1

A case study related to the achievement of proficiencies

Student’s name

Institution

Date
 2

A Case Study Related To Achievement Of Proficiencies

Every healthcare provider must have a holistic approach to patient care. This includes an emo-
tional, psychological, spiritual, and social policy to care. As a healthcare provider, when giving
care to a patient in a hospital, it is essential to maintain the patient's personal data and informa-
tion confidential (NMC, 2018). Under legal and ethical principles, caregiving should be tailored
towards the client's illness, age, other comorbidities, and their family's well-being. It should hap-
pen within a treatment process with complete confidentiality (NMC, 2018). This essay is a case
study to show nursing care proficiencies such as promoting health, preventing ill health, assess-
ing needs, and planning care as a critical part of patient care that directly affects health outcomes
and well-being. This is a single-intervention nursing care case study. We will name our patient
Mr. A.R. (NMC, 2018) for privacy reasons.
This patient is a 65-year-old man who used a wheelchair at his admission to the ward,
and his main complaints were a painful leg wound, blurry vision, tiredness, and excessive sweat-
ing. At first glance, it looks like the patient is overweight, with his face red and swollen. This pa-
tient was diagnosed with type 2 diabetes when he was 35. AR has been hospitalized several
times because of complications from this chronic disease and an open wound on the left leg,
which was amputated below the knee about three years ago. The patient's wife explains that he
sometimes refuses to take his medications, which explains this crisis. The couple has two chil-
dren who are both married, and they are supportive of their parents. The patient has been a
known alcoholic for over 20 years. The patient states he does not take regular treatment because
he has lost hope of getting well. Living with an open wound for a long time without improve-
ment has affected his psychological perception. The relatives are asked about medication adher-
ence, and they confirm non-adherence.
AR is provided with a bed in a bay where an initial assessment is done, and his vital signs
are taken and documented. He has a NEWS2 score of 5 with a blood pressure of 137/84 mmHg,
a temperature of 38.5 degrees Celsius, a respiratory rate of 24, oxygen saturation of 95%, and a
pulse is 105 beats per minute. His blood sugar level is 16.6 mmol/L, which is high (NEWS, May
2018). He weighs 121 kg with a BMI of 29, indicating he is overweight and needs assistance for
personal care (MYEPAD, page 172, art. 7). During physical assessment in the ward, pressure
points and skin surfaces are checked for bed sores.
The patient is oriented to time, place, and person and has a good memory, speech, and in-
telligence. His sensory and motor responses are intact. All cranial nerves are intact (MYEPAD,
page 173, art. 8 & 9). Assessment tools used are the Glasgow coma scale, Waterlow scale,
CAGE (Cut down, Annoyed, Guilty, and Early morning drink eye-opener) questionnaire, and
CIWA (Clinical Institute Withdrawal Assessment for Alcohol) Assessment for alcohol use dis-
order. After thorough history taking and examination, the student nurse notes down and immedi-
ately informs the registered nurse, increasing the frequency of vital sign checks to at least once
per hour.
AR has hyperglycemia of 14.7mmol, an infected wound, and an unstable temperature and
pulse. The nursing care plan was planned after the doctor was informed that a senior consultant
should review this patient. This patient's psychological balance is also altered. After AR has been
advised of all the next steps in his nursing care, the nurse asks the patient for consent to with-
draw blood samples for laboratory checks (NMC, 2018). The nurse administers insulin injections
to the patient per the doctor's instructions to help lower his blood glucose levels (Sarathi, S &
Deepa, M, 2021). Before administering these two types of insulin to the patient, another nurse is
 3

asked to check them as a witness as per standard procedure (NMC, 2018). There are checks for
the type of insulin prescribed, the quantity, the route of administration, and the viability date of
the medication. One litre of saline solution was administered intravenously as maintenance fluid
(Sarathi, S & Deepa, M, 2021). The patient's wound is dressed, observing sterile measures to
prevent infections and promote healing (The University of Nottingham, 2019-page 11; art. 19).
Analgesics for pain and antibiotics for infection are administered according to the doctor's notes
in the patient's medical notes. The psychologist, the surgeon, the physiotherapist, and the nutri-
tionist are called upon to review the patient and provide advice on care (MYEPAD, page 178,
part 3, no. 4).
Diabetic patients must watch their diet, take their medications as prescribed, and go to
their appointments with the doctor. The wife explained that the patient no longer cared about his
health and refused to take drugs and food as advised. This led to the worsening of his symptoms.
The patient explains that he has not followed instructions because he has lost hope creating an
ethical dilemma as the patient was firm in his decisions. A nurse must allow autonomy while en-
suring holistic care (NMC, 2018). Lack of medication adherence, failure to attend appointments,
failure to cease alcohol intake, and not following the recommended diet might have led AR to
complications before he was admitted to the hospital (National Frameworks for Diabetes: Stand-
ards).
In a hospital, there are many ethical problems, and the most important thing to do is
teach the patient (MYEPAD, page 171, art. 1). The nurse is responsible for educating the patient
about his condition, symptoms, appropriate management, complications, and the consequences
of ignoring instructions (NMC, 2018). This helps the patient change his psychological perception
by understanding the importance of his health and adhering to the drug prescription and restric-
ted diet (Kumar et al., 2022). Physiotherapists also advise the patient to perform regular daily ex-
ercises to help reduce his weight. Being overweight and obese are two risk factors for developing
diabetes mellitus (Molina-Mula, J et al., 2020).
The patient followed the care plan. Giving care was straightforward and did not cause any prob-
lems. Involving the patient and their family in care and planning makes it easier for them to work
together to care for the patient (MYEPAD, page 171, art. 4, 5, 6). The patient required medica-
tions which included analgesics, antidiabetics, and antibiotics. After psychological counseling,
the patient complied with the care plan and cooperated with the healthcare team.
The student nurse showed professionalism and respect for the law by learning from their work
experience and following the policies and ethical standards of nursing practice. AR and his fam-
ily were informed about and involved in his care plan. The patient's condition improved com-
pared to when he first came to the hospital's AMU ward (Haghravan S et al., 2021). This was be-
cause the patient was involved in decision-making, the multidisciplinary team was consulted, the
ethical dilemma was solved, a healthy relationship was built, and confidentiality was ensured.
This was an excellent opportunity to understand and learn from an evidence-based situation
about promoting health, preventing ill health, assessing needs, and planning the care of patients.
 
 4

References
Haghravan, S., Mohammadi-Nasrabadi, F., & Rafraf, M. (2021). A critical review of national
diabetes prevention and control programs in 12 countries in the Middle East. Diabetes &
Metabolic Syndrome: Clinical Research & Reviews, 15(1), 439-445.
https://www.sciencedirect.com/science/article/pii/S1871402121000254

Anker, J. J., & Kushner, M. G. (2019). Co-occurring alcohol use disorder and anxiety: bridging
psychiatric, psychological, and neurobiological perspectives. Alcohol research: current re
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927748/

Bodien, Y. G., Barra, A., Temkin, N. R., Barber, J., Foreman, B., Vassar, M., ... & TRACK-TBI
Investigators. (2021). Diagnosing level of consciousness: the limits of the Glasgow coma
scale total score. Journal of neurotrauma, 38(23), 3295–3305.
https://www.liebertpub.com/doi/abs/10.1089/neu.2021.0199

The University of Nottingham.

 https://www.nottingham.ac.uk/healthsciences/documents/practice-nursing/mentor
resources/achievement-of-proficiencies-adult-mapping-version-field-specific-examples
mapping.pdf 2019 (page 11, art 19)

Curran, K., Piyasena, P., Congdon, N., Duke, L., Malanda, B., & Peto, T. (2023). Inclusion of
diabetic retinopathy screening strategies in national-level diabetes care planning in low-and
middle-income countries: a scoping review. Health Research Policy and Systems, 21(1), 1-11.
https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-022-00940-0

Kumar, R., Rehman, S., Baloch, G. M., Vankwani, M., Somrongthong, R., & Pongpanich, S.
(2022). Effectiveness of health education intervention on diabetes mellitus among the teachers
working in public sector schools of Pakistan. BMC Endocrine Disorders, 22(1).
https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-022-01110-7

Molina-Mula, J., & Gallo-Estrada, J. (2020). Impact of Nurse-Patient Relationship on Quality of

Care and Patient Autonomy in Decision-Making. International Journal of Environmental
Research and Public Health, 17(3), 835.
https://www.mdpi.com/628098
 5

Nursing & Midwifery Council. (2018). The Code: Professional Standards of Practice and
Behaviour for Nurses, Midwives, and Nursing Associates. NMC; Nursing and Midwifery
https://www.nmc.org.uk/

Clemett, V. J., & Raleigh, M. (2021). The validity and reliability of clinical judgment and
decision-making skills assessment in nursing: a systematic literature review. Nurse Education
Today, p. 102, 104885.
https://www.sciencedirect.com/science/article/pii/S0260691721001428

Sarathi, S., & Deepa, M. (2021). Legal and Ethical Issues–Code of Ethics and Standards of
Midwifery Practice. NVEO-NATURAL VOLATILES & ESSENTIAL OILS Journal| NVEO, pp.
5771–5778.
http://www.nveo.org/index.php/journal/article/view/1240