NU416M6 Using Evidence to Maximize Wellness Essay

NU416M6 Using Evidence to Maximize Wellness Essay

Assemble Evidence based nursing interventions that maximize wellness for complex patients with chronic comorbid conditions and is consistent with chronic care delivery model.


This paper explores chronic comorbid conditions through the case study of Mr. Bale, an 85-year-old patient with Chronic Obstructive Pulmonary Disorder (COPD), hearing loss and Congestive Heart Failure (CHF). He is currently on Western healthcare and also uses the cultural remedies for his condition. He is secretly smoking even after being advised to stop since he was oxygen dependent. NU416M6 Using Evidence to Maximize Wellness Essay He and his wife live at the home of their eldest son independently with their daughter-in-law, two grandchildren and their other two children live nearby. He is a Mexican immigrant in the US with 15-year old citizenship. His understanding of English is limited but the family translates for him.


Impacts of the three comorbid conditions

Mr. Bale has hearing, respiratory and heart problems. He also has an addiction to smoking which further complicates his situation. The health safety problems include the lack of adherence to treatment. For instance, the patient is on oxygen therapy and continues to smoke even after signing that he would stop. Exposure to tobacco smoke is a significant risk factor associated with COPD.  The age of the patient is also a risk factor to hearing, COPD and CHF disorders (Rutten et al., 2006).

Risk factors increase the chances of occurrence of other diseases and also death. Cigarette smoking can cause lung cancer, trigger heart diseases and as well worsen the comorbidity of these diseases resulting in death. It can also cause respiratory infections to the family NU416M6 Using Evidence to Maximize Wellness Essay. The age of the patient is also a risk that influences the development of these diseases. As the age increases, so does the likelihood of acquiring more comorbidities and succumbing to them.  The risk factors worsen the effects of comorbid conditions and could result to heart attacks and death due to breathing problems of the client.

The chronic care model can assist in Mr. Bale’s care since it promotes the delivery of care through evidence-based frameworks that support disease management that is customized to particular patients.  For instance, it promotes cultural sensitivity in health systems to promote safety and quality. In this case, this will help the practitioner in understanding the cultural remedies used by Mr. Bale to supplement the medical treatment provided. On the other hand, it supports informed decision making and thus will help the nurse in engaging the patient and the family in making appropriate courses of action for the chronic disorders treatment. NU416M6 Using Evidence to Maximize Wellness Essay.

If I were the home health nurse, I would engage the patient and the family in decision making after advising them concerning the medical conditions. I would then employ the evidence-based interventions to address the issues. One of the interventions I would utilize is medications. I would provide drugs that manage COPD and CHF as well as hearing aids to improve Mr. Bale’s hearing capabilities. Another intervention would be the use of cognitive behavioral therapy to modify the harmful smoking behavior of the patient that puts him at an increased risk of worsening the symptoms NU416M6 Using Evidence to Maximize Wellness Essay.

Notably, communication is significant particularly with the cultural diversity depicted in this case. As such, I would create a rapport with the patient and the family through interactive conversations that will help in building trust and encourage openness. Another strategy will be listening and being empathetic to the patient. This will be supported by the development of a personalized approach depending on his prevailing circumstances. I will also use simple and easily understandable terms considering that the patient does not understand much of the English language. In order to make the communication more effective I will use non-verbal cues such as gestures and body language and also be on the lookout for the patients reactions.

Ethical situations

Mr. Bale’s case presents an ethical dilemma involving his adherence to treatment terms.  Despite agreeing to stop smoking, he still continues to smoke in the house which affects the oxygen therapy. The ethical principle of beneficence demands that the patient is given treatment that benefits his health (Rainer, Schneider & Lorenz, 2018). In this case, prohibition of smoking is important in ensuring the effective management of the patient. NU416M6 Using Evidence to Maximize Wellness Essay. However, lack of adherence undermines the ethics of treatment and the practitioner restriction could undermine the patient’s autonomy.

The possible solution for this ethical dilemma could be the involvement of the family in counselling in order to advice on the right approaches towards effective management of the patients comorbidity. This will engage social support in the treatment and help refrain Mr. Bale from accessing cigarettes. Another solution would be to enforce compliance to medication through evidence based cognitive behavioral therapy for drug addiction.  This is the most appropriate course of action because; it will seek to modify the client’s behavior in a manner that will help stop smoking. This approach has been employed in addiction programs successfully due to its flexibility as an adaptable treatment tool (Hillas, Perlikos, Tsiligianni & Tzanakis, 2015). Individual counselling therapies will help address the underlying issues causing tobacco abuse and group therapies will help him engage in activities with fellow addicted patients NU416M6 Using Evidence to Maximize Wellness Essay.


Hillas, G., Perlikos, F., Tsiligianni, I., & Tzanakis, N. (2015). Managing comorbidities in COPD. International journal of chronic obstructive pulmonary disease10, 95.

Rainer, J., Schneider, J. K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of clinical nursing, 27(19-20), 3446-3461.

Rutten, F. H., Cramer, M. J. M., Lammers, J. W. J., Grobbee, D. E., & Hoes, A. W. (2006). Heart failure and chronic obstructive pulmonary disease: an ignored combination?. European journal of heart failure8(7), 706-711. NU416M6 Using Evidence to Maximize Wellness Essay.