INTRODUCTION:The Client’s name is Florence Welch, she is 80 years old and she is suffering from Urinary Incontinence. Florence is a residence in the TLC Nursing Home in Maynooth. The HCA has established at the evaluation stage that the Client has a Stress and mixed Incontinence and it is recommended for her to strengthen her pelvic floor muscles through exercises.Here is a more detailed look into what Incontinence is. Types of Incontinence:Stress Incontinence occurs when too much pressure is put on the bladder by heavy lifting, through coughing/sneezing, laughing or exercise.Urgency Incontinence is when a person needs to urinate urgently and is experiencing involuntary loss of their bladder, could be due to infection or diabetes.Overactive Bladder (OAB) is a combination of stress and urgency incontinence and is and when the bladder is never completely empty, when the person experiences constant dribbling.Mixed Incontinence is when the person encounters more than one type of Incontinence.Statistics reveal that 36 per 10,000 of the population per annum consult their GP for incontinence. This is often distressing for the individual and represents a major public health problem that may increase over time.Urinary Incontinence means any involuntary leakage of urine. Incontinence can occur in men or women of any age, but a person who is elderly, disabled or has a chronic health problem is at higher risk.Urinary Incontinence is the sudden urge to urinate and the person is unable to control his/her bladder.It is often an embarrassing problem which can affect the person’s daily activities. Urinary incontinence can vary from sneezing/coughing to not being able to go to the toilet on time, which can very often be reversed. Many serious problems can be caused due to incontinence like skin rashes, pressure sores/ulcers, falls, isolation and discomfort.CLIENTS NEEDS:Physical needs:Physical needs is when a person can no longer perform tasks for themselves, like bathing, eating, swallowing, toileting. Is she able to dress herself, pick out clothes ?Can she get herself in and out of bed and into a seated position without assistance?Can she feed herself ?Does she drink enough water?Is she still able to groom herself, use the bathroom, toilet and oral care?The Client is still able to dress and feed herself. She does not need any assistance with bathing, but needs assistance to get in and out of bed and into a seated position.Emotional needs:Emotional needs are when a person is moving from their home into a care setting, when they have experienced a bereavement, someone who is ill, elderly, dependant or a major life change has happened where their normal routine has stopped. When such a change occurs elderly can feel, unwanted, isolated, depressed.Does she have difficulty in sleeping?Does she have lack of appetite?Are Family members/ Friends visiting her?What are/were her hobbies ?Family members visit the Client every 2 weeks and she enjoys crossword puzzles, board games and painting. She has normal appetite and has no problem sleeping.Social needs:Social needs are very important to patients to feel and stay connected and being a member of a community.The client should be encouraged to participate in social events/gatherings.Does she participate in social outings?Is she being visited by family and friends?Does she attend the social area/ TV room?When Florence arrived she was shown around and introduced to fellow residents and has since made good friends. She loves social outings and attends regularly the social area etc. and family members and friends visit her regularly.Rehabilitation and Recreational Needs:Rehabilitation needs is to restore some of the physical, sensory and mental capabilities lost due to illness, disease or injury. Recreational needs is important in defining a person’s purpose for life.Is she experiencing sensory loss?Does she have problems speaking/ expressing herself?Does she participate in any recreational activities?Is she exercising her pelvic floor muscles?The client is experiencing no sensory loss and can express herself clearly with words. She is participating in the Relaxation program that is being offered such as seated tai-chi and music therapy and is doing her pelvic floor exercises.Intellectual needs:An elderly person still has intellectual needs to learn,to grow, for communication and companionship. As with physical development, the aging process also bring with it a decline in intellectual/cognitive skills. Process of information becomes slower and the person may be less efficient in their problem solving skills.Is she being stimulated through mental activities?Is she reading newspaper or other material?Through talking to the client one can access that she has a very good memory and is understanding all aspects of her care plan and treatments. She enjoys crossword puzzles and likes reading books which stimulate her mentally.Spiritual needs:Are where a person  makes sense about life, death, illness and comes to accept oneself the way we are. It enables us to be ourselves, to be unique and parts of life that are about our beliefs, relationships, values, dignity, attitude and more.Where we can choose different lifestyles and realise our potential.Through communicating,active listening and getting to know my Patient , we established that she would like to attend mass/ service.LEVEL OF ASSISTANCE REQUIRED:Assisting the patient in the use of the bedpan can minimize embarrassment and prevent unpleasant messes. The Healthcare assistant should wash their hands to prevent the spread of germs.  Greet the patient, explain and ask for their consent in helping the client to use the bedpan. The HCA should ensure that the patient has adequate privacy by drawing the curtains or closing the door and should proceed by putting on a pair of gloves.  The whole procedure should be communicated efficiently to the patient, that the patient knows at all times what is happening to avoid feelings of  fear/ embarrassment/ confusion and it puts the patient at ease. The patient should also be encouraged to participate inasmuch as she/he can to support their independence.Giving the bedpan as outlined in Care Skills, Level 5, Unit 3 Assisting Skills, Page 43:Bring the covered bedpan, the pad for bed protection, the toilet paper to the patient’s room.Place the pad under the patient’s hips.Fold back the covers at the side to prevent soiling.Place the bedpan on the bed beside the patient;grasp by the side or closed end and have to open end toward the foot of the bed.Place one hand under the small of the patient’s back and on signal help the patient lift his hips;with the other hand, slip the pan under the patient’s hips and adjust for comfort.The patient may with to be helped to a sitting position, if the doctor permits. Unless there is a need to remain with the patient, place the toilet paper and call bell handy and leave the room. Cleanse the patient after use of the pan; the patient does this if he/she is able.To avoid spreading the soiled area to the openings of bladder and vagina, wipe downward toward the spine.Remove the pan in the same manner as placed.Observe the skin for redness or soreness. Keep the skin dry.Ensure the patient is comfortable and provide hand hygiene.Observe the contents of the pan and note on the daily record. If unusual, save for the Nurse to see.Clean bedpan in sluice if not being saved and place in bedpan washer as per policy.Overseas infection control precautions throughout task, ie hand hygiene and PPE.ROLE OF THE HEALTHCARE ASSISTANT:Clients privacy and dignity:As stated in the Care skills,( Understanding Client Care, Level 5, Page 36) It is the responsibility of the care assistant to ensure that the patient’s privacy is maintained. This is achieved by ensuring confidentiality, by attending the patient/service user during medical procedures and personal care needs in a way that protects their privacy.Treating people with dignity and respect involves:Respecting their rightsAllowing them freedom of choiceListening and taking into consideration what they sayRespecting their wishes and decisions, even if one disagrees.Involving them in the decision making processTreating them as an adult, not a child.Respecting their individuality.Independence/Autonomy:We as Healthcare Assistants should encourage clients to be as independent as they can and only offer assistance when asked. The Client should also be involved in the decision making process about their treatments and care.Self-esteem:A person’s self-esteem is greatly affected if they no longer can perform daily tasks independently and need assistance in maintaining their care. The Healthcare Assistant can help a Client’s self-esteem by:Helping the patient to groom herself/himself (to support their independence).Encouraging patients to choose the clothes they want to wear and that they are wearing their own clothes (to support their self-worth).Providing privacy when is necessary (when the patient’s body might be exposed).Clients safety:The Health, Safety and Welfare Act 2005, clearly states the responsibilities of the employer and employee in the work setting. It is imperative that everybody works toward an accident free workplace. The majority of accidents is due to a person slipping and falling and handling/lifting accidents. A Healthcare Assistant can promote a client’s safety through :Using safe, up to date equipment.Always wearing protective clothing and using proper equipment.Following procedures and guidelines at all times.Report to supervisor if something is faulty or poor practice is being used that may harm or endanger clients/staff etc.To attend training programmes.Confidentiality:A client’s records/information should always be taken seriously, with the greatest privilege and confidentiality.The Healthcare assistant must always handle the patients records, care plan, personal information such as family, home etc., with the utmost confidentiality.EVALUATION:The Healthcare Assistants and clients goal was to improve stress and mixed urinary incontinence with pelvic floor exercises and after the six weeks evaluation process there has been a vast improvement. The Client has now more control over the Incontinence especially when coughing, sneezing etc. and will continue with the pelvic floor exercises.The Healthcare Assistant will start a new evaluation process as new problems may arise and will put a new or revised care plan into action. References(Care Skills, Understanding Client Care, Page 41)Care Skills, Level 5, Unit 3 Assisting Skills, Page 43Care Skills, Understanding the Client, Level 5, Page 36Health and Safety Act,2005


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