Advanced nursing Practice
The aim of this essay is to demonstrate the development of existing skills in health assessment and critically utilise outcomes of advancing health assessment as the basis for expert decision making in stroke patient care.
This assignment will compare four cases describing my journey through the development of health assessment skills using the medical model of assessment, ‘history, examination and diagnosis ‘and joining it with the nursing assessment to give a holistic approach. The process of formulating a diagnosis will be explored, together with how advancing practice has enabled me to use collaborative working and expert decision making to improve the care of stroke patients. The identity of all patients and colleagues referred to in this essay will be anonymised as in accordance with the NMC Code of Conduct (2008)
Stroke is now considered a medical emergency. The department of health now categorise potential stroke event as category A response similar to a Myocardial infarction (DH 2007a).Saver (2006) had estimated that for each minute untreated a person will lose 1.9 million neurones and 14 billion synapses. The acute care of a patient with a suspected stroke is dependent on rapid recognition of the symptoms and signs of the stroke, immediate CT scanning to exclude a haemorrhage and treatment where possible including potential thrombolysis to improve blood flow to the ischaemic brain. Once a diagnosis of a stroke has been made and haemorrhage excluded on CT and a symptom onset within four and half hours has been determined (ECASS 3) the patient may benefit from thrombolysis using alteplase. In selected patients alteplase can considerably improve the outcome for patients in reducing long term disability (NINDS 1995). The increasing focus on acute and hyperacute stroke care together with development of stroke units and community stroke
services mean that nursing staff with advanced health assessment skills play a vital role in the early rapid assessment and initiation of stroke care. Avoidance of complications and secondary prevention of further events is also vital. Throughout the assessment and reflection of each of the cases referred to, the emphasis on time and good history taking is essential to clinical decision making/reasoning within the emergency setting where patients initially present. The cases were selected based on their presentation and underlying theme of a classic stroke presentation.
Good assessment starts with good history taking from the patient from which a provisional diagnosis is then tested by examination and then diagnostic tests (Epstein et al 2004). History taking is commonly utilised as a key factor in formulating a diagnosis (Mursell 2010). The success of the medical consultation depends not only on the assessor’s clinical knowledge and interview skills but also on the nature of the relationship that exists between AP and patient. For this reason, increasing emphasis is being placed on communication skills alongside history-taking in advanced health assessment training in order to enhance the AP-patient relationship and promote more effective consultations. How we communicate is just as important as what we say. The patient needs to feel sufficiently at ease to disclose any problems and express any concerns, and to know they have been understood by the assessor. The patient also needs to reach a shared understanding with the
practitioner about the nature of any illness and what is proposed to deal with it. As well as being more supportive for patients, good Communication skills make history-taking more accurate and effective.The ability to take an accurate medical history from a patient is one of the core clinical skills and an essential component of clinical competence. All four cases had a dysphasia therefore the efficacy of questioning a patient who presents with expressive...
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