Assessment 2 - Professional Communication Case Study Essay
ATTACHED FILES:
- Health Assessment Scenario 1 George Pham.pdf XXXXXXXXXXKB)
- Health Assessment Scenario 2 Helen Henderson.pdf XXXXXXXXXXKB)
- Health Assessment Scenario 3 Chester Abioye.pdf XXXXXXXXXXKB)
- Reading 1 Person-centred care.pdf XXXXXXXXXXKB)
- Reading 2 Therapeutic Relationship and Communication.pdf XXXXXXXXXXKB)
- Reading 3 Patient Safety and Communication.pdf(1.624 MB
- Assessment 3: Health Assessment Professional Communication in Nursing 2019: History for Nurse and Patient Interaction
- HealthAssessment Scenario 1 Patient 1: History for Nurse and Patient Interaction – Health Assessment Student (Community – Registered Nurse): Use professional nursing communication with the patient to conduct a 10 minute health assessment video interview taking into account the following: • Introduction – nurse and patient • Situation – reasons for assessment, allergies, and relevant personal details • Background – health history, general health and psychosocial status • Assessment – observations, nutrition/diet, exercise, lifestyle, health beliefs and values, and cultural/spiritual/religious practices • Recommendation – confirm health assessment information and implications for wellbeing, recommend changes to manage and improve health and suggest timeframes for any plans Assessor (Patient – George Pham): You are cooperative, alert and orientated. You are willing to provide all requested information. You like to ask general questions of the nurse related to the health assessment and like to know your observations and if they are within normal limits. You are open to discuss ways to improve your health through possible changes to your diet, exercise, daily habits, and lifestyle choices. Assessment 3: Health Assessment Professional Communication in Nursing 2018: History for Nurse and Patient Interaction – HealthAssessment STUDENT(General Practitioner’s Office – REGISTERED NURSE) Scenario 1: Patient- George Pham George Pham has come to see a Registered Nurse at his General Practitioner’s Office for a health assessment. George is reasonably active and has a stressful lifestyle with work and caring for his daughter’s children. He has some minor health problems and wants to improve his health through eating well and by making positive changes to his lifestyle. George Pham: male, height 170 cm; weight 71 kg (BMI = XXXXXXXXXXBP 164/ 92, HR 94, RR 20, temperature 37.0 C, SaO2 98% on room air. Assessment 3: Health Assessment Professional Communication in Nursing 2019: History for Nurse and Patient Interaction –
- HealthAssessment Assessor (Patient) Scenario 1: Patient 1- George Pham BIODATA: • George is a 73-year-old male (D.O.B: 17/01/1946) with no known allergies, and his current address is 52 Homebush St, Central, 2001 • George was born in Vietnam and came to Australia as a ‘boat person’ in 1979 with his wife and daughter. His wife died five years later from ovarian cancer. • George has a 35-year-old daughter and three school-aged grandchildren (Jessica 14 years, Amanda aged 10 years, and Robert aged 6 years) who all live next door to him. He lives in a small two bedroom rented flat near the city centre. He spends time with his daughter and grandchildren each day. • George is concerned that he has a cough that is not getting better after five weeks. He recently gave up smoking but still misses not having his cigarettes - he smoked 20 cigarettes a day for 42 years. • George drinks alcohol at home every night with his evening meal. He often consumes 3 to 5 standard drinks (beer) of an evening. He sometimes drinks socially or on outings with his friends from the club. • George works as a baker, starting work very early in the morning. He looks after his grandchildren after school until his daughter finishes work. • George often takes his grandchildren to the park. On weekends he enjoys talking to his friends at the local Vietnamese Club where they share a Vietnamese meal together. • George tries to cook meals at home but is often so busy that he buys take away from local Asian cafés. He always makes sure he has a supply of take away Fried Noodles or Rice to take to work each day. • George takes his grandchildren to the beach on Sundays in summer. He doesn’t use sunscreen because he says he never burns - he just gets more tanned. He never wears a hat either. • George is very family orientated and encourages the family to come to a local café with him at any opportunity. • George is a Buddhist but there is no temple close to where he lives. He says he misses the chance to go to the temple at Festivals, but he has a small shrine in his flat.
Assessment 3: Health Assessment Professional Communication in Nursing 2019: History for Nurse and Patient Interaction – HealthAssessment Scenario 2 Patient 2: History for Nurse and Patient Interaction – Health Assessment Student (Community – Registered Nurse): Use professional nursing communication with the patient to conduct a 10 minute health assessment video interview taking into account the following: • Introduction – nurse and patient • Situation – reasons for assessment, allergies, and relevant personal details • Background – health history, general health and psychosocial status • Assessment – observations, nutrition/diet, exercise, lifestyle, health beliefs and values, and cultural/spiritual/religious practices • Recommendation – confirm health assessment information and implications for wellbeing, recommend changes to manage and improve health and suggest timeframes for any plans Assessor (Patient – Helen Henderson): You are cooperative, alert and orientated. You are willing to provide all requested information. You like to ask general questions of the nurse related to the health assessment and like to know your observations and if they are within normal limits. You are open to discuss ways to improve your health through possible changes to your diet, exercise, daily habits, and lifestyle choices. Assessment 3: Health Assessment Professional Communication in Nursing 2019: History for Nurse and Patient Interaction –
HealthAssessment STUDENT(General Practitioner’s Office – REGISTERED NURSE) Scenario 2: Patient- Helen Henderson Helen Henderson has come to see a Registered Nurse at her General Practitioner’s Office for a health assessment. Helen is not very active and has a stressful lifestyle with work and other activities. She is well but always feels tired and would like to know how to feel more energetic through regular exercise, eating well and by making positive changes to her lifestyle. Helen Henderson: Female, height 175 cm; weight 94 kg (BMI = XXXXXXXXXXBP 158/ 90, HR 96, RR 18, temperature 36.4 C, SaO2 99% on room air. Assessment 3: Health Assessment Professional Communication in Nursing 2019: History for Nurse and Patient Interaction – HealthAssessment Assessor (Patient) Scenario 2: Patient 2- Helen Henderson BIODATA: • Helen is a 43-year-old female (D.O.B: 24/05/1976) with no known allergies, and her current address is 48 Villahome Drive, Southwood, 2074 • Helen lives with her wife Janine. They have been married for 6 months but have been partners for 21 years since meeting at university. • Helen works as a chief financial controller at a very busy engineering company in the city. She works very long hours and often on the weekends. • Helen is very close to her family however, doesn't see them often because of work demands. • Helen currently feels well but is often too tired to cook meals and she buys takeaway from the local shopping centre trying to choose the healthiest options like a salad or sushi but does eat a hamburger and hot chips sometimes. Presently her only exercise is the 10-minute walk to the bus to get to work every day. One weekend a month Helen and Janine try to get out to the country to escape the city. • Helen does not drink during the week but enjoys a 2-3 glasses of champagne over the weekend. • Helen is very conscious of protecting her skin from the sun as she is very fair. • Helen has always been very religious, and goes to mass at her local Catholic Church when she can. • Helen has come for a health check and would like to know if there is anything she can do to stop her feeling tired all the time.
Assessment 3: Health Assessment Professional Communication in Nursing 2019: History for Nurse and Patient Interaction – HealthAssessment Scenario 3 Patient 3: History for Nurse and Patient Interaction – Health Assessment Student (Community – Registered Nurse): Use professional nursing communication with the patient to conduct a 10 minute health assessment video interview taking into account the following: • Introduction – nurse and patient • Situation – reasons for assessment, allergies, and relevant personal details • Background – health history, general health and psychosocial status • Assessment – observations, nutrition/diet, exercise, lifestyle, health beliefs and values, and cultural/spiritual/religious practices • Recommendation – confirm health assessment information and implications for well-being, recommend changes to manage and improve health and suggest timeframes for any plans Assessor (Patient – Chester Abioye): You are cooperative, alert and orientated. You are willing to provide all requested information. You like to ask general questions of the nurse related to the health assessment and like to know your observations and if they are within normal limits. You are open to discuss ways to improve your health through possible changes to your diet, exercise, daily habits, and lifestyle choices. STUDENT (General Practitioner’s Office – REGISTERED NURSE) Scenario 3: Patient- Chester Abioye Chester has come to see a Registered Nurse at his General Practitioner’s Office for a health assessment. Chester is not very active and feels stress and lonely living Australia without his family. He has suffered from depression in the past and wants to improve his health through regular exercise, eating well and by making positive changes to his lifestyle. Chester Abioye: Male, height 187 cm; weight 73kg (BMI = XXXXXXXXXXBP 118/ 70, HR 86, RR 22, temperature 37.0 C, SaO2 99% on room air. Assessment 3: Health Assessment Professional Communication in Nursing 2019: History for Nurse and Patient Interaction – HealthAssessment ASSESSOR (PATIENT ) Scenario 3 Patient 3- Chester Abioye Biodata • Chester is a 19 year old man (DOB-14th January 2000) and lives at 97 Leafy Avenue, Broadfields, 2173 in a share house with 4 other people. • Chester has a girlfriend that lives in Melbourne who is planning to move to Broadfields later in the year to be closer to him. • Chester regularly smokes about a packet (30 cigarettes per day). • Chester often drinks up to 6 to 10 standard drinks (beer and spirits) when he catches up with two of his friends once a month. • Chester was born in Zambia and came to Australia to commence a law degree but only did 1 year of the degree because he did not enjoy the course. He is now working at Aldi in the storeroom. He often volunteers to work overtime to save money to send back to his family. • Chester mostly stays at home watching television. He rarely exercises because he finds it boring. He does enjoy emailing and talking to his girlfriend and family on the computer when he can. • Chester says he is no good in the kitchen. He mainly eats rice, bread and meat. Sometimes he buys vegetables to include in a meal. • Chester doesn’t like wearing a hat or using sun block when he does go outside. • Chester does not follow any religion.
READING 1Person-centred care Person-centred care occurs when the concepts of personhood and person-centredness are applied to the actual care that is delivered to people across their life span and in a range of settings. Person-centred care involves trust and respect and is essential in every specialty
and in everysetting, whether it be mental health or aged care, maternity care or community-based family practice. If personcentredness is understood and supported, person-centred processes can become the accepted practice of the healthcare environment regardless of its focus. Person-centred care recognises individuality so that the care provided is in direct response to the person’s unique holistic needs (Chenoweth et al., XXXXXXXXXXTherefore, the person-centred health professional needs to be both knowledgeable and skilled. However, person-centred care goes beyond simply individualising care through token adjustments to physical care. It permeates all aspects of care and is compatible with the values and beliefs of the person receiving care. Again, this requires knowing the person. For example, assessment must be undertaken with the purpose of getting to know the person, their story and the needs related to their whole being, not just those related to what brought the person to the healthcare environment. Each individual interaction or intervention should bundertaken in the spirit of partnership and social justice. This partnership approach necessitates empowerment— a sharing of power by accepting the rights of people, acknowledging their autonomy and enabling the person and others that are part of the relationship to engage in informed decision making (National Ageing Research Institute, XXXXXXXXXXThis allows the person being empowered to make decisions about their own healthcare and to take responsibility for those decisions. There is some evidence to support the assertion that care processes embedded in a holistic, person-centred approach lead to increased satisfaction of the cared for and others. This approach also improves teamwork by improving communication and reducing stress and anxiety among clinicians (McCormack & McCance, XXXXXXXXXXIn aaddition to the common skills presented in Box 1-4, person-centred clinicians need certain attributes and additional skills, as outlined in Box 1-5. Considering what you have read so far, you can see that the principles of person-centred care must be internalised by nurses and midwives so that they can permeate all healthcare endeavours. When person-centred care is consistent with the values of each individual (as well as with their competence and personal attributes) and with the care environment (the physical surroundings and a culture that preserves dignity), person-centred processes (the activities and interventions of care) influence the expected outcomes (McCormack & McCance, XXXXXXXXXXThe principles of personhood, person-centredness and person-centred care that are used throughout this text create the foundation for thoughtful practice, which will be discussed below. Barriers to person-centred care As with all things, there are barriers that impede the implementation of person-centred care. This approach is sometimes criticised as being too individualistic and time-consuming. However, when care focuses on tasks or a case, it fails to optimise opportunities to promote person-centredness, and values the system rather than the person. As a result, it can lead to ritualised behaviour and ‘robotic’ care, where clinicians become disconnected and disengaged. Yet, when clinicians are skilled, committed and enthusiastic about implementing the principles of person-centred care, this therapeutic relationship naturally carries over into the care processes. The principles that underpin person-centred care are also sometimes criticised as being idealistic and optimistic, and as being difficult to achieve in healthcare environments, due to the many other competing priorities and pressures. However, these environments also need to be as therapeutic as possible. For example, physical surroundings must preserve peoples’ privacy and dignity so that their sense of self is not threatened. But person-centredness relates not just to physical surroundings but has a more expansive meaning. The culture of the healthcare environment must be conducive to working in this person-centred way, and services should be flexible, supportive and easy for users to navigate. McCormack and McCance XXXXXXXXXXdescribe the crucial aspects of healthcare environments as being freedom for nurses to act autonomously, and organisational and decision-making systems that recognise power differences and tolerate innovation. Unfortunately, many healthcare environments are large and complex and do not facilitate person-centredness, as schedules and routines take precedence over people. This does not mean that person-centred care is impossible in such large organisations, but it does mean that it can be more difficult to achieve, and that it requires commitment to its principles. Further, when integration and coordination between many different services is poor, this disorganisation can result in care that disregards the importance of the persons in the partnership
reading 2THERAPEUTIC RELATIONSHIP AND COMMUNICATION When applying a person-centred approach to communication you must include the person and family members in all aspects of the process. To ensure that the health issues are being addressed through the delivery of planned care you need to seek feedback from the person and encourage them to be part of decision-making process related to their care. Nurses and midwives cannot reliably identify a person’s health problems without their input. Values Communication is influenced by the way people value themselves, one another, and the purpose of any human interaction (Eunson, XXXXXXXXXXNurses and midwives who believe that teaching is an important aspect of care annd who value empowering people will communicate this to them. Conversely, those who believe teaching is an unimportant chore are unlikely to be effective teachers. Similarly, a person’s motivation (or lack of motivation) to develop new self-care behaviours will influence this interaction. In order to ensure that you are taking a person-centred approach to delivering planned care, ask yourself the following questions: 1. Have I included the person in the process? 2. Have I listened to what the person has told me? 3. Have I sought out the person’s feedback on the planned care strategies I have identified? 4. Are the strategies accurate for the person? 5. Have I included the person’s family in the process? Using therapeutic communication in a person-centred relationship Most healthcare professionals enter their chosen profession in order to help people. Relationships between healthcare professionals and people in care are not accomplished randomly, but through purposeful relationships. A person-centred relationship exists among people who provide and receive assistance in meeting human needs. In this book, the term is used to refer to person-centred relationships between healthcare providers and people in their care. These relationships set the climate to move towards the common goal of meeting a person’s needs. The quality of the relationship with another person is the most significant element in determining its effectiveness. The most common problem that can arise in care is failure to establish rapport and a helping–trust relationship with people (Higgs et al., XXXXXXXXXXPerson-centred relationship versus a social relationship The difference between a person-centred relationship and a friendship is important. These relationships contain many of the qualities of a social relationship—they have in common the components of care, concern, trust and growth. They are also very different: ● The person-centred relationship occurs for a specific purpose with a specific person. ● The person-centred relationship is characterised by an unequal sharing of information. The person shares information related to personal health problems, whereas the nurse or midwife shares information in terms of a professional role. In a friendship, information sharing is more likely to be similar in quantity and type, and equal in shared responsibility. ● The person-centred relationship is built on the person’s needs, not on those of the healthcare provider. In a friendship, needs of both participants are generally considered. A friendship might grow out of a person- centred relationship, but this is separate from the purposeful, time-limited interaction pertinent to this relationship. It is of great importance that nurses and midwives remember that these are professional relationships. Professional relationships have boundaries that are essential to recognise. Crossing of professional boundaries may result in disciplinary action from the profession (see Chapter 12). It can be helpful for students and novice nurses and mmidwives to identify those who communicate a clear sense of professionalism in the way they conduct themselves. Much of an everyday person-centred relationship resembles a social relationship, sometimes consisting of casual chat about anything from the weather to sporting teams. But there is always an awareness of the person’s needs and a more therapeutic approach is adopted, dealing with more in-depth issues in a manner which encourages trust and confidence, at any time (Egan, XXXXXXXXXXA person is more likely to trust and value nurses and midwives who appear competent and confident and who are focused on person-centred care.
reading 3Patient safety and communication Patient safety is defined as actions undertaken by individuals and organisations to protect healthcare recipients from being harmed by their healthcare (National Patient Safety Foundation XXXXXXXXXXIt is important to note that patient safety is not limited to physical safety but also includes psychological, emotional and cultural safety. Patient safety is an attribute of trustworthy healthcare systems that work to minimise the incidence and impact of, and maximise recovery from, adverse events (Emanuel et al XXXXXXXXXXPatient safety is considered to be one of the most important issues facing healthcare today. Health professionals need highly developed communication skills in order to manage the complexity and competing tensions that define contemporary healthcare organisations. Communication is much more than the provision of information, instructions or advice. It is a two-way interaction where information, meanings and feelings are shared both verbally and nonverbally and when the message being conveyed is understood as intended (Dunne XXXXXXXXXXMany health professionals think that effective ion means giving patients clear, unambiguous information in a timely manner. This is true, but it is only part of the story. Communication involves listening as well as talking. When we listen to patients, we are less likely to jump to erroneous conclusions because we haven’t seen the whole picture (this is referred to as premature closure). Patients expect to be communicated with in ways that are inclusive, accurate, timely and appropriate. The Australian Charter of Healthcare Rights (Box 1.1) outlines patients’ rights in regards to healthcare and emphasises that communication and working in partnership with patients underpin safe care. Indeed, communication is considered by many people to be one of the most important aspects of quality healthcare. In 2009 Australian patients and their families were surveyed in an attempt to clarify what their priorities were when undergoing healthcare (New South Wales Health XXXXXXXXXXThe list in Box 1.2 demonstrates the importance of communication to the survey participants’ healthcare experience and illustrates the particular elements of communication that they believed were key. It is noteworthy that the only other clinical concern mentioned was in relation to pain management. Effective communication impacts on patient outcomes in many ways. Studies have demonstrated a relationship between effective communication and compliance with medication and rehabilitation programs, reduction in stress and anxiety (Harms 2007), improved pain management, self-management, mood, self-esteem, functional and psychological status (Goleman 2006), symptom resolution, reduced length of hospitalisation, improved coordination of caare, reduced costs (Mickan & Rodger 2005), reduction in surgical mortality and post-operative complications (Vats et al. 2010), enhanced patient satisfaction and wellbeing (Mickan & Rodger 2005), improvedpatient safety, and error reduction (Abbott XXXXXXXXXXIn contrast, poor communication can lead to hostility, anger, confusion, misunderstanding, lack of trust, poor compliance and greatly increased risk of error and patient harm. Patient-safe communication is a goal-orientated activity focused on preventing adverse events and helping patients attain optimal health outcomes. It is a means by which health professionals gather and share information, clarify and verify accurate interpretations of information, and establish a process for working collaboratively with both patients and other health professionals to achieve common goals of safe and high-quality patient care (Schuster & Nykolyn XXXXXXXXXXEvery aspect of patient care depends upon how well healthcare professionals communicate with each other and the patients they care for. Clinical decisions based on incomplete or misinterpreted information are likely to be inappropriate and may cause patient harm and distress. For health professionals, unsafe communication is considered to be a breach of professional standards and a leading cause of litigation (Trede, Ellis & Jones XXXXXXXXXXExamples of this may include: • inadequate or inaccurate advice on self-management • failure to communicate in ways that the patient and their family can understand • failure to disclose the risk of interventions and potential complications • failure to obtain valid consent to an intervention/procedure • failure to maintain client confidentiality • failure to give the patient an opportunity to ask questionfailure to respond appropriately to those questions • failure to respect the opinion of a patient (even though the patient’s opinion may be medically inaccurate, their observations usually are accurate and can be very valuable) • failure to realise that, from the patient’s point of view, there is no such thing as a ‘silly question’ • failure to realise that the way we talk with patients (courteous, respectful, clear and jargonfree) can be just as important as the content of what we actually say to them • failure to communicate with other relevant health professionals to provide a reasonable standard of carefailure to communicate with supervisors/administrators when patient safety is in jeopardy • failure to warn authorities when to do so would be in the public interest. Health professionals should be aware that there are six groups of patients who are at particular risk of harm from poor communication: older people, children, people with mental illness, people who do not speak English, people with sensory impairment (e.g. diminished hearing or limited verbal ability), and people with cognitive changes (e.g. delirium or dementia). The skills needed for patient-safe communication when caring for these groups are discussed in Chapters 10–16. When many and varied healthcare professionals (including doctors, midwives, dentists, nurses, pharmacists, social workers, dieticians, physiotherapists, psychologists, and others) are involved in patient care, ensuring exchange of accurate information in a timely manner can be difficult. Patientsafe communication is a complex and context-dependent process and many human and system factors influence how effectively it transpires. Despite health professionals being well intentioned, there are numerous factors that can impact on their ability to engage in patient-safe communication. Figure 1.1 illustrates some of the risk factors for communicating safely with both patients and other health professionals. Communication risk factors have the potential to distort the clarity of the message being conveyed and impede the effectiveness of the process. This can lead to misinterpretation, time wasting, frustration and inaccurate decision making (Schuster & Nykolyn 2010, p. 25). The outer circle in this figure depicts strategies that have been identified as preventing or overcoming risk factors, improving communication and promoting patient safety. Throughout thiss book, these risk factors and strategies will be defined, discussed and applied to a range of clinical stories.