Patent-care study. Kirsty is a seventeen-year-old young lady who was diagnosed with Crohns Disease when she was thirteen years old.

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Patient-Care Study.

        The aim of this patient care study is to discuss the care and nursing interventions that a particular patient received whilst staying on acute medical ward. Clause five of the Nursing and Midwifery Council’s Code of Professional Conduct (2002) states that “as a registered nurse or midwife you must protect confidential information” and if information is to be revealed the patient’s consent must be sought. The patient’s permission was obtained after an explanation of the purpose and proposed content of the care study, with a staff nurse present. For reasons of confidentiality, the patient will be referred to under the pseudonym of Kirsty. Kirsty is a seventeen-year-old young lady who was diagnosed with Crohn’s Disease when she was thirteen years old. She lives in a terraced house with her mother and is a hairdressing student. She was admitted to the ward from the Children’s Outpatient Department following a routine check-up, where she presented with right-sided abdominal pain and loose stools. She was diagnosed with a flare-up of Crohn’s Disease. Kirsty was chosen for the purpose of this care study because her strength of character was admired and a good relationship was established.

        Kirsty was admitted to a twenty-six bedded acute medical ward, which is primarily gastrointestinal conditions, however medical outliers are admitted. There are three bays: one male, and two female, one called the Day Room (as it used to be the patient’s day room, but was opened as a bay as there was a bed shortage) and the second is called the Female Bay.  There is a double side-room and two single side rooms, top of the ward and bottom. Kirsty was admitted to a bed in the female bay.

The ward is split to accommodate the Primary Nursing framework. Walsh (1997) suggests that primary nursing requires one nurse to be accountable for patient care delivery twenty-four hours a day (from, admission, through assessing, planning, implementing and evaluating patient care, through to discharge), and when the primary nurse is off duty, associate nurses continues the plan of care prescribed by the primary nurse. Characteristics of primary nursing according to Mead (1991, cited in Walsh, 1997) include accountability for the nursing care of the patient, patient-centred care, continuity of care, confirmation of a ward philosophy, changes in ward organization and skill mix, and patient and family participation in care planning. Each bay on the ward has at least one primary nurse (when staffing levels improve, it is the aim of the ward to have two primary nurses in each bay, each nurse allocated with their own patients) and the ward is split to accommodate the primary nursing framework: the double side room, the bottom side room and the Day Room is one allocation, the top side room and the male bay is another and the last one is the female bay.

As is characteristic with primary nursing the ward has a philosophy of care, which is displayed in the centre of the ward (Walsh, 1997). The aims of the ward are to promote the health, well-being and dignity of their patients, to educate patients in order to allow insight and encourage independence and responsibility, to work within a multi-disciplinary team framework to enable patients to reach their optimal potential, and when necessary assist patients to a peaceful death, to ensure honest, open communication and the understanding that this is a two-way process, to involve family and friends in the achievement of these goals within the framework of primary nursing and to promote a stimulating learning environment to enable appreciation and respect of patients needs, to act as advocates for patients and understand the theory underlying practice and to always ask why. This philosophy of care is inline with the characteristics of primary nursing (Walsh, 1997) and patient-centred care (Swankin, 2002).

There is a varied skill mix on the ward, from the senior sister to auxiliary nurse. Some of the nurses have specific interests such as nutrition or wounds; some of the nurses have come from abroad and are C grade, one of the nurses qualified only twelve months ago, whereas the other nurses have been qualified for a number of years. The same is true for the nursing auxiliaries, some are fairly new and others have a number of years experience and have trained or training to NVQ Level three in care. The ward team all bring a positive contribution to patient care whatever their level of skill and all are committed to the care of their patients and the ward philosophy and primary nursing.

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The model of nursing used on the ward is an adaptation of the Roper, Logan and Tierney Activities of Living Model. The focal point of this model involves twelve activities of living: maintaining a safe environment; communicating; breathing; eating and drinking; eliminating; personal cleansing and dressing; controlling body temperature; mobilising; working and playing; expressing sexuality; sleeping; and dying (Aggleton and Chalmers, 2000). The model on the ward incorporated communication, diet, and sleep, mobility, hygiene, toilet, occupation and a section for activities of daily living prior to admission on the admission form. The activities the admission form does not cover can ...

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