Assessment and Nurses

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Module Assessment

The aim of this assignment is to explore the four stages of APIE, explaining their importance in nursing, as well as identifying possible problems within the stages, in relation to the videos of Joe. These issues will then be anaylsed using theory, to create possible explanations and consequences for the behaviour and actions shown by Joe and the nurses.

APIE is a nursing process which guides health professionals through the problem solving approach, which promotes the individualised, holistic delivery of care. It is tailored around the patient’s needs and allows nurses to holistically assess the patient, then plan and set goals according to the information gathered. These plans and goals are then implemented into the care delivery and evaluated for effectiveness (Wilson, 2012).

Assessment
Assessment requires looking at the patient holistically and establishing what the patient was like before being admitted and what they are like now. If there is any change between the two, then the cause of this change must be identified. Once this is established, a detailed plan can be derived to tackle the actual problem and potential problems which may arise as a result. Assessment is important because it views the person as an individual (Barrett, Wilson and Woollands, 2009).The consequences of wrongly assessing a patient are that at the planning stage, care may be tailored incorrectly to their gender, religion and other factors which are paramount to that individual. This will in turn affect the way care is implemented. An individual’s culture, values and beliefs are highly influential in establishing what the carer may do for them and what they prefer to do themselves (Baldwin, Longhurst, Smith, et al, 2003).Information collected may be objective or subjective. Objective data is measurable and verifiable whereas subjective data is determined by the individual in order to understand their experience (Long, Phipps and Cassmeyer, 1995).In order to validate and verify the information collected during assessment, it is crucial to relay the information collected back to the patient (Lippincott, Williams and Wilkins, 2007).

One explanation of Joe’s behaviour is the Cognitive Dissonance Theory (Festinger, 1954) in the sense that he expresses an idealistic view by saying that he would not change anything about the implementation of his care and stating that all the nurses are lovely. These statements are contradicted by the fact the nurses do not acknowledge him when he repeatedly asks for his glasses, and they talk over him and ignore him as he is getting out of bed. He makes excuses for their bad practice by stating that the nurses are busy and that it does not matter anyway because he does not have anywhere to go. Joe may be using cognitive dissonance as a coping strategy to maintain harmony and avoid the truth (McLeod, 2008). Coping strategies are a way of the individual dealing with their problem to make it more manageable. These strategies, whether adaptive or maladaptive, should be identified though patient interaction in the assessment stage. If the coping strategy is maladaptive thenit should be identified by the nurses and then plans and goals should be set out to find the cause of this behaviour and how to rectify it. Joe may be using a coping strategy to cope with hisdeterioration in independence, since becoming immobile and incontinent. The reasons behind these problems occurring should be identified at this stage, before moving on to the planning stage (Barrett et al, 2009).

Physiologically, Joe is at Stage Eight of Erikson’s (1980) Development which means he should be at a stage where he is evaluating his life and passing on his wisdom to others, however Joe is not able to communicate in the home as he is sat alone at meal times and is not listened to by the carers. Erikson (1980) states that we continue developing until we die and that by Joe’s stage, all the ego strengths from the past...
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