Care of the adult in hospital setting

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In this assignment a patient assessment was carried out, which demonstrates the use of a named nursing model. In this case the nursing model is the Roper, Logan and Tierney. This model is an assessment of the activities of daily living.

Interpersonal skills used in the assessment process are discussed and their effectiveness evaluated. A patient assessment was carried out using a nursing model, one actual or potential problem highlighted by the model was identified, and the strategies set out to deal with this problem will then be discussed. Before the patient assessment was carried out, it was ensured that consent was obtained from the patient prior to their inclusion in the assignment.

Throughout the assessment and the following assignment confidentiality is maintained to a high standard by following the NMC code of conduct, ‘you must respect people’s right to confidentiality’ (NMC 2008).

The data protection act (1998) was followed throughout. For the purpose of this assignment all information regarding the trust, hospital, ward and members of the multi disciplinary team were altered and the patient was referred to as Mr. Raymond Wilson to ensure the patients rights to confidentiality.

The assessment was carried out on an eighty eight year old man who was admitted to an elderly orthopaedic trauma ward following a fall. The diagnosis was a suspected fractured neck of femur. The assessment took place in a busy ward; the patient was located in a six bedded bay. The curtains were pulled around the patient bed to try and maintain privacy and patient confidentiality.

The nursing model used in this patient assessment (Appendix 1) was based on the theories of Roper, Logan and Tierney (1996). It assesses patient activities of daily living in a twelve point plan. This includes points such as maintaining a safe environment, communication, breathing, eating and drinking.

The first interpersonal skill that was looked at before starting the assessment was the environment. The environment is a key part in communication and the wrong environment can hinder the overall outcome of the assessment. The environment in this assessment was a bed in a six bedded bay. As the information required from the patient is confidential the curtains were pulled around. Raymond was in his chair with the table in front of him and I sat on the bed next to him. I feel that the environment in this assessment could have been more effective. The first factor that I would like to have changed would be the actual room.

 As the assessment involved confidential information I felt that the six bedded bay was not private enough and other patients could easily over hear what was being said. However there was nowhere else available to do the assessment. Ideally I would have gone to a private room where the patient would feel that anything said would have been truly confidential.

Also Raymond had a table in front of him while the assessment was taking place and this was a barrier between me and the patient. This may have hindered the assessment because the table may have given the patient something to hide behind stopping him from being fully open. During social interaction with others a certain distance is kept from them this is called proximity (Williams, D 1997).  Nurses usually maintain what is known as social or consultative proximity, which is between 1.2 meters to 3.6 meters away from their patients. However sometimes it is acceptable for a nurse to be closer to their patient when they are providing treatment to them or giving a diagnosis. When sitting next to a patient, the closeness of the nurse to the patient can symbolize rank or the relationship between patient and nurse

There are two types of communication skills used when assessing a patient verbal and non-verbal. Verbal communication is the spoken word and although it is the most obvious form of communication it represents only a small amount of how humans communicate with one another. Non-verbal communication skills or what is often referred to as body language, is how we communicate without using speech. This style of communication has a tendency to be viewed as more accurate or honest than verbal communication (Stein-Parbury, J 2000).Throughout a human’s life time the use of non-verbal skills goes full circle from using non-verbal skills as babies to when senses such as sight and hearing start to deteriorate in later life Both forms of communication were used during in the assessment. I have looked at each one and evaluated how they were used.

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Body posture is the position of the body and limbs, such as the placement of the head, arms, legs and the position of the body in relation to the person, whether it is leant forward, backward or sideways. Body posture can be seen as open or closed. An open body position is perceived as more welcoming (Williams D 1997). When a person sits quite close to someone or has their legs pointing in the direction of the person this is seen as an open body position. Whereas if they sit with their arms and legs crossed and their body ...

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