I focus my essay on a patient who suffers from urine incontinence following a cerebrovascular accident/stroke. For the reason that, I am interest in the causes of urine incontinence post-stroke, and the impact that it has both physically and psychologically on suffers. I choose this particular patient after self-assess and reflect upon my Part one placement. Being involved in this individual patient care was one of the most rewarding experiences in my living, caring for others. The hardest being to confront the reality that, just like this patient, every year, over 130,000 people in England and Wales have a stroke (The Stroke Association 2006) and between 44 and 69% of people admitted to hospital after stroke are urine incontinent (Britain at al 1999 p509).
The Patient is a 76 years old male who has been given the pseudonym Mr Smith in order to maintain confidentiality in accordance with the Code of Professional Conduct, which stated that patients’ confidentiality should be maintained at all times (NMC 2004 p8).
Mr Smith has had a plaid medical history, experiencing good health until last year when he was admitted to hospital with a right cerebrovascular accident/stroke and left hemiplegia.
Mr Smith had a stroke defined by Tortora ; Derrickson (2006 p517) as a brain attack causing injury or death to parts of the brain due to an interruption in the blood supply. Because a stroke is a brain injury, the effects, or symptoms, will depend on the part of the brain that is affected (Michael 2006 p21). In Mr. Smith case in accordance with Thibodeau ; Patton (2002 p280) the right hemisphere of the brain controls the movement of the left side of the body. Therefore a stroke in the right hemisphere (right cerebrovascular accident) caused paralysis in the left side of Mr. Smith body (left hemiplegia).
The stroke left Mr Smith with impaired mobility and postural balance mechanism. Unable to use his left arm and hand, or to support himself when upright.
One week pos-event Mr Smith developed urinary incontinence duo to the cerebrovascular accident, as recorded in his care plan. Described by Olsen (2003 p37), Gross (2003 p6164) and Bean (2003 p176) Urine incontinence is frequent following stroke, most common caused by the effects of the stroke in a certain area of the brain where nerves leads to and from the bladder or due to decreased mental function, decreased functional status. Both factors seem to be what occurred with Mr. Smith, as he does not have any history of incontinence prior to the stroke.
During Mr Smith dwelling in hospital Mr Smith had several assessments and interventions without the expected outcome. Mr Smith has drastically reduced mobility, remained incontinent and wheelchair bound.
Mr Smith was discharged from hospital 14 weeks after his stroke to the nursing home. Mr Smith’s daughter and himself felt that it was safer for him to be in the nursing home which provides Mr Smith with twenty four hour care to meet his needs.
Urine incontinence after stroke is closely associated with poor outcome in terms of, morbidity, mobility, cognition and substantially increases the risk of admission to nursing homes in persons over 65 years of age (Gross 2003 p61).
Biographical and Social Aspects
Mr Smith just celebrated his 76th birthday; he’s a widow of his life-time beloved wife with whom he used to share the second-floor flat. Since his wife passed away, two years ago, He has been living independently and alone for the past 2years with snoops, his 11 year old dog. He has two grown-up children, both married with children, who live locally and occasionally used to visit and stay over in the guests room in the flat. Mr Smith used to work at the local butcher’s, and even being retired for 10 years, up to date, every time he used to go for his walks down to the town market he was still a very popular man; as his daughter describes.
Mr Smith had a warm welcome from staff into the nursing home; a few of the carers who live locally know him by name and his daughter who arrived with him in admission to the nursing home. Mr Smith realises that he had a stroke and the severe affects it had on him. Mr Smith realizes that the flat will not be suitable for his predicted mobility and incontinence problems. He is depressed and downhearted with the future. He cries easily. He starts to sob silently. He cries seemed to happen when his looking out of window and when he mentions his wife, his flat, his family, friends and snoops; that is now being looked after his daughter. According to Olsen (2003 p38) depression is twice as likely in stroke survivors who are incontinent compared with those who are not. Mr Smith feels most embarrassed about his incontinence.
Mr Smith seems to be bereaving the drastic changes in his personal life, health status, daily living, social role, family role and lost of independence.
Mr Smith room is decorated with memories; he has a photograph collection displayed in the wall of his family and life time friendships. Mr Smith also has his TV. and radio on the corner, that his daughter brought from his flat. As request from him to the nursing home, Mr Smith was allowed to bring this comfy arm chair from home, which he most appreciated. Mr Smith agreed to have bedrails for his own protection; however he always asks to cover them up as he feels embarrassed. Mr Smith used to sleep on a double bed prior admission to hospital and the nursing home.
In admission to long-term care, it is vital to make the patient as “at home” as possible, encouraging them to bring their personal belonging and decorate their individual bedrooms to their preferences (Lancaster 2006 p36).
Mr Smith is gradually adapting himself to the health and safety requirements, to meet his needs and preferences. The cord bell to call for assistant is still no his favourite thing to date. According to Castledine (2006 p715) good environment that provides safety, dignity and discusses the assessments with the patient to write and implement his individual care plans, provides reassurance to the patient and improves patient sense of security and motivates recovery and well being.
Mr Smith has reduced his anxiety regarding his physiotherapy, and he now accepted that recovery is a slower process than what he would expect. But has he says “persistence will get him moving”. In stroke patients, within the first six months, Anxiety and low-self-esteem are secondary factors in the development of depression (Yozbatiran et al 2006 p505).
Mr Smith daughters normally visit twice a week and the occasionally Saturday with the grandchildren. This gives Mr Smith great joy and great sadness when they live. One of Mr Smith daughter’s been enquiring about starting to organize a day in the month where she will take her dad out for a family roast dinner with all the trimmings at her house. However his daughter says she is not ready yet, because she is still daunted and scared about what happen. How sudden her dad health deteriorated. Also, how would she move and handling him, or if something happens, and how would her dad feel if she would have to assist him with toileting. His daughter intention is noble but her anxiety and frustration is common, a stroke is a crisis for the family the onset is sudden and multiple aspects makes close family member and stroke survivors disheartened (king ; Semik 2006 p41-42).
This assignment skilled me to have in my mind at all times that for me to understand each patient, in health and in disease, I must understand the biological – psychological and social aspects of each patient to understand how to promote health and high quality care (Candib 2005 p385).