Identification of patient needs

Collection, observing/ performing activities relating to caring

Interpretation and analysis

Needs arising from present illness and the consequent response to cope with

·     “I have pain at genital region”

·     “I have problem of passing urine without control, that is why tube is inserted”

·     “I want to get this urine tube removed”

·     “Who will pay my hospital bill of Rs.50,000?”

·     Patient complains that he is not getting adequate sleep during night

·     He sleeps during daytime

·     Patient’s main complaints are pain, irritation at the site of urinary catheter, and sleep disturbance

·     He was a cook, working most of his life in night time for marriage parties

·     Currently, he is hospitalised for cancer, prostate and is receiving radiotherapy for the last one month

Basic physical needs

·    He is advised not to take bath till the end of radiotherapy to avoid skin excoriation at the site

·    He maintains adequate cleanliness

·    He visits toilet with assistance from his wife

·    He is catheterized for the last 2 months

·    He says is a practicing Muslim

·    He is taking bath means it interferes with his religious practices

·    He is advised not to take bath because he may wet the irradiation area, but the cultural issues are not addressed.

Needs related to life style

·    He is a non-vegetarian

·    But he not getting any non-veg food in the hospital

·       His life style related needs hindered in this hospital environment

Needs related to habits

·    He does not take tea or coffee

·    He does not smoke or take drinks

·         As he has any regular habits of taking tea or coffee or drinking alcohol

Individual’s knowledge and experience of illness

Patient’s Knowledge of Present illness

·    Patient has understanding of the illness as his illness is serious.

·    Patient underwent orchidectomy and TURP in -------- 4 months back and later referred to Manipal for further management

·    Patient wants to know whether his illness will get cured.

·    He says he has no money to spend her.

·    But his expenses are met by his daughter and one brother

Experience of illness

What has been his past experience with illness?

Past Illness History

·       Patient has consulted many folk doctors for minor illness and never satisfied with them.

·       He had minor troubles with urinary frequency for about 4 years

·       So he consulted some folk people for some remedies

·       But never satisfied

·     Patient has accepted the illness as some thing which he does not deserve.

·     He puts it on fate

Knowledge of formal and alternative therapies

·    He has adequate information about formal and folk medicines

·    “I have gone to them, but no benefits”

He had tried alternative medicines and found to have no benefit in his illness

Knowledge at present and future course of action.

What is the treatment plan

Does the person knows about it

·    Patient says he has one month duration of x-ray treatment

·    “nobody tells me what is my illness”

·    “I’m taking medicines regularly”

·    Patient has only partial knowledge of his illness and treatment plans

·    He is illiterate, but nobody has explained him about his treatment plans

Coping with the illness and its outcome (Patient and family)

·    “What will we do?”

·    “We have to suffer everything”

·    He looks depressed and tries to avoid visitors

·    “I don’t have money pay here, I don’t know what to do”

·    Patient is not showing adaptive responses

·    He has depressive cognitions

·    He has financial problems

Analyse the individuals and family’s views on

·    health team

·    doctors

·    nurses

·    “Doctor People come and asks how you are? (he explains sarcastically), nothing else”

·    “They do not want to know about my pain”

·    “sometimes, nurses come asks about me”

“Doctor has told something to my daughter”

He is not satisfied with the psychological attention given to him by nurse or doctor

His wife too has the same opinion

Doctor has explained about the illness to his daughter about the diagnosis and prognosis

Distinguish between the meanings of the patient, doctor, nurse

Patient: “they are not asking me anything”

Doctor: “he will not understand anything, it is explained to his daughter”

Nurse: “doctor has explained everything to him, we cannot tell anything to the patient”

Patient wants to know about his illness, and course of treatment, but doctor is preoccupied with the patient’s educational status.

Nursing staff is bothered whether they may convey wrong message to the patient.

There is a communication gap exists among these people.

Observe the patient, doctor and nurse interaction

What patient says has reason.

·    Doctor has advised him RT for 1 month, so he feels there is nothing more to talk to the patient than enquiring any problems

·    Nurse is largely functionally oriented and interact with patient only in such occasions

The mutual interaction among the treating team and patient is missing in this situation