Nurses Role and Individualised Patient Care

The Author will describe the nurses role and discuss individualised patient care based around legal and ethical frameworks that guide and govern nurses in their roles as healthcare professionals. A five stage process to nursing care is one framework use to deliver this care and consists of assessment, diagnosis, care planning, implementation and evaluation and is an on-going, continuous cycle that only ends when goals are achieved and homeostasis is restored, or reasonable expectations of health for individuals are met.

There are many definitions on the role of the professional nurse and one put forward by the RCN (2002) states that Nursing is the use of clinical judgement and the provision of care to enable people to promote, improve, maintain or recover health or when death is inevitable, to die peacefully. Good communication is vital for any nursing activities to begin. Patients often feel anxious, and vulnerable, they may have learning disabilities, depression or confusion caused by anxiety, especially on admission into a hospital setting. The relationship between patient and the nurse, is one based on trust.

Patients have expectations to be cared for by a professional, without causing them harm within a safe environment. Clear verbal, or non-verbal communication using body language, respecting individual needs, wishes, and desires are key components to assessment in the nursing process (Kopp, 2002). Nurses have a professional obligation to ensure they promote and protect the interests and dignity of patients and clients, irrespective of gender, age race, ability, sexuality, economic status, lifestyle, culture and religious and political beliefs (NMC, 2002).

A non-judgemental approach must be taken not just respecting the uniqueness of individuals, but also not letting the nurses own perceptions, personal beliefs, attitudes or any other factors discriminate against patients in the care they deliver (Koh, 1999). Assessment is not performed only once, but used throughout the whole care cycle. It also requires empathetic listening and good observation skills. Correlating information provided by them, family, friends, previous records and use of careful open questioning will llow the patient to be more descriptive about their symptoms (Kopp, 1996). Permission or Consent must be acquired either verbally or non-verbally to perform procedures such as temperature, blood pressure, pulse and respiration. Non-verbal consent is an act the patient may do such as offering an arm for the nurse to take blood pressure, or open their mouth to have their temperature taken. Nurses must also work within their competence ensuring they seek a more qualified practitioner when they are unsure in their knowledge (Diamond, 2002).

Accurate and relevant record keeping are essential to ensure the safety and continuity of care for patients and are legal documents that may be presented in a court of law to prove negligence (Pennels, 2002). All information given must remain confidential unless it poses a risk to the public. Examples of this are governed by acts of law like Public Health Control of Disease (1984), Public Health Infectious Diseases (1988), or cases where there is reasonable doubt about abuse, especially to children, Children Act (1989), and Prevention of Terrorism (Temporary provisions) Act (1989) cited by (Green 1999).

Translation of all the information gathered enables a diagnosis to be made about actual and potential problems the patient may have. For example, a patient has had back surgery which renders them immobile (actual), potentially they are at greater risk of suffering pressure sores and or constipation. It is the nurses job to use clinical knowledge and judgement to implement such procedures as air flow mattresses or assist the patient to frequently change their position.

Give advice on fluid intake and where possible to advise or assist them to do exercises they may be able to perform in bed to reduce these risks. Identifying patient needs and implementation of risk reducing measures require accurate documentation in the form of a care plan (Hogston & Simpson, 1999). Care planning is seen as a decision making process creating a record of specific care for the individual. It involves the whole nursing team and other professionals like physiotherapists, dieticians, social workers, key workers and community nurses (Kopp, 1996) Nurses have the losest contact with patients and are essentially seen as the binding agents bringing all aspect of care together. A care plan is a legal record of continuous care the patient requires, receives and condition of the patient. It is in essence a written prescription for care following assessment and diagnosis, which may be implemented by other professionals. The planning process involves setting goals for the patient to achieve, with the assistance of the nurse where goals are expectations, in this instance for the patient to achieve to recover health.

These must be realistic, measurable, observable and achievable within a limited time scale, with an expected written outcome that is short and explicit. A patient for example may have had a hip operation, so one goal identified and written in their care plan would be to walk a short distance, by themselves, by day three. It would be unrealistic to expect them to walk up a flight of stairs, within this time, if the patients expected stay for this operation was only one week (Hogston & Simpson, 1999).

The named nurse will plan care for the patient, but it is not realistic for this nurse to provide 24 hour care, owing to shift changes. This means other members of the nursing team will have to implement care prescribed, when they hand over responsibility for patient care after their shift. Nursing handover is a process where the nursing team share information with the next nursing team about patients. The written care plan and verbal comments about the patients condition, recent recorded observations and assessments.

Accuracy in these documents are essential to provide continuity of care during handover and are a reflection of skilled, safe practice expected of professionals (NMC, 2002). The plan of care has to be constantly reviewed as the patients condition changes to determine if goals are being achieved. This process is not just for the patients condition but to see if the original assessment, diagnosis, plan of care and implementation of prescribed care is helping the patient towards desired outcomes (Hogston & Simpson, 1999).

Evaluation therefore is a reflective process after events have happened or looking back at events to see if they have had the desired affect. Nurses can use reflection as a method of learning, to change practices where their actions did not result in the anticipated outcome (Cooney, 1999). In theory, evaluation is the end product to the nursing process, but where outcomes are not achieved it is the beginning to the same cyclical nursing process starting with assessment. It may be the nurse must look for new evidence to support their clinical decisions.

When this is the case, research of current or recent published literature like journals or books, specialist professionals and colleagues can help to maintain their competence through learning and understanding (Thompson et al, 2002). If the patient does achieve goals set and both patient and nurse are satisfied with the outcome, it is necessary to plan care for their return home, or into the community. Discharge planning is an assessment of, the level of ability for the patient to perform normal activities for daily living and is based around criteria devised by Roper et al (1996).

A detailed account provided by the patient, about their home environment and level of support they receive from family or friends will determine the necessary involvement of other health professionals and services. Elderly patients may need interventions from home care services who could provide safety measures in their home like non-slip bath mats and hand rails. It may be the patient needs the community nurse to change wound dressings thrice weekly or speech therapy recommended for a patient who has suffered a stoke. These are only a few examples of the many services that need planning upon discharge.

Prescribed medication may need to be taken after the patients discharge and It is the nurses responsibility for making sure the patient or carer is competent in administering their own medicines, checking that any labels state clearly who the medication is for, correct dosage and advice is given about storage to ensure safety. Empowering patients with information to have independence in self-administration and informing them about continued access and support to professional advice (NMC, 2002). Nursing therefore is the ability of pulling ogether subject, practice, professional and reflective knowledge by the use of interpersonal skills. The importance, in this instance, of legal and ethical frameworks used to underpin all nursing activities and the impact this has on the delivery of patient care. Safety for the patient must remain the core for all nursing care. Professional training, education and continued research can improve the quality and continuity of care. It is through a holistic, individualised care approach without adding extra stress, discomfort or offence to the patient, that a non-discriminatory care service can be provided through the nursing profession.