STEP #3: Recognizing HOLISTIC Care Holistic Care:
1. Integrate caring, empathy, engagement, and presence while providing care. 2. Care for the entire person (physical-emotional-spiritual). 3. Identify educational and psychosocial needs. 4. Determine psychosocial PRIORITY and plan of care.
History of Present Problem: John Gates is a 59-year-old male with a history of diabetes type II and hypertension who was at work when he had sudden
onset of right-sided weakness, right facial droop, and difficulty speaking. He was transported to the emergency
department (ED) where these symptoms continue to persist. It has been one hour from the onset of his neurologic
symptoms when he presents to the ED. You are the nurse responsible for his care.
Personal/Social History: John lives with his wife in their own home in a small rural community. He owns a hardware store where he remains
active and involved in the day-to-day operations. His wife insists on being by his side and talking to John despite John’s
frustration in not being able to answer her questions. His wife reports that the past week he has been complaining of
episodes where his heart felt as if it was beating irregularly and fast but then resolved. His wife also states that he has been
complaining of pain in his right foot the past week. John has been trying to quit smoking the past month and has been
using a nicotine patch. His wife reports that he does not regularly check his blood glucose and eats what he wants. He is 6
feet tall and weighs 250 pounds (113.6 kg/BMI of 33.9).
What data from the PERSONAL/SOCIAL history are RELEVANT and must be interpreted as clinically significant by
RELEVANT Data from Social History: Clinical Significance:
Put it All Together and CARE Like a Nurse! 1. Based on your identification of RELEVANT clinical data, is a psychosocial concern present?
2. If a psychosocial concern is present, what is it?
3. How does the psychosocial concern contribute to the primary medical problem or disease progression for this patient?
4. What are your PSYCHOSOCIAL nursing PRIORITY (ies)?
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5. What interventions can you initiate with each holistic category as well as address these psychosocial priorities?
Nursing Interventions: Rationale: Expected Outcome:
6. What principles of therapeutic communication will be needed to encourage dialogue between the nurse, patient, and/or family?
his or he
7. What educational priorities will be needed to develop a teaching plan to limit disease progression for this patient and/or family?
8. What additional members of the health care team can be utilized to address psychosocial priorities with this patient and/or family?
9. What is the patient likely experiencing/feeling right now in this situation?
10. What can you do to engage yourself with this patient’s experience, and show that he/she matters to you as a person?
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