A patient from practice  who has an oesophageal stent fitted on endoscopy unit due to oesophageal cancer, briefly explain their journey up to the time you became involved in their care; include the care pathway the patient is being cared under e.g. Stroke pathway.

2.A)Critically discuss the nursing assessment used to plan your chosen patients care needs.  Consider the patients physical and mental health. From this nursing assessment choose one care plan/element of care. For example, eating and drinking.

B)Critically discuss the person-centred care delivered for this one element including reference to the appropriate risk assessments used e.g., MUST. You must refer to the relevant evidence base that supports the nursing care delivered.

C)Critically discuss which member/s of the MDT the patient was referred to, or were involved in their care, for the chosen care plan/element of care only e.g., dietician.

3.Interpret and evaluate the overall effectiveness of the nursing care given to the patient for the chosen element only. Discuss the discharge planning process in relation to the chosen element of care.

reference is NHS England,  NMC CODE 2018, NICE guidelines

ANSWER

Patient Journey and Care Pathway

The patient’s journey began with their diagnosis of oesophageal cancer, which led to the fitting of an oesophageal stent in the endoscopy unit. They were likely diagnosed through a combination of imaging studies, biopsies, and clinical assessments. The patient’s care pathway would fall under the “Cancer Care Pathway,” which involves multidisciplinary coordination and a personalized approach to cancer treatment and management. This pathway encompasses diagnosis, treatment options, supportive care, and rehabilitation.

Nursing Assessment and Care Plan

The nursing assessment for the patient would involve a comprehensive evaluation of both their physical and mental health. Physically, the assessment would focus on their general health status, vital signs, pain assessment, nutritional status, wound care (if any incisions were made during the stent placement), and monitoring for potential complications such as bleeding or infection. Mentally, the assessment would explore the patient’s emotional well-being, coping mechanisms, and any signs of anxiety or depression related to their cancer diagnosis and treatment.

For the chosen care plan element of “eating and drinking,” a person-centered approach is essential. This involves tailoring the care plan to the patient’s preferences, needs, and values. Risk assessments such as the Malnutrition Universal Screening Tool (MUST) would be used to assess the patient’s nutritional status and identify any risks of malnutrition. Evidence-based interventions would be implemented to ensure that the patient receives adequate nutrition and hydration. This may include collaborating with a dietitian to develop a personalized diet plan that meets the patient’s nutritional requirements.

Person-Centered Care and MDT Involvement

Person-centered care for eating and drinking involves creating an environment that supports the patient’s dietary preferences while addressing their nutritional needs. The care team would ensure that the patient’s dietary choices are respected and accommodated within the context of their medical condition. This may involve modifying the consistency of foods to suit the patient’s ability to swallow comfortably with the oesophageal stent in place.

The Multidisciplinary Team (MDT) involved in the patient’s care for the chosen care plan element of “eating and drinking” would likely include a dietitian, speech and language therapist, and potentially a gastroenterologist or oncologist. The dietitian would assess the patient’s nutritional needs, provide guidance on appropriate dietary modifications, and monitor their nutritional status. The speech and language therapist would assess the patient’s ability to swallow safely with the stent in place and recommend any necessary swallowing techniques or modifications.

Effectiveness of Nursing Care and Discharge Planning

The effectiveness of nursing care for the chosen element of “eating and drinking” can be evaluated by assessing the patient’s nutritional status, weight stability, hydration levels, and overall well-being. Regular monitoring and communication with the patient can provide insights into the success of the interventions implemented.

Discharge planning related to the chosen care plan element would involve providing the patient and their caregivers with clear instructions on dietary modifications, swallowing techniques, and strategies to ensure adequate nutrition and hydration at home. The patient would receive information on signs of complications and when to seek medical assistance. Collaborative communication between the patient, nursing staff, and the MDT is crucial to ensure a smooth transition from the hospital to home care.