Comprehensive Assessment Of A Chosen Patient Nursing Essay

This essay will give a critical account of a patient summary given below. It will incorporate the pathophysiology of COPD, linking the signs and symptoms that the patient presented on admission. It will also explore the detailed process of respiratory assessment of a patient experiencing exacerbation of COPD in hospital. The patient’s name has been changed to maintain confidentiality in accordance with Nursing and Midwifery Council standards (NMC, 2008). Below is the summary of patient’s condition.Comprehensive Assessment Of A Chosen Patient Nursing Essay

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Mrs Williams had been admitted to A & E following exacerbation of COPD. She is known type two diabetes, asthmatic and a heavy smoker. On admission she is alert and orientated. However she is unable to talk in full sentences and to take up her peak expiry flow rate due to an increased respiratory rate. She presented with BM of 2.4mmhg, RR of 32BPM, HR of 120BPM, and SPo2 levels of 80% on 60% O2. Her presenting symptoms included increased breathlessness, wheeziness, cough, increased sputum production and increased anxiety. She was using her accessory muscles while breathing and appeared distressed and tired. From the summary above it is clear that Mrs. William is acutely ill suffering from diagnosis given at the handover of exacerbation of COPD. It was evident from her old medical notes that she has been admitted with the same problems before several times.

Chronic obstructive pulmonary disease (COPD) is a chronic lung disease marked by an irreversible, damage to the smaller air sacs in the lungs called alveoli (www.patient.co.uk). COPD leads to damaged airways in the lungs, causing them to become narrower and making it harder for air to get in and out of the lung. George-Gay & Chernecky (2002) claims that an excercabation of COPD is acute in onset and a constant deterioration of the patient’s symptoms.Comprehensive Assessment Of A Chosen Patient Nursing Essay

The main complaint of the presented complain on admission was increased breathlessness which is common worsening symptom of excercabation of COPD. The primary cause for breathless in COPD is due to the interference of gaseous exchange process in the alveoli. The interference is caused due to the loose of elasticity of the alveoli which results in the airways to become narrow (Hoggs and Senior 2002). Therefore the lungs hyper-inflates in order to get rid of trapped air in side the lungs which causes shortness of breath (Bersten & Soni (2009) and Price et al, 2005).

Another symptom of excercabation of COPD is breathlessness with wheeze. Mrs. Williams also presented with wheeziness as well as shortness of breath which could be heard without stethoscope. A wheeze is an unusual symptom of COPD however it is classic for Mrs. William as she has history of asthma and the fact that she is a heavy smoker. A wheeze is defined as a whistling sound while breathing. This occurs as a result of an air flow due to an obstructed airway in the lungs (www.patient.co.uk & Ali, Summer & Levitzky (2009).Comprehensive Assessment Of A Chosen Patient Nursing Essay

Cox (2001) states that the purpose of the respiratory assessment is to determine the respiratory status of the patient and to determine information related to other systems such as cardiovascular and neurological system. It is claimed the deterioration in patient condition often starts with respiratory function abnormalities. Hunter & Rawlings-Anderson (2008) also claims that a thorough assessment helps the nurses to diagnose, manage and evaluate therapeutic interventions for the patient at and early stage which is also agreed by Kennedy (2007).

The look, listen and feel approach is used throughout the assessment in the practice in order to carry out an effective assessment. The use of this approach is also emphasized by Hunter & Rawlings-Anderson (2008). Simpson (2006) suggests that a comprehensive respiratory assessment is carried out in different steps. These steps include initial assessment, history taking, physical examination and further examinations. Following these steps will ensure that no information is missed which can give a vital information on patient’s health status (Hunter & Rawlings-Anderson , 2008). This essay will now explore each stage in detail.Comprehensive Assessment Of A Chosen Patient Nursing Essay

Simpson (2006) identifies the first stage in respiratory assessment as preparing the patient for an assessment making sure that the patient is comfortable and patient has been explained with the procedure and consented verbally. It also involves making sure that patient is seated in an upright position to facilitate maximum lung expansion. According to Bickely (2003) and Moore (2007) an upright position also helps to access the anterior and posterior thorax. Moreover, it is responsibility of the nurse to make sure that a suitable environment is provided in order to ensure privacy. Cox (2001) agrees that this can help physical and psychological comfort for the patient. Simpson (2006) and Hunter & Rawlings-Anderson (2008) states that using the look listen and feel approach during an initial assessment stage is paramount as by observing a patient can give us lots of vital information about their condition. This involves observing the patient to determine the degree of breathlessness, distress, cyanosis and their speech pattern. Vital sings of the patient must be noted as an emergency interventions must be provided such as oxygen therapy is provided if signs of restlessness, anxiety, inability to focus on the conversation or laboured breathing is shown. Addressing such issues is paramount before continuing to take the full assessment of the patient. (Cox , 2001).Comprehensive Assessment Of A Chosen Patient Nursing Essay

Simpson (2006) identifies the next stage of respiratory assessment as history taking stage. However, Kennedy (2007) suggests that the respiratory assessment should begin with history taking stage as it provides vital information which can help to identify the cause of respiratory illness. Simpson (2006) also agrees that in some cases patient’s condition might not allow to obtain history such as if patient is unconscious. In this instance the nurse has to rely on patient’s family to provide as much information as they can. Finesilver (2003) agrees with this stating that the purpose of physical examination is to emphasize the information gathered from history. Finesilver (2003) also agrees that it enables the nurse to assess the patient’s mental status which can indicate if the information provided by patient is accurate or not. As agreed by Cox (2001) above a compromised mental status of the patient can be as a result of hypoxemia, anxiety, laboured breathing which affects the history taking process.Comprehensive Assessment Of A Chosen Patient Nursing Essay

Jarvis (2004) and Cox (2001) identify main areas of focus for a respiratory history as following. The main focus of the history taking should be on patient’s presenting complain which can help to lead the diagnosis process. However other components of history taking are equally important as that can indicate if patient has chronic or acute illness. Jarvis (2004) also emphasizes on finding about patients present health status by asking questions such as if they had cough, shortness of breath, chest pain while breathing. Patients past history medical and surgical history also plays an important part in history taking as that will help to indicate if patient is suffering from any secondary illness that is caused by any underlying problems that patient may have already. Other components of history taking process include smoking history, environmental exposure history, family health and travel history. It is also supported by Reinke (2008).Comprehensive Assessment Of A Chosen Patient Nursing Essay

The next stage of respiratory assessment includes physical examination. Simpson (2006) & Rhoads (2006) states physical examination stage of respiratory assessment involves four stages which are identified as inspection, palpation, percussion and auscultation. Sheppard, Adam & Wright (2006) claims that this stage involves using look, listen and feel approach. Moore and Woodrow (2004) identifies the main components of inspection stage as counting respiratory rate, checking the rhythm, quality of breathing, degree of effort in breathing, skin colour deformities, patient’s mental status and secretions.Comprehensive Assessment Of A Chosen Patient Nursing Essay

According to Moore (2007) respiratory rate should be count for the full minute in order to categorize their breathing rate in one of the following: eupnoea (normal rate of 10-18BPM), tachyonoea (greater than 18BPM), bradypnoea (less than 10 BPM) and hypopnoea which refers to an abnormally shallow breathing rate. Drain (2003) claims that checking rhythm is equally important as rate. It is also suggested that gender should be consideration when checking the rhythm as it could be very due to the nature of breathing pattern. An abnormal rhythm indicates underlying disorders depending on type of rhythm. For example, kussmaul breathing indicates possible metabolic acidosis and cheyne strokes respirations rhythm indicates left ventricular failure or possible cerebral injury.

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White (2004) states that the inspection stage includes looking at quality of breathing. This involves looking at the chest movement which should be symmetrical. If the chest movements are not symmetrical it could be an indication of fibrosis, collapse of upper lobes of the lung or bronchial obstruction. The degree of efforts should also be inspected for the use of any accessory muscles while breathing as it suggests that patient is having difficulty in breathing. The skin also should be inspected for cyanosis which is a late sign of respiratory dysfunction and also finger nails could indicate signs of clubbing (Simpson, 2006).Comprehensive Assessment Of A Chosen Patient Nursing Essay

The next component of the examination stage is palpation stage. This stage aims to assess the bilateral movements of the chest and the diaphragm and to identify any abnormalities (Simpson, 2006). It also helps to assess vibrations caused by the transfer of sound waves from inside the chest to the chest wall. This assessment involves use of the hands and fingers in order to gain information through the sense of touch (Francis, 2006). The trachea should be palpated to ensure that is in the midline. In addition, the thoracic area should be palpated for any pulsation, tenderness, and depression to the thoracic cavity (White, 2004) .Comprehensive Assessment Of A Chosen Patient Nursing Essay

Percussion is identified as next important component of physical examination. According to Grefory & Mursell (2010) percussion is aimed at listening to the sounds produced on the patient’s chest wall by tapping with fingers and hands. It helps to find out whether the underlying tissues are filled with air, fluid or solid material. There are different sounds that can be heard during percussion which can indicate what problem patient might be suffering. Springhouse (2008) categorizes the sounds as following. Resonance sounds are referred as normal lung tissue sounds. the tympanic like sound which are normally heard over the stomach which indicates air in the bowel however sounds heard over the chest is an indication of excessive air in the chest which can be occur from pneumothorax. Hyperresonance which are heard when lungs are hyper inflated and such sound is an indication of pneumothorax. Dullness like sounds heard when fluid or solid tissue replaces air in the lung tissue and occurs in patient with pneumonia, pleural effusions or tumours (Terry, Jardins & Burton, 2006).Comprehensive Assessment Of A Chosen Patient Nursing Essay

According to Middleton and Middleton (2002), the last stage of the physical examination is identified as auscultation. This stage involves listening to the sounds transmitted through the thorax with the use of stethoscope. The sounds are described as vesicular, bronchovesicular and bronchial sounds. Abnormal breath sounds are known as adventitious sounds such as crackles which can be indicated as pulmonary oedema, wheezing, indicating asthma.

Finally, the last stage of the comprehensive respiratory assessment involves carrying out further investigations in order to confirm the provisional diagnosis which was from the history taking stage and physical examination (Simpson, 2006).Comprehensive Assessment Of A Chosen Patient Nursing Essay

If the patient is able to produce sputum it should be tested as it can give an indication of the infection suspected. Moreover, other useful investigations include spirometry, arterial blood gases, pulse oximetry reading and chest radiography, lung function tests and peak expiratory flow rate. Simpson (2006) claims that all this tests will help to determine the adequacy of ventilation, oxygen delivery to the tissue, acid base balance and a clear picture of the extent and severity of disease. On completion of the assessment the nurse must document whole assessment process thoroughly as it might help other members of team which are looking after patient as well.

In conclusion, this essay covered a rationale for the need of respiratory assessment and explored the assessment procedure in detail. In addition it also discussed the anatomy and physiology related to signs and symptoms of excercabation of COPD that patient presented used in the scenario.Comprehensive Assessment Of A Chosen Patient Nursing Essay

Patient assessment of the quality of their care has a long
history. The concept was introduced in the 1970s as an
endpoint in the evaluation of health care services. In
oncology, attention to patient satisfaction is more recent
[1-6]. It coincides with the recognition of the impact of
cancer at all human levels. Cancer is no longer inevitably fatal. Thanks to new technologies the probability
of recovery or prolonged survival has expanded. However, this has been at the cost of increasingly sophisticated technical procedures often accompanied by side
effects and long-term sequelae. These may also cause
impersonal interactions with patients. In that context,
attention has been directed to the patients’ viewpoint in
the evaluation of treatment efficacy and overall care.
Quality of life instruments have been elaborated to
measure the effects of cancer and its treatment on the
individual. Satisfaction with care instruments are intended to raise patient opinion of the quality of health
care interventions and services. Insufficient quality of
health care provision may constitute an additional burden on patients. Besides, dissatisfaction with care may
alter an already challenged compliance which in turn
may undermine treatment effectiveness [7].Comprehensive Assessment Of A Chosen Patient Nursing Essay
In the cancer field, patient satisfaction with care
entails particular features. Cancer patients usually experience long-term uncertainty and concerns about the
nature, course and prognosis of their illness. They inevitably face continued dependency on health care providers, for either lengthy treatment, medical follow-up
or rehabilitation. Moreover, in view of the frequent
combinations of therapies they are often handled by
numerous different health care professionals. In that
context, providers’ interpersonal and communication
skills are of special value, not only in their interaction
with patients but also to ensure consistency.
The content and format of instruments used until
now in studies of the satisfaction of cancer patients with
their care vary widely. It is thus difficult to compare their
results. Consequently, little is known about patients’
opinions of the quality of their care across settings.
Besides considering the common over-reporting of high
satisfaction with care levels, alternative methods for
assessing satisfaction with care need to be tested.
The general objective of this study was to assess
cancer patients’ perception of the quality of hospital
physicians and nurses as well as of selected aspects of
care organisation and hospital environment across settings in different countries. A’comprehensive assessment
840
of satisfaction with care’ (CASC) was designed for that
purpose [8]. The present paper reports on the psychometric testing of the CASC in patients treated at an
oncology institute in Italy (EIO).
For the psychometric analysis of the CASC, the
following research questions were posed:
1. To what extent does the conceptual structure of
the CASC fit the empirically generated structure
of the scale?Comprehensive Assessment Of A Chosen Patient Nursing Essay
To what extent do the multi-item scales of the
CASC reflect internal consistency?
To what extent do the multi-item scales of the
Table 1. Patient characteristics.
2.
3.
CASC demonstrate convergent-discriminant validity?
Development of a comprehensive assessment of
satisfaction with care (CASC)
The initial design and pre-testing of the CASC was
reported in a previous publication [8]. The CASC is
composed of items selected from existing patient satisfaction questionnaires but reviewed for their relevance
by oncology specialists and cancer patients. It is organised in three parts: the first pertaining to doctors; the
second to nurses; and the third to hospital services and
general satisfaction. It addresses the technical and interpersonal skills, information provision and availability of
physicians and nurses, and includes issues pertinent to
oncology which are rarely addressed in other satisfaction
with care assessment questionnaires such as co-ordination between health care providers, elicitation of information on psychosocial difficulties, waiting time for
obtaining test results or implementing treatment.
To counter the over-reporting of elevated satisfaction
levels and increase the variability of scores, we took
several precautions. First, we chose a multi-dimensional
rather than a global assessment approach. A multidimensional questionnaire encompasses multiple items
bearing on specific aspects of care whereas a global item
consists of an overall assessment (e.g., ‘I am fully satisfied with the medical care I received’). Second, a ‘poor’,
‘fair’, ‘good’, ‘very good’ or ‘excellent’ response scale was
used to rate each aspect of care. This type of response
scale was shown in the literature to provide methodological advantages [9].Comprehensive Assessment Of A Chosen Patient Nursing Essay
The CASC was originally written in French, then
translated into and pilot-tested in the languages of each
of the participating institutions. The translation process
followed the guidelines of the European Organisation
for Research and Treatment of Cancer Quality of Life
study group [10]. For the Italian version, however, the
translation was directly made from French. Two initial
translations were independently performed by two persons of Italian mother tongue with good knowledge of
French. A comparison of the two translations led to an
intermediate Italian version that was then re-translated
into the original questionnaire language by a French
person working in Italy. An Italian version for pilotAge (years)
Median
Range
Sex
Male
Female
Education level
Elementary
High school
College/University
Diagnosis
Not yet established
Breast cancer
Gynaecological cancer
Digestive cancer
Colon cancer
Lung cancer
Head and neck cancer
Urologic cancer
Lymphoma/leukemia
Others
No information
Disease stage
Not yet established
Solid tumour
Local
Loco-regional
Metastasis
Leukaemia/lymphoma/myeloma Comprehensive Assessment Of A Chosen Patient Nursing Essay
No information
Treatment setting
In-patient
Out-patient
Respondents
(n = 290)
54
21-96
86 (30)
204(70)
74 (26)
170(57)
46(16)
8(3)
132(46)
29(10)
25(9)
23(8)
23(8)
12(4)
10(3)
10(3)
16(6)
2(1)
54(19)
93(32)
41 (14)
86 (30)
10(3)
6(2)
264(91)
26(9)
Non-respondents
(n = 105)
57
19-87
32(31)
73 (69)
30 (29)
63 (60)
12(12)
1(1)
36 (34)
8(8)
9(9)
12(11)
14(13)
5(5)
7(7)
4(4)
8(8)
1(1)
14(13)
22(21)
19(18)
44 (42)
4(4)
2(2)
96(91)Comprehensive Assessment Of A Chosen Patient Nursing Essay
9(9)
testing with patients was produced on the basis of
comparison of both the original and re-translated
French questionnaires. The final Italian version took
into account patients’ comments and a review by an
Italian research assistant. A report of this translation
process is available from the first author.
Patients and methods
Patients and data collection
Between March 1997 and March 1998, several hours per week were
dedicated to patient recruitment, resulting in a consecutive series of
approximately eight patients who were approached per week in the
different EIO departments. All patients were within three days of
hospital discharge or undergoing out-patient chemotherapy. They
were approached and the study was explained to them in a face-toface meeting. However, they were invited to complete the CASC at
home and to return it in a self-addressed pre-stamped envelope. This
procedure purports to minimise the social-desirability bias likely to
show up in patients’ responses. In addition patients had to fill in a
debriefing form inquiring about the time it took to complete the
questionnaire and the difficulties encountered Comprehensive Assessment Of A Chosen Patient Nursing Essay

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This assignment will discuss and analyse the nursing care given to an 85 year old female patient, during a four week hospital practice placement. In order to fully comply with the Nursing and Midwifery Council (NMC) Code of Conduct (2008), full consent has been verbally granted by the patient to utilise personal clinical information for the purpose of this case study. To ensure patient anonymity, throughout this assignment the patient will be referred to as Rose (Swift).
Chapelhow et al (2005) states, in order for a novice to become an expert practitioner there are several enablers which are fundamental to the nursing care that Rose received. These are: communication, assessment, managing risk, documentation, decision making and managing uncertainty. For the purpose of this assignment, the enablers of assessment and communication in relation to the care that Rose received will be discussed.Comprehensive Assessment Of A Chosen Patient Nursing Essay
Background
Rose Swift is a retired teacher, a widower and is a mother of two sons. Rose was admitted to the accident and emergency department (A&E) via ambulance following an unexplained fall at home. Upon admission to A&E, Roses’ medical notes stated Rose had recently been diagnosed with Dry Macular degeneration, which is an age related chronic eye disease, causing loss of vision in the centre field (Samuel, 2008, Watkinson, 2010). After a short stay in a general medical ward for treatment of a urinary tract infection, Rose was transferred to an intermediate care ward for further rehabilitation, before being discharged home with a care package. Prior to admisson Rose lived alone, was independantly mobile with a stick and would cook her own meals.Comprehensive Assessment Of A Chosen Patient Nursing Essay
Assessment
The Royal Marsden (2011), regards initial nursing assessments as a step to providing an individualised patient centered nursing care plan. By conducting nursing assessments, key information is obtained to aid the improvement of Roses’ health and develop a plan of care, which will ultimatly enable Rose to establish control of her own health (The Royal College of Nursing (RCN), 2004). However, as cited by Chapelhowe et al (2005) nursing assessments are far from static. As part of the nursing assessment process, a set of individualised outcomes are agreed, in collaboration with the nurse, Rose and the multidisiplinary team. These outcomes are continously evaulated by the nurse, in order to moniter Roses’ progress and where nessescary clincal judgement will be used to adjust these outcomes to suit the needs of Rose (Estes & Ellen, 2013).Comprehensive Assessment Of A Chosen Patient Nursing Essay
For a successful assessment to take place, it is argued a sufficient baseline knowledge is required by the nurse (Peate, 2012). In contrast however Chapelhowe, et al (2005) argue that base line knowledge alone is not enough. Irrespective of how knowledgeable a nurse maybe, without effective communication and interpersonal skills, the care the nurse provides to Rose will be limited as Roses’ individual needs may not be met. It is therefore considered that a combination of the two is thus required (NMC, 2010).
Throughout Roses’ hospital journey, there are several assessments that took place. During Roses’ initial admission to A&E, the nurse conducted a systematic `mini’ assessment to obtain a rapid outline of Rose from both a visual and physical point of view (The Royal Marsden NHS Foundation Trust, 2011). As the resusitation council (2005) points out, inital nursing assessments in acute settings enable preservation of life, by providing fast intervention where required, using the Airways, Breathing and Circulation (ABC) algorithm. By asking Rose questions and obtaining qualitive information, the nurse established that Rose was breathing, had a clear airway and brain perfusion as well as establishing vital background information to aid diagnosis (Fawcett & Rhynas, 2012). In addition, the nurse was also able to quickly access Roses neurologial state using the Modifed Glasgow Coma Scale (MGCS) (Jennett & Teasdale, 1977).Comprehensive Assessment Of A Chosen Patient Nursing Essay
When a patient such a Rose sustains a head injury, the National insititute of Health and Care Excellence (NICE) (National Insitiute for Health and Care Excellence, 2014) recommends the use of MGCS. According to Pillay (2013), MGCS provides a tangible way of noting the concious state of Rose, it is a widely recognised and accepted standarised practical assessment tool, designed for ease of use (Jennett & Teasdale, 1977) which has been used for many years at both a national and international level. When used repeatedly, MGCS can indicate the progression of a brain injury (Teasdale, et al., 2014), this in turn can aid decision making (Nursing Times, 2014). Recently however, there has been some criticism against MGCS regarding the tools ease of use (Mattar, et al., 2013). McLernon (2014) questions if the MGCS tool is still fit for purpose, citing reduced reliability due to lack of clinical consistency and poor communication between professionals. It is therefore suggested that a remedy of a uniformed approach and concise communication between professionals is essential, to ensure safe theraputic practice.Comprehensive Assessment Of A Chosen Patient Nursing Essay
Whilst conducting Roses’ MGCS assessment the nurse noted a reduced score on account of Rose presenting symptoms of delirium. Farne, et al., (2010) states new confusion in patients can often be caused by underlying medical conditions. By utalising this knowledge, this enabled the nurse to apply her professional decision making skills, in order to continue with further assesssments which included a set of observations.
Observations (also known as vital signs) enables the nurse to check Roses’ basic bodily functions such as temperature, pulse, respiration rate and blood pressure (The Royal Marsden NHS Foundation Trust, 2011). A fundamental part of the asessment process, observations allow the nurse to obtain a baseline figure in order to carry out a continous assessment and evaluation, and enable the nurse to establish the level of care that Rose requires (Wheatly, 2006). To identify the risk of Rose deteriorating further, as per Nursing and Midwifery Council (2008) guidelines, each quantitive result was charted correctly, concisely and legiblibly by the nurse and given a score using a modified early warning score (MEWS) (Department of Health, 2000). After combining all results, the nurse was then able to establish that Rose was scoring a MEWS for a raised temperature and increased pulse in addition to a reduced MGCS. By drawing on previous experience and knowledge, the nurse was able to evaluate the overall asssessment, to establish that the presenting symptoms could indicate Rose has some form of an infection. This could be the reason for the fall and delerium (Schroeder, 2010). To rule out a urinary tract infection, a urine dip stick test on a midstream urine sample was conducted. This test showed positive for leukocytes and nitrates, indicating a positive infection result (Little, et al., 2009).Comprehensive Assessment Of A Chosen Patient Nursing Essay
In order to treat Roses’ symptoms the doctor prescribed antibiotics, providing treatment under the biomedical model. Considered a dualistic approach, this model treats the mind and body as separate entities. Fast acting in its approach it treats the immediate problem (Mehta, 2011). However, in order to provide truly effective care the biomedical model alone is simply not enough. It is considered by many professionals that a holistic viewpoint should be taken (The Royal Marsden NHS Foundation Trust, 2011). Id est, in addition to Roses’ physical requirements, consideration should also be given to her emotional and social needs (Chapelhowe, et al., 2005). The psychosocial model should therefore also be considered, in order to treat Rose from a holistic perspective (Chapelhowe, et al., 2005).
Given Roses’ confused state of mind, unsteady gait and MEWS score it was decided to admit Rose to a general medical ward. In order to assess Roses’ psychosocial and cultural needs, the Activities of Daily Living (ADL’s) model (Roper, et al., 2000) was used. ADL’s is a systematic framework, which recognises Roses individuality and beliefs. It considers twelve fundamental concepts and provides a continuum in recognition that dependency can change throughout time (Roper, et al., 2000). Kearney (2001) argues however, that the care Rose receives maybe jeopardised using this model, due to its inflexibility and complex structure. To alleviate this, The Royal Marsden (2011) therefore advises that the nurse should use a pragmatic approach, and use the ADL framework as a guideline for professional decision making. In Roses’ case the nurse was able to utilise the ADL framework to identify a change in care needs. Due to Roses confused state and unsteady gait, assistance would now be required with washing, dressing, mobilising and other essential care needs as defined by the Department of Health (2010) in the Essence of Care guidelines.Comprehensive Assessment Of A Chosen Patient Nursing Essay
Communication
Effective communication is an essential skill which enables the expert nurse to build a therapeutic relationship with Rose (Chapelhowe, et al., 2005). According to Dwamena, et al., (2012), communication is considered to be a significant factor in the rapid recovery of Rose. Throughout Roses hospital journey there are many ways in which the nurse interacts with Rose. However, as cited by The Royal Marsden (2011), interpersonal communication skills are the most widely used medium in nursing and arguably the most important skill.Comprehensive Assessment Of A Chosen Patient Nursing Essay
In order for interpersonal skills to be effective Arnold & Underman Boggs (2011), states the nurse must consider several elements such as, verbal and non-verbal exchanges of information, active listening and observation skills. As the initial assessment process is often the first interaction Rose may have with the ward staff, Rose maybe reluctant to share information (Perry Black, 2013). The Royal Marsden (2011), recognises this could be a potential barrier for the nurse to deliver effective care to Rose and key communication factors such as environmental and nurse time restraints maybe contributory to Roses’ unwillingness to share information. To aid the nurse in overcoming this issue, (Cotoi & Ilkiescu, 2013) suggests a trusting environment should be created. Trusting environments enable Rose to feel safe and supported and provide a platform where Rose will feel comfortable and confident in sharing information with the multi-disciplinary team (The Royal Marsden NHS Foundation Trust, 2011).Comprehensive Assessment Of A Chosen Patient Nursing Essay
In order to assimilate meaningful information from Rose, the nurse utilised her communication skills effectively in a number of different ways. An example of this would be, during the initial assessment process. When Rose was admitted to the ward, in line with NMC (2010) Code of Conduct to ensure privacy and dignity is maintained, the assessment took place in a cubicle, with the door closed thus creating a quiet environment. The Royal Marsden (2011) states a quiet environment during assessments is essential to enable Rose to maintain optimum concentration and remain complicit in her responses. Past research has shown discrepancies can often occur between the nurses understanding and that of Rose during assessments (Lauri, et al., 1997). A quiet environment therefore enables the nurse to focus solely on Roses responses, to maintain a meaningful interaction and deliver effective individualised therapeutic care (The Royal Marsden NHS Foundation Trust, 2011).
To ensure effective non verbal communication takes place, body language should also be considered. White, et al., (2011) states body language can be a powerful means of sending a message to Rose, therefore a postive open posture should always be maintained. Throughout Roses hospital journey it was noted the nurse positivly adapted her body language to suit the needs of Rose. An example of this would be when conducting assessments the nurse sat facing Rose, kept an open posture and maintained regular eye contact. These interations are considered by Egan (2002), to be fundamental elements of non verbal exchanges, in order to achieve optimum levels of communication.Comprehensive Assessment Of A Chosen Patient Nursing Essay
As specified by the nursing and midwifery Code of Conduct (2008) optimum communication is an essential nursing skill. To be proficient, the nurse should respect Roses right to be involved in the decisions of her care (NMC, 2010). During discharge planning the nurse demonstated the proficient use of communication, when a conflict occurred between Rose and her family. Acting as an advocate, the nurse conveyed the wishes of Rose to return to her home against her sons wishes. Xxx xxx states during discharge planning, conflict can often occur due to lack of communication. To remedy this, the nurse utalised her commuication skills by asking open ended questions to asscertain the reasons behind the familys anxieties. Questions that are open ended allow the answer given by the receiver to be expanded and explored xxxxx xxxx. However XXX XXX states questions alone are not enough. In order to gauge the true meaning of the answer, non verbal signals should also be observed xxx xxxx.
In conclusion in order to provide effective nursing care to Rose the nurse must ensure that a thourgh assessment is conducted. This cannot be fully completed however, without effective communication skills, concise documentation and decision making. Each enabler is therefore interlinked to provide individualised holistic nursing care to Rose. As a nurse, good communication is vital to build a positive theraputic relationship with Rose and to enhance the relationship there are a number of factors the nurse should be aware of such as enviroment and non verbal communication prompts. Good interpersonal skills are therefore an essential nursing skill to aid the recovery of Rose. Comprehensive Assessment Of A Chosen Patient Nursing Essay