The Role of Assessment in Care In The UK Essay

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).The Role of Assessment in Care In The UK Essay
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.

ORDER  HERE A PLAGIARISM-FREE PAPER HERE

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.The Role of Assessment in Care In The UK 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).The Role of Assessment in Care In The UK 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).The Role of Assessment in Care In The UK 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.
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.The Role of Assessment in Care In The UK Essay
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).The Role of Assessment in Care In The UK 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.The Role of Assessment in Care In The UK 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.
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).The Role of Assessment in Care In The UK 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.The Role of Assessment in Care In The UK 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 Ros The Role of Assessment in Care In The UK Essay

PURPOSE OF ASSESSMENT The primary purpose of assessment is for the learner to provide evidence of learning by demonstrating the understanding of content and achievement of learning outcomes. This gives an insight of their strengths and areas of development. Whereas for teacher, it provides a moment to review their assessment strategies in terms of effectiveness and facilitate progression by giving constructive feedback. It also informs the curriculum board, managers, and relevant staff to evaluate learning programmes for any improvements.
Learners are assessed through various stages of learning journey by using variety of methods and strategies. They are usually assessed formatively before or during the course and summatively near or…show more content…
Some teachers are predominantly concerned with cognitive learning with some use of psychomotor skills but affective learning can be a useful tool in changing attitudes i.e. gender, culture etc. even if it’s not a requirement of a course. Summative Assessment happens at the end of the course, unit etc. and is for grading and decision purpose. It is used for informing employers, institutions etc. about learner’s overall performance. It does not however, give information about detailed abilities of learner and there is no feedback so it is debated for its complete reliability and validity. (Scales, 2008 and Rust, 2002). Learners are assessed summatively mostly by Examination, Assignments, Portfolios, and Essay The Role of Assessment in Care In The UK Essay

This essay deals with the holistic assessment of a patient who was admitted onto the medical ward where I undertook my placement. Firstly, the relevant life history of the patient will be briefly explained. Secondly, the Roper, Logan and Tierney model of nursing that was used to assess the care needs of the patient will be discussed, and then the assessment process will be analysed critically. Identified areas of need – breathing and personal cleansing – will be discussed in relation to the care given and with reference to psychological, social, and biological factors as well as patho-physiology. Furthermore, the role of inter-professional skills in relation to care planning and delivery will be analysed, and finally the care given to the patient will be evaluated.

Throughout this assignment, confidentiality will be maintained to a high standard by following the Nursing and Midwifery Council (NMC), Code of Conduct (2008). No information regarding the hospital or ward will be mentioned, in accordance with the Data Protection Act 1998. The pseudonym Kate will be used to maintain the confidentiality of the patient The Role of Assessment in Care In The UK Essay

Kate, a lady aged 84, was admitted to a medical ward through the Accident and Emergency department. She was admitted with asthma and a chest infection. She presented with severe dyspnoea, wheezing, chest tightness and immobility. Kate is a patient known to suffer from chronic chest infections and asthma, with which she was diagnosed when she was young. She takes regular bronchodilators and corticosteroids in the form of inhalers and tablets. Kate lives on her own in a one bedroom flat. She has a daughter who lives one street away and visits her frequently. Her daughter stated that Kate has a very active social life; she enjoys going out for shopping using a shopping trolley.The Role of Assessment in Care In The UK Essay

Elkin, Perry and Potter (2007) outlined nursing process as a systematic way to planning and delivering care to the patient. It involves four stages: assessment, planning, implementation and evaluation. Assessment is the first and most critical step of the nursing process, in which the nurse carries out a holistic assessment by collecting all the data about a patient in order to identify the patients nursing problems (Alfaro-Lefevre 2008). Holland (2008) stated that assessment as an on-going process used to identify needs, preferences and abilities of a patient. Rennie (2009) stated that subjective and objective data, as well as medical and social history are collected during patient’s interview. Among the physical aspects assessed are vital signs and general observations of the patient. Assessment is extremely important because it provides the scientific basis for a complete nursing care plan (Wilkinson 2006). Assessment is of benefit to the patient because it allows his or her medical needs to be known, but it can feel intimidating or embarrassing so the nurse needs to develop a good rapport (NursingLink 2012). Under time pressure this can sometimes be neglected. Are tools used? Are the tools user-friendly? What are they for? Why do we have them?The Role of Assessment in Care In The UK Essay

After assessment, care plan is formulated. Barrett, Wilson and Woollands (2012a), defined a care plan as an integrated document that addresses each identified need and risk. Care planning is important because it guides in the on-going provision of nursing care. Good care planning allows healthcare professionals make evidence-based decisions about care based on a comprehensive assessment, and to prove this, if necessary (Barrett, Wilson and Woollands 2012a). Care plans can be problematic when they are not filled in correctly or are completed carelessly. This can jeopardise patient care. Every nurse has a professional responsibility to make sure that care plans are filled in to the best of her ability to help herself and her colleagues to continue the process of giving the best care possible necessary (Barrett, Wilson and Woollands 2012a).The Role of Assessment in Care In The UK Essay

Before assessment takes place, the nurse should explain when and why it will be carried out; allow adequate time; attend to the needs of the patient; consider confidentiality; ensure the environment is conducive; and consider the coping patterns of the patient (Jenkins 2008). The nurse should also introduce herself to help reduce anxiety and gain the patient’s confidence. During assessment, the nurse needs to use both verbal and non-verbal communication. Using non-verbal communication means that she should observe the patient, looking at the colour of the skin, the eyes, and taking note of odour and breathing. An accurate assessment enables nursing staff to prioritise a patient’s needs and to deal with the problem immediately it has been identified (Esmond 2011). Documentation is also very important in this process; all information collected has to be recorded either in the patient’s file or electronically (NMC, 2009b).The Role of Assessment in Care In The UK Essay

Kate was allocated a bed within a four-bed female bay. Her daughter was with her at the bedside. Gordon (2008) stated that understanding that any admission to hospital can be frightening for patients and allowing them some time to get used to the environment is important for nursing staff. Both Kate and her daughter were asked if it was okay for her daughter to be around while assessment was carried out, so that she could help with some information, to which both agreed. As Kate was an adult and was judged by the nurses present to understand what she was consenting to, it was acceptable for her to consent to having her daughter present (Ebersole and Hess 1998). Her confidentiality was not compromised because she agreed to the presence of a family member. Alfaro-Lefevre (2008) recommended that nursing assessments take place in a separate room, which respects confidentiality, and that the patient be free to participate in the assessment. Although there was a room available, Kate and her daughter said it was fine for the assessment to take place at the bedside especially that Kate was so restless. The curtains were pulled around the bed, though Sibson (2010) argued that it ensures visual privacy only and not a barrier to sound. NMC (2009a) acknowledges this, along with the need to speak at an appropriate volume when asking for personal details to maintain confidentiality.The Role of Assessment in Care In The UK Essay

In this ward the Roper, Logan and Tierney model of nursing, which is based on the twelve activities of living, is used as a base for assessing patients (Alabaster 2011). This model is extremely prevalent in the United Kingdom and it is used as a checklist on admission in order to get as much background data about the patient Holland (2008, p.9).

ORDER   HERE NOW

The assessment form that was used during Kate’s assessment addressed personal details and the twelve activities of living. Personal details such as name, age, address, nickname, religion, and housing status were recorded. Information was also recorded about any agency involved, along with next of kin and contact details, and details of the general practitioner. Holland (2008) stated that these details should be accurate and legible so that, in case of any concerns about the patient, the next of kin can be contacted easily. The name and age are also vital in order to correctly identify the patient to avoid mistakes. Knowing what type of a job the patient does or the type of the house she lives in helps to indicate how the patient is going to cope after discharge. Holland also insisted that religion should be known in case the patient would like to have some privacy during prayers, and this should be included in the care plan.The Role of Assessment in Care In The UK Essay

The second assessment to be done focused on physical assessment and the activities of living. Barrett, Wilson and Woollands (2009) suggested that when enquiring about the activities of living, two elements should be addressed: usual and current routines. Additionally, identifying a patient’s habits will help in care planning and setting goals. During physical assessment, Kate demonstrated laboured, audible breath sounds and breathlessness. Use of accessory muscles and nose flaring was also noted. She was agitated and anxious. Her vital signs were: pulse 102 beats /min; respirations 26/min; temperature 37.4 degrees Celsius; oxygen saturation 88%; and peak flow 100 litres. Taking and recording observations is very important because it helps to recognise the significance of changes in vital signs. Observations also help to detect any signs of deterioration or progress in the patient’s condition (Field and Smith 2008). Carpenito-Moyet (2006) stated that it is important to take the first observations before any medical intervention, in order to assist in the diagnosis and to help assess the effects of treatment. How did all this affect her ability to provide you with information during the assessment?The Role of Assessment in Care In The UK Essay

Kate’s initial assessment was carried out in a professional way, taking account of the patient’s particular circumstances, anxieties and wishes. After the baseline observations were taken, the twelve activities of living were analysed and Kate’s needs were identified. How gave the information, Kate or the daughter? Did this affect the way the questions were asked? Or the information received? Could Kate answer all the questions? Did the daughter know the answer to all the questions? Among the needs identified, breathing and personal hygiene (cleansing), being priority needs, will be explored.The Role of Assessment in Care In The UK Essay

Breathing will be discussed first being an underlying problem which Kate presented with before moving on to personal cleansing. Wilkinson (2006) states that a nursing diagnosis is an account about the patient’s current health situation. The normal breathing rate in a fit adult is 16-20 respirations/minute, but can go up to 30 due to pain, anxiety, pyrexia, sepsis, sleep and old age (Jenkins 2008). In old people, muscles become less efficient, resulting in increasing efforts to breathe, causing a high respiratory rate (Mallon 2010). On assessment, Kate’s problem was breathing that resulted in insufficient intake of air, due to asthma. She was wheezing, cyanosed, anxious and had shortness of breath.The Role of Assessment in Care In The UK Essay

Wilkinson (2006) explained that a goal statement is a quantifiable and noticeable criterion that can be used for evaluation. The goal statement in this case would be for Kate to maintain normal breathing, which is normally 12 – 18 breaths per minute in adults (Mallon 2010), and to increase air intake. The prescription of care for Kate depended on the assessment, which was achieved by monitoring her breathing rate, rhythm, pattern, and saturation levels. These were documented hourly for early identification of any deterioration of condition; it also encouraged early identification of interventions. Readings were compared with initial readings to determine changes and to report any concerns. The other part of the plan was to give psychological care to Kate by involving her in her care and informing her about the progress, in order to reduce anxiety. Barrett, Wilson and Woollands (2012a) stated that it is very important to give psychological care to patients who are dyspnoeic because they panic and become anxious.The Role of Assessment in Care In The UK Essay

Checking and recording of breathing rate and pattern is very important because it is the only good way to assess whether this patient is improving or deteriorating, and it can be a very helpful method for nurses to evaluate the care of the patient (Jamieson 2007). Mallon (2010) stated that, if the breathing rate is more than 20, it indicates that the body is trying to increase its intake of oxygen to meet unusual demands. This can happen even after doing exercise, not only in people with respiratory problems (Blows 2001). Griffin and Potter (2006) stated that, respirations are normally quiet, and therefore if they are audible it indicates respiratory disease, wheezing sound indicates bronchiole constriction. Kate’s breathing was audible and the rate was also above normal and that is why breathing was prioritised as the first need The Role of Assessment in Care In The UK Essay

Oxygen saturation level was also monitored with the use of a pulse oximeter. The normal saturation level is 95-99% (British National Formulary ((BNF)) 2011a). Nevertheless the doctor said that 90-95% was fine for Kate, considering her condition and her age. Kate was started on two litres of oxygen using nasal catheter and she maintained her oxygen saturation between 90 and 94%. With nasal catheter, Kate was able to communicate with the nurses and her daughter what about comfort?. The peak expiratory flow was monitored and recorded to identify the obstructive pattern of breathing that takes place in asthma (Hilton, 2005). This is another method that is used to assess the effectiveness of the medication (inhalers) the asthmatic patient is taking, and this test should be carried out 20 minutes after medication has been absorbed. It is the Trust’s policy to do hourly observations on patients who have had one, two or three abnormal readings, until readings return to normal. Kate was observed for any blueness in the lips and oral mucosa as this could be a sign of cyanosis. All the prescribed nebulisers, inhalers, bronchodilators, corticosteroids, antibiotics and oxygen therapy were administered according to the doctor’s instructions. Bronchodilators are given to dilate the bronchioles constricted due to asthma, and corticosteroids reduce inflammation in the airway (BNF 2011b). Kate was also started on antibiotics to combat the infection because, on auscultation, the doctor found that the chest was not clear.The Role of Assessment in Care In The UK Essay

Kate was being reassured during care, her daughter was encouraged to be visiting her mum regularly because she used to be settled whenever the daughter was around. The call bell was always in reach for to call when in need.

Kate was nursed in an upright position using pillows and a profiling bed in order to increase chest capacity and facilitate easy respiratory function by use of gravity (Brooker and Nicol, 2011). In this position, Kate was comfortable and calm while other vital signs were being checked. Pulse rate and temperature were also being checked and recorded because if raised, they indicate infection in the blood.The Role of Assessment in Care In The UK Essay

Considering Kate’s age and her breathing problem, she needed multi- professional teamwork. NMC (2008) encouraged teamwork to maintain good quality care. Kate was referred to the respiratory nurse who is specialised in helping patients with breathing problems. Specialist nurses have expert knowledge of a particular area of nursing, and as well as offering direct care, like ‘normal’ nurses, they educate patients in the management of their condition and can provide a consistent point of contact for sufferers of particular illnesses, which can help with psychological well-being (Royal College of Nursing 2010). Kate was on oxygen since admission; therefore she was taught about importance of healthy breathing and taught her about breathing exercises to help her wean from oxygen.

Due to breathlessness and loss of mobility it was difficulty for Kate to maintain her personal hygiene. Hygiene is the practice of cleanliness that is needed to maintain health, for example bathing, mouth washing and hair washing. The skin is the first line of defence, so it is vital to maintain personal cleansing to protect the inner organs against injuries and infection (Hemming 2010). Field and Smith (2008) stated that personal cleansing also stimulates the body, produces a sense of well-being, and enables nurses to assess the patient holistically. Personal hygiene is particularly important for the elderly because their skin becomes fragile and more prone to breaking down (Holloway and Jones 2005). This is due to slower epidermal cell renewal and a reduction in collagen (Hess 1998). Therefore this need was very important for Kate; she needed to maintain her hygiene as she used to, before she was ill.The Role of Assessment in Care In The UK Essay

The goal for meeting this need was to maintain personal hygiene and comfort. The care plan prescribed involved first gaining consent from Kate, explaining what was going to be done. Hemming (2010) recommended that identifying the patient’s usual habit is very important because each individual has different ideas about hygiene due to age, culture or religion. Identifying usual habits helps individuals to maintain their social life if things are done according to their wishes. Though Hemming said all human beings need personal hygiene, Holland (2008) argued that it is important to ask patients how they feel about being cleaned, especially genital area. Kate indicated that she didn’t mind being assisted with washing and dressing. She preferred washing daily, shower and a hair wash once a week, and a mouth wash every morning and before going to bed.The Role of Assessment in Care In The UK Essay

Kate was assisted with personal care after having her medication, especially the nebuliser. Individuals with asthma experience shortness of breath whenever they are physically active (Ritz, Rosenfield and Steptoe 2010). After having medication Kate was able to participate during personal hygiene. According to NMC guidelines on confidentiality (2009a), privacy and dignity should be maintained when giving care to patients. Therefore, whenever Kate was being assisted with personal care, it was ensured that the screens were closed and she was properly covered. Field and Smith (2008) suggested that assisting a patient with personal hygiene is the time that nurses can assess the patient holistically. Since Kate was immobile, it was very important to check her pressure areas for any redness. She was also checked for any pallor, jaundice, cyanosis or dry skin that needed attention. The care was always carried out according to her wishes.The Role of Assessment in Care In The UK Essay

Kate responded well to the medication she was prescribed; normal breathing was maintained, her respirations became normal, ranging from 18 to 20 respirations per minute, and her oxygen saturation ranged from 95% to 99%. Kate was able to wash and dress herself with minimal assistance. She was discharged on a continuous care package comprising care three times a day, although discharge was delayed by one week so that the care package could be ready.

The model of the twelve activities of living was followed successfully on the whole. The nurse collected subjective and objective data, allowing a nursing diagnosis to be formulated, goals to be identified and a care plan to be constructed and implemented. Privacy is very important in carrying out assessments, and this was not achieved fully in Kate’s assessment. However, this lower level of privacy has to be balanced against causing anxiety to the patient. Kate’s daughter thought that the bedside assessment would be more comfortable for her mother, and therefore cause least anxiety. This was very important because of the effects of potential panic on breathing; therefore, this was the correct balance to strike.The Role of Assessment in Care In The UK Essay

A multi-disciplinary team was involved in meeting Kate’s care goals. This is a good example of the use of inter-professional skills, as a number of different departments were involved in creating and implementing the care plan. However, the system was not as efficient as it should have been: Kate spent unnecessary time in hospital after recovery because the care plan was not yet in place.

Assessment can also take a long time, especially with the elderly who are usually slow to respond. Therefore, more time is needed to be sure that the necessary progress has been achieved before taking further steps. However, poor staffing also affects performance in this area, an observation supported by the Royal College of Nursing (2012).The Role of Assessment in Care In The UK Essay

In conclusion, the assessment of this patient was completed successfully, and the deviation from best practice recommendations (the lower level of privacy) was justified by the clinical circumstances. Progress from assessment to care goals was good, and at this point an inter-disciplinary team was used successfully. However, the one flaw in this process was delays, caused partly by the difficulties of working across different departments, and partly, it seems, by staff shortages. The Role of Assessment in Care In The UK Essay