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Throughout this assignment, the Chapel how et al. (2005) framework wereexamined focusing mainly on two enablers which were assessment andcommunication and how they were used in practice to influence patientcare.  A case study was done on a patientwhose name was under pseudonym (Mrs. Daniels) for confidentiality purposes. Abrief background was given, and I analysed how assessment and communicationwere used in relation to her care.

It has shown that both assessment andcommunication were both essential parts of nursing and played a vital role whenproviding patient care. It was evident that the care provided to Mrs. Danielswas effective and the assessment tools used were appropriate and usingeffective communication meant her needs were met.  It was evident that assessment andcommunication both linked together when caring for a patient. The assessmenttools were reliant on effective communication and vice versa. This wasbecause many of the assessment tools required the use of verbal communication.Effective communication encourages effective team work and promotes continuityand clarity within the patient care team. Accurate assessment of a patient createsimproved information flow, more effective interventions, improved safety andincrease in satisfaction in the care being provided.

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 One way we in which we tried to eliminatepsychosocial barriers was to promote equal and effective care for all by assistingMrs. Daniels with reading, writing and filling of form. Another way of dealingwith psychosocial barriers is expansion of professional interpreting andtranslation services for service users who do not have English as a firstlanguage as well as cultural diversity training for health care professionalson appropriate practices; putting aside all prejudice and stereotypes andproviding the best patient-centred care possible (Arksey and Jackson, 2003). Dueto Mrs.

Daniels loss of sight in the centre field, it was difficult for her tolip read during conversations, so we had to speak as loudly and clearly aspossible and also offered appropriate hand of touch as reassurances whichmade Mrs. Daniels fell included and valued in the communication process. Hanley et al, 2017 highlightsthe importance of sometimes using touch for a therapeutic relationship, howeverBraille 2001 recommends the careful use of nonverbal communication since touchhas a positive as well as negative effect on patient.Psychosocial barriers to communication could include physiologicalbarriers such as a disability or illness in which in Mrs Daniels case was lossof vision in the centre field due to dry macular degeneration ; psychologicalor emotional barriers which could be the state of mind of everyone involved inthe communication process that can lead to a person only takin in informationthey are emotionally tuned into, known as ‘filtering’; social barriers whichcould be conflict, violent and abusive situations as well as the ability toread and write in a particular language or style  ; cultural barriers which include people’sbackgrounds, values, ethics, prejudices, perceptions, needs and expectations.Psychosocial barriers often involve a psychological distance (Antes, 2011). Forexample, if a health and social care practitioner talks down to a patient allthe time, he will resent this attitude, and this resentment separates them,thereby blocking opportunity for effective communication.

It is thereforeimportant to overcome these barriers.Semantic barriers refer to the barriers in communication caused byproblems with interpretation of the meaning of the words used. The tendency tooverlook the fact that certain words have different meanings to differentpeople also known as bypassing which may lead to the message being interpreteddifferently by the Mrs. Daniels which in turn leads to breakdown incommunication is one of the major categories of semantic barriers.

My mentorand I made a conscious effort to overcome this barrier by avoiding makingassumptions that the Mrs. Daniels understands what we were trying tocommunicate. We ask questions to make sure the she understood the message inthe way it was intended. We also avoided the use of abbreviations in our correspondencewith Mrs. Daniels (Malik, 2016).

The environmental and natural condition where the assessment was takingplace could also be a physical barrier in conveying the message from sender toreceiver. For example, conducting the assessment in Mrs. Daniels room with thedoor and blinds closed was more effective and professional than if we had doneit 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 themost powerful factors of the physical barriers that can completely change theintended meaning of a message. Some of these factors can be controlled andadjusted but others are beyond anyone’s control (Collins et al, 2002).  A person’senvironment can be a physical barrier if there are adverse weather conditions.

People’s abilities to make decisions and their perceptions and moods could beaffected by the kind of weather there is. This barrier is difficult to overcomeas it is hard to control the different weather conditions.Communication models can be a sturdy tool for thinking about anindividual’s communication skills, pinpointing possible barriers and puttingplans in place to control these barriers. The four main types of barriers toeffective communication as identified by Eisenberg (2010) are: processbarriers, physical barriers, semantic barriers and psychosocial barriers.

Any misunderstandingor misinterpretation in the process of communication from the communicator tothe Mrs. Daniels becomes a barrier that affects effective communication. Toovercome process barriers in communication, the healthcare professional mustclearly know should know the purpose of their message and present it in thatorder. They also need to take into consideration language, tone and content oftheir message and deliver it to Mrs. Daniels’ level of understanding. Anotherway of getting rid of process barriers was for both my mentor and I as well asMrs. Daniels to listen to each other’s opinion, paying attention, having patienceand a presenting a positive body language at all times (Pujari, 2015).Adapting communication methods for Mrs.

Daniels was essential due to herdry macular degeneration diagnosis, which is an age related chronic eyedisease, causing loss of vision in the centre field. This meant that we neededto explain everything clearly. Moonie (2005) reports that if individualdifferences are not understood, communication can be affected suggesting thatinformation cannot be transmitted as well as it should which may lead to errorsin healthcare provision.Because the initial assessment process is often the first interaction apatient has with the healthcare providers, they may be unwilling to share personalinformation (Perry Black, 2017). This could be a potential barrier for effectivecare planning and provision. Creating a trusting environment where Mrs.

Danielswill feel comfortable and less intimidated will be a big step in overcomingthis 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 apowerful means of sending a message, therefore it was important to maintain apositive open posture throughout any assessment and/or interaction with Mrs. Daniels.Cvetic 2011 simply defines effective communication as the accurate andunbroken transmission of information that results in understanding. Mutualunderstanding between the communicator and the listener must be established foreffective communication to take place. The main reasoning and significance ofeffective communication in healthcare provision is to reduce risks of errorsand mishaps.

It also builds trust between patients and healthcare providers aswell as help patients and their families make better health decisions byinvolving them fully in decisions concerning their health which will in turn leadto more realistic patient outcomes (Balzer-Riley, 2008)Good and effective communication skills play a vital role in patientassessment and all other aspects of nursing. A nurse practitioner cannotdevelop all the other skills required by the nursing and midwifery councilunless they have good and effective communication skills (Rasheed et al,2010).  Collins 2009 argues that effectivecommunication helps develop a therapeutic relationship between patients andtheir care providers which is central to nursing. It is a tool that allowsnurses to reassure, empower, motivate, put patients at ease, and conveyunderstanding of patients’ concerns.

Salsali et al (2011) agree that communication is a vital element in all nursinginterventions such as prevention, treatment, therapy, rehabilitation, educationand health promotion. To ensure that Mrs Daniels wascomfortable always, a bariatric bed and chair were ordered because, during theinitial assessment of Mrs Daniels, it was identified that she had an increasedBMI over 30, classifying her as obese. A plan was put in place to check herpressure areas regularly and policies followed to reduce her vulnerability topressure sores.  Patients with anincreased BMI are at higher risk of pressure sores making it important to checkpressure areas on a regular basis (Rubayi 2015).Mrs.

Daniels’ mobility, nutritional needs, elimination needs, andpersonal hygiene and dressing as well as her psychosocial and cultural needs werealso assessed using the Activities of Daily Living (ADL) model to identify anychanges since she was in hospital. (Roper, et al., 2000).  ADL is asystematic framework, which recognises a patient’s individuality and beliefs.

It considers twelve fundamental concepts and recognises that dependency issubject to change over time (Roper, et al., 2000). Kearney (2001) argueshowever that, Mrs. Daniels’ patient centred care may be compromised if thismodel 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 areduced mobility issue due to her unsteady gait. The assessment also brought tolight that Mrs. Daniels took other regular medications for previous healthconditions. It was important to know Mrs.

Daniels’ medication history so thatprecaution will be taken when administering new medications to avoid druginteractions as stated by Fitzgerald (2009). Mrs Daniels also made us awareduring the assessment that she had been constipated quite recently. A stoolchart was therefore maintained to monitor her current bowel movements whichcould aid in further treatment plans (Scully and Wilson 2014).I HAVE READ UP TO THISPOINT On this particular day, my mentor andI approached Mrs. Daniels, made eye contact and welcomed her with a smile as weintroduced ourselves. It was important to maintain eye contact because eye contactforms 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 forengagement and interaction. Patients also get the reassurance that carepractitioners have the time to deliver care to suit them (Baillie 2014).Maintaining eye contact is very important during communication as it creates asense of confidence, warmth and honesty and holds the patient’s attention; italso allows the nurse to watch patient gestures and facial expression which isparticularly important because Arnold and Boggs (2016) also suggested facialexpressions can indicate pain or anxiety. Flensburg (2009) further argued that making eyecontact is necessary to create an impact on the listener. The initial assessment of Mrs. Daniels was in the form of verbalquestioning and was comprised of various questioning styles.

To gather specificdetails, closed ended questions were used which also enabled us to establishbaseline information (Howatson-Jones, Standing and Roberts 2012).  Peate and Peate 2012 agree that a sufficientbaseline knowledge is required for a successful assessment to take place. Chapel how etal (2005) however argue in contrast that base line knowledge alone is notenough. 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 experienceand feelings further (Sully and Dallas 2010). Patient assessment is essential to enable effective patient centred careto take place which will in turn minimise the chances of putting patients atrisk. Howatson-Jones, Standing and Roberts (2012) also define patientassessment as a process of evaluating a patients physical, social, mental,cultural and personal needs in order to deliver care appropriate to theirindividual needs.

It was imperative therefore that Mrs Daniels will be assessedfor implementation of patient centred care. A good assessment should includegood communication skills as suggested by Sully and Dallas 2010Mrs.Daniels is a retired nurse, a widower and a mother of four who prior to her admissionlived alone, was independently mobile with a stick and also mobile with activitiesof 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, hermedical notes stated she had recently been diagnosed with Dry Macular degeneration, which is an age related chronic eye disease, causing loss ofvision in the center field (Stephenson, 2008).

The doctors concludedthat this could have been a possible cause for her fall. She had to be operatedon because she sustained a fractured neck of femur. After recovering very wellon a surgical ward, Mrs.

Daniels’ was transferred to an intermediatecare ward for further rehabilitation. Due to Mrs. Daniels confused state andunsteady gait, she required a lot more assistance with washing, dressing, mobilizingand other essential care that she was previously independent with and although shehad gained significant recovery after a few weeks, the Medical Practitioner atthis point had concluded that the rest of Mrs. Daniels’ care should bedelivered in a tertiary healthcare section. This decision thereforenecessitated her admission into the nursing home where I was placed. Before Icame to look after this patient, I found it necessary to familiarize myselfwith her history because Fawcett and Rhynes (2012) stated that, knowing apatient’s history is essential in delivering accurate care to patients.

 A criticaldiscussion of the assessment and communication methods used during thepatient’s journey will be done throughout this assignment. Reliable literaturewill used to support all statements. There will be a focus on patient-centredcare and reflection on learning to provide a greater understanding of theexperience (Chapel how et al. 2005).

This assignment will also aim to discuss some specific skills inpractice and elaborate on why and how the particular nursing skill is carriedout with a reflective piece on one of the skills mentioned (Chapel how et al2005). For the purpose of privacy and confidentiality placement location andpatient names will not be disclosed because the NMC (2015) code of professional ethics guidelines stated that   names used in writings should be   underpseudonyms. Full consent has been verbally granted by the patient to utilise personalinformation for the purpose of this case study.  The patient will therefore be referredto as Mrs.

Daniels.Thereare various enablers which are fundamental to nursing (Chapel how et al 2005). Theseenablers are include Assessment, Communication, Documentation, Risk,Professional decision making and managing uncertainty. For the purpose of thisassignment, assessment and communication will be discussed in relation to the caregiven to a patient in my practice placement in a Nursing and Residentialhome. The rational for choosing these two enablers stems from the fact that, theseare essential skills to nursing practice and helps in enhancing the deliveringpatient care.

Assessment and communication skills are vital to healthcareprofessional and are closely linked when caring for patients.

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