A1: Patient History Summary
The patients name is Jane Vuong, who is a 24 year old single Vietnamese women. She has been living in the United States for two years on an academic visa, and studies cellular biology at the local university. She spends most of her day studying to maintain her strait “A” average. Jane works part time at the university’s molecular biology research lab. She rides her bike sometimes to get around, and loves to do martial arts. Due to her Vietnamese background she has a very particular diet that consists of cooking vegetables, chicken, rice, and noodles; with fish sauce, soy sauce, sour lemons, bean sprouts, and scallions. Jane is also a practicing Mahayana Buddhist. Besides studying and working out, Jane likes to socialize at the college bar and meet boys, but is not interested in any type of longer term relationships. Jane is a smoker and has contracted Hepatitis B. A2: Erikson’s Theory of Development
When you look at Jane’s history and behavior related to Erik Erikson’s theory of growth and development, you can clearly see a relationship between the two. Jane’s inability to commit in a relationship shows that she has not mastered the sixth stage of Erikson’s developmental theory which is “Intimacy vs. Isolation”. This stage occurs during young adulthood, and according to Potter (2013),” if not mastered could develop into isolation due to fear of rejection and disappointment” (p. 133). The mastery of the previous stages have allowed Jane to trust herself and others, as well as build a good foundation for making decisions for herself and identifying priorities. The fact that Jane spends countless hours per day studying shows that stage 4 (Industry vs. Inferiority) was a successful stage of development for her.
A2: Freud’s Theory of Development
Sigmund Freud believed that the id, ego, and superego are the components of human personality development. These components develop through 5 different stages and guide our behaviors. (Potter, 2013, p. 132). Based on Jane’s history and behaviors you can see that the id portion of her personality; which is developed during infancy, is controlling her impulses. You can see based on some of her attributes that her ego and super ego are guiding her in certain aspects of life, such as religion, school, work, and exercise. Unfortunately, her impulsive (id) nature has allowed her to make some poor decisions such as smoking, and random unprotected sexual encounters with boys she meets in bars.
Freud’s 5th and final stage of development is called “Genital”, and occurs from puberty and continues during adulthood (Potter, 2013, p. 132). This is where Jane’s developmental stage falls in Freud’s theory. Freud believed that this stage of development is key to obtaining a mature adult sexual relationship (Potter, (2013), p. 132). Jane’s sexual history indicates that she may have some unresolved issues from her youth that are preventing her from developing this area. A2: Maslow’s Needs Theory
Maslow’s theory is based on the hierarchy of human needs. There are five levels to Maslow’s theory which are: physiological needs (water, food, air), safety and security needs (physical, psychological), love and belonging needs (friendships, socializing, sex), esteem and self-esteem needs (self-assurance, value, accomplishments, confidence), and self-actualization needs (achieving full potential, problem solving capability, managing life situations). When you look at these needs from a nursing standpoint; you have a great tool on how to prioritize nursing care. (Potter, 2013, p. 44).
The first problem I would handle based on the hierarchy of importance would be her physiological need for oxygen. When looking at Jane’s history and behavior and relating it to this theory I can see that Jane may have a problem with self actualization. She has so much on her plate that she has a hard time coping with life situations. So she takes up smoking and avoids relationships to keep things as simple as possible. A3: Plan of Care Related to Developmental Theories
Jane’s plan of care needs to be formulated around what she needs. In comparing her history and behaviors to the developmental theories above, we can determine that based on Erikson’s developmental theory, Jane is in the stage of intimacy vs. Isolation. This stage begins in young adulthood until the beginning of middle age. Nurses need to show people in this age group support if family is not available. This is due to their intimacy needs increasing due to hospitalization (Potter, 2013, p. 133). Jane is also an efficient learner, which can be determined bases on her education level, major, and grades. Stage four of Erikson’s theory shows that Jane’s development in industry vs. inferiority was very successful.
In comparison to the plan of care required when evaluating Freud’s theory you have to look at Jane’s sexual history. She can be impulsive and do things without thinking of the consequence. Jane appears to have some unsettled issues that have emerged from adolescences, which could explain the reason she is incapable of making wise decisions about sexual relationships. If Jane is acting out with her id personality; according to Potter (2013), she is acting out with the most primitive parts of her personality that are developed as an infant (p. 132). This would affect Jane’s decision making and learning capability. In this case I would need to assess her drive to learn and follow instructions. If unsuccessful I would have to see if she may have family that can help her if needed.
In assessing Jane’s plan of care in regards to her human needs; Maslow’s theory is very relevant. She is going to have certain needs that have to be met in her plan of care such as her need for oxygen, nutritional needs, and even spiritual needs. Jane’s need for oxygen is the most important need to be cared for from a medical perspective. After insuring Jane’s physiological needs have been met, the nurse can cater to her personal needs. By meeting her most important needs she will feel safe and secure which is of great importance in the hierarchy of human needs (Potter, 2013, p.44). This will also help build a good relationship between you and the patient. A4: Adapting to Cultural Needs
Given Jane’s Vietnamese background and the short time she has lived in the United Sates, cultural competence is something the nurse must consider in this situation. A good example is Jane’s diet. She states that she only eats a traditional Vietnamese diet. This is something that I as the nurse would cater to by first evaluating what is involved in a Vietnamese diet and obtaining it for her. By adapting to Jane’s dietary needs I would be respecting her lifestyle and culture, in turn gaining her trust. Another very important thing that must be addressed is if the patient uses cultural healing methods that could impact her plan of care or her willingness to accept various medical treatment. I would begin by telling Jane everything that would be involved in her treatment step by step.
This will help Jane identify anything she is not comfortable with, or if any treatments are contradictory to any of her beliefs. Jane’s is a practicing Mahayana Buddhist as well. I as the nurse would adapt Jane’s care to meet this need by listening to her religious needs and catering to those needs. Jane states that she meditates every morning in the temple, which brings her blessings and keeps her healthy. I would have to work my plan of care around her meditation schedule out of respect for her beliefs. Based on why Jane meditates every morning, catering to this need would only increase her respect for me as her nurse, and would also make her feel good every morning. A5: The Nursing Process and Planning Care
One process ties all of nursing together as a whole, it’s called the nursing process. Nurses use it to assist in delivering patient centered care. In Jane’s case the nursing process is very important because of her background, lifestyle, education, age, etc. The nursing process consists of five steps: Assessment, Nursing Diagnosis, Outcomes/Planning, Implementation, and Evaluation. This process helps the nurse in planning Jane’s care by systematically determining her individual needs. Because of the utilization of the nursing process, the nurse is able to collect subjective and objective data that led her to the nursing diagnosis of impaired gas exchange.
The nursing diagnosis is the foundation for the nursing care plan. (American Nurses Association, n.d.). Given the diagnosis of impaired gas exchange and the information ascertained from Jane, the nurse can formulate a plan of care that is relevant to Jane’s needs. Based on Maslow’s theory of patient needs, Jane’s primary health concerns are her inability to speak, wheezing, and dusky lips that indicate her need for osxygen. Initial plan of care would be to administer supplemental oxygen, then using the nursing process; evaluate the patients response to the therapy.
Potter, P. (2013). Fundamentals of nursing. (8th ed.). St. Louis, Missouri: Elsevier Mosby. Retrieved from https://online.vitalsource.com/ American Nurses Association. (n.d.). The nursing process. Retrieved from http://www.nursingworld.org/EspeciallyForYou/What-is-Nursing/Tools-You-Need/Thenursingprocess.html