Nursing case study. The aspect selected is pressure area care and nursing models, knowledge, and theories necessary to deliver care when assessing the risk of developing pressure ulcer will be discussed. In accord with NMC Code (2008), confidentiality wil

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This assignment is about an aspect of nursing care and how nursing theories, models, and knowledge affected the way this care has been delivered to patients and how it has been communicated to others, which I could observe while on placement. The aspect selected is pressure area care and nursing models, knowledge, and theories necessary to deliver care when assessing the risk of developing pressure ulcer will be discussed. In accord with NMC Code (2008), confidentiality will be maintained and names have been changed.

The placement happened in an acute medical ward, with a wide range of medical problems; where many patients were elderly people and people who need to be bed rest due their condition, while in hospital. Both types of patients are in high risk of developing pressure ulcer, and I could observe and help the nurse called Claire in the assessment of patients in risk of development of pressure ulcer and in the care of  which have already developed it.



In order to choose the appropriated care, nurses need to assess the patients. Assessment is a vital part of nursing process, which is a ‘professional approach for selecting, organizing, and delivering appropriate nursing care to a patient’ (Potter and Perry, 2007). Nursing process it is a continuous patient-centred process and can be change in accordance with patient needs. It involves five stages: assess, diagnose, planning, implementation and evaluation (Kozier et al, 2008). To help in the nursing process, nurses will use nursing models.

Nursing models aim to help the nursing process work. It is a way of represent the nursing process, telling what nurses do to assess and gain information about patient, providing guidance when planning and delivering care (Aggleton and Chalmers, 2000). In this ward, nurses use the model developed by Roper, Logan, and Tierney in the 1970s.

This model is based in 12 activities of living ( appendix 1) which are linked with biological, social, or psychological needs required for health (Kozier et al, 2008). It is a way of identify and evaluate the care needs of the patient. The nurse’s interventions are based in the prevention, resolution, and management of actual or potential problems related with the activities of living, not forgetting that the activities of living may me influenced by biological, psychological, socio-cultural, environmental, and politico-economic factors to some degree (Alexander, Fawcett and Runciman, 2007).

The assessment using this model will include collecting information about the person, reviewing the collected information, identifying the problems and identifying priorities among problems; and supplementary information can be added later.  It involves two types of information: the first, which is called by Roper, Logan and Tierney the patient’s biographical and health data; provide information for nurses to start look after the patient. The second one is called the Activities of Living data, which is focused on the patient’s abilities to carry out the activities of living, routines, and current problems (Roper, Logan and Tierney, 1996).

The use of this model helps nurses in that ward to identify patients that are in risk of developing pressure ulcer, as when assessing a patient’s activities of living nurses will find out about patient’s diet and fluid intakes, mobility, any existing medical condition, any medication that is being used, mental state and any other risk factors that may help on the development of the pressure ulcer. Also, the nurse will know if these factors are a usual pattern in patient’s life or they are actual/potential problems, which can be affected by life spam, dependence/independence continuum, and other factors that can influence the activities of life and have been mentioned before. The nurses also used Waterlow Pressure Sore Prevention tool as complementary assessment. This tool helps the nurses to assess some activities of living, like eating and drinking, mobilizing, eliminating, based in the actual patient’s condition and identify the risk of development of pressure ulcer.

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In order to deliver care, nurses need to be competent and to have knowledge. We can develop knowledge from education, clinical or life experience, intuition, and nurses need to develop and use relevant ways of knowing that improve patient care (Bailey, 2004). Carper (1978) identified four types of nursing knowledge: empirical, aesthetic, personal and ethical (Basford and Slevin, 2003).

Empirical knowledge is the science knowledge of nursing. It includes theoretical knowledge from books, journals and conferences and draws on traditional ideas of science (Edwards, 2002), and research will support practice. When assessing the patient, Claire used her empirical knowledge to ...

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