Discussion_of_a_Care_Plan

I will draw upon my experience as a student nurse in a recent nursing placement and highlight the importance of a care plan. The patient that I will be assessing will be referred to as ‘Patient A’ due to the verbal confidentiality agreement formed when asking for their informed consent. They were admitted to a ward that specialised in trauma, elective plastic and reconstructive surgery. The grounds in which the patient was admitted was due to an extensive burn to most of the right lower leg, from a hot pan of water. The surgery consisted of skin grafts placed on the lower leg acquired from the left thigh. Patient A was feeling the effects of post-operative pain, and so we devised a care plan that was based on assessment tools, to enable an accurate account of the pain, so that the correct care could be prearranged. Care plans are devised to cover aspects that may often be neglected; they provide a ‘road map’, enabling good care o be provided for the patient from all health care professionals involved. (Sox 2006) One of the assessment tools used was based on the framework constructed by Roper, Logan and Tierney which considered factors influencing physical, psychological, sociocultural and environmental activities of living.(Kozier et al 2008) For example one of the activities considered is sleeping; Patient A found it hard to sleep due to pain coming from the lower right leg. Another assessment tool was verbal communication between patient A and healthcare professionals explaining the exact problem. It has been stated that the best way to assess a patient is to talk to them (Higginson 1998) It is also important to keep on reassessing pain as it is rarely static. Looking at Patient A I first began with an assessment process. I looked at the Roper, Logan and Tierney model (1990); this model was based on the theories of a psychologist named Maslow (1954) and his hierarchy of biological needs. The model by Roper et al is structured around 12 activities of daily living providing its core. All of the twelve activities are structured around biological, social and psychological needs of a client. These twelve activities allow the patient to be assessed systematically and their care needs can be identified, leading to a care plan being implemented describing the intervention. In addition, to the twelve activities there are also 3 behaviour traits that are to be considered, these are preventing, comforting, and seeking. (Erb et al 2008) By assessing Patient A using the model I could see that a few of these daily activities were relevant. Firstly, the two activities which linked to Patient A were eliminating and mobilising. This was due to Patient A finding it very hard to mobilise due to the pian caused by the injury and so was catheterised. Patient A would remain catheterised until they felt comfortable; this sense of comfort was facilitated through physiotherapy appointments consisting of muscular exercises to stop the muscles from deuterating. These exercises started off with simple strategies such as moving the toes and progressing to walking up stairs. The second activity was sleeping, again due to the pain factor which caused an irregulare sleeping pattern not normal for the patient. The essence of care document was released in February 2001, to aid health professionals to provided care that is structured and focused on the patient. This means that the care being provided involved the patient in all decisions before coming to a conclusion on the direction of care. The document looks into eight areas of care and lays out how to provide good quality care in theses areas called benchmarks. (NHS Essence of Care 2003) There is a benchmark that looks the patients’ bladder and bowl care and how those needs are met. It states that the patient should have access to professionals, who can understand their continence needs, and provide a service to help. This will usually start with a bladder and bowel continence assessment, which will be continuously evaluating and the care plan as well as being changed accordingly. (NHS Essence of Care 2003) Looking at Patient A the catheter was inserted due to incontinence, the benchmark relates showing how to provide care in a patient centred way, allowing the patient to feel like an individual and in an environment that they are comfortable in allowing ease and providing an earlier recovery. Due to the inability of movement, Patient A would not be easily able to provide personal and oral hygiene though self care, linking in with another two benchmarks. A Personal care assessment would be undertaken to see what Patient A can achieve by them self and gain an understanding from the patient on what they would like help in. The health professionals would also try to promote individual personal hygiene for every patient in n environment that is safe and acceptable to the individual. This will constantly be revaluated to ensure that the best care is being provided. This will also be in link with the privacy and dignity benchmark to make sure that it is maintained throughout the patients stay and through all aspects of care enabling them to feel like an individual not just another patient.(NHS Essence of Care 2003) Once I had completed my first assessment, I then talked to the patient to allow their input into the situation, this is so that I could really determine how they were feeling with the use of open questions (providing detail) and closed questions (simply answering ‘yes’ or ‘no’) (Doordan, 1998 cited in Dempsey and Dempsey1999) By using this technique I could relate the convocation to obtain the best answers possible and try to pick up on as many queues to further my knowledge, however I was very conscious not to talk about things that the patient did not feel comfortable with. The questions that were asked were; 1. Where was the pain originating from' It was clear that patient A was experiencing pain from the lower leg. 2. What type of pain was it' Stabbing was the first word that came to Patient A. 3. How they would score it on a scale of 0 – 10 (where ‘0’ is no pain and 10 is the worst pain imaginal)' They rated themselves at around the ‘3’ marker. 4. How was the onset of the pain, sudden or gradual' Patient A clearly described that the pain was there since they came out of theatre. 5. The duration of the pain' (Does it flick on and off or it always there). Patient A stated that it was always there however hurt a lot more when trying to mobilise. When asking a patient questions about themselves, and how they are feel you must be very contentious to not lead them to an answer, as well as not making assumptions on there condition. (Hogston and Marjoram 2007) This is why it is very important to take notes to relate back to enable accuracy. Referring back to the essence of care document, communication is another benchmark that had to be thought of throughout the assessment process. Communication is defined as conversation between two or more people exchanging thoughts, feelings, emotions and concerns from both sides of the party. (Dougherty and Lister 2008) The surrounding environment should be appropriate for everyone involved. An example of this would be having enough space for movement. The information shared should always strive to meet the needs of the individual however the final conclusion should be patient focused which involved contributions from all parties concerned. In the attempts to provide a care plan for Patient A Communication was a key factor to interpret how the patient was feeling. From the assessment stage it was now clear to identify the patient’s goal and this was discussed with the patient that pain was the main concern and if that was alleviated then they would be able to mobilise meaning that the catheter could be removed. Now that the goal was identified this ment that further research was needed to analyse what type of pain the Patient A was experiencing. The pain was due to the operation for a skin graft being applied to the burn. A skin graft is when a piece of skin is removed from a donor sight and placed over the wound, it serves two purposes; the first to reduce the treatment needed therefore reducing the time in hospital and allowing the area to have a better appearance. There are two types of skin grafts; the first being a thin layer of skin and a full thickness skin graft which involves a larger amount of skin being removed from the donor site. (Weerda 2001) Patient A had a thin layer remove from the donor sight which was the taken from the thigh of the left leg. Pain is an individual sensation that can be very disagreeable for the person involved. It can have a sensory and emotional factor and is generally is associated with tissue damage. (McCaffery 1968 cited in McCaffery 2000 p2) It can be determined that patient A is experiencing acute pain in the lower leg Ready and Edwards (1992 cited in Dougherty and Lister 2008) said that acute pain has a ‘recent onset and probable limited duration’ and is usually related to injury or disease. The intervention decided for best treatment to alleviate the pain being experienced was the non-opioid analgesic Paracetamol. One gram would be administered orally every 4-6 hours on the patients request but must not exceed the guide of four grams in twenty four hours (British National Formulary 2006) Paracetamol is absorbed into the gastrointestinal track and surrounded by peak plasma concentrations; this happens every 10 - 60 minutes after oral administration. The paracetamol is present in most body tissue. Overall creating a care plan provides a stable component to allow care to be provided in a continuous, stable and simple way. It does not allow for the problem of miscommunication between members of the health care team as it is a written document stating the exact care that is needed by the individual. (NMC) A care plan can be created for every patient in need allowing the patient to feel comfortable and secure throughout their stay as they would have a big contribution to overall decision of the intervention. Record keeping is major component in the nursing profession as is stated in the essence of care document. It is clearly set out that all records ‘must be legible, accurate, signed with designation stated, time, date and contemporaneous’ this will ensure that all paper work can be placed in a chronological order.(NHS Essence of Care 2003) This allows quick access which saves valuable time, decreases stress levels and gives evidence of a organised calm setting. The code of conduct (2008) states that all records should be completed as soon as possible to allow for accuracy which if not done will cause the health professional concerned to be stressed. Patients are allowed to have access to all their current files and so it is very important that only abbreviations that have been agreed can be used. Records that are kept show evidence of care given and ‘evidence based guidance’ (NHS Essence of Care 2003). The code of conduct written by the Nursing and Midwifery Council also uses the same criteria, however also states that all records that have been written/altered by the individual must be signed so that they are clearly attributable to them. Every health care professional chooses to work in a multidisciplinary team and so must follow the guidelines that have been set down and have a professional responsibility to oblige to these factors. In conclusion, this essay presents how the quality of care being provided has impact on the patient. Therefore a care plan creates structure to the provision and quality of care which is unique to the patients needs.