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Throughout this assignment, the Chapel how et al. (2005) framework were
examined focusing mainly on two enablers which were assessment and
communication and how they were used in practice to influence patient
care.  A case study was done on a patient
whose name was under pseudonym (Mrs. Daniels) for confidentiality purposes. A
brief background was given, and I analysed how assessment and communication
were used in relation to her care. It has shown that both assessment and
communication were both essential parts of nursing and played a vital role when
providing patient care. It was evident that the care provided to Mrs. Daniels
was effective and the assessment tools used were appropriate and using
effective communication meant her needs were met.  It was evident that assessment and
communication both linked together when caring for a patient. The assessment
tools were reliant on effective communication and vice versa. This was
because many of the assessment tools required the use of verbal communication.
Effective communication encourages effective team work and promotes continuity
and clarity within the patient care team. Accurate assessment of a patient creates
improved information flow, more effective interventions, improved safety and
increase in satisfaction in the care being provided.

 One way we in which we tried to eliminate
psychosocial barriers was to promote equal and effective care for all by assisting
Mrs. Daniels with reading, writing and filling of form. Another way of dealing
with psychosocial barriers is expansion of professional interpreting and
translation services for service users who do not have English as a first
language as well as cultural diversity training for health care professionals
on appropriate practices; putting aside all prejudice and stereotypes and
providing the best patient-centred care possible (Arksey and Jackson, 2003). Due
to Mrs. Daniels loss of sight in the centre field, it was difficult for her to
lip read during conversations, so we had to speak as loudly and clearly as
possible and also offered appropriate hand of touch as reassurances which
made Mrs. Daniels fell included and valued in the communication process. Hanley et al, 2017 highlights
the importance of sometimes using touch for a therapeutic relationship, however
Braille 2001 recommends the careful use of nonverbal communication since touch
has a positive as well as negative effect on patient.

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Psychosocial barriers to communication could include physiological
barriers such as a disability or illness in which in Mrs Daniels case was loss
of vision in the centre field due to dry macular degeneration ; psychological
or emotional barriers which could be the state of mind of everyone involved in
the communication process that can lead to a person only takin in information
they are emotionally tuned into, known as ‘filtering’; social barriers which
could be conflict, violent and abusive situations as well as the ability to
read and write in a particular language or style  ; cultural barriers which include people’s
backgrounds, values, ethics, prejudices, perceptions, needs and expectations.
Psychosocial barriers often involve a psychological distance (Antes, 2011). For
example, if a health and social care practitioner talks down to a patient all
the time, he will resent this attitude, and this resentment separates them,
thereby blocking opportunity for effective communication. It is therefore
important to overcome these barriers.

Semantic barriers refer to the barriers in communication caused by
problems with interpretation of the meaning of the words used. The tendency to
overlook the fact that certain words have different meanings to different
people also known as bypassing which may lead to the message being interpreted
differently by the Mrs. Daniels which in turn leads to breakdown in
communication is one of the major categories of semantic barriers. My mentor
and I made a conscious effort to overcome this barrier by avoiding making
assumptions that the Mrs. Daniels understands what we were trying to
communicate. We ask questions to make sure the she understood the message in
the way it was intended. We also avoided the use of abbreviations in our correspondence
with Mrs. Daniels (Malik, 2016).

The environmental and natural condition where the assessment was taking
place could also be a physical barrier in conveying the message from sender to
receiver. For example, conducting the assessment in Mrs. Daniels room with the
door and blinds closed was more effective and professional than if we had done
it in the lounge where other residents and their family members were seated.
This was also essential in promoting confidentiality, privacy and dignity.  Time, place, space, climate and noise are the
most powerful factors of the physical barriers that can completely change the
intended meaning of a message. Some of these factors can be controlled and
adjusted but others are beyond anyone’s control (Collins et al, 2002).  A person’s
environment can be a physical barrier if there are adverse weather conditions.
People’s abilities to make decisions and their perceptions and moods could be
affected by the kind of weather there is. This barrier is difficult to overcome
as it is hard to control the different weather conditions.

Communication models can be a sturdy tool for thinking about an
individual’s communication skills, pinpointing possible barriers and putting
plans in place to control these barriers. The four main types of barriers to
effective communication as identified by Eisenberg (2010) are: process
barriers, physical barriers, semantic barriers and psychosocial barriers. Any misunderstanding
or misinterpretation in the process of communication from the communicator to
the Mrs. Daniels becomes a barrier that affects effective communication. To
overcome process barriers in communication, the healthcare professional must
clearly know should know the purpose of their message and present it in that
order. They also need to take into consideration language, tone and content of
their message and deliver it to Mrs. Daniels’ level of understanding. Another
way of getting rid of process barriers was for both my mentor and I as well as
Mrs. Daniels to listen to each other’s opinion, paying attention, having patience
and a presenting a positive body language at all times (Pujari, 2015).

Adapting communication methods for Mrs. Daniels was essential due to her
dry macular degeneration diagnosis, which is an age related chronic eye
disease, causing loss of vision in the centre field. This meant that we needed
to explain everything clearly. Moonie (2005) reports that if individual
differences are not understood, communication can be affected suggesting that
information cannot be transmitted as well as it should which may lead to errors
in healthcare provision.

Because the initial assessment process is often the first interaction a
patient has with the healthcare providers, they may be unwilling to share personal
information (Perry Black, 2017). This could be a potential barrier for effective
care planning and provision. Creating a trusting environment where Mrs. Daniels
will feel comfortable and less intimidated will be a big step in overcoming
this barrier and make her more confident in opening up and sharing information.
Using positive body language can also make Mrs. Daniels fell less intimidated. Loi et al, 2013 states body language can be a
powerful means of sending a message, therefore it was important to maintain a
positive open posture throughout any assessment and/or interaction with Mrs. Daniels.

Cvetic 2011 simply defines effective communication as the accurate and
unbroken transmission of information that results in understanding. Mutual
understanding between the communicator and the listener must be established for
effective communication to take place. The main reasoning and significance of
effective communication in healthcare provision is to reduce risks of errors
and mishaps. It also builds trust between patients and healthcare providers as
well as help patients and their families make better health decisions by
involving them fully in decisions concerning their health which will in turn lead
to more realistic patient outcomes (Balzer-Riley, 2008)

Good and effective communication skills play a vital role in patient
assessment and all other aspects of nursing. A nurse practitioner cannot
develop all the other skills required by the nursing and midwifery council
unless they have good and effective communication skills (Rasheed et al,
2010).  Collins 2009 argues that effective
communication helps develop a therapeutic relationship between patients and
their care providers which is central to nursing. It is a tool that allows
nurses to reassure, empower, motivate, put patients at ease, and convey
understanding of patients’ concerns. Salsali et al (2011) agree that communication is a vital element in all nursing
interventions such as prevention, treatment, therapy, rehabilitation, education
and health promotion.

 To ensure that Mrs Daniels was
comfortable always, a bariatric bed and chair were ordered because, during the
initial assessment of Mrs Daniels, it was identified that she had an increased
BMI over 30, classifying her as obese. A plan was put in place to check her
pressure areas regularly and policies followed to reduce her vulnerability to
pressure sores.  Patients with an
increased BMI are at higher risk of pressure sores making it important to check
pressure areas on a regular basis (Rubayi 2015).

Mrs. Daniels’ mobility, nutritional needs, elimination needs, and
personal hygiene and dressing as well as her psychosocial and cultural needs were
also assessed using the Activities of Daily Living (ADL) model to identify any
changes since she was in hospital. (Roper, et al., 2000).  ADL is a
systematic framework, which recognises a patient’s individuality and beliefs.
It considers twelve fundamental concepts and recognises that dependency is
subject to change over time (Roper, et al., 2000). Kearney (2001) argues
however that, Mrs. Daniels’ patient centred care may be compromised if this
model is used due to its inflexibility and complex nature. Dougherty and Lister
(2011) therefore advise that a nurse should mainly use a pragmatic approach,
and only use the ADL framework as a guideline for professional decision making.
In Mrs. Daniels’ case this framework was to identify a change in care needs.  Mrs. Daniels had been noticed to have a
reduced mobility issue due to her unsteady gait. The assessment also brought to
light that Mrs. Daniels took other regular medications for previous health
conditions. It was important to know Mrs. Daniels’ medication history so that
precaution will be taken when administering new medications to avoid drug
interactions as stated by Fitzgerald (2009). Mrs Daniels also made us aware
during the assessment that she had been constipated quite recently. A stool
chart was therefore maintained to monitor her current bowel movements which
could aid in further treatment plans (Scully and Wilson 2014).I HAVE READ UP TO THIS

 On this particular day, my mentor and
I approached Mrs. Daniels, made eye contact and welcomed her with a smile as we
introduced ourselves. It was important to maintain eye contact because eye contact
forms a greater part of non-verbal communication as argued by Egan (2009). Giddens and Sutton
(2012) agree that eye contact forms a basic requirement when seeking for
engagement and interaction. Patients also get the reassurance that care
practitioners have the time to deliver care to suit them (Baillie 2014).
Maintaining eye contact is very important during communication as it creates a
sense of confidence, warmth and honesty and holds the patient’s attention; it
also allows the nurse to watch patient gestures and facial expression which is
particularly important because Arnold and Boggs (2016) also suggested facial
expressions can indicate pain or anxiety. Flensburg (2009) further argued that making eye
contact is necessary to create an impact on the listener.

The initial assessment of Mrs. Daniels was in the form of verbal
questioning and was comprised of various questioning styles. To gather specific
details, closed ended questions were used which also enabled us to establish
baseline information (Howatson-Jones, Standing and Roberts 2012).  Peate and Peate 2012 agree that a sufficient
baseline knowledge is required for a successful assessment to take place. Chapel how et
al (2005) however argue in contrast that base line knowledge alone is not
enough. A series of open ended questions were used to identify the problem (Howatson-Jones,
Standing and Roberts 2012) which allowed Mrs. Daniels to describe her experience
and feelings further (Sully and Dallas 2010).

Patient assessment is essential to enable effective patient centred care
to take place which will in turn minimise the chances of putting patients at
risk. Howatson-Jones, Standing and Roberts (2012) also define patient
assessment as a process of evaluating a patients physical, social, mental,
cultural and personal needs in order to deliver care appropriate to their
individual needs. It was imperative therefore that Mrs Daniels will be assessed
for implementation of patient centred care. A good assessment should include
good communication skills as suggested by Sully and Dallas 2010

Daniels is a retired nurse, a widower and a mother of four who prior to her admission
lived alone, was independently mobile with a stick and also mobile with activities
of daily living. She was admitted to the accident and emergency department
(A&E) via ambulance following a fall at home. Upon admission to A&E, her
medical notes stated she had recently been diagnosed with Dry Macular degeneration, which is an age related chronic eye disease, causing loss of
vision in the center field (Stephenson, 2008).The doctors concluded
that this could have been a possible cause for her fall. She had to be operated
on because she sustained a fractured neck of femur. After recovering very well
on a surgical ward, Mrs. Daniels’ was transferred to an intermediate
care ward for further rehabilitation. Due to Mrs. Daniels confused state and
unsteady gait, she required a lot more assistance with washing, dressing, mobilizing
and other essential care that she was previously independent with and although she
had gained significant recovery after a few weeks, the Medical Practitioner at
this point had concluded that the rest of Mrs. Daniels’ care should be
delivered in a tertiary healthcare section. This decision therefore
necessitated her admission into the nursing home where I was placed. Before I
came to look after this patient, I found it necessary to familiarize myself
with her history because Fawcett and Rhynes (2012) stated that, knowing a
patient’s history is essential in delivering accurate care to patients.

 A critical
discussion of the assessment and communication methods used during the
patient’s journey will be done throughout this assignment. Reliable literature
will used to support all statements. There will be a focus on patient-centred
care and reflection on learning to provide a greater understanding of the
experience (Chapel how et al. 2005).

This assignment will also aim to discuss some specific skills in
practice and elaborate on why and how the particular nursing skill is carried
out with a reflective piece on one of the skills mentioned (Chapel how et al
2005). For the purpose of privacy and confidentiality placement location and
patient names will not be disclosed because the NMC (2015) code of professional ethics guidelines stated that   names used in writings should be   under
pseudonyms. Full consent has been verbally granted by the patient to utilise personal
information for the purpose of this case study.  The patient will therefore be referred
to as Mrs. Daniels.

are various enablers which are fundamental to nursing (Chapel how et al 2005). These
enablers are include Assessment, Communication, Documentation, Risk,
Professional decision making and managing uncertainty. For the purpose of this
assignment, assessment and communication will be discussed in relation to the care
given to a patient in my practice placement in a Nursing and Residential
home. The rational for choosing these two enablers stems from the fact that, these
are essential skills to nursing practice and helps in enhancing the delivering
patient care. Assessment and communication skills are vital to healthcare
professional and are closely linked when caring for patients.

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