Health and Social Care Professionals - Assignment Example

Running Head: Health and Social Care Professionals Health and Social Care Professionals of the of the institution] Health and Social Care Professionals This assignment will commence with defining the implications of resource management and professional regulation. The paper will also demonstrate competence in promoting sound multi-professional working. A definition and symptoms of the initial diagnosis will also be given and a social history of the complaint will be offered. Incorporated in the assessment will be how principles such as data collection and history taking were involved. While using the chosen model of nursing a range of problems involved will be identified. Two activities of living that are identified from the assessment including any actual and potential problems that may occur will be identified. How measurable data and the rationale for goals will be identified within the model that was used, together with how the underlying physical and psychosocial perspectives were assessed and the rationale behind this. On concluding a reflection on the strength, weaknesses and consistency or discrepancies of the model chosen will be discussed. Pearson and Vaughan, (1986) see a nursing model as a picture or representation of what nursing actually is, although Aggleton and Chalmers (2000) claim that the aim of a nursing model is for those who use them to understand more fully what they are doing and why they are doing it. The nursing model is used in conjunction with the nursing process according to Roper, Logan and Tierney (1996), who go on to say that individualized nursing is carried out by using the nursing process, which includes assessment, planning, implementation and evaluation. A nursing model is a concept of what nursing is. Models are used as a tool to assess patient's needs/problems. There are many models of nursing but the two that are more commonly used are, Roper, Logan and Tierney's Activities of Daily Living (1979) and Orem's Conceptual model (Self-care Deficit Model) (1980). Assessment as defined by McFerran (1998) is the initial stage of the nursing process, in which information about the patient's health status is gathered and from which a nursing care plan my be devised. The assessment tool used in this case was Roper, Logan and Tierney's model. Roper et al (1996) claims that to plan the nursing care successfully the nurse will need to be able to assess where there are problems of continuing a sufficient quality and quantity of self-care activity for health and well being. Mr Brown is a pseudonym in order to comply with the confidentiality guidelines set by the Nursing and Midwifery Council (2002). Mr Brown is a fifty eight year old man who lives with his wife and son in a semi-detached bungalow in a city suburb. He is employed as a police sergeant and is involved in his local church; he is also the chairman of his local neighborhood watch program. Mr Brown has been fit and well though slightly over weight, he drinks and smokes moderately. During the last week he has complained of indigestion occasionally. Whilst watching his son play football he had severe chest pain, radiating down his left arm. He became very ashen grey and vomited. An ambulance was called for. The symptoms presented by Mr Brown were, severe chest pain, cold clammy and pale skin, his pulse rate was one hundred beats per minute, a blood pressure reading of one hundred mm Hg (millimeters of mercury), systolic and a diastolic reading of eighty mm Hg, his respirations were quite rapid and peripheral cyanosis was present. He also showed signs of being weak, feeble, anxious and shaky. Mr Brown was consequently admitted to an accident and emergency department in an inner city hospital. On examination a suspected Myocardial Infarction and cardiogenic shock was diagnosed. Cardiogenic shock as defined by Brunner and Suddarth (1990) as when the heart is no longer able to pump blood around the body properly as it has been severely damaged, for example, by a major heart attack, it can then cause lack of blood and oxygen to vital organs such as heart, brain and kidneys. Myocardial infarction defined by Smart (2001) is the blockage of a coronary artery, which deprives an area of the heart of its blood supply causing the death of part of the heart muscle. Smart (2001) claims that disorders of the heart and circulatory system are among the leading causes of ill-health in the developed world and Millburn (2000) agrees and goes on to say that Coronary heart disease is among the biggest killers in this country. Millburn (2000) also claims that more than eleven thousand people die of heart problems in England every year. Three hundred thousand people have heart attacks every year. More than 1.4 million suffer from angina. But the effects of heart disease are unequal, for example among unskilled men the death rate is almost three times higher than among professionals. Heart disease is much more common in deprived areas yet treatment and care is often better in more prosperous areas. Williams D (1998) adds, men are more likely than women to experience problems related to cardiovascular changes and in general the risk increases with age, in association with smoking, high blood pressure, lack of exercise, high blood cholesterol and diabetes. Mr Brown was admitted to the medical ward and an initial holistic, nursing assessment was undertaken. The nursing history should be completed within a fairly short time following the patient's admission, although not necessarily on admission, or all at one time. Information can be added as and when needed but it should never be erased according to Hunt and Marks Maran (1981). The nursing history includes the models of care relevant, which in this case were Roper, Logan and Tierney's activities of daily living, which were introduced in 1980 as 'The elements of Nursing'. There are five components to the model, twelve activities of living, lifespan, dependence/independence continuum, and factors influencing the activities of living and individualizing nursing. The activities of living identify actual and potential problems. Roper, Logan and Tierney's model was used because it encourages minimal disturbance of the individuals normal pattern of living, this model is also seen as being broad and flexible and nursing care can be given in accordance to the patients circumstances and it is easy to follow. (Roper et al, 1998) The factors influencing the activities of living are, biological, psychological, sociocultural, and environmental and politico economic. Psychological factors influencing the activities of living include intellectual development and emotional development. Although Kemp and Richardson (1994) disagree, they claim that Roper et al's list of activities of living may not clearly identify the important areas of social and psychological needs and does not always follow or that it may be the best or only way to make an comprehensive enquiry. Kemp and Richardson (1994) continue with stating that the assessment of the patient taken at the time only gives an idea of what the patient is like at that particular moment in the interview and it is important to find out how the patient was before they were ill. This is also important when setting realistic goals, as goals that are impossible for that patient may be set unknowingly. Orem (1991) maintains that a person's ability to undertake a range of factors influences self- care, but injury illness and disease may create additional demands for self care. Whilst taking the patient's history there were certain skills and qualities that were required, all of the relevant information about the patient's past and present health problems, their social history, habits of daily living, likes and dislikes, nurses observations about the patient and a general overview of their condition was collected. The information gained gave the necessary data for making a nursing diagnosis. It also enabled problems to be identified according to Roper et al (1996). Aggleton and Chalmers (2000) claim that the use of an appropriate nursing model informs assessment by establishing the kind of information required, the detail that is likely to be helpful and the ways in which the information might be gathered. They go on to say that by placing the emphasis on assessment the nursing process encourages the nurse to identify with the patient potential and actual health problems. While some of these problems may be linked to specific medical conditions, others will be specific to individuals, their psychology and their social and cultural status. Aggleton and Chalmers (2000) continue with adding that assessment is more often than not a multistage process in which initial ideas are formed about existing health problems, followed by efforts to confirm the existence of these problems and to identify their probable causes. Evaluation offers a starting point for assessment in progress and planning as the person's circumstances and requirements change. The skills used are observing, questioning, examining, testing and measuring to ascertain whether or not the set goals are being or have been accomplished declare Roper et al (1996). To make an initial assessment, information is required on all aspects of performance claim Roper et al (1996). Boore et al (1987) continue with saying that data may be collected from a primary source, which is the patient and/or a secondary source which can be from a variety of places such as in this case the family, friends, patient records or health team members. Past medical notes were reviewed and compared to before undertaking the initial nursing assessment on Mr Brown and whilst he was being medically assessed by the ward doctor. According to Hunt and Marks Maran (1981) the medical history is used to determine whether pathology is present as a basis for planning medical care and treatment. The use of a nursing history enables a nurse to collect information relevant to the nursing needs of patient's, evaluate that information and identify the patients nursing problems. The nursing history was essential for the systematic recording of relevant information about Mr Brown. Data such as full name and address, age and date of birth were all completed before speaking to Mr Brown, although he would be able to confirm or correct them once the doctors had medically assessed him. This also gave the opportunity to complete the initial and final diagnosis to be filed as the doctor's notes could then be referred to. The case notes were also used as a tool as this gave other information on any past illnesses and Mr Brown's General Practitioner's details which was again confirmed or corrected during the assessment. On approaching Mr Brown introductions were made and an explanation of what the assessment involved was offered, his consent to continue was gained before commencing with the nursing assessment, the curtain was also drawn around the bed in order to provide privacy and prevent distractions from activity within the ward. During the initial nursing assessment many problems were identified, two of these were breathing and mobility, these are relevant to the diagnosis of a myocardial infarction claim Brunner and Suddarth (1990). Firstly breathing is affected as the process of breathing takes place in order to supply the body cells with oxygen and to remove carbon dioxide, Collins and Parker (1988). This is a vital function, if breathing ceases irreversible damage to the neurones in the brain may occur within a few minutes. Cardiac pain affects the activity of breathing and is also a feature of myocardial infarction and it must be relieved so that the shocked state may be reversed. Some patient's for a variety of reasons do not report their pain and this should be recognized as a potential problem according to Roper et al (1996). Asking questions such as, had he been coughing and if the cough was productive of any sputum, and what the color of the sputum was, assessed Mr Brown's breathing. As smoking is a potential problem information was also gained on his smoking habits and, as he expressed a wish to stop smoking advice was given on how to achieve this by giving him leaflets and a free phone number. Mr Brown's normal breathing pattern was gained from previous notes and was compared to his pattern at the time of the assessment, he was asked about his perception of his breathing and his knowledge of his own pattern. Mr Brown was also asked if he had been unduly conscious of his heart beating, for example if he had noticed it beating faster without any known or obvious cause, if he had experienced a fleeting coldness in any of his extremities, pain in his chest or legs when walking (apart from the pain that brought him into hospital). Actual problems identified during this assessment was a change in his usual chest pain, pulse rate and blood pressure, which could also be identified as a potential problem. A change in the environment and routine was also found as Mr Brown was now in hospital and was not in his usual environment of home and work. When asked appropriate questions, listening to the patient, and using relevant information previously gained, an assessment on mobilizing was achieved. A change in mobilizing had occurred due to the chest pain and also due to the fact that the doctors had advised Mr Brown to remain on bed rest, this was advised according to Brunner and Suddarth (1990) to allow the heart adequate time to heal, from this assessment actual and potential problems were then identified. Roper et al (1996) claim that all patients are exposed to potential problems because of their reduction in mobilizing. Giving the patient adequate encouragement and supervision can prevent potential problems. Lack of movement can be a hazard as pressure on the skin can be caused as the patients weight will rest on the bony prominent compressing the skin against the underlying subcutaneous tissue and bone, which then leads to pressure sores, therefore he was encouraged to contract and relax his calf muscles and to breathe deeply. This exercise causes pressure on the veins deep in the legs and the blood then moves upwards towards the heart. Inactive leg muscles cause potential stagnation of the blood in the veins, which can lead to disease and possible death of the patient. Gentle exercise and walking affect breathing and stimulate the blood circulation and the intake of oxygen into the lungs. Another potential problem identified during this assessment due to immobility was constipation as lack of movement interferes with the bowel function; this also has the possibility of being an actual problem. To conclude and reflect, the patient, Mr Brown, received an assessment that was based on the Roper, Logan and Tierney model, due to it being easy to follow, flexible and well structured. The activities of living identified actual and potential problems. It encouraged minimal disturbance of the individuals normal pattern of living, it was also seen as being broad and flexible and nursing care was given in accordance to the patients circumstances. As a result of taking into account the physiological, psychological and social factors of the patient it could be said that holistic care was provided for Mr Brown. However there are also weaknesses in this model, knowing what activity would be best to use caused confusion, as the activities of living were closely related to each other and was more socially and psychologically based in parts. Extra paper work was created unnecessarily due to the nature of the assessment being repetitive and lengthy. References Aggleton, P. and Chalmers, H. (2000) 2nd Edition Nursing models and the nursing process. London. Palgrave Publishers Limited Bassett, S. & Smyer, T. (2003) Health Screening Practices in Rural Long-Term Care Facilities, Journal of Gerontological Nursing; Vol. 29 (4) 42-49 Boore, J. Campion, R. Ferguson, M. (1987) Nursing the physically ill adult Churchill Livingston, London Carney, M., Kahan, F. & Paris, B. (2003) Elder Abuse: Is Every Bruise a Sign of Abuse, Mount Sinai Journal of Medicine; Vol. 70 (2) 69-74 Collins, S. and Parker, E. (1988) Essentials of nursing an introduction 2nd edition London Macmillan Education Ltd Hunt J.M., Marks-Maran D., (1981) Nursing Care Plans - The Nursing Process at Work London, HM and M Publishers Kemp, N. Richardson, E. (1994) The Nursing Process and Quality Care London Edward Arnold McFarlane, J. and Castledine, G. (1982) A guide to the practice of nursing using the nursing process. London, The C.V. Mosby Company McFerran T A (1998) Oxford mini-dictionary for nurses Oxford Oxford University press. Millburn A (2000) cited in D.O.H. (2000) National service framework for Coronary Heart Disease Modern Standards and service models N.M.C. (2002) Guidelines for Professional Practice. London, N.M.C. Orem, D. E. (1991) Nursing: Concepts of Practice Cited in Aggleton, P. and Chalmers, H. (2000) 2nd Edition. Nursing models and the nursing process London. 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