Leanne Battersby


BA Hons Adult Nursing

Faculty of Health and Wellbeing

Sheffield Hallam University

20th June 2008

Principles and Practice of Nursing 1

Word Count 3,838

Principles and Practice of Nursing 1 Assignment

This assignment will show the writers understanding and knowledge of the nursing process. In order to do this a specific patient has been chosen, focussing on one goal of care highlighted through the use of the assessment of a nursing model.


To maintain confidentiality and protect autonomy, the patients name has been changed and any details through which a reader could identify the patient or the care location have also been changed. This complies with the NMC professional code of conduct (2002). Furthermore for legal issues, the writer has gained consent from the selected patient. The writer explained to the patient clearly what information would be needed in the report and that confidentiality would always be maintained. With this information the writer was able to gain informed consent. The information provided was gathered from a number of sources. Primarily the patient and their medical notes, but also from medical and nursing staff.

The specific patient is Joyce, 66 years of age. Joyce visited her GP complaining of abdominal and back pain along with indigestion. After being referred for an ultra sound scan and having several blood tests, she was diagnosed with gallstones. Halton (1994) verifies that gallstones are hard pieces of stone-like material that are made from cholesterol, calcium carbonate, calcium bilirubinate, or a mixture of these. They are normally caused when the chemical balance of your bile has too much cholesterol in it. This causes the bile to form into small particles which may then grow into gallstones. Joyce was prone to getting gallstones as Sanford (1982) explains that in more than 80% of cases, gallstones occur when your liver produces bile with high cholesterol content. An excess of cholesterol in your bile may be due to factors such as a high cholesterol diet and advancing age. Joyce is overweight and has a past medical history of high cholesterol which is a direct link to gallstones. Her other past medical history includes ovarian cysts and a hysterectomy fifteen years ago. Joyce leads an extremely independent life and works part time as a school canteen assistant. She drinks occasionally, drinking between five to ten units per week and is a heavy smoker consuming thirty cigarettes a day.

Upon the diagnosis, Joyce was referred to a specialist liver and pancreatic clinic where the choice was made that Joyce would require keyhole surgery to remove the gall bladder, also known as a laparoscopic cholecystectomy. The care outlined in this essay is based on the assessment on admission 24hours pre operation.

The nursing process is a problem-solving framework for planning and delivering nursing care to patients and their families (Atkinson and Murray 1995). It consists of four phases - assessment, planning, implementation and evaluation. This systematic approach to care is cyclical in nature and when used in nursing practice, will result in competent nursing care. The nursing process is beneficial to both the practitioner and the patient. When the nurse becomes skilled in the use of this tool, they will gain confidence, job satisfaction, professional growth and opportunities to share knowledge. Benefits to the patients include continuity of care, improved quality of care and autonomy.


Assessment can be defined as 'the first stage of the nursing process, in which data about the patients health status is collected and from which a care plan may be devised' (Oxford Dictionary for Nurses, 1998). However, McCormack etal argues that 'assessment is not just the undertaking of a set of technical skills; rather, it requires a certain kind of relationship between those who participate in it and with whom we share the purposes and standards of the practice' (2004). Assessments should not only focus on the needs presented by the patient, but on the strengths and abilities that the patient may bring to bear on resolving those needs (Kemp and Richardson 1994). This approach enables the nurse to use the assessment to plan care that is truly person centred. It was with this theory that Joyce was assessed. This is best approached through biography because all patients have a past, a present and a future. The NMC code of professional conduct (2002) explains that you must respect the patient as an individual. This means that you look at all the different elements that make up a patient. This provides the basis of holism. Siviter (2004) outlines that holism and holistic care look at the patient as a whole person, with unique and individual needs and circumstances. Holism ensures the nurse to see more than just the reason the patients are in care. It encourages them to look at the way the patients feel, what is important to them and their families, their living situation and their beliefs. It focus’s on their spiritual, emotional, physiological, psychological and cultural needs. This ensures the care given meets all a patients needs in a respectful and dignified way.

When undertaking holistic assessment, nurses have a key role in creating a picture of the patient that enables decision making which is representative of the patients life as a whole (Iyer etal 1995). A biography can be built through discussions with the patient, patients' family and friends. It is important to gain knowledge and understanding of the patients' perspectives and needs to develop a care plan, as the care plan has to be meaningful to the patient if it is to be successful in maximising health. To make it meaningful, it is important to focus on social, psychological and spiritual needs of the patient, rather than just focusing upon medical needs.

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In order to successfully use the nursing process to asses a patient and plan care a nursing model should be used. The model of nursing that is most familiar to nurses was originally developed by Roper in 1976 and was updated and added to in 1980, 1981 and 1983 by Roper, Logan and Tierney. The model has been used in a wide variety of nursing settings (Holland etal 2003). The model of nursing specifies 12 activities of daily living which are related to basic human needs and will be used to produce a care plan for Joyce. They are maintaining ...

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