Assessment and Nurses Essay

The aim of this assignment is to explore the four stages of APIE, formulateing their enormousness in nursing, as comfortably as identifying come-at-able problems within the stages, in relation to the videos of Joe. These issues will then be anaylsed apply theory, to create possible definitions and issuings for the demeanor and actions sh take a shit got by Joe and the nurses. APIE is a nursing process which guides health professionals with the problem solving get, which nurtures the various(prenominal)ised, holistic delivery of c atomic number 18.It is tailored around the tolerants ineluctably and allows nurses to holistically assess the enduring, then plan and even off goals check to the information gather. These plans and goals be then enforceed into the complaint delivery and evaluated for military cap tycoon (Wilson, 2012). appraisal Assessment requires looking at the unhurried holistically and establishing what the diligent was want before creation admitted and what they are like now. If there is any kind between the two, then the cause of this qualifying must be identify. at once this is established, a detailed plan can be derived to tackle the unfeigned problem and electric potential problems which may arise as a result. Assessment is authorised because it look ats the person as an private (Barrett, Wilson and Woollands, 2009). The consequences of wrongly assessing a forbearing are that at the planning stage, occupy may be tailored incorrectly to their gender, religion and other factors which are paramount to that individual. This will in turn affect the way disturbance is implemented.An individuals culture, determine and beliefs are highly influential in establishing what the dish outr may do for them and what they favour to do themselves (Baldwin, Longhurst, Smith, et al, 2003). Information collected may be objective or subjective. Objective data is measurable and verifiable whereas subjective data is indomi table by the individual in swan to understand their experience (Long, Phipps and Cassmeyer, 1995). In order to validate and verify the information collected during assessment, it is crucial to pass along the information collected back to the patient (Lippincott, Williams and Wilkins, 2007).One business relationship of Joes behaviour is the Cognitive Dissonance Theory (Festinger, 1954) in the sense that he expresses an idealistic view by saying that he would non change anything about the writ of execution of his care and stating that all the nurses are lovely. These statements are contradicted by the fact the nurses do non acknowledge him when he repeatedly asks for his glasses, and they slop over him and ignore him as he is getting out of bed. He makes excuses for their bad perpetrate by stating that the nurses are busy and that it does not consider anyway because he does not have anywhere to go.Joe may be using cognitive dissonance as a coping system to maintain harmony a nd avoid the truth (McLeod, 2008). Coping strategies are a way of the individual dealing with their problem to make it much than than manageable. These strategies, whether adaptive or maladaptive, should be set though patient interaction in the assessment stage. If the coping strategy is maladaptive thenit should be identified by the nurses and then plans and goals should be set out to find the cause of this behaviour and how to rectify it. Joe may be using a coping strategy to cope with hisdeterioration in independence, since becoming immobile and incontinent.The reasons behind these problems occurring should be identified at this stage, before moving on to the planning stage (Barrett et al, 2009). Physiologically, Joe is at Stage Eight of Eriksons (1980) Development which means he should be at a stage where he is evaluating his life and passing on his wisdom to others, however Joe is not able to communicate in the plateful as he is sat alone at meal propagation and is not listened to by the carers. Erikson (1980) states that we continue developing until we die and that by Joes stage, all the ego strengths from the past seven stages come together and are used to evaluate ones life.On observation however, it seems intelligibly that some of the ego strengths are being shamed will power, decision and confidence and fidelity are undermined by the fact he is called idiotic thing and ignored when he repeatedly asks for his glasses. Stage Two shore leave is also undermined as he is not given the independence of choosing him own meals or choosing what time he wakes up or eats breakfast. This guides that Joe was not assessed in accordance with his age.To rectify this problem, Joe inescapably to be made more autonomous, given encouragement to usethe urinal instead of a catheter and allowing him to make his own choices. The government White Paper (2006) focuses on the need for individualised care and calls for service to be tailored around the needs of t he individual and not the service provider. It aims to place the individual in control of their life and promote independence, by providing a more flexible service, with a view to a reaching and fulfilling a healthy old age. In addition, violence, stress and shout out which pose a threat to an individuals overall well being, must be identified and addressed.The nurses did not view Joe as an individual because they did not give him the opportunity to choose what he treasured to eat, or allow him to get dressed before leaving his room. To adopt a more individualised approach, the nurses should have let him choose what tine to get up in a morning, allowing him to get dressed and further choose what he wanted to eat for breakfast, thusly adhering to The White Paper guidelines. formulation Planning is important because it clearly sets out SMART Goals which are patient concentrate on and therefore involve the patient directly, when the goals are being established (Barrett et al, 2009) .A consequence of not involving the patient directly or clarifying expound to the patient is that the goals will not be met, or goals will be set which are irrelevant. Important goals may be omitted or set goals will not be beneficial to the individual. A Systematic nursing Diagnosis should gather information from the patient about the consequences of living with their picky condition and the impact it has on their life. A way of doing so, is establishing a service line what was the patient like before the condition arose, and what are they like now.In addition to this, it should be identified how the patient copes with this change. For example, Joe should have been asked what it is like for him having a catheter. Joes daily continence routine before wearing a catheter should have been established, in order to compare it to his up-to-date daily routine. past Joe should be asked how he is coping with this change and how this change affects his life. The same method acting shoul d also have been used to assess his immobility, so that a needs statement may be written, along with a baseline, in order to make progress measurable (Barrett et al, 2009).Joe used to be able to notch when he was admitted, now he is in a wheelchair. He says he cannot get to the bathroom on his own, and because of this, his independence has been compromised. The nurses should take into account the psychological, sociological and biological implications of this change in mobility. If APIE, was do correctly, the cause of Joes damage mobility should be established, as well as what can be done to avoid any potential problems arising from immobility such as constipation, oedema, decreased muscle mass and compromised circulation(Carpenito-Moyet, 2009).A further goal which was not identified at this stage was to maintain Joes identity and masculinity by letting him wear his own clothes and asking what he wanted to wear, as oppose to sitting in pyjamas all sidereal day. This is bad pra ctice because sitting in pyjamas all day assumes Joe into The Sick Role, a Functionalist share identified by Talcott Parsons (1951)as withdrawing from normal social behaviour and adopting a more deviant portion, which deems them excluded from the social responsibilities and normal day to day functioning(Bilton, Bonnett, Jones, Lawson, Skinner, Stanworth and Webster,2002).The nurses further show signs of this behaviour because they seat Joe alone at breakfast, hence excluding him from social interaction. An explanation of this may be that the nurses gain a sense of power if they are able to assume someone into a passive reference, because the sick role gives the health professional authority over a patients health, plus the right to gain personal information from them. A consequence of the nurses behaving in this way, may lead to the self-fulfilling prophecy whereby Joe adapts and begins to adapt to the sick role which is assumed of him.This process of conforming to deviance is also known as deviance amplification (Bilton et al, 2002). The reasons for the carers not setting a goal for this flavor of Joes life may be delinquent to the nurses not being aware of the implications of sitting someone in pyjamas all day. Another explanation may be that the nurses automatically labelled Joe as being ill, thus assuming him into a sick role without pre meditation of doing so. Joe may not feel comfortable asking to wear his own clothes in case he is seen as being a difficult patient, due(p) to sociological cognition that the practitioner is dominant andthe patient must conform to their rulings (Bilton et al, 2002).A suggestion to alleviate this problem may be to commit a goal in place for Joe to wear his own clothes. murder Implementation is important because it puts into action what has been set out in the care plan and in the goal setting process. The consequence of not implementing care properly is that a standardised method of care may be implemented as oppo se to a holistic method, which respects individual needs and cultural diversity (Barrett et al, 2009).The NMC Code (2008) supports this by emphasising the need to brood patients as individuals as well as listening to them and responding accordingly. The nurses did not implement Joes care properly because they did not respond to his request for his glasses, which he asked for several times. A possible explanation for their behaviour may be due to ageist views. To support this theory, studies have highlighted a preference amongst care adders to work with children or young adults an ageist view which has resulted in older people lots not properly assessed or receiving thorough care.Overall, this age group a good deal do not benefit from the up most efforts of medical module (Gross, 1992). Another theory to explain Joes and the nurses behaviour may be explained by the Social Disengagement Theory which illustrates co-operation of the elderly individual in the process of disengageme nt between them and society. Erikson (1951)guides an individual through life up until old age, from which point, the individual is left to mature and develop by reflecting on their past, thus disengaging with their role in society and conforming to a more submissive role.(Cumming, Dean and Newell, 1960). Some argue that the ageist view is justified. A. B. Shaw, of Bradford Royal hospital (1994) argues that in an age of limited healthcare, ageism towards the elderly is a positivistic method in reserving healthcare facilities for those who will most benefit, i. e. the younger generation. This public debate however is not in keeping with the NMC Code (2008) which states that you must not offer care which is discriminatory in any way. A. B. Shaws view however, may be the same view adopted by the nurses, which could explain their behaviour.The nurses could possibly have implemented his care better by taking a holistic approach to Joe, and not simply viewing him as another statistic. If the assessment and planning stages had been one correctly then the implementation of his care would have been at a higher standard and more patient touch. Joes undesirable learned behaviour is to keep placidness and shut up. He has learnt this by the fact that every time he speaks, he is ignored. Learning is a process which results in permanent changes in behaviour. Joes catheter (also mentioned in the planning stage) was not check out in the morning.Joe complains that his catheter practically gets full and pulls. The consequences of not checking his catheter regularly are that signs of dehydration or transmission may go unnoticed. The amount of urine should also be checked because if the amount is low, it may be that that the catheter is blocked or obstructed (McMillen and Pitcher, 2010). prevalent urinary output should be around 30ml per hour. (Colvin, Guffey, Hoelscher and Smith, 2011). The nurses should be familiar with catheter care and should initiate learning of such procedures, in order to benefit the patient and promote Joes wellbeing.Evaluation There are two types of rating summative evaluation and formative evaluation. Summative evaluations evaluate how centreive the superior general approach to care and the process of care were. It determines whether a holistic approach to care was used and how effective the assessment process was in specify the nursing diagnosis in order to lead to patient centered planning regards their needs statements and baselines. Goals are also assessed in terms of relevancy and how realistic they were.Formative evaluations rely on direct nurse to patient interaction to determine whether the problem has got better or worse. For this to be effective, a baseline must be in place for each goal, in order to assess whether the patient has moved away from or towards the goal. tolerant activity and behaviour also are scrutinised to fulfill this evaluation. Interaction with the patient, in order to learn about their ex periences, is key to this type of evaluation as they know themselves better than anyone Evaluation is important because it reviews the effectiveness of the current plan.If the current plan is not deemed to be beneficial to the patient then it is important to return to the assessment stage and correct any problems (Barrett et al, 2009). The consequence of not evaluating correctly is that the process has therefore been ineffective in establishing any potential problems with the previous stages. The elderly have different nutritional requirements to younger adults due to age related biological changes such as changes in metabolism, digestive enzyme ability and changes in the gastrointestinal tract (Long et.al. , 1995). On admission, Joe was asked to write come out which foods he liked to eat, yet he is given porridge every day and was told it was his favourite. The Evaluation Stage should involve interaction with Joe to identify whether his needs were met in the previous three stages( Long et. al. , 1995). The Evaluation stage here has therefore been unsuccessful because it has not identified that the assessment process has failed to produce a patient centered nursing diagnosis for his diet and fluid white plague.The consequences of victuals someone that same food every day is that Joe is at adventure of Protein Energy Malnutrition, onset by inadequate protein, carbohydrates and fats in the diet, or vitamin deficiencies (Waugh and Grant, 2010). The consequences of malnutrition in the elderly, if sustained are fatigue, muscle spillage due to the body using muscle for energy, impaired immune response and organ function (due to deficiency of the nutrients required to perform) and eventually death (Cope, 1996).Joe mentions that all he would like is a lovely cup of tea, because when they do give him a take in, it is lukewarm, so he probably does not wish to drink it. The consequences of Joe not been given a drink with his breakfast is that he may become dehydrat ed. The elderly are at an increased risk of dehydration due to biological factors such as reduced thirst perception, body water mass, reduced kidney ability and vasopressin, so it is even more important to evaluate fluid ambition in this age group, therefore the nurses should be ensuring Joes fluid intake meets the recommended guidelines (Lavizzo-Mourey, 1997).Becoming dehydrated may also lead to Joe experiencing mental murkiness, fatigue, constipation, firing of appetite (which will contribute to malnutrition), concentrated urine, fatigue and irritability (Denby, Baic and Rinzler, 2006). oedema is a further manifestation of dehydration, a problem which may be made worse by Joes immobility. Other manifestations include confusion (which will be heightened by the fact Joe cannot see properly without his glasses) and if not treated may lead to coma.Untreated, dehydration leads to shock were tissues begin to die and major organs such as the liver and kidney become damaged due to a reduction in circulating blood pot (Rosdahl and Kowalski, 2007). Nurses should be aware of these signs in order to recognise when a patient is suffering from dehydration and malnutrition, in order to rectify the problem within a safe timescale. Tea is also not a recommended drink to give older adults with a meal because it inhibits weightlift absorption. Low iron levels may cause anaemia, as well as memory loss and fatigue.His diet should therefore be evaluated to include more red meat, fat fish, eggs and breakfast cereals which are fortified with iron. Finding a alternate to drinking tea at mealtimes may also be considered at this stage (Denby, Baic and Rinzler, 2006). As supported by the evidence shown above, it can be concluded that the behaviour of the nurses does not support the guidelines illustrated in the stages of A. P. I. E, therefore the nurses have failed to successfully use a problem solving process.Information gathered during the assessment stage was not sufficient enough to devise able plans and goals, therefore the implementation stage failed. Evaluation was also unsuccessful as it did not identify were the previous stages had gone wrong. Because all of the stages are interrelated, loser in one stage has a knock on effect to the other stages (Barrett et al, 2009). Because the nurses failed at the assessment stage, it automatically affected the rest of the process. 201101791.