What? (This is a description of the event)
Give a brief and relevant summary of undertaking a person-centred assessment of your patient, explain what happened.
So What? (This is an analysis of the event)
Analyse what affected the assessment positively or negatively and why you think so
Now What? (Proposed actions following the event)
Critique what you would/would not do again and why and/or what else would need to happen and why in order to improve future practice.
Clinical Care Need: use the information you gather during the assessment process to identify one priority clinical care need for your patient. Ensure you provide evidence base rationale to support the care need you have chosen.
I conducted a holistic assessment with a patient and for this assignment, confidentiality will be maintained by adhering to the Nursing and Midwifery Council Code of Conduct (NMC, 2015); no information regarding the hospital or ward will be mentioned, in accordance with the Data Protection Act 1998. The pseudonym Mrs. M will be used to maintain the confidentiality of the patient.
An assessment is a systematic and?continuous collection, organisation, validation?and documentation of information (Berman et al. 2010), it is a process of evaluating the patient’s mental, physical, social, cultural, spiritual and personal needs and of identifying the patient’s wishes in relation to the options available. (Howatson-Jones et al. 2012)
A holistic assessment looks at the person as a whole which helps to identify the patient’s needs, preferences and wishes concerning their physical and mental health therefore, helping them remain in control of their life with ‘dignity and choice’ (Gmecscn.nhs.uk, 2018). Holistic patient assessment is a tool used in nursing to give a holistic view of the patient healthy in general, their needs and provide the foundations of patient care. Through holistic assessment, improved communication and a therapeutic relationship is formed between the patient and nurse; and in-turn helps to provide quality person-centred care to the patient. A holistic assessment approach acknowledges and addresses many different aspects of the patient’s life and needs (Care and University, 2018), this includes the patient’s family. Treating the patient holistically will not only involve the current illness they have, but will look at the patient as a whole and use different aspects of their life’s such as family, friend, hobbies to help them in their recovery (Atkinson, A. 2008).
This is important because the information gathered during the holistic assessment determines the root or initial phases of nursing care (Luxford, 2012). As part of holistic assessment, developmental assessment can assist in making better informed, evidence-based patient care decisions by determining the person’s physical, behavioural, cognitive and social development (Weber, 2005). Throughout the essay I will be comparing and contrasting the information I gathered from the assessment with the patient and the information from the medical notes.
Before undertaking the assessment, I had a conversation with Mrs. M on how they would want this assessment to be carried out and why they feel that way; and what time suited them best. This was important in-order to develop a trusting relationship with the patient as they felt valued (Jenkins, 2008). Before going in for the assessment i organised and prepared myself, firstly by introducing myself and giving my name, position and purpose. This helped the patient to remember the purpose why I was there and therefore not feel anxious towards the assessment. I made sure my full attention was towards the patient and that she was comfortable.
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. Mrs. M was seated in her room for the assessment as this was a familiar place for her. 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,’ as this will reduce anxiousness as the patient will be in a familiar place and feel safe. Mrs. M felt comfortable in her room and felt she was safe to take the assessment in her room as she was familiar with the surroundings rather than if she was in a different room which makes her feel anxious. Throughout the process, I used open or closed questions and this was helpful when I wanted to get a yes or no answer from the patient and when I wanted the patient to express more I would ask them an open question which allowed them to give their answer in more depth (First Steps, 2018). I focused my questions on the patient’s main problems especially why she got admitted to the hospital.
During the assessment I also used the SOLER approach by Gerald Egan which was effective in that it helped to achieve the goal of the assessment and was an important means of communication especially in a none verbal way to the patient. Sitting attentively meant that I could look at the person directly and this showed that i was listening to the patient and this showed I was interested. I sat down with open poster, leaning forward and this was important because it helped the patient to open up and talk about her feelings and it made the patient feel listened to and showed I was interested in what she was saying. I made sure I make eye contact with the patient as this showed that I was interested and paying attention to what the patient was conveying. To make sure the patient did not get anxious I showed a relaxed body language and this was a positive and important thing to do as this conveyed to the patient I was not in a rush. This enabled the patient to give their responses to questions in their own time, which in-turn helped the patient not to feel anxious as she used to feel anxious if she felt she was being rushed. (Ocr.org.uk, 2018)
Nursing intervention person cantered care is a key aspect as Mr. Jones has the capacity to have an input in the amount of care he needs, for example how much support he needs from the nursing team or the physiotherapist. Providing that Mr. Jones is being offered the opportunity to contribute to his care would benefit him as he knowns what he required in order to recover (NMC,2015)
. Implementing use of holistic care allows the patient to be treated with all aspect of their life, which include, physical, social, psychological and spiritual aspect of life and be care for as an individual. Using holistic care also interlinks with caring for a patient using percent centred care this gets the patient involved with the care plan.
Also learnt more about the nursing intervention as a student seeing the nursing intervention first hand, using the knowledge learnt from university and introducing it on to the ward placement, I was able to ensure I was caring for the patients within the NMC guidelines. For future practice the knowledge I have gain through this assignment and the four topic; the older adult and the ageing process, Introduction to holistic care, nutrition for health and ill health and multidisciplinary team across the lifespan, carrying the knowledge that I have gained and use it on my next placements and keep on trying to improve my knowledge will benefit me, so that I am able to help more patients.
For the holistic assessment I undertook, I will point out what affected it positively and negatively and will analyse this. Firstly, I think the assessment went well because, during the assessment the patient was made to feel comfortable and was aware what the assessment was for. This was important because it helped the patient to be prepared for the assessment mentally and emotionally. The outcome of the assessment provided some vital information about the patient’s care needs, as she was able to express how she felt about her present health situation. There are a number of factors that affected the assessment positively. Before undertaking the assessment, I made sure the patient was aware of what was going on and the time this was taking place. This gave both the patient and me time to prepare for this task, which was important because it helped to reduce the patient’s anxiety towards the assessment (Jenkins, 2008). For the assessment I chose a place where the patient felt comfortable and was familiar with (Gordon, 2008). I made sure the environment was clean and it was not a crowded place as this would distract the patient which in-turn would have affected the assessment process with the patient (Alfaro-Lefevre, 2008).
This was beneficial to both the patient and myself in that the patient felt empowered about talking about their own care and making their own decisions, and to build a therapeutic relationship between the patient and myself and that I understood the patient and be able to tend to their needs effectively (Webb, 2008). However, the disadvantage of using the soler theory as reference to my assessment is that this approach required me to do many different gestures towards the patient. This made it difficult for me because I had to remember what was acceptable and unacceptable in certain cultures so that I may not end up doing gestures that the patient may feel disrespected therefore causing the patient not express their concerns fully (prezi.com, 2018), which was distracting my concentration towards the patient. Even though I manage to make sure that the environment was not crowded and it was a quiet place, this did not prevent other patients from entering the room and this would distract the patient. The room was not sound proof enough so if someone shouted, we could hear them and this distracted the patient which in-turn was causing her to feel anxious as she thought she was wasting my time by getting distracted.
The holistic assessment process, even though there were some negative things that affected this, the benefits of this process were much higher as this was proved by the reaction of the patient to the whole process. Since a holistic assessment focus on every aspect of the patient’s life, the patient pointed out that they felt respected and listened to and they felt more compliant to answer any questions. This process helped me to understand the patient more, their feelings, fears and worries. From the information I gathered I was able to attend to Mrs. M needs effectively and was able to produce a new care plan for them that suited their care needs, (Gordon 2008) thus ‘A complete assessment produces both subjective and objective findings’ (Wilkinson, 2006), which helps to provide person centred care for the patient.
For the assignment the things that I would do again are to make sure to get consent from the patient or family and to make sure that the patient understands the purpose of the assessment. This is important because it allows the patient time to…. therefore, helping to reduce anxiousness for the patient. ( ). When I was doing the assessment with Mrs. M, my ability to use best practice was shown in me incorporating all my skills and abilities, national care standards and codes of conduct together to complete the activity with my chosen service user. I did this by showing respect to the service user and treating her as a unique individual. I respected her wishes and choices throughout the assessment. I showed this by treating the patient as a unique individual and showing them respect and dignity and also not keeping them down by treating them differently due to their current health condition. According to the Nursing Midwifery respecting and treating people as individuals and upholding their dignity and autonomy is a key intervention in helping the patient maintain their self-worth (NMC 2015). Whilst doing the assessment, I managed to promote the independence of the patient whilst protecting them as far as possible and respecting and protecting their rights. I did this by letting the service user choose what they wanted to be put in their memory box rather choose for them. This also ties in with the codes of conduct because I was respecting and protecting their rights and because as a service user he had the right to choose. All this helped the service user to gain self-esteem, that is they felt proud and good about themselves.
person cantered theory which suggest that everything is centred on the person and his needs and according to Carl Rogers ‘humans have the tendency to develop towards their full potential,’ if the focus is on the person.
PART 3: Prioritise One Clinical Care Need
During my assessment process, the information I gathered has helped me to identify a priority clinical care need for the above patient. I chose this clinical care need because during the assessment, the patient expressed that all the problems she is facing with her general health and mental health which led to her been admitted in to the hospital at the present moment is due to her anxiety and stress. This is supported by the information I gathered from the medical notes showed that she was frequently calling her GP, extremely destressed anxious and agitated. According to the medical notes this was the major factors affecting the patient at the current moment even though they were other factors affecting the patient. This is also added with the fact that she has been diagnosed with COPD which meant that she experienced shortness of breath and this ended up with her needing to use oxygen to breath.
Relaxation Therapy is an approach that uses many different ways, techniques and coping skills to handle anxiety and stress. The key factor for relaxation therapy, is to consciously control breathing. This means becoming aware of the way the patient breaths in and out and making a conscious effort to incrementally slow them down to a more acceptable pace. It has been proven that when an individual learns how to self-initiate the relaxation response some of the negative effects of chronic stress may be counter-balanced (Ost, 1987). By learning the relaxation technics, this will help Mrs. M to control her breathing, balancing her stress levels and reducing her anxiety.
There are many different approaches used to achieve a relaxed state. The Jacobson Method of progressive muscle relaxation involves flexing specific muscles, holding that position, and then relaxing the muscles. Progressive relaxation may be practiced while lying down or sitting. This approach has been suggested for pain relief, to relieve anxiety including stress (Jacobson, 1987).
Applied relaxation involves imagination of relaxing situations with the intention of inducing muscular and mental relaxation (Ost, 1987). Relaxation therapy may include other elements along with the controlled breathing. Seeking a quiet spot to begin the process can also help expedite the achievement of a calm state.
However It is not clear if effects of relaxation therapy are long-term. If a person stops practicing the deep-breathing exercises, the symptoms of stress may return. While relaxation techniques may be used for conditions related to stress management, there is not enough evidence to form firm conclusions about the effectiveness of relaxation for other, more severe mental conditions (Ost L., 2000).
Often, in the midst of a stressful situation, it is difficult to relax. Sometimes doing something simple like, sitting in a comfortable chair, listening to soothing music, or taking a warm bath is enough to help a person to unwind. In other instances, the levels of anxiety and tension may be so overwhelming that a person may have to turn to a professional for help. Whether a person’s stress is spiraling out of control or they have already got it tamed, learning one of the various relaxation techniques can be beneficial. When practiced regularly, these activities lead to a reduction in everyday stress levels and a boost in feelings of joy and serenity. What’s more, they also serve a protective quality by teaching you how to stay calm and collected in the face of life’s curveballs.
Coping techniques of relaxation therapy can benefit people in many situations
PART 4: Develop an Outcome Focused Goal
Outcome Focused Goal: identify an outcome focused goal for this clinical care need, insuring the goal is SMART (Specific, Measurable, Achievable, Realistic, Timely) and involves the patient.
For the clinical care above, I have identified breathing exercises as an outcome focused goal for the patient which will help her to reduce her feeling of anxiety and stress. Taking calm, deep breaths has a soothing effect on your body. It’s not clear exactly why, but it’s likely that controlled breathing combined with a few minutes away from your stressful situation gives you an opportunity to relax in a way that few people can do in the moment. There are different types of deep breathing strategies, but the simplest involves sitting in a chair with your back straight and your arms on the armrests. You take a deep, slow breath in through your nose lasting close to 5 or 6 seconds. You then hold for a few seconds, and breathe out slowly through your mouth, taking close to 7 seconds (breathe out like you’re whistling). Repeat 10 times. Advanced deep breathing combines both of the benefits of the above two breathing exercises, making it great for those suffering from severe anxiety and panic attacks. However, it can be hard to master in a time of panic, so many people struggle to perform this type of exercise at first. If you’re confident you can get the strength to use this exercise, you may find yourself able to calm down much faster. It can be very hard to perform this type of exercise, especially if it’s your first time with breathing exercises. During an anxiety attack, it’s hard to gather your thoughts enough to count heartbeats and calm your body. But if you can master this technique, you’ll find that you should be able to calm yourself during a panic attack, and possibly experience some relief from your panic symptoms. (Calmclinic.com, 2018)
She will do this twice a day in the morning and then at night time as this is the time when Mrs M feels more anxious. This goal will be ongoing as this is a long term goal to help the patient manage her anxiety. The patient will achieve this goal with the help of the physio-therapist, who will be monitoring Mrs M and also by doing this herself in her own time or when she feels anxious.
Specific Twice daily
Achievable The goal does not require a lot of preparation
Timely Will be reviewed weekly