Assessing Student Nurse in Planning Patient Care: Holistic Assessment

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This assignment will focus on the holistic assessment and care plan of a patient who was cared for during practice placement. It aims to discuss how the care planning decisions were made and relate these decisions with the relevant literature. The setting was an emergency trauma and orthopaedic ward and the care plan was developed in order to meets the patient’s needs after 1 week admission. The care plan was compiled by the student nurse and his mentor and aimed to identify the patient’s needs and the necessary interventions to meet these needs. The Nursing and Midwifery Council (NMC) Code of Professional Conduct (2008) states that a person’s right to confidentiality must be respected, therefore pseudonyms will be used to refer to individuals and all personal information used within the care plan are fictitious. Also, consent was obtained from the people involved in this scenario. John Smith is fifty seven years old and was admitted after a fall and consequently left neck of femur fracture. He has undergone surgery to repair his fracture and was able to mobilize with full weight bearing a day after the procedure. However the post-op x-ray three days later has shown a crack fracture below the prosthesis and John was put on bed rest with 5lbs traction on his left leg for six weeks. John was born with cystic spina bifida, and has no motor sensation on his legs, however he was able to mobilise independently using elbow crutches before the surgery. In spina bifida, the spinal cord is damaged or not properly developed and as a result, there is always some paralysis and loss of sensation below the damaged region. The amount of disability depends very much on where the spina bifida is, and the amount of affected nerve tissue involved. Also, bladder and bowel problems occur in most people with spina bifida, as the nerves come from the bottom of the spinal cord, so are always below the lesion (ASBAH, 2010). John is expected to stay in the ward for at least another eight weeks and will be discharged home once he is able to mobilize again. The care plan was elaborated following the model developed by Roper, Logan, and Tierney in the 1970s, which is based on 12 activities of living and link the biological, social and psychological needs required for health (Kozier et at, 2008). This model is widely used on the ward and allows nursing staff to use a holistic approach when planning care. Alexander, Fawcett and Runciman (2007) say that with this model, nursing interventions are grounded in the prevention, resolution, and management of actual or potential problems related to the activities of living, which may be influenced by biological, psychological, socio-cultural, environmental, and politico-economic factors. The assessment using this model integrates the patient’s biographical and health data, thus providing information for both nurses beginning care and the Activities of Living data, which is focused on the patient’s abilities to carry out the activities of living and routines, along with current problems (Roper, Logan and Tierney, 1996). Together with the care plan, other nursing assessment tools were used to aid on the patient’s care. The Nutritional Screening and Prevention and Management of Pressure Ulcers was incorporated to John’s care plan and updated weekly. For the purpose of this assignment, two aspects of the care plan will be prioritised and the decisions made by the nurse when planning his care will be discussed in relation to theory.

To identify and assess John’s needs it is necessary to adopt a person centred care approach when assessing him in order to deliver the appropriate care. Potter and Perry (2007) argue that assessment is vital to the nursing process, therefore this approach needs to be patient–centred and can be adapted in accordance with the patient’s needs. Ford and Mc Cormack (2000) argue that the person centred approach represents a development of healthcare services at which the needs of the...
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