Explore the assessment process and how it informs the assessment of a patient.

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The admission into hospital of a patient is routine for hospital staff, but forms a major event in people's lives. It is suggested often as being a source of anxiety and stress (Scrambler 2002). The aim of this essay is to explore the assessment process and how it informs the assessment of a patient. I aim to effectively assess a patient on my most recent clinical placement, using evidence-based practice. The ethical issue of consent needs consideration. I explaining to the patient the purpose of my assessment. That all the work would be confidential, and a pseudonym would be used in the essay to protect her identity, as stated in NMC (2002) section 5. By doing this I gained valid, informed consent NMC (2002) section 3.

I aim to discuss effective communication, by reviewing and reflecting on my interviewing techniques and interpersonal skills. I will introduce the patient and give a brief social, biological and personal history. From this assessment I will highlight one patient problem and discuss the biological, sociological and psychological perspective, which influences and informed the care given. During the assessment I used the Roper- Logan-Tierney model for nursing. I aim to discuss the advantages and disadvantages of using this nursing framework, and compare it to a more appropriate nursing model in relation to the individual patient problem.

Introduction of Patient

The patient I have chosen for the purpose of the assessment will be referred to as Janet.

Janet is an 84 years old independent widow admitted into hospital via GP referral. It was during Janet's admission that nursing assessment took place. Janet is an intelligent woman and very aware of her surroundings, she was happy to be involved in the assessment. She has two children both who live close to her and give her a great deal of social support. Janet is a retired personnel manager and worked full time until her retirement. She was admitted into hospital due to exacerbation of her chronic obstructive pulmonary disease. This is her first admission into hospital due to this disease. Janet was a smoker, she smoked 10 cigarettes a day for 40 years and gave up two years ago when she was first diagnosed. Janet has help at home from home care services, to perform tasks such as housework and general maintenance of the house and garden. Janet manages to cook for herself and attend to her own personal care. She is an affluent lady and lives alone in a four-bedroom house, and is use to her own personal space.

Process of assessment

The use of nursing models developed initially in the USA ''to provide a basis for nursing practice that went beyond following medical instructions'' (Walsh 1998). During the assessment process the Roper-Logan-Tierney model of nursing was used, in relation to the Gloucester Patient Profile, which was adapted from this model. There is little evidence written on the Gloucester Patient Profile, but it is being used as a derivative of Roper, Logan, and Tierney model for nursing.

The Roper model of nursing, which is based on Virginia Henderson's 'Human Needs' based on Maslow's analysis of Human motivation, emphasises the importance of considering factors such as age, culture, education and environment, as well as psychological and social factors. All of which influence health and an individuals potential for health (Hinchliff 1994). This model uses the nursing process as a system to deliver nursing care, and is based on the 12 activities of daily living. Maintaining a safe environment, Communication, breathing, eating and drinking, eliminating, personal cleansing and dressing, control of body temperature, mobilising, working and playing, expressing sexuality, sleeping, dying, (Roper, Logan and Tierney 1996).

The use of nursing model is a way to inform assessment by establishing the kind of information required (Aggleton and Chalmers 2000). It gives a guideline to the nursing assessment, by collecting baseline information, assessing patient needs, and helps to plan, implement and evaluate their care.therefore nursing models help us to underpin and direct the care of the individual, and provide an individualised holistic approach to nursing care.

Assessment should be done continuously throughout the hospital stay as this will help provide continuity and quality care. Aggleton and Chalmers (2000) discuss how individualized care should be given according to the patient's individual needs, such as culture, age and ethnic origin. This is also highlighted in the NMC (2002) in section 2 where it states ''as a registered nurse you must respect the patient as an individual''. Ogden (2000) and Brown (1996) discuss how assessment of patients will help the nurse identify the patient's own perception of their health and needs. I believe this can be achieved during the assessment by hearing the patient own story, gaining an insight to the person's life. This will help identify problems; needs and concerns of the patient (Hincliff 1994). I feel it will also give a clear picture to the nurse, of the patients understanding of what is happening to them and any psychosocial problems they may face. This knowledge can then help plan evidence based care with clear rationals, which are patient centred (Kagan and Evans1998). Balzer-Riley (2000) agree with this and believe communication is also fundamental to the assessment process (Communication will be discussed further on page 5). Enabling the patient to form a connection to someone, and build a relationship will enable effective communication throughout there hospital stay.
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Janet had arrived on the ward one hour prior to her assessment, she was allowed time to settle in and familiarise herself with her surroundings. During this time her stress levels had become increased. Contributed by the sociological factor of having to share a room with a patient, which she felt was from a different social class and culture. Janet arrived at visiting time so had met the ladies son. She found him scruffy and unpleasant and explained to me that she thinks he is a drug dealer. Being in a hospital environment often throws people together of ...

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