Health Assessments in Nursing Care

Introduction

In nursing care, the health assessment of the patients informs patient’s health needs and demands to be fulfilled to achieve enhanced health and well-being for them. It also supports the nurses to develop good care plan for the patients that offers them satisfactory care. In this essay, the case study of Maggie will be analysed who has suffered a hip fracture and is recovering from the condition. The two different assessment tools and frameworks to be used to assess her needs are Roper-Logan-Tierney Model and the modified Frailty Index-19 Tool. The purpose of using the tool and framework along with its strength and weakness will be discussed. Moreover, the communication skills required in caring for Maggie and the way principle of courage, transparency and duty of candour are followed in her care will also be discussed.

Pain Assessment Tools

The case analysis of Maggie following discharge from the treatment of her hip fracture from a fall informs she has not been recovering effectively and is showing signs of frailty like reluctance to move, poor activity, avoiding eating and others. Pizzonia et al. (2021) inform the modified Frailty Index (mFI-19) tool is most validated tool to effectively identify the frailty score in patients after surgery since Harrell’s C-index score for the tool was 0.68. A Harrell’s C-index score of above 0.5 for any tool indicates high significance of its use in determining aspects of healthcare. The mFI-19 successfully determined the frailty of 364 older adults after surgery. Thus, the modified Frailty Index (mFI-19) tool is to be used for Maggie in measuring her level of frailty as it helps to effectively determine the seriousness of her frail condition. The strength of using mFI-19 tool is that it helps in the assessment of cognitive, functional, comorbidity and other level of health in generating the frailty score to summarise the overall fitness of the patient (Kistler et al., 2015). However, the challenge with using the tool is that it cannot be implemented in measuring the frailty score of older adults with dementia because it requires situational participation of the patients to determine their fitness (Winters et al., 2018). Maggie is mentally healthy and therefore, the use of the tool is appropriate to determine her level of fitness. The Roper-Logan-Tierney model is to be used apart from Frailty Index (mFI-19) tool because it identifies specific needs raised from the hindered fitness level of the patient. The model also helps to holistically examine different health aspects of the patient to identify their specific needs to be supported in promoting their activities of daily living to ensure their well-being (Holland and Jenkins, 2019). The 12 activities of living based on which the health assessment of the patient’s condition is made are a safe environment, communication, elimination, eating and drinking, washing, and dressing, temperature control, working and playing, mobilisation, sleeping, expressing sexuality and death (Williams, 2015). According to Maggie’s condition, she is facing issues with elimination out of her inability to move to the toilet. Maggie's elimination need is identified by the district nurse while dressing her wound when she found her abdomen to be distended and firm indicating long hours of avoiding going to the toilet. Maggie also experiences issues with eating and drinking regarding which she requires assistance as Lilly who is her friend mentioned she is not eating her meals properly. Moreover, she requires assistance with mobilisation which she is currently incapable to perform due to increased pain irrespective of having codeine prescribed by the physician. The strength of using the Roper-Logan-Tierney model in assessing Maggie’s health is that it helps to maintain consistency in care with little chance of their specific needs to be avoided in care (Fawcett, 2022). However, the disadvantage of using the model is it does not inform the way to measure and monitor the success of meeting the needs related to activities of living for the patients (Williams, 2015).

Communication Skills

One of the communication skills to be present in nurses in the health assessment of Maggie while using the Frailty Index Scale and Roper-Logan-Tierney model is active listening. This is because active listening helps the nurses to determine the specific needs of the patients along with gather essential medical information to determine the urgency of meeting the needs (van Belle et al., 2020). Active listening by nurses while using the Roper-Logan-Tierney model is important to allow the patients convey their level of hindrance in performing each everyday activity of living and prioritise the needs accordingly to deliver care (Holland and Jenkins, 2019). Moreover, active listening in using mFI-19 is required as it helps to determine the level of pain perception of patients (Pizzonia et al., 2021). CCompassion and empathetic skills are to be expressed in communicating with the patients because it helps the nurses to show understanding of the suffering of the patients and make them feel valued which supports building a trusted therapeutic relationship (Hofmeyer and Taylor, 2021). As argued by Rawlings et al. (2019), uncompassionate communication makes the patients feel ignored and intend them to non-comply with care out of a lack of valued feeling by the nurses. Compassionate and empathy skills are essential to be used in communicating with Maggie while following the Roper-Logan-Tierney model. This is because empathy in communication helps the patient to trust the nurses which makes them reveal effective personal information to determine the way specific needs of everyday activities of living are to be managed for the patient for satisfactory care (Hannan et al., 2019). The verbal communication skill is another essential part of interaction to be present in nurse caring for Maggie in using mFI-19 and the Roper-Logan-Tierney model as a health assessment tool. This is because both the assessment tool or framework requires active gathering of verbal data regarding the patient’s health condition to determine the extent of their specific needs related to cognition, eating, moving and others are to be targeted to be resolved (Hofmeyer and Taylor, 2021).

Courage, Transparency and Professional Duty of Candour

The 6 C’s of nursing care informs that courage is to be present in nurses as it makes them think righteously and be brave to overcome difficulties in executing care which is right for the patient (securehealthcaresolutions.co.uk, 2016). Pajakoski et al. (2021) argue that a lack of courage by nurses leads them to avoid taking the right decision or speaking up regarding their concerns faced with patients. This leads to hindered care delivery to the patient which compromises their health. In case of Maggie, the district nurse is required to show the courage in reporting to the physician who cares for her that the medication codeine is not working, and the dose is to be raised or the medication is to be changed. Moreover, Maggie is to be provided with a social carer who could assist her in mobilisation until her entire recovery from the surgery. This is because Maggie is showing hindrance in moving which has led her to avoid going to the toilet for long hours eventually raising the need of supporting in elimination. Transparency in nursing allows the nurses to reveal true information regarding the patient’s condition and act with greater accountability in care. This is because it helps the nurses to reveal the true needs of the patients to be cared which is their duty and leads to better health outcomes (Mowbray et al., 2022). Wiig et al. (2018) argue that poor transparency in care leads nurses to fail to show integrity in supporting the patients. It questions their accountability and professionalism in care. The transparency in caring for Maggie is important to be expressed by the district nurse according to which she requires to initiate consultations with the physicians regarding the way her current mobilisation and elimination along with eating issues are hindering her positive health outcome. The Duty of Candour informs that all healthcare professionals are required to be open and honest with the patients in case any wrong action is performed in the treatment which could cause them harm or distress (Glasper, 2021). In Maggie’s condition, the district nurse is to inform her regarding any error made in care that is causing her still to experience pain and hindered mobilisation after surgery.

Recommendations

The study led to recommend that the current medication Codeine provided to Maggie is to be changed immediately with other pain medication or its dose is to be increased. This is because the medication is unable to relieve pain after surgery for Maggie which is hindering her ability to move. Moreover, a social carer is to be referred to Maggie who could support her in regularly eating her meal to maintain effective physical state and recovery after surgery.

Conclusion

The above discussion informs that Maggie is being cared at home after discharge from the hospital for her treatment of the hip fracture. The Roper-Logan-Tierney model informs that her current needs to be supported are elimination, eating and drinking along with mobilisation that she is unable to perform on her own. The communication skills including verbal sharing of information, compassion, empathy and active listening are to be shown to effectively communicate with Maggie. Moreover, the nurse caring for Maggie is to show courage and transparency in care to ensure positive health outcome for the patient.

References

Fawcett, J., 2022. Thoughts About Teaching: A Nursing Discipline–Specific Perspective of Lifespan Growth and Development. Nursing Science Quarterly, 35(4), pp.494-497.

Hannan, J., Fonseca, M., Lara, E.G., Braithwaite, M., Irving, F. and Azutillo, E., 2019. Coaching nurses to care: Empathetic communication in challenging situations. In Teaching Empathy in Healthcare (pp. 193-209). Springer, Cham.

Hofmeyer, A. and Taylor, R., 2021. Strategies and resources for nurse leaders to use to lead with empathy and prudence so they understand and address sources of anxiety among nurses practising in the era of COVID‐19. Journal of clinical nursing, 30(1-2), pp.298-305.

Kistler, E.A., Nicholas, J.A., Kates, S.L. and Friedman, S.M., 2015. Frailty and short-term outcomes in patients with hip fracture. Geriatric orthopaedic surgery & rehabilitation, 6(3), pp.209-214.

Mowbray, F.I., Manlongat, D. and Shukla, M., 2022. Sensitivity Analysis: A Method to Promote Certainty and Transparency in Nursing and Health Research. Canadian Journal of Nursing Research, p.08445621221107108.

Pizzonia, M., Giannotti, C., Carmisciano, L., Signori, A., Rosa, G., Santolini, F., Caffa, I., Montecucco, F., Nencioni, A. and Monacelli, F., 2021. Frailty assessment, hip fracture and long‐term clinical outcomes in older adults. European Journal of Clinical Investigation, 51(4), p.e13445.

Rawlings, D., Devery, K. and Poole, N., 2019. Improving quality in hospital end-of-life care: honest communication, compassion and empathy. BMJ open quality, 8(2), p.e000669.

van Belle, E., Giesen, J., Conroy, T., van Mierlo, M., Vermeulen, H., Huisman‐de Waal, G. and Heinen, M., 2020. Exploring person‐centred fundamental nursing care in hospital wards: A multi‐site ethnography. Journal of clinical nursing, 29(11-12), pp.1933-1944.

Wiig, S., Aase, K., Bourrier, M. and Røise, O., 2018. Transparency in health care: disclosing adverse events to the public. In Risk communication for the future (pp. 111-125). Springer, Cham.

Williams, B.C., 2015. The Roper-Logan-Tierney model of nursing: A framework to complement the nursing process. Nursing2022, 45(3), pp.24-26.

Winters, A.M., Hartog, L.C., Roijen, H.I.F., Brohet, R.M. and Kamper, A.M., 2018. Relationship between clinical outcomes and Dutch frailty score among elderly patients who underwent surgery for hip fracture. Clinical interventions in aging, 13, p.2481.