Essentials Of Care Using Evidence – A Reflective Piece

INTRODUCTION:

In this paper, I will reflect upon my learning about the assessment and communication of activities of living and my personal role in providing essentials of care for future practice as a Registered Nurse.

The paper further outlines the Roper-Logan-Tierney Model for Nursing Holland & Jenkins, (2019), that formulates an important framework of care in which both assessment and communication of activities of living are simultaneously addressed.

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This, I believe helps future Registered Nurses to strategically plan and analyze a patient’s care needs leading to interventions that are intended to sustain independence in carrying out activities of living that are otherwise rendered difficult or impossible for the patient to continue performing on their own.

Essentials of Care in the model for nursing is a framework that develops and evaluates nursing practice and patient care involving actions that a nurse undertakes who respects and focuses on a patient’s essential needs to make sure their physical and psychosocial wellbeing is not compromised.

WHAT?

I understand the importance of assessment and communication of activities of living as the fundamental knowledge required for nursing practice. As a future Registered Nurse, this semester helped me understand that the role of a nurse is dynamic, it continuously evolves and in order to effectively provide high-quality nursing care to patients, I need to assess and communicate the 12 activities of living which as per Holland & Jenkins, (2019), are maintaining a safe environment, communicating, breathing, eating and drinking, eliminating, personal cleansing and dressing, controlling body temperature, mobilizing, working and playing, expressing sexuality, sleeping and dying.

The activities of living outlined above, are to be assessed and reviewed as the patient is under care and as the care plan evolves to provide appropriate support to the patient. This helps in understanding the dependence-independence continuum of a patient’s care where nurses must strive to help a patient achieve greater independence throughout the patient’s care.

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According to Dougherty and Lister, (2015), nursing assessments are an integral part of patient care. It is the initial stage in the process of person-centered care and providing an individualized patient-centered care in nursing practice. Assessment of the patient’s relative independence and potential for independence on a continuum is highly important in order to identify and plan interventions which will lead to increased independence.

There was this one time during my semester that I visited one of my relatives who had an accident and following the surgery he had almost lost mobility, the experience led me into realizing that he was becoming more dependent in mobilizing, maintaining a safe environment as well as in eliminating. Now, the nursing care would constantly be trying to restore his independence. At that time, I greatly empathized with him and thought to myself, that as a Registered Nurse, I would be striving for my patients’ independence more and more.  I realize that by regularly and frequently keeping a check on the variations in the dependence-independence continuum of my patient as a future Nurse, I will be able to see how the patient is either improving or failing to improve.

Understanding the activities of living alone is not sufficient in devising an effective nursing care plan, so taking external factors affecting an individual into consideration is equally important, it makes the model all-inclusive, and not taking these factors into consideration means that the resulting assessment is not sufficient. As per Holland & Jenkins, (2019), these factors have been broadly organized into five broad categories, biological, psychological, sociocultural, environmental, and politico-economic.

The factors include biological factors which determine the overall health of a patient. For instance, my friend’s mother is a diabetic patient who recently experienced a sudden drop in blood pressure in this case her dietary requirements would differ from a person who is not diabetic. Psychological factors include emotional, cognition, behavioral and intellectual aspects of a patient while, sociocultural factors encompass cultural, ethical, philosophical, religious, spiritual and communal impacts of a society on a patient. Environmental factors comprise of the natural environment that surrounds the habitat of the patient. Politico-economic factors include governmental, political and economic impacts.

SO WHAT?

As per Gillespie, M. (2010), Nurses' detection of cues or signs that indicate possible patient deterioration is an important aspect of clinical decision-making.

The cues that I identified from my experience this semester that have shaped my judgements, involved reviewing available information like patient reports, patient history, vital signs results, and previous nursing assessments as well as recall knowledge of physiology, pathophysiology, social, cultural, and law. As per (Gillespie and Paterson, 2009; Tanner, 2006), nurses’ clinical decisions occur within the dynamic context of clinical practice, are informed by multiple sources of knowledge, influenced by all that the nurse brings to the situation, and supported by a range of thinking processes.

Cues: There was this one time during my semester when I went to take my neighbor to the hospital. He lived alone and had no external care. The only connections he had were two of his friends who checked up once in a while. The patient aged 50, was presented in the ER as a case of trauma due to fall. He was experiencing extreme fatigue and numbness in hands. He reported feeling confused and complains of visual disturbances before the fall. The patient was breaking into cold sweats and bleeding profusely from the side of the head.

Upon taking the history, it was revealed that he was a patient of Diabetes Mellitus and regularly took insulin to correct it. He injected insulin before meal an hour ago.

His friends and neighbors also notified behavioral changes and mood swings.

Judgement: The probable cause of the condition presented seemed to be Hypoglycemia i.e. a drop in blood sugar levels which might be due to injection of insulin more than the prescribed amount. The visual and cognitive impairment explained the loss of balance and eventual fall.

The recommended course of treatment, in my opinion, should have been concentrated IV dextrose 50% to compensate for the decline in blood glucose levels.

To counter the emotional turmoil he was going through, I would recommend a healthy amount of social interaction among friends. I was so moved by the incident that I thought to myself that as a future nurse, I would want to emphasize on empathetic and nurturing care of old patients, go about making their meal plans to engaging in conversations with them to ensure they don’t feel lonely.

NOW WHAT?

As per Smith, S., James, A., Brogan, A., Adamson, E. & Gentleman, M. (2016), the LCCP action research identified that the model for compassionate care was a key activity in flourishing compassionate care in a health care setting. The model incorporates six components; Caring conversations, flexible person-centered risk taking, feedback, knowing you, knowing me, Involving, valuing and transparency, creating spaces that work.

According to Kitson, (2018), the framework of fundamentals of care will help us understand how nurses, deliver high-quality fundamental care to patients. It suggests high- quality fundamentals of care require nurse qualities and actions across three interrelated dimensions: beneficent relationships with patients; care delivery and coordination focused on patients' fundamental needs; and the ability to critically analyze and competently navigate the context of care.

To ensure the deliverance of a holistic, patient-focused care, nurses must adapt a dynamic and versatile approach. The foremost examinations held by me should be the biographical information and reasons for seeking healthcare, in which the patient would express their concerns. It includes the history of allergies, dietary restrictions and any relevant medical history that the nurse deems necessary.

In order to promote the mitigation of the disease or impacts of injury, there are a lot of physical factors that should be taken into consideration.

Personal cleansing should be properly maintained. Their nutrition plans should be charted and routinely provided. The comfort level of the patient must be carefully scrutinized; pain management, temperature control, easy breathing must be managed.

The responsibilities of a nurse are not restricted to the physical welfare of the patient but lies on a broader spectrum. The psychosocial fundamentals of care are equally important as the physical ones. I must attend to the therapeutic nature of interactions taking place with the patients. It is vital that my attitude is empathetic, and I must demonstrate kindness, courtesy and sincerity.

The nature of my studies suggest that it is imperative for me to maintain the necessary confidentiality, developing a deep interpersonal relationship with the patient and their family/caregivers while confined to professional role boundaries. As per Chadwick, R., & Gallagher, A. (2016), ethics is an inevitable and absolutely necessary part of nursing practice. It involves doing the right thing while aiming to be a good nurse. So, I’m aware that as a future Registered Nurse, I will encounter organizational pressures that might challenge my professional values from time to time and then I will have to make situational choices.

The emotional wellbeing of the patient suffering must be monitored and therapeutic practices should be implemented to keep them optimistic and comfortable in hospital environment.

The religious, social and cultural beliefs of a patient must be dealt with reverence, and any medical practice that threatens these beliefs should be replaced with alternatives. In the inevitable circumstances leading to death, as a health professional my duty will be to appear undeterred and support my dependents through the processes perceived to lead to death; loss of independence, intermittent periods of relapses, inability to recover and fear of the unknown.
As per Shea, S., Wynyard, R., & Lionis, C. (Eds.). (2014), in organizations there needs to be clear intention, leadership and determination for compassionate care to become central in all healthcare practice’

CONCLUSION:

The most significant facet of the reflective process is that it develops critical cognitive skills which in turn helps in developing a sound clinical decision-making ability ultimately becoming a cornerstone for good nursing practices.

The model I followed is the Roper-Logan-Tierney Model for Nursing which intends to help nurses assist a patient in achieving independence at every stage of care by determining the appropriate interventions required for achieving independence. The 12 activities of living, the factors influencing them, and the dependence-independence continuum are all used as a framework for the assessment, planning, implementing and evaluating process in the provision of care.

Using my personal experiences from time to time, I was able to connect different concepts of nursing with my experiences. It was a good teaching guide and helped me in understanding the foundation of a good nurse-patient relationship which requires active listening, compassion, and attending to a patient’s and their family’s needs.

I believe, as a future Registered Nurse, this understanding will help me in effectively assessing, communicating, evaluating, making sound judgments and making amendments in my current care plan for.

REFERENCES:

Holland, K. & Jenkins, J. (Eds.). (2019). Applying the Roper, Logan, Tierney Model in Practice (3rd ed.). Sydney, N.S.W.: Elsevier.

Dougherty, L. and Lister, S. (2015). The Royal Marsden Hospital Manual of Clinical Nursing Procedures 9th ed. Hoboken, N.J.: Wiley.

Gillespie, M. (2010). Using the Situated Clinical Decision-Making framework to guide analysis of nurses’ clinical decision-making. Nurse Education in Practice, 10(6), 333-340.

Gillespie, M. & Paterson, B. (2009) Helping novice nurses make effective clinical decisions: The situated clinical decision-making framework. Nursing Education Perspectives. 30 (3): 164-170.

Smith, S., James, A., Brogan, A., Adamson, E., & Gentleman, M. (2016). Reflections about experiences of compassionate care from award winning undergraduate nurses–What, so what… now what?. Journal of Compassionate Health Care, 3(1), 6.

Kitson, A. L. (2018). The fundamentals of care framework as a point-of-care nursing theory. Nursing research, 67(2), 99-107.

Chadwick, R., & Gallagher, A. (2016). Ethics and nursing practice. Macmillan International Higher Education.

Shea, S., Wynyard, R., & Lionis, C. (Eds.). (2014). Providing compassionate healthcare: challenges in policy and practice. Routledge.