Investigating the nursing process and nursing care.

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In this essay I will use the nursing process which is an individualised problem-solving approach to nursing care. It involves four stages: assessment (of the patient’s problems), planning (how to resolve them), implementation (of the plans), and evaluation (of their success). (Oxford Nurses Dictionary, Fifth edition, 2003 New York). I shall be focusing on one aspect of the nursing process, which will be implementation.

The implementation phase is when you put your care plan into action. Implementation encompasses all nursing interventions directed at solving the patient’s problems and meeting health care needs. While you co-ordinate implementation, you also seek help from the patient, the patient’s family, and other members of the health-care team.

(Lippencott, Williams and Wilkins, Medical-Surgical Nursing Made Incredibly Easy, 2004).

I have already used the process of planning to work out the solutions to my Patient’s needs. I referred to the workings of the SMART (Specific, measurable, achievable, realistic and time orientated) principle. (Hinchcliff, S, 2004) and the 12 activities of living by Roper, Logan and Tierney (Roper, N et al 2001) in order to help me achieve that.

Egan explains that ‘a helping model is like a map that helps you know what to do in your interactions with clients. At any given moment, it also helps you orient yourself, to understand ‘where you are’ with the client and what kind of intervention would be most useful’. (G.Egan, The Skilled Helper: A problem Management Approach to Helping 6th Edition).

I have used a pseudonym to comply with my patient’s confidentiality as stated in the NMC (Nursing and Midwifery council) guidelines (NMC Code of Conduct clause 5.1 2004).

My patient’s name will be changed to Rachel; she is 35-year-old lady who has been admitted to have a bilateral breast reduction.  She has been admitted to a surgical ward within the local trust. Rachel is married with two children who are two and four. She lives with her husband and children in the local area, with her husband being her next of kin.

I have focused on one aspect of care that was highlighted from the planning process, which is Rachel’s post-operative care. The nurse in charge explained the hospital’s policies and procedures for when the patient is received back into the ward from recovery. This was to check the airway is patent and the patient is breathing adequately. (Botti, M. and Hunt, J. (2000) The routine of post anesthetic observations. Contemporary Nurse 3(2): 52-57.)                                                                                                           The nurse explained that usually the patient is conscious before leaving the recovery room. Then I was told to record her temperature, pulse, blood pressure and oxygen saturation and compare the results with the patient’s pre-operative recordings. “One of the most significant nursing activities in relation to ‘prevention being the key’ is to keep observing patient/ client” (Kenworthy.N, Snowley.G, C.?Ask christy. Common Foundation Studies in Nursing, third edition 2002). The nurse told me to observe the wound and any drains that may be present. Such as a Redivac or a catheter. I was told that I will need to check, if an intravenous infusion is present, and that I should inform the nurse in charge of her care, so she can check the intravenous infusion is functioning according to medical staff instructions. The nurse explained to me how important it is to read the patient’s theatre notes to confirm the surgical procedure, which has been carried out and ascertain any instructions from the surgeon or anaesthetist. For example, positioning of the patient, oxygen therapy. I was explained that I will have to ensure that the patient is lying in the most comfortable position possible, and that the limbs are positioned in a manner, which will not endanger muscle and nerve tissue.  The nurse informed me, she would administer analgesia as required by the patient and as prescribed by the medical staff on her drug chart, as explained in the NMC guidelines for the administration of medicines london 2004. I was instructed to record blood pressure, pulse, oxygen saturation and respiration rates until they were within normal range and stable. Also to encourage and assist patient with breathing exercises to promote lung expansion, and therefore prevent chest infection.

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Simple nursing interventions, such as early mobilization and encouraging patients to do leg exercises while in bed, can help to reduce the risk of thrombus formation as well as urinary tract infections, pressure ulcers and constipation (Torrance C, Serginson E (2000) Surgical Nursing. London, Baillière Tindall.)

The nurse told me that the policy was also to allow graduated amounts of fluid unless contra-indicated (e.g. the presence of a naso-gastric tube), then gradually introduce solid food if there is no vomiting and if bowel sounds are present. Also to record the amount and time when the patient passes urine and when ...

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