Caring Science in Phc: A Guide for Nurses in Primary Health Care Clinics

By Mogalagadi Makua and Thuledi Makua

This Caring Science in PHC, a guide for nurses in Primary Health Care, intends to lead the lecturers facilitating the Clinical assessment, diagnosis, treatment and diagnosis(Primary Health Care) and the basic Community Nursing Sciences students on the assessment of the client in the Primary Health Care (PHC) clinics in both rural and urban countries. The book teaches the integration of the caritas processes in the physical assessment. Lecturers and students in other countries that have PHC as a qualification will also benefit from this book. This book is based on the clinic practice setting as well as the needs and the expectations of the patients.

• Language: English
• Publisher: Xlibris UK
• Release date: Jun 20, 2013
• ISBN: 9781483645568

Book preview

307098-MAKU-PBint-LSI.pdf

Copyright © 2013 by Thuledi Makua and Mogalagadi Makua 307098-MAKU

ISBN:   Softcover   978-1-4836-4555-1

            Ebook      978-1-4836-4556-8

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

Rev. date: 06/17/2013

To order additional copies of this book, contact:

Xlibris Corporation

0-800-644-6988

www.xlibrispublishing.co.uk

[e-mail]

TABLES OF CONTENTS

DEDICATION

ABOUT THE AUTHORS

PREFACE

ORGANISATION OF THIS BOOK

THE IMPORTANCE OF THIS BOOK

PART ONE

CHAPTER ONE: PRIMARY HEALTH CARE CARING PHILOSOPHY

1.1 Introduction

1. 2 Caritas processes

1.2.1 Practising loving-kindness and equanimity for self and others

1.2.2 Being authentically present; enabling/sustaining/honouring deep belief system and subjective world of self

1.2.3 Cultivating one’s own spiritual practices; deepening self-awareness; going beyond the ego self

1.2.4 Developing and sustaining a helping-trusting caring relationship

1.2.5 Being present to, and supportive of, the expression of positive and negative feelings as a connection with deeper spirit of self and the one-being cared for.

1.2.6 Creative use of self and all ways of knowing/being/doing as part of the caritas processes

1.2.7 Engaging in genuine teaching-learning experience within the context of caring relationship; attend to the whole person and subjective meaning

1.2.8 Creating healing environments at all levels; physical and non-physical

1.2.9 Reverentially and respectfully assisting with basic needs

1.2.10 Opening and attending to spiritual, mysterious, unknown existential dimensions of life-death suffering.

1.3. Establishing a relationship in a working environment

1.4 Caring Practices in PHC

1.5 Consequences of caring and non-caring for you, your colleagues, and the patients

CHAPTER TWO: HISTORY TAKING

2.1 Introduction

2.2 Setting the stage

2.3 History of present complaint

2.4 Medical history

2.5 Surgical history

2.6 Obstetric and gynaecological history

2.6.1 Past obstetric history

2.6.2 Menstrual history

2.7 Male reproductive history

2.9 Occupational history

2.10 Family and social history

2.11 Nutritional history

2.13 Systemic history taking

2.13.1 Ear, nose, mouth and throat

2.13.2 Eye

2.13.3 Thyroid

2.13.4 Cardiovascular

2.13.5 Lungs (respiratory)

2.13.6 Breast

2.13.7 Abdomen

2.13.8 Genitourinary

2.13.9 Musculoskeletal

2.13.10 Backache

2.13.11 Knees

2.13.12 Central nervous system

PART TWO

CHAPTER THREE: VITAL SIGNS

3.1 Introduction

3.2 The primary four vital signs

Equipment Needed

3.2.1 Measuring of body temperature

3.2.2 Blood pressure

3.2.3 Respiration

3.2.4 Pulse

3.3 Secondary four vital signs

3.3.1 Body Mass and Height

3.3.2 Pain Assessment (PA)

3.3.3 Urinalysis

3.3.4 Haemoglucotest

3.4 Conditional screening tests

3.4.1 Human Immune-deficiency Virus Rapid Test

3.4.2 Malaria Rapid Diagnostic Test (MRDT)

3.4.3 Electrocardiogram (ECG)

3.4.4 Pregnancy Rapid Test

3.4.5 Rapid Plasma Reagin Test

3.4.6 Rhesus Factor

3.4.7 Haemoglobin test

PART THREE

CHAPTER FOUR: PHYSICAL ASSESSMENT

4.1 Introduction

4.2 JACCOL

4.2.1 Differential diagnosis

4.2.2 Skin Conditions

4.2.3 Skin tests

4.2.4 Hair tests

CHAPTER FIVE: THE HEAD

5.1 Introduction

5.2 The head

5.2.1 Differential diagnosis

5.3 ENT

5.3.1 Introduction

5.3.2 The Ear

5.3.3 The Nose

5.3.4 Mouth and Throat

5.3.5 The eye

CHAPTER SIX: THE THYROID (NECK

6.1 Introduction

6.2 Thyroid (neck)

6.2.1 Differential diagnosis

6.3 Neck conditions

6.4 Assessment of the neck

CHAPTER SEVEN: CARDIOVASCULAR

7.1 Introduction

7.2 Cardiovascular

7.2.1 Differential diagnosis

7.2.2 Signs and symptoms of heart failure

7.3 Cardiovascular conditions

CHAPTER EIGHT: LUNGS (RESPIRATORY)

8.1 Introduction

8.2 Lungs (respiratory)

8.2.1 Differential diagnosis

8.3 Lungs (respiratory) conditions

CHAPTER NINE: BREAST

9.1 Introduction

9.2 Breast

9.2.1 Differential diagnosis

9.3 Breast conditions

CHAPTER TEN: ABDOMEN

10.1 Introduction

10.2 Abdomen

10.2.1 Differential diagnosis

10.2.2 Special abdominal assessment

CHAPTER ELEVEN: MALE UROGENITAL

11.1 Introduction

11.2 Differential diagnosis

11.3 Male urogenital conditions

11.4 Prostate Assessment

11.5 Penis Assessment

11.6 Physical Causes of Erectile Dysfunction (ED)

CHAPTER TWELVE: FEMALE UROGENITAL

12.1 Introduction

12.2 Female urogenital conditions

12.3 Pregnancy signs

CHAPTER THIRTEEN: MUSCULOSKELETAL

13.1 Introduction

13.2 Upper limbs

13.2.1 Differential diagnosis

13.2.2 Upper limbs conditions

13.2.3 Assessment for the shoulder

13.2.4 Assessment for the elbow

13.3 The back

13.3.1 Differential diagnosis

13.3.2 Conditions of the back

13.3.3 The back special assessment

13.4 Lower limbs

13.4.1 Differential diagnosis

13.4.2 Lower limbs conditions

13.4.3 Hip assessment

13.4.4 The knee assessment

13.4.5 The ankle assessment

CHAPTER FOURTEEN: NERVOUS SYSTEM

14.1 Introduction

14.2 Central nervous system

14.2.1 Assessment of cerebrum:

14.2.2 Central Nervous System Conditions

14.3 Peripheral nervous system

14.3.1 Assessment of the cranial nerves

14.3.2 Peripheral Nervous System conditions

PART FOUR

CHAPTER FIFTEEN: FOLLOW-UP

15.1 Introduction

15.2 General follow-up services

15.3 Missing the follow-up date

15.3.1 Reasons for missing the follow-up date

15.3.2 Management of patients who miss their follow-up dates

PART FIVE

CHAPTER SIXTEEN: CHECKLISTS

16.1 Introduction

16.2 History taking checklist

16.3 Physical assessment checklist

16.4 Follow-up visits checklist

16.5 Medical abbreviations

FOLLOW-UP CALENDAR

REFERENCES

List of Figures:

Figure 1.1 Robert Plutchik’s wheel of emotions

Figure 1.2. Patterns of knowing according to Carper

Figure 1.3 Practitioner’s relationship with self

Figure 1.4 Practitioner-to-patient relationship

Figure 1.5 Practitioner-to-community relationship

Figure 1.6 Practitioner-to-practitioner relationship

Figure 1.7 Primary Health Care Nurse Competencies

Figure 2.1 Caring moment

Figure 3.1: Rapid HIV test kits

Figure 3.2 Malaria Rapid Diagnostic Test

Figure 3.3 ECG graph

Figure 3.4 ECG waves and complexes

Figure 3.5 ECG intervals and segments

Figure 3.6 Pregnancy Rapid test

List of Tables:

Table 1.1 Fundamental patterns of knowing

Table 1.2 Caring Practices in PHC

Table 1.3 Consequences of caring and non-caring practices

Table 2.1 Thyroid history according to body functioning and thyroid abnormality

Table 3.1 Adult vital signs (18 years and older)

Table 3.2 Child vital signs (11 to 17 years)

Table 3.3 Child vital signs (5 to 10 years)

Table 3.4 Infant vital signs (2 months up to 5 years)

Table 3.5 Neonatal vital signs (up to 2 months)

Table 3.6 Abnormal body temperature readings

Table 3.7 Abnormal Blood pressure readings

Table 3.8 Classification of hypertension in adults

Table 3.9 Abnormal respiratory rate

Table 3.10 Abnormal pulse readings

Table 3.11 Urine Dipstick Interpretation

Table 3.12 Blood glucose normal readings

Table 3.13 Interpretation of intervals and segments

Table 3.14 Steps to interprete the ECG

Table 3.15 Normal haemoglobin ranges

DEDICATION

To our two children, Mmakoko and Tiišetšo

ABOUT THE AUTHORS

Image267.tif

Thuledi Makua

Thuledi Makua, a comprehensive nursing diploma graduate, received advanced diploma in community nursing science from University of South Africa, received a Primary Health Care (PHC) diploma from South African Military Health Services (SAMHS), graduated with baccalaureate technologiae (BTech) in Primary Health Care from Durban University of Technology, and earned a magister technologiae (MTech) from Tshwane University of Technology. Mr Makua gained Primary Health Care experience from the Primary Health Care clinics (about ten clinics) he worked in for many years in Limpopo province, South Africa both as a junior and senior nurse. Mr Makua worked at Gauteng province PHC clinics both as a senior nurse and as a facility manager.

Whilst still at the clinics, his teaching responsibilities included the mentoring of the university and the college students in the Primary Health Care skills. He taught at SG Laurens Nursing College where his responsibilities were also to facilitate physical examination and community development in the classroom, skills laboratories and clinical settings. He piloted the establishment of the skills laboratory for the college community nursing science students and thereafter participated in the functioning of these centres. Mr Makua has been a lecturer at University of Limpopo, Medical University of South Africa,a (MEDUNSA campus) where he facilitated theory and clinical practice in nursing science. He is the member of Sigma Theta Tau International Honor Society of Nursing Tau Lambda Chapter, Nurse Educators Association and. He is the lecturer at the University of South Africa, an Open Distance Learning institution. Mr Makua is the author of two other books: The descendants of Letlakana Makua: a genealogy study and Men contribute to women health.

Image274.tif

Mogalagadi Makua

Mogalagadi Makua received a comprehensive diploma from the nursing college, graduated with baccalaureate technologiae in Primary Health Care from Durban University of Technology, and earned a magister technologiae from Tshwane University of Technology. Mrs Makua worked in the PHC clinics for many years both as the junior and senior nurse in Limpopo and Gauteng provinces. She has been a PHC facility manager for several years where her clinic received four awards as the best managed facility. Her responsibilities as the clinic manager included mentoring and in servicing the junior staff as well as university and college students on PHC skills. She is both a postgraduate supervisor at the University of South Africa, an Open Distance Learning institution and a district clinical specialist at Sekhukhune district and responsible for improving quality of care in the PHC setting towards MDG 4 & %, re-engineering of PHC service and ultimatetly the implementation of the National Health Insurance system . She is the member of Sigma Theta Tau International Honour Society of Nursing Tau Lambda Chapter, Nurse Educators Association and a graduant of Caritas Coach Education Programme with the Watson Caring Science Institute. She has also completed the certificate in Theory and Philosophy of Caring-Healing science with University of Colorado in the USA.

PREFACE

This Caring Science in PHC, a guide for nurses in Primary Health Care, intends to lead the lecturers facilitating the Clinical assessment, diagnosis, treatment and diagnosis (Primary Health Care) and the basic Community Nursing Sciences students on the assessment of the client in the Primary Health Care (PHC) clinics in both rural and urban countries. The book teaches the integration of the caritas processes in the physical assessment. Lecturers and students in other countries that have PHC as a qualification will also benefit from this book. This book is based on the clinic practice setting as well as the needs and the expectations of the patients. Nursing lecturers who are leading and facilitating clinical practice for the students in the clinics will find this book valuable for the development of the student skill in assessment of the patients. The lecturers need to orientate the students thoroughly on Part One Chapter One as it teaches both the lecturer and the student on the Caring Philosophy. This chapter makes this book different from other books on PHC as it re-orientates the PHC nurse as a specialist into ‘Developing - helping - trusting- caring relationships’ (Caritas process 4). The students will find Part One, Chapter two, very interesting as it goes deeper into explaining the importance of history taking and the art of doing it. The Clinical assessment, diagnosis, treatment, and care students need the skills demonstrated in the whole book as these are the competencies that define a PHC nurse. The use of this book by the Primary Health Care students in rural areas is valuable. The importance of the Primary Health Care nurses in developing countries clinics cannot be under estimated as it lowers the costs of health care to both the government and the community, it promotes greater equity in health. It has best outcomes as far as the prevention and promotion services are concerned.

The Caring Science in PHC, a guide for nurses in Primary Health Care, is also providing guidelines to the nurses working in the most remote rural areas where sometimes there are no doctors as well as the urban Primary Health Clinics. The Caring Science in PHC, a guide for nurses in Primary Health Care provides recent information, which is relevant to the nurses in the clinics. The relevancy of this book to PHC nurses is based on the vast experience that the authors gathered while working in both rural and urban clinics and teaching Community Nursing Sciences students for many years and its attempt to shift the focus of the nurse specialist from a modern medical science-techno cure orientation to a true caring-healing-loving model.

Not only the nurses but also the clinic managers will benefit from this book as well as it assists them in auditing of patients records periodically in order to monitor quality of care especially when conducting in-depth programme reviews.

ORGANISATION OF THIS BOOK

We divided this book into five Parts: Primary Health Care Caring Philosophy; History taking; Vital signs; Physical assessment; Follow-Up and Checklists with chapters under each part. Each part is opened by the learning objectives to be attained at the end of the study. The learning objectives are structured in such a way that the lecturer can use them for assignments, class assessments, or even examination purposes.

Primary Health Care caring philosophy

Primary health care nursing is not only about diagnosis and giving of medication but also caring which the basis of prevention and promotion is. The caring practice of PHC is anchored on the philosophy of loving-kindness and equanimity for self and others. The Primary Health Care caring philosophy shapes the nature of a nurse who is taking history and assessing the patient holistically. It equips the nurse to ask the right questions in the right manner that will preserve the integrity of the patient and establish the trusting relationship between the nurses and patients.

History taking

I wrote this chapter two to assist the lecturers, clinical mentors and the students to develop the skills of talking to the patients in the clinical setting. I wrote it so comprehensively that the lecturers should not be frustrated when encountered by the various clinical situations. Knowing that history taking is the backbone of diagnosis in the PHC setting, I covered the techniques that lay a therapeutic milieu for both the patient and the nurse. This book emphasises the open-ended data gathering method as it encourages the nurses to Let the patient relate and the nurse listens attentively in order to avoid repetition of the questions, which the patient answered relating his story.

Vital signs

In this section, we divided the vital signs into three categories: primary vital signs, secondary vital signs and the conditional screening vital signs. This assists the lecturers and the students to obtain objective data to be correlated to the history taken. The appropriate use of this objective data will enable the nurse to identify possible emergency before the patient is allowed to sit and start relating the story.

Physical assessment

This section covers chapters four to thirteen. I assist both the lecturer and the student on gathering of objective data. In Primary Heath Care, unlike in Secondary Care, less complicated instruments are used to obtain objective data. The four techniques: Inspection; Palpation; Percussion and Auscultation (IPPA) are the main tools to be used. The chapters are divided into assessment; findings; differential diagnosis and common conditions related to the specific system. There are various tests and assessments demonstrated on different systems with the purpose augmenting the history taken in chapter one and correct diagnosis.

Follow-Up

In PHC, we conduct follow-up sessions as part of disease or condition control. This section guides the students on how to manage the follow-up as part of the service. This section is being used in conjunction with the Follow-up calendar.

Checklists

Checklists can be used by either the lecturers as rubric for student assessment purposes; students for self-check during theoretical or clinical studies; clinic nurses to exclude mistakes of misdiagnosis or the PHC supervisors during the support visits.

Follow-up Calendar

I put in the calendar which is not specific to any year and which