Running Head: HOLISTIC HEALTH CARE PLAN

Holistic Health Care Plan

Delaware Technical Community College - Stanton Campus

NUR 320-5W1

Andrea DiMartino

April 26, 2019

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Holistic Health Care Plan

Caring for patients goes beyond the bumps and scrapes of acute care. Clients who are

healthy can still benefit from regular physicals and interactions with a nurse to evaluate their

holistic well-being and identify any potential health concerns before they become illness. An

effective holistic assessment involves a complete head to toe physical, therapeutic

communication, and acknowledgement of both objective and subjective data (Dillon, 2016). This

health care plan follows the holistic assessment of a 39 year old female and mother of two who

works as a registered nurse. This care plan identifies two health concerns and one opportunity for

health promotion with specific interventions and recommendations that were identified during

two patient assessments.

Health Problem 1: Disturbed Sleep Pattern

During the psychosocial evaluation and health history, the client was asked about her job.

She indicated that the new shift she is working makes restful sleep difficult due to her body

consistently adjusting to an appropriate sleep/wake cycle. She stated she sometimes feels tired at

work because she doesn't feel like she's sleeping very well, which is a subjective observation.

Additionally, she described difficulties falling asleep and staying asleep.

Several opportunities for intervention are available for this issue. First, she should begin

keeping a sleep diary which should include notes on how she felt before and after sleep, how

long she slept, and if her sleep was interrupted. Since altering her work schedule to a shift that is

more consistent with her family is not currently an option, other alternatives must be explored to

improve daytime sleep quality and nighttime wakefulness. Often, caffeine and melatonin are

used to promote altered sleep patterns, but this solution is not a complete solution either for this
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patient as she reorients her sleep schedule on days she is not working to align with her family.

Instead, the client is encouraged to make the day to night transition easier by practicing calming

activities, such as meditation, prior to bed (Lee, Gay, & Alsten, 2014). Also, it is recommended

the sleeping environment is kept cool and free of daylight through the use of light-blocking

curtains (Chinoy, Harris, Kim, Wang, & Duffy, 2016). Finally, if she is still unable to find restful

sleep, she is encouraged to reach out to the Christiana Care Sleep Center for evaluation. The

sleep journal should be a helpful tool should she be evaluated for insomnia.

Christiana Care Sleep Center

774 Christiana Road
Suite 103
Newark, DE 19713
302-623-0650

At her appointment she can expect to answer questions about her lifestyle, sleep habits,

and challenges with restful sleep. If the interventions are successful, at her next office visit she

should report improved sleep, feeling more rested upon waking, and reduction in sleepiness

while awake.

Health Problem 2: Alteration in Bowel Elimination

During the physical assessment, and later during a focused assessment, the patient indicated

difficulties with frequent constipation. She described that at times she has to take stool softeners

and laxatives to relieve the discomfort from constipation. A brief discussion about her diet

revealed she is drinking adequate amounts of fluids, but may have insufficient fiber intake.

Additionally, the health history revealed that she had given birth to multiple children and does

not exercise frequently (Khera, et al., 2019). Diets low in fiber, female gender, getting little to no

physical activity, and weakened pelvic muscles could contribute to constipation (Mayo Clinic,
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2018). Contributing stress and feeling anxious about utilizing restrooms away from home were

also noted as potentially contributing factors.

Recommended interventions include increasing physical activity, since that has been

shown to improve symptoms of constipation. If she is able, she should increase physical activity

to 20 minutes per day, then more frequent low-impact exercise as she is able, such as walking or

jogging (Khera, et al., 2019). The second recommendation is maintaining a food journal and

elimination diary, including times of day, in conjunction with consulting a nutritionist about

dietary changes and increased fiber intake (Woo, et al., 2015). Her health insurance is accepted

in many places, so a referral to an appropriate nutritionist is appropriate, and an office has been

identified near her home.

The Nutrition Clinic at UD Health

540 S. College Ave
Newark, DE 19713
302-831-3195

The Nutritionist will evaluate her diet, make recommendations about foods that can cause

or relieve constipation symptoms, and suggest several other options based on her needs. The

office will perform a thorough assessment, calculate her BMI, and possibly draw blood for

biochemical lab tests. With the additional information from the elimination diary, the patient

should be able to see if there is a pattern in time of day for her bowel movements, and if possible

plan to be at home to reduce anxiety about defecation in unfamiliar surroundings. If the

interventions are implemented, the client should be able to report decreased frequency of

constipation and relief of discomfort associated with constipation at her next office visit.
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Health Promotion and Disease Prevention: Improved Stress Coping

Now that the patient has successfully made the transition from student to full-time nurse,

there are opportunities for her maintain health. Since the career field of nursing can be stressful,

stress coping skills are important to her ongoing health and well-being. Stress coping skills may

include mindfulness, meditation, group discussions, prayer, aromatherapy or massage therapy,

and even scrapbooking or other artistic outlets (Mayo Clinic, 2017). During her assessment, the

patient did verbalize some stress associated with a work/life balance, and coping skills could be

helpful to her. Additionally, ineffective sleep has been associated with impaired stress coping, so

pursuing more restful sleep may have additional benefits for her health and well-being (Blaxton,

et al., 2017). Finally, she should seek out a support group for stress coping skills, and one has

been identified in her area that specializes in mindfulness skills and focus on the challenges of

working mothers. The meeting times for the group align well with her work schedule.

Women's Mindful Wellness Psychotherapy Group

The Present Center for Mindfulness and Healing, LLC
2607 North Harrison St
Wilmington, Delaware 19802
302-927-1216

Successful intervention will be evident in her next office visit if she is able to identify at least

three coping skills. Additionally, the patient should verbalize and improvement in stress level.

Evaluation and Reflection

Though the patient initially didn't identify any health concerns, therapeutic

communication techniques caused her to open up and disclose several areas of concern. Body

language and other non-verbal queues let me know when to dig a bit deeper into a subject to help

identify issues the patient didn't initially articulate. The most important part of the care plan for a
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patient is developing a plan that is individualized and realistic based on the needs and goals of

that specific patient. I have learned the value of spending some extra time with my clients and

listening closely to what they're saying, not just through words, but through their expressions and

body language as well.

Nursing plan of care

Identified Identified Plan/ Interventions: Projected Community Resources/
problem/need: goal or (Provide rationale/ and Evaluation/ Referrals: (Must be actual
(include outcome: cited evidence to justify Outcomes: resources from the client’s
supporting the rationale) (How will you community. Include Name,
subjective and measure that it address, web address, and
objective data) worked?) phone number)

Patient will Encourage calming Patient will Christiana Care Sleep Center
Disturbed sleep achieve 7 activities prior to sleep describe 774 Christiana Road
pattern related hours of improved sleep Suite 103
to shift work as uninterrupte Evaluate sleep/wake quality and Newark, DE 19713
evidenced by d sleep at disturbances related to quantity of https://christianacare.org/ser
difficulty least 5 days schedule inconsistency sleep at next vices/neurosciences/sleepme
falling asleep per week check-up dicine/
and waking Obtain blackout curtains 302-623-0650
without feeling to improve sleep
rested environment

(Lee, Gay, Alsten, 2014)

Patient will Consult a nutritionist Patient will The Nutrition Clinic at UD

Alteration in have a about dietary changes describe relief Health
bowel bowel and increase fiber intake from symptoms 540 S. College Ave
elimination movement 3 (Woo, et al., 2015) of constipation Newark, DE 19713
related to or more at next check- https://sites.udel.edu/bhan/th
insufficient times Maintain a food journal up e-nutrition-clinic-at-ud-
fiber intake and weekly and elimination diary to health/
insufficient track trends Patient will be 302-831-3195
sleep as free of
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evidenced by increase physical discomfort

occasional activity to 20 minutes related to
constipation per day constipation
(Khera, et al., 2019)

Encourage calming
activities prior to sleep

Evaluate sleep/wake
disturbances related to
schedule inconsistency

Obtain blackout curtains

to improve sleep
environment

(Lee, Gay, Alsten, 2014)

Readiness for Patient will Patient will join a group Patient will
enhanced stress identify for support with stress describe Women's Mindful Wellness
coping as new skills coping reduction in Psychotherapy Group
evidenced by for coping stress levels at
desire to with stress Patient will improve next check-up The Present Center for
improve stress sleep/wake patterns Mindfulness and Healing,
coping skills (Blaxton, et al., 2017) Patient will LLC
describe a new 2607 North Harrison St
Patient will be offered stress coping Wilmington, Delaware
stress coping techniques technique she 19802
and choose 1 to 3 has found https://www.psychologytoda
techniques to practice helpful y.com/us/groups/stress/de/ca
mden/134868?sid=5cc2a7e2
d866a&ref=1&tr=ResultsNa
me
(302) 927-1216

Group Meets
Every Thursday
6:15pm - 7:45pm
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References

Blaxton J., Bergeman C., Whitehead B., Braun M., Payne J. Relationships Among Nightly

Sleep Quality, Daily Stress, and Daily Affect. Journals of Gerontology Series B:

Psychological Sciences & Social Sciences. 2017;72(3):363-372.

doi:10.1093/geronb/gbv060.

Chinoy, E., Harris, M., Kim, M., Wang, W., & Duffy, J. (2016). Scheduled evening sleep and

enhanced lighting improve adaptation to night shift work in older adults. Occupational

and Environmental Medicine. doi:10.1136/oemed-2016-103712

Christiana Care Health System. (n.d.). Sleep Medicine – Christiana Care Health System.

Retrieved from https://christianacare.org/services/neurosciences/sleepmedicine/

Dillon, P. M. (2016). Nursing health assessment: The foundation of clinical practice. (3rd ed.).

Philadelphia, PA: F.A. Davis Company.

Khera A., Chase J., Salzberg M., Thompson A., Kamm M. (2019, March). Gut-directed pelvic

floor behavioral treatment for fecal incontinence and constipation in patients with

inflammatory bowel disease. Inflammatory Bowel Diseases. 25(3), 620-626.

doi:10.1093/ibd/izy344.

Lee K., Gay C., Alsten C.. Home-based behavioral sleep training for shift workers: a pilot

study. Behavioral Sleep Medicine. 2014;12(6):455-468.

doi:10.1080/15402002.2013.825840.

Mayo Clinic. (2018, January 10). Constipation. Retrieved from

https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-

20354253
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Mayo Clinic. (2017, April 19). Relaxation techniques: Try these steps to reduce stress. Retrieved

from https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-

depth/relaxation-technique/art-20045368

Tedesco, J., MA, PsyD. (2019, February 26). Women's Mindful Wellness Psychotherapy Group.

Retrieved from

https://www.psychologytoday.com/us/groups/stress/de/camden/134868?sid=5cc2a7e2d8

66a&ref=1&tr=ResultsName