Summative Assignment: The Nursing And Essential Care Needs
Principles of Nursing Practice and Applied Health Sciences
(NPCG1017 & NCPG1016)
‘ The nursing process and essential care needs ’
Summative Assignment
SA072
Student ID: 25519662
Word count: 3294 (excluding reference list and text boxes)
Introduction
This assignment will endeavour to look at essential care needs and explore exactly what they are and why they are important. The assignment will then discuss one particular essential care need relevant for a chosen patient, explore this care need in detail, and define exactly what it is and why it is important. Finally this assignment will be looking at the chosen essential care need and exploring the nursing care required to facilitate this; This is done through the systematic technique known as the nursing process.
Essential care needs within nursing are extremely important for improving the health and wellbeing of a patient, some essential care needs are; nutrition, personal …show more content…
care, hygiene and pain management. All nurses are expected to be able to meet each patients individual care need. ‘All nurses must be able to assess people’s needs and help people meet them when they cannot do so for themselves. This means that nurses must be able to deliver care that meets the essential needs of people and enables them to feel safe and cared for’ (NMC 2010). An essential care need is the nurse looking at the patient holistically to assess how they can be assisted and what they are safely capable of doing themselves. It is a need of care that is essential to the health and well being of a patient (Arnett 2013), for example with Sarah the nurse would look at her holistically taking into consideration she has Parkinson’s disease and Arthritis to assess what her essential care needs are, and the specific care she needs to manage her conditions. As Sarah suffers from a lot of shakes from Parkinson’s disease, one of her essential care needs may be to reduce falls. Due to her pain caused by Arthritis she finds mobility difficult, so other essential care needs may be pain management and pressure area care if she is not as mobile.
All patients no matter of age, culture or gender have essential care needs, Maslow in 1954 developed a theory of human needs and placed them in a hierarchy representing the order in which people seek to satisfy them. Maslow believed that people are motivated to achieve certain needs, and once one certain need is fulfilled the move onto the next. Essential care needs are linked to Maslow’s hierarchy of needs, as they are what people need in order to satisfy them, the hierarchy they best fit into is psychological needs as these are vital for survival and basic care needs; without meeting these Maslow believed that all other needs in the hierarchy become secondary (Cherry 2013).
The chosen essential care need will be pain management; the reason for choosing this to discuss is because the patient who’s the focus within this assignment suffers with pain in her knees and hips, due to Arthritis. Moreover pain management is a key element within nursing, as many people with health conditions suffer from pain; pain is individual to the patient so it’s difficult to define pain. Pain management is an important essential care need adult nurses should be aware of, as people get older and their body becomes frailer they sometimes suffer with a lot more aches and pains, therefore they sometimes require care to help manage their pain. However in some cases elderly patients don’t like to complain of pain, therefore the pain management might not be adequate enough to ease the pain (Taverner 2005). As people age they can develop conditions such as Dementia, people with this condition may not be able to communicate about the symptoms of the pain. Therefore nurses must be able to asses the pain through different ways of communicating, this can be done through; behavioral observation, physiological observation, and body language (Cunningham 2006). There are 800,00 people in the UK with a form of Dementia, therefore it’s essential nurses are able to assess pain through other methods if the patient with dementia is not able to communicate (Alzheimer’s society 2013).
Nurses must provide the best care to patients; have appropriate attitudes and knowledge towards pain, pain assessment and the management of pain (Nursing times 2008).
Pain management must be from the best evidence based research available to prevent patients suffering from harm (NMC 2008). The British pain society helps to promote education and research in all fields of pain. It also aims to increase awareness of pain and the facilities that are available for management (British pain society 2008).
This part of the assignment will include the 4 stages of the nursing process. The nursing process was introduced into nursing by Yura and Walsh (Yura&Walsh 1967), it defines 4 stages that nursing care should follow, these are: assessment, planning, implement and evaluation (Daniels 2004). This process will be applied to the essential care need of pain management, due to the chosen patient’s condition. A community nurse will be undertaking the nursing process, due to Sarah's poor mobility, and not being able to get to the
doctors.
Assessment is the first stage of the nursing process; in this stage the nurse will assess the patients needs and gather subjective and objective data (Hawtson-Jones&Roberts 2012). Assessing the patient effectively is a crucial part of this stage; it helps to look at the patient holistically in order to provide an effective care plan, in Sarah’s case effective pain management to manage her Arthritis. It is essential that the nurse has excellent communication skills when assessing Sarah, so she clearly understands the questions being asked and so the nurse does not miss any vital information given by Sarah. The nurse must have excellent people skills and be sympathetic, this helps patients’ feel at ease with the nurse and confident in discussing their problem (NHS careers 2013). Throughout the nursing process the nurse has to understand that everyone perceives pain differently. Pain isn’t just influenced by physiological factors, but is also influenced by psychological factors; emotions, memories and experiences all have an effect on how people perceive pain (NHS CHOICES 2011). The emotional state of a person can effect how they perceive pain, Field and Smith 2008 suggests that when a patient is anxious and in pain they ask for more analgesia as anxiety contributes to increasing the level of pain.
Firstly the nurse will ask Sarah’s medical history, this is so Sarah can give her explanation of her present problem, this will help provide essential information for the nurse. A medical history is an important part of the assessment as taking a medical history is a holistic approach, meaning the nurse is not just focusing on the problem but considering the patient as a whole, this can help when planning the type of care or assessment Sarah may need next, being holistic is taking into account environmental, spiritual and psychological wellbeing of the patient, it is also looking at the patient in a patient centred approach. (Ghebrehiwet 2011) (Lloyd&Craig 2007).
Once the medical history has been recorded the nurse will ask the patient questions about the pain; this is a fundamental way of assessing the pain as it’s important that the patients own perception of the pain is used for the basis of the treatment, the nurse must not be influenced by their own beliefs, attitudes or own personal experiences about pain, during the patients assessment. Some patients do not like to express how bad the pain really is or they may say they have no pain at all because they do not like taking analgesics. Furthermore this part of the assessment is also important for the nurse to find out how the patient usually deals with the pain (Field and Smith 2008).
The nurse will then observe Sarah’s behaviour as there are many behavioural changes that can be associated with a change in pain. The nurse would ask Sarah to walk about or just sit on the chair, or even both, to do these observations. Firstly the nurse could observe Sarah’s breathing, for example if her breathing rate increases this may mean she is in more pain, she may also start to sweat if the pain becomes so severe. Secondly the nurse could, either when Sarah is walking or sitting down, look at her facial expressions, if she grimacing or wincing this could indicate the pain is worse or extremely severe. The nurse could also observe when Sarah is walking the type of movement if it’s stiff or rigid when stepping or if she has difficulties changing position when standing, if Sarah struggles with this assessment because of pain then the nurse would suggest to do this observation in short bouts, this would already give an indication about the intensity of pain Sarah suffers with (British pain society 2007). Field and Smith 2008 in their book ‘Nursing care, and essential guide’ also suggest that this observational assessment of pain is a very fundamental part of the assessment process for pain.
Planning is the next stage of the nursing process; this is where a care plan is produced to help provide effective pain management for Sarah’s condition previously stated (Hawtson-Jones&Roberts 2012). It is fundamental that the nurse has excellent communication skills with the patient within this stage, so the nurse can discuss effectively with the patient the outcomes the patient would like to achieve from the care, and so the nurse can suggest care options they think would be a good idea to help (NHS careers 2013). Moreover the nurse must have the ability to answer and discuss questions that Sarah may have related to the care planning process and outcomes (NHS careers 2013). Once the nurse has discussed with Sarah the outcomes and goals she would like to achieve, the nurse will then produce the care plan.
The care plan shall be based around controlling the pain of Sarah’s Arthritis; when producing the care plan the nurse would look at Sarah holistically taking into account she has Parkinson’s disease, and consider factors of the care plan that may be more difficult due to this. The first part of the care plan, is for Sarah to take NSAIDs and analgesics at regular set intervals throughout the day, the rationale for this is, taking these regularly will ease stiffness, inflammation and pain that is caused by the arthritis. Relieving these will hopefully help to manage her pain making daily living easier (WebMD 2013).
The next part of the care plan, would be to refer Sarah to a physiotherapist, the rationale is that the physiotherapist can assess Sarah arthritis and put together a programme of exercises and advice. The exercises will help to manage pain and strengthen the muscle around the effected joint; by strengthening the muscle will also help to support the joint (Arthritis research UK 2013). This section of the care plan will also include a referral to an occupational therapist, who can provide all types of equipment, aids and adaptions to help mange arthritis and keep the pain under control (NHS careers 2013). In order for the nurse to be able to make these referrals to these other healthcare professionals the nurse must have the knowledge and understanding of the type of treatment, care and advice that they can offer to Sarah, without this knowledge it may be a wasted referral. Also the nurse be able to work as part of a multidisciplinary team as throughout the care plan the nurse will be working alongside other healthcare professionals (NHS careers 2013).
The next stage of the care plan would be for Sarah to have a healthy balance diet as it can help arthritis. On the NHS choices website research that has taken place shows that that a lot of fruit and vegetables are good for arthritis and also that omega 3 works as an anti inflammatory in patients with arthritis, which will also help the pain if the pain is due to inflammation (NHS choices 2013). Also from eating a balanced diet it will help to control weight, which will help to ease pressure on the joints, which will help the pain. The nurse will also order specialist equipment. This equipment would include a firm mattress, small pillow and bed cradle, the rationale is that, soft or worn out mattresses and big pillows effects the bodies proper alignment, which places stress of affected joints. The bed cradle is to elevate duvet covers, which reduces pressure on inflamed joint. (Arthritis research UK 2013)
The next stage of the nursing process is implementation; this is where the care plan produced in the previous stage is put into effect (Hawtson-Jones&Roberts 2012). The nurse will go through each stage of the plan in detail with Sarah, before the care plan is put into effect to ensure Sarah is happy. The first part of the care plan is Sarah taking regular NSAID’s and analgesics, the most common type of these are ibuprofen and paracetamol (NHS choices 2013). These would be prescribed for Sarah, so she does not have to pay, the nurse would explain to Sarah the correct dosage to take of the drugs, which is for Ibuprofen 400 mg 800 mg every 4-8 hours, this will be 1-2 capsules taken with or after food. Paracetamol 500 mg every 4 hours, which is 1-2 capsule. The nurse will then explain to Sarah that it is best to take the ibuprofen first then the paracetamol 2 hours later, this is so she constantly has pain relief, without it wearing off (NHS choices 2013), also she would explain to Sarah that she should take these medications with water as tea, coffee or fruit juices can cause a chemical reaction which may effect the drugs from working properly (Reid 2013). The nurse will follow up Sarah, by home visits and telephone consultations, to make sure she is taking the medication correctly, and making sure that it is not giving Sarah any side effects.
The next stage of the care plan is the referral to the physiotherapist, the nurse will send the referral to the physiotherapist team and occupational health team with the details of Sarah and the aim of the referral, which is pain management, as previously stated. Once the physiotherapists have received the referral they will send out an appointment in the post to Sarah. Once Sarah has seen the physiotherapist the nurse will arrange a visit to make sure Sarah understands the advice and exercises given, there are many types of exercises for arthritis (see appendix 1). Once the occupational has received the referral they will contact Sarah to make an appointment to come visit her in her home. On the visit they will see what aids and adaptations are needed within the home, to make daily living activities easier for Sarah, so it does not cause her as much pain as it previously would. The types of aids or adaptions could be things such as; stair lifts, bath rails and walking aids. (NHS careers 2013)
The nurse for the next part of the care plan will give advice to Sarah to have a healthy balanced diet, the nurse will give Dorothy the eat well plate guide. (See appendix 2). The nurse will also explain all the things previously stated in the planning section of why it is important to have a balanced diet while trying to mange the pain of her arthritis.
For the final stage of the care plan the nurse will communicate with Sarah to make sure she is happy with the equipment being ordered and the nurse will also make sure that Sarah understands the benefits of this equipment. The nurse will order the equipment, make sure Sarah knows when it’s being delivered, and continuously have home visits to Sarah to make sure the equipment is doing its proper job and if she’s seeing the effects of managing her pain.
The final stage of the nursing process is evaluation; this is where the nurse evaluates the care plan that was put in place in the previous stage. The nurse would evaluate each stage of the care plan all at once. The nurse would communicate with Sarah to ask her if she feels that parts of the care plan is not managing her pain or making it worse. The nurse would ask if the analgesics and NSAID’s are helping to reduce the pain and if they are giving Sarah any side effects. If they are not working or giving Sarah side effects then the nurse would prescribe different NSAID’s or analgesics. The nurse would liaise with the physiotherapist and occupational health to see if they feel the care is managing Sarah’s pain. If them or Sarah feel the care is not working then the nurse would suggest stopping the care and finding another method for managing the pain. Next the nurse would see if Sarah is still having a balanced diet and if it’s helping with the weight control, then would ask if eating lots of omega 3 and fruit and vegetables is helping to reduce pain and inflammation like the studies previously suggest. Even if it was not working the nurse would suggest to keep having a balanced diet, as it is very important in order to achieve a healthy lifestyle. The final stage of the care plan the nurse would evaluate if the mattress and pillow, the nurse would ask Sarah if she feels the pain has been reduced due to sleeping on her new mattress compared to when sleeping on her old mattress. If the pain has increased then the nurse may suggest Dorothy using her old mattress again.
This assignment concludes that essential care needs are a need of care that’s essential to the health and well being of a patient (Arnett 2013). As previously stated there are many essential care needs, however I have only focused on one of these in particular. The reason for choosing pain management as my essential care need is because in my last placement I witnessed many patients suffering in pain and I wanted to learn more about how to assess pain, how to write care plans for pain, and how to treat patients who are in pain.
Writing this assignment I have learnt that Pain isn’t just influenced by physiological factors, but is also influenced by psychological factors; emotions, memories and experiences all has an effect on how people perceive pain. I have also learnt the types of skills I will need as a nurse, not just for the nursing process but nursing in general, these skills are; working in multidisciplinary teams, the ability to communicate effectively with a patient, the ability to answer patients questions, to have essential people skills, I am optimistic that I will develop these skills within placements and carry them with me in the near future. Also this assignment has taught me that when doing the nursing process it is important that as a student or qualified nurse, when assessing or planning the patients’ care that I am not influenced by my own beliefs, attitudes, or personal experiences and everything done should be evidence based. Moreover it is clear that the nursing process is a big factor within nursing and is used daily by nurses. Without the nursing process all care would potentially be standardised to specific care needs and not individualised to the patient’s own specific care needs (NMC 2008). Writing about the nursing process has increased my knowledge of why it is important to care for someone this way and what essential care needs are. Also it has increased my knowledge on how to do an assessment on a patient in pain, and provide and effective care plan, furthermore I have learnt how to evaluate care and the things I can do to improve care, I feel that I can take all these things I have learnt forward with me into practice.
Reference list
Alzheimer’s society (2013) Demography. Available from; http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=412 [Accessed 2 May 2013]
Arnett W ,Personal communication, April 2013
Arthritis Reasearch UK (2013) Knee pain exercises. Available from:http://www.arthritisresearchuk.org/arthritis-information/exercises-to-manage-pain/knee-pain-exercises.aspx [Accessed 30 May]
Arthritis research UK (2013) How can physiotherapy help? Available from:http://www.arthritisresearchuk.org/arthritis-information/therapies/physiotherapy/how-can-it-help.aspx [Accessed 24 May 2013]
British pain society (2008) What is the British pain society? Available from: http://www.britishpainsociety.org/about_what_is_bps.htm [Accessed 3 May 2013]
Cherry K (2013) Hierarchy of needs. Available from: http://psychology.about.com/od/theoriesofpersonality/a/hierarchyneeds.htm [Acessed 5 May]
Cummings (2006) managing pain in patients with dementia. Nursing Standards 20.(46), Available from: http://nursingstandard.rcnpublishing.co.uk/archive/article-managing-pain-in-patients-with-dementia-in-hospital [Accessed 2 May 2013]
Daniels R (2004) Nursing Fundamentals: Caring and Clinical Decision-Making. United states of America :Delmar Learning
Field L & Smith B (2008) Nursing care, an essential guide. London: Pearson education limited
Ghebrehiwet T (2011) Nurses and person centered care: The International Journal of Person Centered Medicine 1(1):20-22. [PDF] Available from: www.ijpcm.org/index.php/IJPCM/article/download/17/14 [Accessed May 21 2013]
Hawtson-Jones L & Roberts S (2012) Patient Assessment and Care Planning in Nursing. London: Learning Matters
Lloyd H & Craig S (2007) A guide to taking a patient’s history. Nursing Standards 22(13). Available from: http://nursingstandard.rcnpublishing.co.uk/archive/article-a-guide-to-taking-a-patient-s-history [Accessed 24 May 2013]
NHS careers (2013) Nursing, Skills Required . Available from:http://www.nhscareers.nhs.uk/explore-by-career/nursing/skills-required/ [Accessed 30 May]
NHS Careers (2013) Occupational therapist. Available from: http://www.nhscareers.nhs.uk/explore-by-career/allied-health-professions/careers-in-the-allied-health-professions/occupational-therapist/ [Accessed 30 May 2013]
NHS choices (2013) Arthritis. Available from : http://www.nhs.uk/Conditions/Arthritis/Pages/Diet.aspx [Accessed 24 May]
NHS Choices (2013) Arthritis Medicines. Available from: http://www.nhs.uk/Conditions/Arthritis/Pages/MedicineGuidePage.aspx [Accessed 16 May]
NHS Choices (2013) Eatwell plate. Availavle from:http://www.nhs.uk/Livewell/Goodfood/Documents/Eatwellplate2.pdf [Accessed 30 May]
NHS Choices (2010) Strange clues to pain perception. Available from:http://www.nhs.uk/news/2010/09September/Pages/experiment-touch-eases-pain.aspx [Accessed 24 May 2013]
NHS Choices (2013) Painkillers,Ibuprofen. Available from:http://www.nhs.uk/Conditions/Painkillers-ibuprofen/Pages/Introduction.aspx [Accessed 30 May 2013]
NHS Choices (2013) Painkillers, parcetamol. Available from: http://www.nhs.uk/Conditions/Painkillers-paracetamol/Pages/Introduction.aspx [Accessed 30 May 2013]
Nursing and Midwifery Council (2010) What nurses do. London:Nursing and Midwifery Council
Nursing and Midwifery Council (2011) Guidance on professional conduct for nursing and midwifery students. London:Nursing and Midwifery Council
Peta R, Personal communications, April 2013
Tavener T (2005) The evidence on perception of pain in older people.Nursing times 101.(36):36. Available from: http://www.nursingtimes.net/the-evidence-on-perceptions-of-pain-in-older-people/203679.article [Accessed 3 May 2013]
The British Pain Society (2007) The assessment of pain in older people [PDF]. Available from: http://britishpainsociety.org/book_pain_older_people.pdf [Accessed 20 May]
WebMD (2013) NSAIDs for Rheumatoid Arthritis . Available from: http://www.webmd.com/rheumatoid-arthritis/guide/nsaids-rheumatoid-arthritis [Accessed 30 May 2013]
White L (2001) Foundations of Nursing: Caring for the Whole Person. United states of America :Delmar Learning
Wood S (2008) Assessment. Nursing times. Available from: http://www.nursingtimes.net/nursing-practice/clinical-zones/pain-management/assessment-of-pain/1861174.article[Accessed 24 May 2013]
YURA, H. & WALSH, M.B (1978). Human needs and the nursing process. New York: Appleton-Century-Crofts
Appendix 1 http://www.arthritisresearchuk.org/arthritis-information/exercises-to-manage-pain/knee-pain-exercises.aspx Appendix 2
http://www.nhs.uk/Livewell/Goodfood/Documents/Eatwellplate2.pdf
(NPCG1017 & NCPG1016)
‘ The nursing process and essential care needs ’
Summative Assignment
SA072
Student ID: 25519662
Word count: 3294 (excluding reference list and text boxes)
Introduction
This assignment will endeavour to look at essential care needs and explore exactly what they are and why they are important. The assignment will then discuss one particular essential care need relevant for a chosen patient, explore this care need in detail, and define exactly what it is and why it is important. Finally this assignment will be looking at the chosen essential care need and exploring the nursing care required to facilitate this; This is done through the systematic technique known as the nursing process.
Essential care needs within nursing are extremely important for improving the health and wellbeing of a patient, some essential care needs are; nutrition, personal …show more content…
care, hygiene and pain management. All nurses are expected to be able to meet each patients individual care need. ‘All nurses must be able to assess people’s needs and help people meet them when they cannot do so for themselves. This means that nurses must be able to deliver care that meets the essential needs of people and enables them to feel safe and cared for’ (NMC 2010). An essential care need is the nurse looking at the patient holistically to assess how they can be assisted and what they are safely capable of doing themselves. It is a need of care that is essential to the health and well being of a patient (Arnett 2013), for example with Sarah the nurse would look at her holistically taking into consideration she has Parkinson’s disease and Arthritis to assess what her essential care needs are, and the specific care she needs to manage her conditions. As Sarah suffers from a lot of shakes from Parkinson’s disease, one of her essential care needs may be to reduce falls. Due to her pain caused by Arthritis she finds mobility difficult, so other essential care needs may be pain management and pressure area care if she is not as mobile.
All patients no matter of age, culture or gender have essential care needs, Maslow in 1954 developed a theory of human needs and placed them in a hierarchy representing the order in which people seek to satisfy them. Maslow believed that people are motivated to achieve certain needs, and once one certain need is fulfilled the move onto the next. Essential care needs are linked to Maslow’s hierarchy of needs, as they are what people need in order to satisfy them, the hierarchy they best fit into is psychological needs as these are vital for survival and basic care needs; without meeting these Maslow believed that all other needs in the hierarchy become secondary (Cherry 2013).
The chosen essential care need will be pain management; the reason for choosing this to discuss is because the patient who’s the focus within this assignment suffers with pain in her knees and hips, due to Arthritis. Moreover pain management is a key element within nursing, as many people with health conditions suffer from pain; pain is individual to the patient so it’s difficult to define pain. Pain management is an important essential care need adult nurses should be aware of, as people get older and their body becomes frailer they sometimes suffer with a lot more aches and pains, therefore they sometimes require care to help manage their pain. However in some cases elderly patients don’t like to complain of pain, therefore the pain management might not be adequate enough to ease the pain (Taverner 2005). As people age they can develop conditions such as Dementia, people with this condition may not be able to communicate about the symptoms of the pain. Therefore nurses must be able to asses the pain through different ways of communicating, this can be done through; behavioral observation, physiological observation, and body language (Cunningham 2006). There are 800,00 people in the UK with a form of Dementia, therefore it’s essential nurses are able to assess pain through other methods if the patient with dementia is not able to communicate (Alzheimer’s society 2013).
Nurses must provide the best care to patients; have appropriate attitudes and knowledge towards pain, pain assessment and the management of pain (Nursing times 2008).
Pain management must be from the best evidence based research available to prevent patients suffering from harm (NMC 2008). The British pain society helps to promote education and research in all fields of pain. It also aims to increase awareness of pain and the facilities that are available for management (British pain society 2008).
This part of the assignment will include the 4 stages of the nursing process. The nursing process was introduced into nursing by Yura and Walsh (Yura&Walsh 1967), it defines 4 stages that nursing care should follow, these are: assessment, planning, implement and evaluation (Daniels 2004). This process will be applied to the essential care need of pain management, due to the chosen patient’s condition. A community nurse will be undertaking the nursing process, due to Sarah's poor mobility, and not being able to get to the
doctors.
Assessment is the first stage of the nursing process; in this stage the nurse will assess the patients needs and gather subjective and objective data (Hawtson-Jones&Roberts 2012). Assessing the patient effectively is a crucial part of this stage; it helps to look at the patient holistically in order to provide an effective care plan, in Sarah’s case effective pain management to manage her Arthritis. It is essential that the nurse has excellent communication skills when assessing Sarah, so she clearly understands the questions being asked and so the nurse does not miss any vital information given by Sarah. The nurse must have excellent people skills and be sympathetic, this helps patients’ feel at ease with the nurse and confident in discussing their problem (NHS careers 2013). Throughout the nursing process the nurse has to understand that everyone perceives pain differently. Pain isn’t just influenced by physiological factors, but is also influenced by psychological factors; emotions, memories and experiences all have an effect on how people perceive pain (NHS CHOICES 2011). The emotional state of a person can effect how they perceive pain, Field and Smith 2008 suggests that when a patient is anxious and in pain they ask for more analgesia as anxiety contributes to increasing the level of pain.
Firstly the nurse will ask Sarah’s medical history, this is so Sarah can give her explanation of her present problem, this will help provide essential information for the nurse. A medical history is an important part of the assessment as taking a medical history is a holistic approach, meaning the nurse is not just focusing on the problem but considering the patient as a whole, this can help when planning the type of care or assessment Sarah may need next, being holistic is taking into account environmental, spiritual and psychological wellbeing of the patient, it is also looking at the patient in a patient centred approach. (Ghebrehiwet 2011) (Lloyd&Craig 2007).
Once the medical history has been recorded the nurse will ask the patient questions about the pain; this is a fundamental way of assessing the pain as it’s important that the patients own perception of the pain is used for the basis of the treatment, the nurse must not be influenced by their own beliefs, attitudes or own personal experiences about pain, during the patients assessment. Some patients do not like to express how bad the pain really is or they may say they have no pain at all because they do not like taking analgesics. Furthermore this part of the assessment is also important for the nurse to find out how the patient usually deals with the pain (Field and Smith 2008).
The nurse will then observe Sarah’s behaviour as there are many behavioural changes that can be associated with a change in pain. The nurse would ask Sarah to walk about or just sit on the chair, or even both, to do these observations. Firstly the nurse could observe Sarah’s breathing, for example if her breathing rate increases this may mean she is in more pain, she may also start to sweat if the pain becomes so severe. Secondly the nurse could, either when Sarah is walking or sitting down, look at her facial expressions, if she grimacing or wincing this could indicate the pain is worse or extremely severe. The nurse could also observe when Sarah is walking the type of movement if it’s stiff or rigid when stepping or if she has difficulties changing position when standing, if Sarah struggles with this assessment because of pain then the nurse would suggest to do this observation in short bouts, this would already give an indication about the intensity of pain Sarah suffers with (British pain society 2007). Field and Smith 2008 in their book ‘Nursing care, and essential guide’ also suggest that this observational assessment of pain is a very fundamental part of the assessment process for pain.
Planning is the next stage of the nursing process; this is where a care plan is produced to help provide effective pain management for Sarah’s condition previously stated (Hawtson-Jones&Roberts 2012). It is fundamental that the nurse has excellent communication skills with the patient within this stage, so the nurse can discuss effectively with the patient the outcomes the patient would like to achieve from the care, and so the nurse can suggest care options they think would be a good idea to help (NHS careers 2013). Moreover the nurse must have the ability to answer and discuss questions that Sarah may have related to the care planning process and outcomes (NHS careers 2013). Once the nurse has discussed with Sarah the outcomes and goals she would like to achieve, the nurse will then produce the care plan.
The care plan shall be based around controlling the pain of Sarah’s Arthritis; when producing the care plan the nurse would look at Sarah holistically taking into account she has Parkinson’s disease, and consider factors of the care plan that may be more difficult due to this. The first part of the care plan, is for Sarah to take NSAIDs and analgesics at regular set intervals throughout the day, the rationale for this is, taking these regularly will ease stiffness, inflammation and pain that is caused by the arthritis. Relieving these will hopefully help to manage her pain making daily living easier (WebMD 2013).
The next part of the care plan, would be to refer Sarah to a physiotherapist, the rationale is that the physiotherapist can assess Sarah arthritis and put together a programme of exercises and advice. The exercises will help to manage pain and strengthen the muscle around the effected joint; by strengthening the muscle will also help to support the joint (Arthritis research UK 2013). This section of the care plan will also include a referral to an occupational therapist, who can provide all types of equipment, aids and adaptions to help mange arthritis and keep the pain under control (NHS careers 2013). In order for the nurse to be able to make these referrals to these other healthcare professionals the nurse must have the knowledge and understanding of the type of treatment, care and advice that they can offer to Sarah, without this knowledge it may be a wasted referral. Also the nurse be able to work as part of a multidisciplinary team as throughout the care plan the nurse will be working alongside other healthcare professionals (NHS careers 2013).
The next stage of the care plan would be for Sarah to have a healthy balance diet as it can help arthritis. On the NHS choices website research that has taken place shows that that a lot of fruit and vegetables are good for arthritis and also that omega 3 works as an anti inflammatory in patients with arthritis, which will also help the pain if the pain is due to inflammation (NHS choices 2013). Also from eating a balanced diet it will help to control weight, which will help to ease pressure on the joints, which will help the pain. The nurse will also order specialist equipment. This equipment would include a firm mattress, small pillow and bed cradle, the rationale is that, soft or worn out mattresses and big pillows effects the bodies proper alignment, which places stress of affected joints. The bed cradle is to elevate duvet covers, which reduces pressure on inflamed joint. (Arthritis research UK 2013)
The next stage of the nursing process is implementation; this is where the care plan produced in the previous stage is put into effect (Hawtson-Jones&Roberts 2012). The nurse will go through each stage of the plan in detail with Sarah, before the care plan is put into effect to ensure Sarah is happy. The first part of the care plan is Sarah taking regular NSAID’s and analgesics, the most common type of these are ibuprofen and paracetamol (NHS choices 2013). These would be prescribed for Sarah, so she does not have to pay, the nurse would explain to Sarah the correct dosage to take of the drugs, which is for Ibuprofen 400 mg 800 mg every 4-8 hours, this will be 1-2 capsules taken with or after food. Paracetamol 500 mg every 4 hours, which is 1-2 capsule. The nurse will then explain to Sarah that it is best to take the ibuprofen first then the paracetamol 2 hours later, this is so she constantly has pain relief, without it wearing off (NHS choices 2013), also she would explain to Sarah that she should take these medications with water as tea, coffee or fruit juices can cause a chemical reaction which may effect the drugs from working properly (Reid 2013). The nurse will follow up Sarah, by home visits and telephone consultations, to make sure she is taking the medication correctly, and making sure that it is not giving Sarah any side effects.
The next stage of the care plan is the referral to the physiotherapist, the nurse will send the referral to the physiotherapist team and occupational health team with the details of Sarah and the aim of the referral, which is pain management, as previously stated. Once the physiotherapists have received the referral they will send out an appointment in the post to Sarah. Once Sarah has seen the physiotherapist the nurse will arrange a visit to make sure Sarah understands the advice and exercises given, there are many types of exercises for arthritis (see appendix 1). Once the occupational has received the referral they will contact Sarah to make an appointment to come visit her in her home. On the visit they will see what aids and adaptations are needed within the home, to make daily living activities easier for Sarah, so it does not cause her as much pain as it previously would. The types of aids or adaptions could be things such as; stair lifts, bath rails and walking aids. (NHS careers 2013)
The nurse for the next part of the care plan will give advice to Sarah to have a healthy balanced diet, the nurse will give Dorothy the eat well plate guide. (See appendix 2). The nurse will also explain all the things previously stated in the planning section of why it is important to have a balanced diet while trying to mange the pain of her arthritis.
For the final stage of the care plan the nurse will communicate with Sarah to make sure she is happy with the equipment being ordered and the nurse will also make sure that Sarah understands the benefits of this equipment. The nurse will order the equipment, make sure Sarah knows when it’s being delivered, and continuously have home visits to Sarah to make sure the equipment is doing its proper job and if she’s seeing the effects of managing her pain.
The final stage of the nursing process is evaluation; this is where the nurse evaluates the care plan that was put in place in the previous stage. The nurse would evaluate each stage of the care plan all at once. The nurse would communicate with Sarah to ask her if she feels that parts of the care plan is not managing her pain or making it worse. The nurse would ask if the analgesics and NSAID’s are helping to reduce the pain and if they are giving Sarah any side effects. If they are not working or giving Sarah side effects then the nurse would prescribe different NSAID’s or analgesics. The nurse would liaise with the physiotherapist and occupational health to see if they feel the care is managing Sarah’s pain. If them or Sarah feel the care is not working then the nurse would suggest stopping the care and finding another method for managing the pain. Next the nurse would see if Sarah is still having a balanced diet and if it’s helping with the weight control, then would ask if eating lots of omega 3 and fruit and vegetables is helping to reduce pain and inflammation like the studies previously suggest. Even if it was not working the nurse would suggest to keep having a balanced diet, as it is very important in order to achieve a healthy lifestyle. The final stage of the care plan the nurse would evaluate if the mattress and pillow, the nurse would ask Sarah if she feels the pain has been reduced due to sleeping on her new mattress compared to when sleeping on her old mattress. If the pain has increased then the nurse may suggest Dorothy using her old mattress again.
This assignment concludes that essential care needs are a need of care that’s essential to the health and well being of a patient (Arnett 2013). As previously stated there are many essential care needs, however I have only focused on one of these in particular. The reason for choosing pain management as my essential care need is because in my last placement I witnessed many patients suffering in pain and I wanted to learn more about how to assess pain, how to write care plans for pain, and how to treat patients who are in pain.
Writing this assignment I have learnt that Pain isn’t just influenced by physiological factors, but is also influenced by psychological factors; emotions, memories and experiences all has an effect on how people perceive pain. I have also learnt the types of skills I will need as a nurse, not just for the nursing process but nursing in general, these skills are; working in multidisciplinary teams, the ability to communicate effectively with a patient, the ability to answer patients questions, to have essential people skills, I am optimistic that I will develop these skills within placements and carry them with me in the near future. Also this assignment has taught me that when doing the nursing process it is important that as a student or qualified nurse, when assessing or planning the patients’ care that I am not influenced by my own beliefs, attitudes, or personal experiences and everything done should be evidence based. Moreover it is clear that the nursing process is a big factor within nursing and is used daily by nurses. Without the nursing process all care would potentially be standardised to specific care needs and not individualised to the patient’s own specific care needs (NMC 2008). Writing about the nursing process has increased my knowledge of why it is important to care for someone this way and what essential care needs are. Also it has increased my knowledge on how to do an assessment on a patient in pain, and provide and effective care plan, furthermore I have learnt how to evaluate care and the things I can do to improve care, I feel that I can take all these things I have learnt forward with me into practice.
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Appendix 1 http://www.arthritisresearchuk.org/arthritis-information/exercises-to-manage-pain/knee-pain-exercises.aspx Appendix 2
http://www.nhs.uk/Livewell/Goodfood/Documents/Eatwellplate2.pdf