Date of Learning: 29/09/2023

Time: 09:30-16:30

Learning Activity 1: The Nursing Process and Care Planning

Today we explored the nursing process ADPIE and how it can be used in conjunction with the Roper Logan Tierney (RLT) model of nursing to provide a framework to plan, guide, and evaluate the provision of care. The learning outcomes for this session are to develop an understanding of the process used in nursing to assess, plan, and deliver care, to explore the use of nursing models in assessment, planning and delivering care, and to identify how these nursing models apply to the nursing process and to apply the nursing process to case study examples and formulate care plans.

The class session started by reviewing what we learned from the previous session, person-centred care. I defined person-centred care as personalised care in which we focus on their individual needs, preferences, and values. The patient is the centre of decision-making. Therefore, they need to be involved when it comes to decision-making. Person-centred care is important because it promotes independence, skills, knowledge, and confidence to make informed decisions about their health. Person-centred care is delivered by working collaboratively with the patient. It is about giving them choices or preferences and treating them with dignity and respect.

The nursing process allows nursing professionals to take a systematic approach when managing patients’ needs. It involves considering potential nursing interventions and evaluating their effectiveness. Assessment, planning, implementation and evaluation for short APIE is a process to direct nursing practice away from intuition and standard practice to a structured systematic way of dealing with care needs.

Patient assessment is needed to identify, understand, and determine the problem or issue. It is an essential requirement to gather accurate assessments to view patients holistically and thus identify their real needs.  Holistic assessment considers the patient’s wishes, mental, physical, social, cultural, spiritual, and personal needs. It is important to know the patient’s current condition, type and frequency of treatment, and observation to help inform clinical judgement and clinical decision-making. The assessment includes an evaluation of the treatment or procedure progress and identifies the patient’s values and preferences.

There are two types of patient assessment, these are comprehensive assessment and focused assessment. Comprehensive assessment provides fundamental and personalised knowledge about the patient and strengthens the therapeutic relationship between the patient and nurses. Nursing processes and models such as RLT, Neuman’s System model and the disease-illness model are examples of comprehensive assessments.  Focused assessment area detailed nursing assessment of a specific body system relating to the presenting problem or other current concerns. This may involve one or more body systems. As a nursing associate, I must utilise clinical judgement to determine which elements of a focused assessment are pertinent for the patient e.g., ABCDE, NEWS2

Good assessment involves subjective data and factual data when gathering information during patient assessment. Subjective data are verbal information provided by the patient, it verbalises the perception of the problem which is often put in quotes and referred to as a chief complaint. Objective data are information that is factual such as age, gender, allergies etc. This is information that clinicians can hear, see, smell, feel or measure. Objective data includes physical, psychological, and socio-cultural factors that may affect the patient’s health status. Past health history must be gathered and the current or present problem of the patient.

The process of comprehensive patient assessment starts with initial assessment, gathering subjective data, physical examination (objective data), explanation and planning, and closing the session and decision making. The key principles of assessment are to practice infection control techniques, establish rapport, gain consent and maintain privacy and dignity, use a systematic approach, listen to the patient, and summarise each stage of history history-taking process and ensure information is documented clearly, accurately and legibly at each stage. It is required to have communication skills when doing an assessment, interpersonal skills, active listening skills, observation skills, taking vital signs and reviewing documents. Some factors may affect the accuracy of an assessment. These factors can be physical, cognitive, psychological and environmental factors.

Documentation is a fundamental part of any nursing process. Assessments should be always documented. Documents must be in logical order. Using subjective data, objective data, assessment, and planning (SOAP) as a method of charting. It is important to use correct terminology and avoid abbreviations.

Care planning is a crucial stage of providing person-centred care. Learning about the different nursing processes and assessments made me understand how important it is to gather accurate information about the patient. By gathering all the right data, I will be able to provide the right level of care for the patients. I can meet their needs, and goals in a way that suits them.

Learning Activity 2: Planning and Monitoring Care – Formative Workshop

In this learning activity, we continued our session from the previous topic of nursing process and care planning. To summarise the session, we had a group activity in which we used the Rogan Logan Tierney Model. The learning outcomes for this session are to apply the RLT model to identify the patient’s care needs and prioritise care, to demonstrate an understanding of evidence-based care when planning and monitoring care, and to demonstrate an understanding of the importance of monitoring care.

The session begins with a discussion of the ethical aspects of the nursing process. Autonomy simply means that the patient has the right to be involved in shared decisions about their care. Care professionals can recommend when care planning, but the individual has the right whether to take it or not. Mental capacity must be considered within this ethical aspect. Beneficence is doing good. Professionals must ensure that assessments are considered for the welfare of the patient and always promote health. Justice simply means that resources, time and distribution of nursing interventions are equally spread. Non-maleficence means ‘doing no harm’. In this perspective of the assessment, it focuses on risk-assessing actual and potential problems. This is to prevent problems from occurring or to minimise the impact.

The Rogan Logan and Tierney Model (RLT) was introduced during this class session. The RLT model consists of 12 activities of daily living which are maintaining a safe environment, communicating, breathing, eating & drinking, eliminating, personal cleansing & dressing, controlling body temperature, mobilising, working & playing, expressing sexuality, sleeping, and dying. The framework offers a holistic assessment of a patient whilst developing a plan of care. We discussed factors that may influence an individual’s activities of living. These are biological, psychological, sociocultural, environmental and politico-economic factors. The activities of living are the centre point of the RLT model, this is used to assess a patient more holistically and the model depicts the patient’s level of degree of independence.

To put the RLT model in practice we had a group activity in which we used a case study to base our assessment. In this group activity, we used Case Study 1 based on Rosemary who was found by a carer. We presented to the whole class our findings and assessment. We introduced the case study, used the RLT to identify priority and explained why. We considered some focus assessment and nursing tools so that we could make a care plan. In this group activity, we used references to support our findings and used them to implement and evaluate the desired outcome to achieve.

Overall, the topic and group activity benefitted me. It reinforced skills that are relevant to the assignment. I gained knowledge of the content of my assignment and gained clarity on how it should be done. The teaching delivery was good which gave me tips and advice when creating my assignment. It was nicely structured and clearly presented.

KSB ADDRESSED:

Knowledge:

Skills:

Behaviour: