Critically Reflective Portfolio Extract Related to One of the Nmc (2004) Standards of Proficiency for Pre-Registration Nursing Education, Allowing the Integration of Theory with Practice

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The aim of this assignment is to produce a critically reflective portfolio extract related to one of the NMC (2004) standards of proficiency for pre-registration nursing education, allowing the integration of theory with practice. The standard which is going to be explored will be to Create and utilise opportunities to promote health and well-being of patients, clients and groups (NMC 2004). The author will reflect on a situation which occurred whilst on a community placement, and also include a brief overview of the topic going to be discussed. For the purpose of this assignment, the author will focus on smoking as the main topic explored, due to the word limit, using the nursing process of assessment, planning, implementation and evaluation. This assignment will systematically review the literature relating it to the health promotion initiative chosen using Ewles and Simnett (2003) Five Approaches to Health Promotion model. The behaviour change approach is the main focus for this essay. The behaviour change approach as described by Ewles and Simnett (2003) is a way of encouraging changes in an individual's attitudes and beliefs to take up a healthier lifestyle. In accordance with the Nursing and Midwifery Council, (NMC) Code of Professional Conduct (NMC, 2004) on safeguarding patient information, no names or places will be disclosed. Therefore, throughout the following assignment, the patient will be referred to as Jack. Cigarette smoking is the greatest single cause of illness and premature death in the UK. Approximately 106,000 people in the UK die each year due to smoking. Smoking-related deaths are mainly due to cancers, COPD (chronic obstructive pulmonary disease) .and heart disease (patient UK 2009).

Patient profile
Jack was a 75 year old gentleman who had smoked nearly all of his life and was presenting signs of breathlessness (dyspnoea). He explained that he was diagnosed with chronic obstructive pulmonary disease (COPD), which the doctor stated was emphysema the year previously. Emphysema decreases the efficiency of the gas exchange process (Shaw 2005) which is the reason for Jack’s dyspnoea. Quitting smoking can slow down the progress of the condition (NHS 2008). A full patient profile is included in (Appendix A).

Assessment is the first part of the nursing process (Archibald, 2000) and nursing observations are an essential part (Jevon & Ewens, 2001). The cycle incorporates a pre-contemplation stage where the individual is unaware of any need for change or has no interest in changing (Ewles and Simnett 2003). At this stage the nurse assessed whether Jack was genuinely interested or not interested in stopping smoking at that present time and respected his decision. The nurse issued a leaflet about giving up smoking, as having the information readily at hand may prompt the individual to think about stopping smoking. The advantages of leaflets are that they allow individuals to read through them at their own pace (Ewles and Simnett 2003).
Jack’s physical examination was performed by the nurse which according to Smeltzer and Bare (2003), provide a baseline for comparison, provide early recognition of deterioration and are useful to monitor changes in the patients’ condition. Jacks respiratory rate was quite high of 21 breaths per minute, which is just outside the normal range for an adult (Dougherty and Lister 2008). The Nurse should take into account Jack may have been aware of the respiratory assessment so subconsciously may have been affected by nerves (Moore 2007). It is the nurse’s role and responsibility to promote health and well being and it was apparent that the reason for Jack’s breathlessness was due to his smoking. Jack was informed by the nurse that if he were to stop smoking, it would prevent any further damage, would relieve any symptoms, would slow down the...
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