of life (O’Daniel & Rosenstein 2008).
It is evident that through the implementation of SBNC enhance Emma’s journey throughout her recovery and help the family to manage and cope with life events through empowerment, health promotion, and partnership in health care.
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