In the following piece of writing I will discuss how the Foundations of Nursing Practice module and my first placement experience have assisted in my development as a nurse. The unit where I spent my four weeks is a day surgery centre. Using experiences from the placement I will discuss the concept of individualised care and its relevance to nursing assessments and care delivery. I will also look at the professional and ethical issues that impact on nursing today, primarily focusing on the aspect of dignity and obtaining patient consent from the Nursing and Midwifery Council (NMC) Code of Conduct (NMC 2008). Another area I will cover is the development of the therapeutic relationship between myself and a patient, exploring various models of communication. I will reflect on the organisation and delivery of care I observed on my placement and the impact the care delivery may have had on a patient whom, for the purposes of confidentiality, I shall call Lily. All names used have been changed and consent gained as per NMC code of conduct (NMC 2008).
During my placement I met Lily. She is a 75 year old lady who attended the centre for cataract surgery. Following a consultation with an ophthalmologist, Lily attended a preoperative assessment with a nurse whom I shall call Rose. Kozier and Erb (2008) suggest that “the nursing process is a systematic, rational method of planning and providing individualised nursing care”. The process is a problem solving approach using the four stages of assessment, planning, implementation and evaluation (Yura and Walsh cited in Brooker and Waugh 2007).
For Lily, the assessment involved baseline physiological observations being taken and then answering a series of questions. These questions included information such as name, date of birth and religion, and any current illnesses, including regular medications, complaints, disabilities and allergies? They also included previous medical history, family medical history and nutritional history such as eating and drinking habits or problems, religious or dietary preferences. The assessment, in essence, follows the nursing model set by Roper Logan and Tierney’s Activities of Daily Living. This framework is used to identify the needs of an individual by using factors that are all interlinked with each other, individuality, Activities of Living, a dependence-independence continuum, progression during a life span and influencing factors such as biological or psychosocial factors (Hinchcliff, Norman and Schober 2008).
Nursing models work effectively when used in conjunction with a nursing framework such as Ropers (McCabe & Timmins 2006). As assessment is an on-going process, they are an essential tool for the multi-disciplinary team to utilise, ensuring patient care is consistent. However the quality of an assessment plan is determined by the standard of nurse completing the assessment. Experience and interpersonal skills will have an impact on assessment skills. Poor communication may also impact on the thoroughness of the plan (Spouse, Cook & Cox 2008). This relates to Bradshaw (1972) and the theory of listening to the expressed needs of a patient as opposed to the normative needs of the health care professional (Bradshaw (1972) cited in Naidoo & Wills 2009).
There are many nursing models. If we look at Orem (1971) in comparison the Ropers it can be seen that while Orem’s theory is systematic and has an emphasis on self-caring it is very illness based (Current Nursing 2012). Roper’s framework is more widely used; it takes a more holistic approach, the concepts are easily understandable, and if used in a comprehensive assessment, a nurse can gain more detailed information. However the model requires information regarding a person’s regular living patterns and any influencing factors and so a person must be able to communicate effectively for information to be collated (Spouse et al, 2008).
At the clinic every patient has a care...
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