Principles and Practice of Nursing Assignment

This assignment will show the writers understanding and knowledge of the nursing process. In order to do this a specific patient has been chosen, focussing on one goal of care highlighted through the use of the assessment of a nursing model. To maintain confidentiality and protect autonomy, the patients name has been changed and any details through which a reader could identify the patient or the care location have also been changed. This complies with the NMC professional code of conduct (2002). Furthermore for legal issues, the writer has gained consent from the selected patient.

The writer explained to the patient clearly what information would be needed in the report and that confidentiality would always be maintained. With this information the writer was able to gain informed consent. The information provided was gathered from a number of sources. Primarily the patient and their medical notes, but also from medical and nursing staff. The specific patient is Joyce, 66 years of age. Joyce visited her GP complaining of abdominal and back pain along with indigestion. After being referred for an ultra sound scan and having several blood tests, she was diagnosed with gallstones.

Halton (1994) verifies that gallstones are hard pieces of stone-like material that are made from cholesterol, calcium carbonate, calcium bilirubinate, or a mixture of these. They are normally caused when the chemical balance of your bile has too much cholesterol in it. This causes the bile to form into small particles which may then grow into gallstones. Joyce was prone to getting gallstones as Sanford (1982) explains that in more than 80% of cases, gallstones occur when your liver produces bile with high cholesterol content. An excess of cholesterol in your bile may be due to factors such as a high cholesterol diet and advancing age.

Joyce is overweight and has a past medical history of high cholesterol which is a direct link to gallstones. Her other past medical history includes ovarian cysts and a hysterectomy fifteen years ago. Joyce leads an extremely independent life and works part time as a school canteen assistant. She drinks occasionally, drinking between five to ten units per week and is a heavy smoker consuming thirty cigarettes a day. Upon the diagnosis, Joyce was referred to a specialist liver and pancreatic clinic where the choice was made that Joyce would require keyhole surgery to remove the gall bladder, also known as a laparoscopic cholecystectomy.

The care outlined in this essay is based on the assessment on admission 24hours pre operation. The nursing process is a problem-solving framework for planning and delivering nursing care to patients and their families (Atkinson and Murray 1995). It consists of four phases – assessment, planning, implementation and evaluation. This systematic approach to care is cyclical in nature and when used in nursing practice, will result in competent nursing care. The nursing process is beneficial to both the practitioner and the patient.

When the nurse becomes skilled in the use of this tool, they will gain confidence, job satisfaction, professional growth and opportunities to share knowledge. Benefits to the patients include continuity of care, improved quality of care and autonomy. Assessment Assessment can be defined as ‘the first stage of the nursing process, in which data about the patients health status is collected and from which a care plan may be devised’ (Oxford Dictionary for Nurses, 1998).

However, McCormack etal argues that ‘assessment is not just the undertaking of a set of technical skills; rather, it requires a certain kind of relationship between those who participate in it and with whom we share the purposes and standards of the practice’ (2004). Assessments should not only focus on the needs presented by the patient, but on the strengths and abilities that the patient may bring to bear on resolving those needs (Kemp and Richardson 1994). This approach enables the nurse to use the assessment to plan care that is truly person centred.

It was with this theory that Joyce was assessed. This is best approached through biography because all patients have a past, a present and a future. The NMC code of professional conduct (2002) explains that you must respect the patient as an individual. This means that you look at all the different elements that make up a patient. This provides the basis of holism. Siviter (2004) outlines that holism and holistic care look at the patient as a whole person, with unique and individual needs and circumstances. Holism ensures the nurse to see more than just the reason the patients are in care.

It encourages them to look at the way the patients feel, what is important to them and their families, their living situation and their beliefs. It focus’s on their spiritual, emotional, physiological, psychological and cultural needs. This ensures the care given meets all a patients needs in a respectful and dignified way. When undertaking holistic assessment, nurses have a key role in creating a picture of the patient that enables decision making which is representative of the patients life as a whole (Iyer etal 1995).

A biography can be built through discussions with the patient, patients’ family and friends. It is important to gain knowledge and understanding of the patients’ perspectives and needs to develop a care plan, as the care plan has to be meaningful to the patient if it is to be successful in maximising health. To make it meaningful, it is important to focus on social, psychological and spiritual needs of the patient, rather than just focusing upon medical needs. In order to successfully use the nursing process to asses a patient and plan care a nursing model should be used.

The model of nursing that is most familiar to nurses was originally developed by Roper in 1976 and was updated and added to in 1980, 1981 and 1983 by Roper, Logan and Tierney. The model has been used in a wide variety of nursing settings (Holland etal 2003). The model of nursing specifies 12 activities of daily living which are related to basic human needs and will be used to produce a care plan for Joyce. They are maintaining a safe environment, communicating, breathing, eating and drinking, eliminating, personal hygiene, controlling body temperature, mobilising, working and playing, expressing sexuality, sleeping and dying.

On admission, a full contact assessment is devised. The contact assessment is based around the 12 activities of daily living to ensure holistic care is achieved. When completing the contact assessment it is essential that effective communication is used. Robinson (2002) outlines that effective communication is an essential prerequisite for valuable nurse – patient relationships. Egan (1986) developed the acronym SOLER as a reminder of the behaviours, or physical tactics, which can be used by listeners to promote communication and improve their own reception of messages.

The rules of this are face the other person squarely. Adapt an open posture. Lean towards the patient slightly. Maintain good eye contact and try to be relaxed while paying attention. This will demonstrate interest. It is also vital that appropriate questions are used during the assessment process. Tactful questioning using open, closed and leading questions enable the nurse to gain as much information from the patient as possible. Moonie etal (2000) illustrates that using the appropriate language also plays a key factor in effective verbal communication.

The use of technical terms or medical jargon often leaves the patients feeling alienated. It also leaves the patient feeling disempowered which can consequently result as a barrier for the service user to collaborate with other professionals in the future. All these factors need to be taken into consideration when undertaking the initial assessment upon Joyce. The 12 Activities of Daily Living Maintaining a safe environment.

All staff around Joyce was fully aware of the infection control policies, Joyce was in a bay of four patients and regular hand washing and application of the alcohol gel was applied before and after coming into contact with her. Joyce was also promoted to cooperate with regular hand washing by showing where the sinks and alcohol gel were located. Joyce was fully able to recognise any dangerous or hazardous situations. Communicating. Joyce was fully able to communicate verbally, none verbally and written. She has no speech problems and doesn’t require any aids for hearing.

Her first language is English. Breathing. On admission Joyce’s respiratory rate was 16 resps per minute and 99% O2 saturates on air, these are within normal limits and show no signs for concerns. However Joyce is a heavy smoker. NHS (2008) outlines that smoking increases the chance of lung cancer, chronic bronchitis, emphysema and other problems such as regular occurrence of chest infections. This may not be a problem for Joyce now but could possibly reduce her recovery time or lead to health complications in the future. Eating and Drinking.

Even though Joyce is overweight, she explained that she’s recently lost weight due to the worry and stress of being ill. She has no dietary requirements at present, but has outlined that when she has fully recovered from the operation she would like help and advice to loose weight. Eliminating. Joyce is fully continent and no concerns expressed. Personal cleansing and dressing. Joyce is self caring with her hygiene needs. Joyce takes pride in her appearance and often has a beauty routine both in the morning and night. She expressed that she doesn’t want this changed and would like facilities to acquire this.

Joyce has brought into hospital her own nightwear and belongings. Controlling body temperature. Joyce’s body temperature on admission is 37. 6 C. This is above the normal range. She is not particularly vulnerable to changes in temperature, the room temperature is set at a medium heat on the thermostat and the weather outside is cold, to which Joyce is wearing the appropriate clothing. Mobilising. Joyce mobilises unaided, and mobilises independently. The waterlow risk assessment provides an indication whether a patient is at risk of developing a pressure sore.

Meyler and Trenoweth (2007) describe that the waterlow pressure ulcer risk assessment/prevention policy tool is, by far, the most frequently used system in the U. K. and it is also the most easily understood and used by nurses dealing directly with patients. It is based on a scoring system and categorised into four risk levels. On admission Joyce scored a 6, resulting in her being at a low risk of developing a pressure sore. However Lammon etal (1995) illustrates that even at a low risk appropriate measures can still be undertaken.

Therefore Joyce’s skin condition and reassessment of her waterlow score needs to assessed weekly. Furthermore Joyce should be educated how to relieve her own pressure areas and a appropriate moving and handling sheet should be completed. Working and Playing. Joyce leads an active life and works part time as a kitchen assistant. She thoroughly enjoys her job and would like a full recovery as soon as possible. Her operation has added extra stress at work as she explains they are regularly short staffed and has the added pressure of a lack of wage. Expressing Sexuality.

Joyce has been married to her husband for over 40 years and has a large extended family. She has expressed that she has never been separated from her husband and would like him to visit as much as possible. Sleeping. Joyce takes no medication to aid her sleeping and explains that she has a ‘good night’s kip’ most nights. She has not suffered any sleep deprivation before coming into hospital. Dying. Joyce did not feel comfortable discussing death. Kindlen (2003) reports that gallstones can sometimes cause flu like symptoms such as a high temperature.

Joyce’s baseline temperature on admission is 37. 6C. This is slightly above the normal range. The writer has chosen the goal of care is to control Joyce’s body temperature. The cause of the temperature could be for several reasons; disturbance of body tissues, malignancy or surgery but in relation to Joyce it could be a sign that gallstones are causing an infection to develop in her gallbladder. It is therefore highlighted that Joyce already has a slightly raised temperature has the potential problems of developing pyrexia.

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