Foundations of Nursing Practice

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A reflection on how the module content and associated practice experience has contributed to the student’s development as a nurse.

This essay is a discussion on how the module content and practice experience has contributed to personal development as a nurse. Therefore it will focus on firstly the concept of individualised care and its relevance to nursing assessment and care delivery, secondly the ethical and professional issues that impact nursing such as confidentiality, consent and dignity. The essay will also focus on exploring the various communication models and the development of the therapeutic relationship between the nurse and the service user, and finally the organisation and delivery of care within the practice environment. With particular reference to a recent placement, at a palliative care nursing home, this essay will discuss Harriet, an 88 year old lady with chronic bronchitis and suffers with multiple sclerosis. For confidentiality purposes the names of service users have been changed to comply with the Nursing and Midwifery Council, Code of Conduct (NMC 2008).

This assignment will firstly discuss the individualised approach to nursing, which developed in the USA during the 1950’s and 1960’s, which coincided with the development of the nursing theory and models of nursing which began to challenge the medical model of health care (Lloyd, Hancock, Campbell 2007). The nursing process can be carried out successfully by implementing a popular model used extensively in the UK originally by Roper et al Activities of Living model in which it is based loosely upon the 12 activities of daily living; however Henderson acknowledges 14 activities that people engage in (Kozier, Erb 2008). This model identifies any deficit in their care usually upon admission; it is reviewed as the care plans of the service user evolve; after which an intervention may be given to the service user. The nursing home that was attended for placement had person centred care plans in which they based them on the 12 activities of daily living from sleeping, eating and drinking to mobility and communication; these were short term care plans that were reviewed monthly.

Another model that is frequently used described by Ellson (2008, pg22) is the Nursing Process, when it was initially identified; Yura and Walsh (1978) showed that it is a four stage cycle that begins with assessment. Harriet was assessed by the Doctor as the registered nurse in charge (RGN) noticed a change in her health; she had developed a wheeze when talking and had a chesty cough, the RGN suspected a chest infection. A care plan was then devised to follow up the assessment. Harriet was to be started on a course of antibiotics for a week, and was to be resumed on her nebuliser. The care was then implemented the following day during the morning drugs round. An evaluation of that care completes the cycle; in which Harriet was to be seen by the Doctor the following week after completing her course of antibiotics and was to remain on her nebuliser. Additionally, more than one stage can be occurring at the same time, for instance assessment may coincide with implementation (Carpenito-Moyet 2007). If goals are achieved after the first cycle, care maybe terminated or in some cases modified and the service user reassessed. (Ellson 2008, pg22) This process is designed to enhance systematic care, drive communication amongst team members and encourage continuity (Mason 1999 cited in Habermann, Uys 2006).The RGN wrote in Harriet’s daily report and updated her care plans, identifying her change in medication and change in her health.

Throughout nursing there are many ethical and professional issues that impact on it from confidentiality, consent to respect and dignity, to clear and accurate records and working as part of a team. The Nursing and Midwifery Council Code of Conduct (NMC 2008) clearly states that nurses should ensure they gain consent (NMC 2008) from the service...
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