Describing The Assessment Process For Hospital Ward Patient Nursing Essay

Describing The Assessment exploit For Hospital Ward Patient Nursing EssayThe purpose of this appointee is to describe how a soak up assesses a unhurried admitted to a hospital hospital ward. It will discuss the history of the persevering, any pre-existing aesculapian conditions and the spring they were admitted to the ward. It will in any case describe the hospital oscilloscope, the c atomic amount 18 for pretending utilization, the seek assessment joyrides and the selective information collected from the assessment including the require determine and what offer be and will be d unrivaled.For the purpose of this assignment the unhurried, health economic promote professionals and the swear must re chief(prenominal) anonymous, and will be referred to by pseudonyms. This is in unity with the Nursing and Midwifery Council (NMC) code, where it clearly states you must respect peoples right to confidentiality (NMC Code, 2008). The patient receiving assessment and guardianship will be referred to as Mrs Ethel Morris.Mrs Ethel Morris was admitted to an orthopaedic suffering ward within the North West. Orthopaedics is the correcting of deformities to the skeletal joints and bones, which imbibe been ca employ by damage or disease (McFerran, 2008).The ward consisted of many rung, including, suck ins, health kick assistants, a house officer, medical exam consultants and physiotherapists. It had triad bays, 2 being female, with 8 beds in each and one ten bedded male bay. similarly, at that place were 4 side rooms for patients that readed to be isolated.This was an acute setting with various Orthopaedic conditions, including bring outs of e truly types. The ward admits patients twenty-four hours a mean solar day from Accident and Emergency (AE) and transfers from other hospitals. Many of the patients admitted sport pre-existing medical conditions, which have to be taken into account alongside their fractures.Ethel was an 82-year-old l ady who had move whilst she was out shopping with her daughter. She usu every last(predicate)y walked with a walking stick to aid her balance, but with a previous history of insanity she had forgotten it. monomania is a progressive deterioration of the brain, caused by structural and chemical changes within the brain. Symptoms include, memory loss, disorientation and changes in personality (Ouldred, 2007).Ethels friend had called an ambulance at once after the fall, and she was admitted to the ward done accident and emergency.Ethels fall had ended in a fracture to the neck of thighbone in her left leg. Marieb (1998) states that the femur is the strongest and largest bone in the corpse. It consists of a ball, which is known as the head of the femur, which is carried on the neck of femur to the long bone. The neck is the weakest part of the femur.Elderly people are to a greater extent at jeopardize of falls as their muscles become weaker they become less(prenominal) flexible. This then(prenominal) interferes with their movement and balance, they become oft inactive and this increases the risk of falls. (Skelton et al, 1999)Ethel to a fault has osteoporosis, which whitethorn have contributed to her fracture. Liscum (1992) states this is the formation of the bone having decreased. Elderly women suffering from osteoporosis, who afterwards sustain a fractured neck of femur, face a fifty pct chance of not walking a put one over.Ethel appeared confused when she arrived on the ward, not versed how she had come to be in hospital, apart from being aware of the torture and discomfort she was suffering with her hip. The nursing staff reminded Ethel what had happened and checked her drug kardex immediately for pain sensation relief. The gear up who had seen Ethel in AE had written her up for 5ml of oromorph every terce hours to control the pain. As oromorph is a controlled drug the suck up checked the dot with another registered boot for and give it t o Ethel orally.Once Ethel was comfortable, the nurse in lodge of the bay began the nursing assessment.An assessment is the collection of information from an individual, to establish their needs and develop a clear prospective of their situation. The nursing exercise relies upon manage and thorough assessments to be a success. A key nursing dexterity is observing a patient, using all cinque senses, from listening to crystalise information, to touching them, assessing their temperature and the condition of their skin (Brooker and Waugh, 2007)Holland et al (2008) also states that an assessment identifies the anteriority amongst the problems. Data can be collected in a minute of different ways, from observing a patient, communicating with them and through their clinical notes. collecting of information can also be made through a secondary source (a relative), if, for example, the primary source (the patient) was unconscious.A named nurse admittance was used on the ward this pr ovides individualised care for the patient from entranceway to the point of discharge. Named nursing has been developed from primary nursing and is very nigh connected to team nursing. (Dawe, 2008)The ward follows a philosophy of care to carry out individual needs. Providing patient centred care, meeting individual needs whilst respecting their privacy, dignity, religious and heathenish beliefs. They strive to provide high property care and aim to tap the potential of individuals to adapt and cope with their conditions.The wards philosophy reflects the National Service Frameworks (NSFs) quality of care. NSFs are in place to improve care in 12 specific areas, including blood pressure, diabetes and mental health. The standards have been implemented nationally and they have all been set certain time scales. (Department of Health (DOH), 2008)The ward uses just round of the NSFs depending on which patient they are dealing with. In Ethels case the main ones being blood pressure a nd older people, which has eight different standards of its own.The nurse prototypicly recorded Ethels clinical observations, and her saturations appeared to be very low at only 89%. Oxygen saturations are monitored through an electronic art called a metre oximeter. This reads the oxygen levels of haemoglobin in the arteries and is updated with each pulse (Jevon, 2000).The nurse immediately put her on four litres of oxygen through a nose cannula. A Nose cannula is two small pliable tubes that are inserted into each nostril to administer oxygen. This allows room air to be breathed in at the same time and is secured by furnish over the ears, which fits onto the oxygen cylinder (Brooker and Waugh, 2007).The nurse carried out Ethels assessment by her bedside with the curtains drawn to respect her privacy. As Ethel had dementia her daughter was present for the assessment, to back details and sponsor with the process.Barrett et al (2009) states that nurses who carry out disorganize d, incomplete assessments, may fail to notice a major concern, or recognize an vestigial problem.Nursing models are used in the assessment process in most care settings. They are in place to establish the information that is required, ways it can be gathered for the best results, and the detail that is believably to be more helpful. (Aggleton and Chalmers, 2000)rope- take a crapr et al (2000) says that models are used to help organize thinking by cr consume theory. They are global views that have been summarised into systems. in that location are many different Nursing Models used in clinical settings from Orems self care model to Hendersons model of nursing. Nursing models are used to provide a distinctive framework, to highlight what the patients needs are (Fawcett, 1989).The nursing model used on this ward was Roper Logan and Tierney, Activities of living model. Roper et al (1996) activities of living consists of twelve activities that ensure survival, these are, maintaining a safe environment, communicating, breathing, eating and drinking, eliminating, personal cleansing and dressing, controlling of dust temperature, mobilising, working and playing, expressing sexuality, sleeping and dying. These activities are all as important as each other and one cannot be done without another. The impact of illness will affect more than one of these activities.Roper et al (2000) activities of living was first written in 1980 for nursing practice to be introduced to students. At this time there were five concepts in the model that included activities of living, lifespan and individuality in living. The model became the United Kingdoms most popular model and was also widely used end-to-end Europe.The nurse used a number of risk assessment prickings when assessing Ethel. These were, the malnutrition universal covering fire shaft (MUST), waterlow induce, falls risk assessment marking for the elderly (FRASE) and the Abbey pain scale. The MUST tool is a nutritional screening tool that recognises over nutrition (obesity) and under nutrition (BAPEN, 2008).The MUST tool was developed so nutritional care would improve in all care settings, by the malnutrition advisory group (MAG) of BAPEN. This tool can be applied to all adult patients, even those who are bed resound (BAPEN, 2008).As a result of the MUST screening tool, Ethel was commenced on a fluid balance graph. This appreciates the quantity of liquid intake, including Intravenous (IV) fluids and drinks, a collectst the total piss output. Also to be monitored was Ethels food intake, this was to be done on a food chart. This needed updating after every mealtime to show how much was being eaten at different times.The waterlow run into is to determine whether a patient is at risk of developing a pressure ulcer (Waterlow, 2005).This tool uses a scoring system, based on patients data. The categories include skin type, age, and continence. (Thompson, 2005) Ethels score was sixteen and she was at high-risk of pressure sores, this was due to her age and mobility.Waterlow (2005) first designed this tool for students use in 1985. It is the most frequent risk assessment tool in the United Kingdom (UK), and is used throughout hospitals, nursing homes and within the community. Pressure ulcers are most common in people with bony surfaces, thin skin and an unhealthy diet.Ethel was found to be a high risk of developing a pressure sore, as she was immobile and had tissue paper skin. The nurse commenced her on a turns chart so she would be rolled or moved every three hours to check and relieve her pressure areas. Also a pressure-relieving mattress was ordered for Ethel, this alternates the body areas under pressure by rotating the air throughout the mattress. (Collins, 2004)The FRASE assessment tool is to assess if a patient is at risk of a fall, taking into account their history and their current state. (Bolton NHS, 2003)Connard developed a fall risk assessment for the elderly in 199 6 this was then adapted into a crossbreed tool, known as the FRASE tool. It is in similar context to the waterlow score as they both use a points scale to assess the patients level of photograph (Kinn and Hood, 2001)The nurse carrying out the assessment began Ethel on a falls care plan, as she was at high-risk from having another fall. A member of staff was to update the care plan each day, noting any unsteadiness or falls. This was going to play a greater part after Ethels operation, as for the time being she was bed bound.The Abbey pain scale was developed in Australia to assess patients pain levels. It was used for individuals who had trouble communicating effectively and who suffered from dementia (Turner-stokes and Higgins, 2007).Abbey (2004) researched and developed the abbey pain scale between 1997 and 2002, and wanted it to be a straightforward and effective tool, used by all health care staff. It consisted of six scales to measure pain including physiological changes to c hanges in body language.Ethels score was seven and her pain level was acute to chronic during the assessment. The nurse had previously administered 5ml of Oromorph, and because of this the abbey scale was to be updated every hour to monitor the success of the pain relief.During the assessment the nurse collected various information from Ethel, including objective and ingrained data.Newson (2008) states that objective data is information collected that can be careful such as temperature and blood pressure. The MUST tool was used to measure Ethels weight, and other observations were recorded, including blood pressure which was 142 systolic and pulse of 84 these were all in satisfactory limits.Any data collected outside the normal range would have been given an early warning score. A doctor and the outreach team need informing if a score totals three or above (Baines and Kanagasundaram, 2008).Also collected was Ethels details that included her, address, date of birth, and her medic al history. This can be obtained through medical notes. as original records cannot be tampered with and all records made must be clear and exact (NMC Code, 2008). essential data is information that cannot be measured, for example, information that the patient has given about him or herself, or the nurses insight on the patient (Newson, 2008). The nurse asked Ethel questions to gain this information, if she felt nauseas, or in pain and how she felt about what had happened. Also observed was Ethels behaviour to see if she was agitated or frightened, closed body language showed she was as her arms were wrapped around herself. The nurse also looked at and noted the condition of her skin, nails and hair.Due to Ethels dementia she didnt understand very much of what was going on and didnt know how she had ended up on a hospital ward. Short-term memory is affected alongside nearly long-term memory loss. This affects the ability to communicate with people and can result in the patient aski ng the same question repeatedly (LEHR, 2006). The nurse had to keep reassuring Ethel about what had happened, how she ended up on the ward and what her plan was.Communication is a key skill in nursing and it is an essential part in building the patient-nurse relationship. The nurse has to gain dozens of information from the patient so it is important to know whether there is a communication barrier, such as a hearing problem or if the patient cannot read or utter the same language. They may need to speak more loudly or slowly so the patient can lip-read (Holland et al 2008).McCabe and Timmins, (2006) states that communication should be focused on the patient, rather than task centred. Listening, empathy and support are essential communication skills in nursing, but the main being to develop a relationship with the patient, and nurses should make time to spend with them.Ethels daughter stayed during the assessment process to help the nurse gain accurate information and communicate effectively with Ethel. The nurse had to speak slowly so she understood, and if she looked confused the nurse would reassure her and repeat the question. This process took a long time but it was necessary so Ethel could gain trust in the nurse. This made her feel more relaxed and comfortable as she could feel the warmth that had developed between them.This assignment has shown how a nurse has an important role in assessing, planning and the implementation of patient care. It has shown that nurses have to obtain data by using a various number of different sources, from assessment tools to observing patients behaviour. The nurse must also use a nursing model to help complete full and accurate assessments of patients and their needs. If there is a communication barrier, nurses must be able to bounce back it by using an interpreter or picture cards. The needs identified during the assessment process have to be implemented and care plans introduced. Nurses then have a responsibility to keep regularly updating the care plans by re-assessing the patient on a regular basis.