Care Plan

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Part B
I found this particular portfolio more challenging than previous ones. The main reason for this was the fact that I was the required to actively take part in the assessment, planning, implementation and evaluation of a patients care within the service. Doing this came with responsibility that I had not had in previous placements. My preceptor had explained to me the process involved in care planning for a patient on the unit, the doctor will do the majority of the assessment, the nurse carries out the risk assessment and completes Roper Logan and Tierney nursing assessment which is the nursing model used by the Louth/Meath services. The nurse also carries out an admission checklist. When the patient has been admitted and the nurse has gathered all the relevant information they will then incorporate the care plan. I familiarised myself with the documents, I will admit I felt a little apprehensive; I was worried I might say the wrong thing or ask the wrong question. As John had a previous history, I had been informed that he suffers severe paranoid delusions. This immediately alarmed me in the sense of communication difficulties. When John arrived on the unit by Gardaí escort he was extremely paranoid and agitated. Initially he was seen by the duty doctor who conducted the assessment (appendix “A”). The assessment took place on the unit, my preceptor and myself were present. Throughout John remained guarded and uncooperative, it was difficult for the doctor to gather information from him. This is evident in the recovery care plan section as John would not engage or answer any more questions. Assessment is the decision making process, based upon the gathering of relevant information, using a formal set of ethical principles, that contributes to an overall estimation of a person and his circumstances (Arnold & Boggs, 2007). Throughout the assessment I was thinking how am I going to gather information from John when the doctor who has years of experience is finding it difficult. After the doctor had finished their assessment, i carried out a risk assessment which was a priority. Assessing and managing risk is a core part of the practice of all mental health nurses, regardless of whether they practice in a high security unit or in a primary care setting (Townsend, 2008). Mental Health Nurses need to be well trained in risk assessment and management. They should work closely with clients and others to develop realistic individual care plans (Schultz, 2009). I found the risk assessment (see appendix “C”) difficult to carry out as the questions were very personal and evasive. The risk assessment is a crucial element of the assessment process (Ashby, 2006); it was in John’s best interest and the best interest of the other patients on the unit. Before beginning I explained to John that I was going to ask him some questions, I did tell him that the questions were quiet personal but that it was in his best interest to answer them honestly as his safety is paramount to us whilst he is in our care. I began the assessment and went through each section (see appendix “C”), John did to my surprise co-operate with me on some areas of the risk assessment. He refused to answer some questions and became un-cooperative towards the end of the assessment. When asked if he had any desire to leave the unit, he said no, this was untrue. John was in denial he told us that the Gardaí did not bring him unto the unit. The decision to place him on level 3 observations was made, even though he expressed no desire to leave the unit, this judgement was made considering Johns behaviour, the nursing staff were sure that once an opportunity arose John would abscond. The risk assessment process is an integral part of a nurses role (ABA, 2000), it enables optimum care levels, values risk taking and attempts to reduce risks, though it is rarely possible to eliminate them (Forster, 2001).

The next stage was to complete Roper, Logan...
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