The focus of this assessment is to assess a service user who has been admitted onto a ward where a student was present and plan care, based on their needs that were highlighted in the holistic assessment process. The assessment will include the initial assessment and the complete care plan as an appendix (appendix 1) in which a model of nursing will be used as a framework. The model preferred was the Roper, Logan and Tierney activities of daily living (2000). This assessment will then discuss the student nurses judgements and decisions about the service users’ needs and why and how they were made. This will then be supported by theory which in-turn underpins the decision-making and assessment processes. The setting of which this assignment uses was as follows; a service user had been admitted through accident and emergency to a surgical ward, with acute abdominal pain and nausea. To act in accordance with the NMC code of conduct (2008) confidential will be maintained, and consent was obtained from all involved in the delivery of care and the service user, subsequently any names mentioned will hold no correlation to genuine names and places.
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The service user ‘anna’ had a previous medical history (PMH) including irritable bowel syndrome (IBS) tonsillectomy (2009) and was an insulin controlled diabetic, and it was clear at present to the student nurse and the ward sister that the Anna was in pain.
As previously mentioned the use of a model of nursing was used to construct a care plan, the model used was Roper Logan and Tierney’s activities of daily living. This model was chosen as it was the model of nursing, in which the student nurse was on placement as it covers a holistic care assessment. This therefore means that the model can be used to create a care plan around the service user which will take into consideration many needs including social, emotional, psychological and physical problems and needs. The model of nursing was also chosen because of the regimented daily living activities which clearly highlighted relevant needs for the Anna. These are as follows; to allow the Anna time to communicate her worries, to manage pain and to successfully manage the feeling Of nausea whilst providing reassurance through communication.
The holistic care plan that had been completed prioritised nausea and pain control as the Anna’s needs. These aspects were identified as being priority after initial assessment had taken place (appendix 1) in which many decisions were made, however only two of these will be discussed, these are as follows; to control the Anna’s pain, and the decision to reassure the Anna.
The decision of giving the Anna reassurance was made before any initial assessment had occurred. This decision was made as it was clear to the student nurse that she was worried and the diagnosis was made because of past experiences with service users who have suffered similar pain with illnesses. According to Taylor (2005, p.46) nursing knowledge is a crucial part of the decision making process. As well is communicating with the service user to reassure them and give the service user knowledge about their possible reason for their current onset of pain. Information was also gained from the Anna’s mother about her normal behaviour which helped confirm why the patient is worried, as there had been a quick change. Kaplow (2007) suggest family members can reassure worried patients. Mallik et al (2004) suggests that the communication is important in the decision-making process, this is evident from the care plan that could communication and data collection from both Anna and her mother was gained.
Hilgard et al (1994) states that pain is controlled in many ways, and that levels of pain are dependant on patient’s perceptions of pain. It was apparent that Anna was in pain as observation of body language and also through communication with her and her morther. Therefore analgesia was given as prescribed and administered by the nurse not the student. To help assess the pain levels of Anna’s a pain chart was used (appendix 2). The Use of the nursing process enabled a methodical approach to recognise that Anna had a problem and helped in the care planning process after communicating with Anna a diagnosis of pain was made and the student was able to make a decision to educate Anna with having relevant knowledge through literature of positions that may help relieve pain.
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It appears that the nursing process is a vast amount of making decisions for service user care. Knowledge of anatomy and physiology also play a part in the decision-making process alongside, past experiences with previous service users with the same problem help make decisions. After much reading it is evident that there is much research on experienced nurses making decisions but only a limited amount on student nurse decision-making. Thompson et al (2004) talked about cognitive continuum theory; this explains how decisions are made by data collection and interpretation as well as intuition. Nurses have always had to make decisions in practice about services users care but now they are increasingly more accountable for decisions that they are making.
Benner’s (1987) theory of novice to expert, explains five different steps from novice to expert this suggests that it takes time and experience to become an expert and nurses must move through each step to travel to the next step. This is evident from this assignment that the student made decisions based on several different factors and use of different information therefore working through the stages of novice to expert.
In conclusion it is evident that decision-making is complex and takes into account a vast amount of aspects to deliver best care for the service user , these aspects include evidence based practice, past experience and knowledge, codes of conduct, government policies and procedures, assessment tools, information seeking and interpretation, and the service users preferences. Furthermore decision-making has been a difficult area to research from a student nurse perspective as there is a limited research and literature for student nurses and decision-making, this suggests there is need for further education for student nurses.
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