The purpose of this essay is to explore the health needs and services experienced by a patient during the writer’s pre-placement visit in the hospital. To respect patient’s right to privacy and confidentiality Nursing and Midwifery Council, (2018), the patient will be referred to as Mr Johnson (pseudonym) and Tonia as the nurse. Consent was gained by all the relevant individuals involved prior to the patient’s care. Mr Johnson who is a 75 years old mobility-obese male patient was admitted in a rehabilitation hospital due to pressure sores and immobility due to stroke.A study by Hartgerink, (2014) suggested that stroke management requires multidisciplinary approach, and that an adult nurse plays various active roles within the Multidisciplinary team (National Health Service, 2011; Hartgerink, 2014). Aligned with these suggestions, the writer observed the importance of adult nurse’s roles in provision of high-quality care for Mr Johnson. He was diagnosed with methicillin resistant staphylococcus aureus (MRSA) infection and type 2 diabetes. As a result of his numerous health problems, Mr Johnson needs daily care support, wound management, wheelchair assessment and therapies from rehabilitation to help her sit upright. The collaboration of different health professional like nurses, dietician, speech and Language therapist, physiotherapist, occupational therapist, physician, psychologist, social worker are needed for a successful MDT rehabilitation team approach (Aydin, et al.,2015).While recognising the importance of various healthcare professionals involved, this essay will also highlight the precondition nursing skills demonstrated by the nurse, the role of the nurse within Multidisciplinary team and the importance of effective communication.
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Mr Johnson is a 75 years male patient who weights 135kg at 159 cm height. According to National Health Service(2018) his body mass index(BMI) of 51.2 shows that he is severely obese and his past medical history includes paraplegia as a result of stroke which involved Thoracic level 7 (T7) and T10, diabetes 2. He was admitted in Rehabilitation hospital as a result of leg pressure ulcer and moisture lesion sacral cleft (National Institute for Health and Clinical Excellence, 2015). Obesity has been regarded as the cause of mobility reduction, which predispose patient to high risk of developing pressure ulcer (fall, et al., 2014) Mr Johnson diabetes type – 2slows down the healing wound process(National Health Service, 2017).However, to support the skin sore healing, the patient is needed to be moved
Regularly, although he usually complains of serious pain being triggered by movement during his personal care. Sometimes, he demands for the possibility of his care being delivered without any body movement to prevent the severe pain; which he claimed that has been his reason for not complying with his regular exercise as suggested by both physiotherapist and occupational therapist in the hospital (Placement hospital, 2019). Through collective and steady effort, all the factors that have incapacitating effect on Mr Johnson’s health and well-being were improved.
As a result of his health problems, the patient needs assistance in most aspect of his personal care, which includes limited support in upper body bathing, complete assistance in dressing up and total support in mobility(Placement hospital,2018). Mr Johnson’s other health needs includes management of his wound pressure, controlling his pains, healthy and proper balance diet, management of diabetes. He communicates his needs to multidisciplinary team for the use of motorised wheelchair, in other to aid his movement because he has been in bed rest for sometimes after previous discharge (National Quality Board,2015). Mr Johnson future nursing care home, that he will be transferred to, requires him to be capable of sitting for some hours per day, and also sit upright independently without any support from his personal carers or nurse. Hence, his treatments during the rehabilitation then focused immensely on his independence promoting, while addressing postural problems. Although he claims an absolute interest to work with Multi-disciplinary team in order to achieve better mobility outcome, this does not appear as an easy achievement as it might sound. In the pre- placement observation period, In the course of pre-placement observation and communication with the patient, the writer observed that Mr Johnson was reluctant to take part in activities that will involve movements due to pains he experience in such occasions, even when supported by his health care assistance or therapist team. Dougherty and Lister (2015) cited that researchers have acknowledged that obese patients that have paraplegia grade A,B, and C, of the American Spinal Injury Association Impairment Scale, has lesser therapy involvements, this has been establish to be related by reduced motoric aftermath of the patient’s Fundamental Independent Measure (FIM) during the period of hospital discharge. Although Mr Johnson has not accepted the need for him to have psychological support, the idea was suggested by the MDT and was documented in his record. As a result of his MRSA, he requires medication as it was necessary to his need due to his active MRSA and Standard Infection Control measures were applied at all times; and also any relevant MRSA infection measures that needs to be applied (National Health Service, 2016).
The pre-placement rehabilitation hospital, where Mr Johnson received his care, made provision of diagnostic and screening service, treatment of long and short term condition, as well as rehabilitation service (Placement hospital, 2018). In accordance with the commission Guidance by National Health Service (2016), holistic approach was provided by the patient rehabilitation hospital. His treatment was not only targeted at maintaining the patient present physical functions, improving on limited physical ability but also, the care that was provided includes; his psychological aspect which involves mental health services. In addition, evidence suggests that appropriate spiritual care can have instant positive influence for those in need (Carson, King and Koenig, 2012), in case Mr Johnson needs spiritual and religious support at the period of his care, the chaplaincy service can provide him with spiritual and religion service notwithstanding his belief (Hurley, 2018; National Health Service, 2015).
Tonia, who was the nurse in Mr Johnson’s care, explained to him what she intends to do and gained consent as stipulated by Nursing and Midwifery Council (2018). Tonia performed an assessment upon the patient on admission (Placement hospital, 2018). Tonia and the nurse who took over when she was off duty, plays the daily assessment roles and providing care on the aspect of pain management, bladder function, bowel management, autonomic dysreflexia, skin management, muscle spasms, regulating core temperature, communication support, swallowing, nutrition and weight check, sleeping pattern or cognition and behaviour. The nurse also carried out daily skin lesion risk assessment that are based on Waterlow Pressure Area Risk assessment Chart to prevent further Mr Johnson from developing more pressure ulcers (National Institute for Health and Clinical Excellence, 2018) and all the assessments were recorded in his file. Kozier et al. (2008, cited in Hemming et al. 2014), describes that after the assessment date record, the diagnosing role follows and that was when the nurse analysed and interpreted her findings in order to find out Mr Johnson’s health problems. His diagnosis was used to plan how to promote his health through nursing care service, which led to implementing his plans, interventions, and evaluation of his result and care plan as the nurse plays the role of care provider. The above processes headed back to re-assessment of his condition and further improvement strategies. National Health Service Improvement (2017) outlines that, apart from updating the patient’s record, the nurse must communicate this information to appropriate professionals within the MDT. The nurses play important role in the patient safeguarding by routinely examining the quality and safety of equipment and ensuring that the proper medication was administered in his care, and also maintaining cross infection control. For instance, his bed was made suitable for his condition as a bariatric patient and fully functional bed rails were fixed; and provision of medication to ensure maximum benefits for the patient (Nursing and Midwifery Council, 2018). Tonia demonstrated that nursing profession’s role involves supporting the patient spiritual well-being throughout care delivery. This was achieved by being attentive and as well as providing time to pay attention to patient in his time of crisis (Royal College of Nursing, 2016). Acknowledging her strengths and limitations, Tonia communicated the patient’s health need to Multidisciplinary team. The nurse gained the consent of the patient and contacted the Chaplaincy team that can help the patient in the spiritual aspect. Tonia administered her role as a nurse by documenting all the patient findings and different steps she undertook on the patient’s behalf. She performed an advocate role by identifying his need to contact Chaplaincy and procedure to provide spiritual support to Mr Johnson.
Effective communication is also vital for the success of multidisciplinary team and failure to do that may lead to devastation like death and so, both nurses and professionals within the MDT use verbal and non- verbal to communicate (Day, 2016). For instance, during handover period or multidisciplinary team meeting, the documentation of the patient record assisted in providing important communication passage whereby his access was given to other professionals such as Physiotherapist, Speech and Language Therapist and so on, to sustain the provision of patient care. Hence, ability to keep clear and accurate record is expected from a nurse by the Nursing and Midwifery Council (2018).
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To deliver high quality of care for Mr Johnson, members of the MDT must work together, constantly communicating and sharing sources (Horton et al., 2014). As mentioned above, the nurse performed her role by communicating together with the patient and his family members and multidisciplinary team. The Royal College of Nursing (2016) outlines the benefits of effective communication as putting patient at ease, assisting patient to regain sense of control, and to help patient to feel valued. In the course of the writer’s pre-placement at the rehabilitation hospital, the MDT that was involved in provision of his care includes; Diabetes nurses, Doctors of rehabilitation, Occupational therapist, Physiotherapist, Chaplaincy, and Health care assistants (Placement hospital, 2018). Diabetes specialist nurse provided care and educate Mr Johnson on how to make lifestyle changes by exercising regularly, change in diet and maintain a balance diet and how to manage the symptoms (British Dietetic Association, 2014). Doctors of rehabilitation medicine are trained in the area of care planning for the patient that has complex health issues as a result of life threating injury or illness (British Society of Rehabilitation Medicine, 2014). The consultant rehabilitation doctor provided vital input concerning Mr Johnson’s rehabilitation needs and suitable advice on how to intervene. The team of physiotherapists apply holistic approach to provide advice, exercise, and help in application of manual therapy in order to restore movement; and prevent more injury and further illness (National Health Service, 2018). Occupational therapist team assessed him and designed occupational plan that was used to improve on the patient participation in his activities of daily living. In terms of Mr Johnson’s pressure sore, him and professional that were involved in his care was educated on appropriate pressure relief technique like tilt in space control, per hour support by two persons (Placement hospital, 2018).The speech and language therapist (SALT) are associated wilt health care professional that provided support, treatment as well as care for the patient who had difficulty with swallowing, drinking and communication.
Holistic approach and patient centred care are important. It underpins the need for nursing care and effective rehabilitation of stroke patient, such as Mr Johnson, which requires cooperation between multidisciplinary team, patient and the supporting family member ((NICE, 2016).An adult nurse holds various role within the MDT, which can interchange with other profession depending on what the situation requires, where communication is imperative. Upon reflection, the student nurse writer realised that working together with other professionals requires good communication skills, as shown by the adult nurse. Furthermore, the adult nurse demonstrated that effective communication is not limited to verbal and written communication. Equally important are the use of appropriate body language, facial expression and at times just being there for the patient and his family. Hence, the student nurse writer aims to develop excellent communication skill which is central to successful delivery of health care (Royal College of Nursing, 2016).
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