The Nursing Process And Critical Thinking Discussion Paper
Nursing intervention plays a critical role in the patient care plan. One of the costly processes is the nursing assessment that has a systematic practice. It has four assessment tools of inspection, palpation, auscultation, and percussion. These skills play an important method in nursing care (Coombs & Moorse, 2002, pp.3). Therefore, nurses should learn the techniques how to gather all necessary data such as psychological, physiological and sociocultural information from the patient (Lewis & Foley, 2014, pp. 25)The Nursing Process And Critical Thinking Discussion Paper. This paper will discuss the interview between an old adult patient, Mr. Makan who had an Aortic valve replacement surgery and a specialist nurse, Len working in the Emergency department. It will analyze the physical assessment framework. Also, it will also discuss the main strengths of the assessment. Furthermore, the limitations of this nursing assessment will also be discussed.
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Weber & Kelley (2014, pp. 6) provide researches with some important evidence that the assessment has used. In this case, focused or problem- oriented assessment is discussed. This means the nurse focus on the specific health problem that affects the patient health life and the nurse ask specific questions such as: How do you feel? When did that happen? Were you doing anything different than usual when they start? (Taylor & Carol, 2008, pp.15)
There is a large unit of published nursing assessment books describing the Head- To –Toe assessment framework (Lewis & Foley, 2014, pp. 5).It is highly recommended for patients who are admitted to hospital wards because Head-To-Toe Assessment is focused on appropriate physical and psychological nursing assessment. Therefore, several lines of evidence suggest that Head-To-Toe framework is a critical tool that establishes baseline information for patients (Haugh, 2015, pp.58-61)The Nursing Process And Critical Thinking Discussion Paper.
First of all, the nurse introduces herself clearly, explains her job and takes a verbal consent from her patient. This is the first phase of an interview with any patient and it is essential to build trust (Weber and Kelley, 2010). According to Belcher and Jones (2009, pp. 142-152) trust is the key to enhance the patient so that one feel comfortable, cooperative and confident to provide all important data about the past and present medical history.
In the second strength, three categories of nursing assessment are used like formal assessment, informal assessment and silent assessment. Formal assessments are tools or activities that could measure or record vital signs. Informal assessments are activities that observe and chat with the patient because this could assist the nurse to take more notes about the patient. Silent assessment is the intuition of nurse that explores health issues during the conversation (Wendy et al., 2015, pp. 7). According to Sharpe & Hemsley, (2016, pp. 228-236) using different kinds of assessment approach in nursing assessment help nurse as well as provide good quality care and improve patient outcomes.
Thirdly, contemporaneously, one of the advanced skills is used by the registered nurse. According to Adlersberg & Winslow, (2007, pp.1) “It is something existing, occurring or beginning at the same time.” “To illustrate the medical record in nursing assessment during the conversation with the patient, it is compensatory to ensure effective communication, decision making, patient safety, and legal investigations” (Pezaro & Lilley, 2015, pp. e171-e176)The Nursing Process And Critical Thinking Discussion Paper.
Finally, any physical examination requires different types of instruments or machines to examine different body systems (Weber and Kelley, 2010). Therefore, the nurse prepares effectively for the physical examination such as for the vital signs, machine, stethoscope, alcoholic gel and torch.
Nursing interaction plays a critical role in the nursing care plan of patients, but it is clear that the nurse does not collect essential information to establish a strong baseline patient file especially biographical data such as education level, occupation and family support (Lewis & Foley, 2014 p. 13).
Another obstacle in this assessment is the patient interruption. The nurse asked the close-ended question as for when did that happen? , but, the nurse should ask the open-ended question as tell me about your accident? (Wilkinson, 2012 pp. 84-87)Because of this, open-ended questions could encourage older adult patients to speak freely and explain their health status and that could help to improve the medical outcomes for them (Secrest, Norwood & Dumont, 2005, pp. 114-118). Therefore, careful interviewing could assist nurse to obtain relevant information that describes the patient feeling, emotional needs and in seeking social support (Hogstel & Mildred, 1994 pp. 85-86)The Nursing Process And Critical Thinking Discussion Paper.
There was a physical examination error because the nurse does not think logically while examining her patient. According to Haugh, (2015, 58-61) suggests that “when the patient is lying supine, you can assess the patient’s head, neck, anterior thorax, abdomen, and extremities of the patient.” Then finish the examination by making the patient sit up or assist the patient to one side to assess the posterior thorax. Throughout the examination, observe the skin for color, lesions, temperature, and dryness or moisture”.
There is a large volume of published studies describing the role oftaking vital signs into consideration which include temperature, pulse respiratory and blood pressure (Perry et al. 2012). The temperature must carefully be managed because it usually becomes abnormal after any operation especially cardio surgery or wound healing. Nevertheless, in this assessment, the temperature is not taken into account by the nurse during the assessment (Nussmeier, 2005,472-476)The Nursing Process And Critical Thinking Discussion Paper.
For Thorax and Lungs examination, the nurse should prepare specific equipment, palpate and auscultator that determines points to find the exact abnormalities. To illustrate that nurse did not bring skin marker and metric ruler, she did not palpate anterior chest expansion. Also, auscultation for anterior chest wall is completely wrong because she did not listen to lung sound in correct point and there are ten specific areas where a nurse listens to it; however, she just listened to 6 areas (Weber and Kelley, 2010)The Nursing Process And Critical Thinking Discussion Paper.
Lane, Chong & Lip, (2005) suggests that psychological nursing assessment for older adult patients is highly recommended to alleviate depression symptoms. It is done because main subjective data from the patient is palpitation. According to Viars, (2009) heart palpitation is the intensive symptom of anxiety. Furthermore, all of the studies reviewed here support the hypothesis thatthere is a direct connection between cardiac heart diseases and negative psychosocial factors. It might help to improve the risk of depression and increase the quality of life (Arthur, 2006, pp. S2-S7)The Nursing Process And Critical Thinking Discussion Paper.
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Conclusion:
The current data highlights the importance of physical nursing assessment skills that contribute to providing high quality of care delivery and in monitoring the body system changes. The main weakness of this assessment in older adult was ineffective communication which includes incomplete basic patient information and registered nurse interrupting her patient. Another challenge is nursing physical assessment mistakes that lack logic examination, incomplete vital signs, incorrect thorax and lung assessment and unfocused psychological assessment. The main positive phenomenon for this assessment is to build a relationship between patient and nurse, effective communication skills and preparation for equipment and contemporaneous skill. The nurse should document the assessment findings from each patient before moving to the next patient and avoiding interruptions. The Nursing Process And Critical Thinking Discussion Paper