Rapid Adult Nursing

Andrée le May

• Publisher: Wiley-Blackwell
• Year: 2016
• ISBN:
  9781119117131
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Rapid Adult Nursing is an essential read for all adult nursing students, as well as a refresher for qualified adult nurses, and a 'dip into text' for other healthcare professionals. Designed for quick reference, it maps on to the essential clinical skills and knowledge required for pre-registration adult nurses, and captures the essentials of adult nursing care in an easy to read, and highly accessible format.

Covering all the key topics in adult nursing, this concise and easy-to-read title is the perfect quick-reference book for student adult nurses.

Part 1
Fundamentals of Nursing Care

A

Adult nursing

Definition

Adult nursing comprises the skilled, dignified care of adults. It focuses on acute and chronic physical conditions rather than mental illness. Adults are nursed in a variety of settings – the community, hospitals and longer‐term care settings.

Excellent care for adults through their lifespan is about what nurses do, and how nurses do it, in partnership with patients, their families and carers, as well as in collaboration with other members of the multi‐disciplinary health and social care team.

Fundamental to excellent nursing is the merging of technically competent care with the maintenance and/or enhancement of the patient’s (and their family’s and carer’s) dignity.

Care that is technically competent but does not promote the patient’s dignity is inadequate; care that promotes dignity but is not technically competent is also inadequate. Excellent nursing is therefore underpinned by the following:

• Safeguarding dignity.
• Skilled, appropriate communication.
• Accurate assessment and monitoring.
• Tailored symptom control and management.
• Attentive risk assessment and management.
• Tailored health education and promotion.
• Thorough discharge planning.
• Evaluation of the outcomes of care and care processes.
• Use of the best evidence from research, theory, audit and service/practice development.

Nurses are accountable for the care they provide and must practise within the legal and ethical frameworks laid down by their professional and regulatory bodies.

Assessment and monitoring

Definition

Assessment is the systematic collection of key information to inform care. Monitoring is the regular updating of this information. Assessment and monitoring are iterative processes.

Accurate assessment and ongoing monitoring of a patient’s physical and mental health are critical to the provision of effective, safe and timely care and the plotting of progress/deterioration. Assessment and monitoring of the patient’s relatives’ responses to the illness/condition and its consequences also need to be conducted. All nurses, regardless of the healthcare setting in which they work, undertake various types of assessment and monitoring.

Skilled assessment is linked to the ability to prioritise care that needs to be done urgently (e.g. through using early‐warning scales) and care that can wait.

Successful assessment and monitoring involve nurses merging hard data (e.g. from measurement equipment and assessment scales) with soft data (e.g. from talking, watching and listening to patients, their families and their healthcare team members) to form a complete picture of the patient’s condition and their response(s) to it and to nursing care and treatments.

Assessments can range from the comprehensive (e.g. covering physical, psychological, social, emotional, spiritual and cultural dimensions) to the specific (e.g. taking a temperature or monitoring wound healing).

Making a comprehensive nursing assessment should be done in partnership with the patient and their family/carers and it underpins the delivery of care. All nursing assessments should inform and be informed by those made by other health and social care workers.

The specific assessment and monitoring of elements of a patient’s health can help in the early detection of general health problems (e.g. hypertension); in establishing the effectiveness of treatments (e.g. in type 1 diabetes); in determining the progression of an acute illness (e.g. an infection) or a long‐term condition (e.g. multiple sclerosis), the impact of one type of illness on another (e.g. an acute respiratory infection on asthma) and the generation of one illness because of another (e.g. depression resulting from chronic obstructive pulmonary disease).

Accurate baseline assessments are essential if improvement or deterioration of a patient’s health is to be identified swiftly and managed appropriately through ongoing monitoring.

The results of assessment and monitoring need to be accurately recorded in a patient’s care plan or notes.

Initial assessments and deviations from the expected course of a patient’s condition need to be effectively communicated to relevant healthcare team members. Using a structured approach to communicating your assessment and planning (e.g. SBAR: Situation, Background, Assessment and Recommendation) can be useful in effectively explaining requirements to patients, their families and members of the multi‐disciplinary team.

Following an initial nursing assessment, the majority of ongoing monitoring is likely to focus on four key areas:

• The patient’s physical health and present condition set against the treatment plan.
• The patient’s mental health and present condition set against the treatment plan.
• Any special requirements the patient has.
• The patient’s and the carer’s requirements for social support.

Audit

Definition

Audit is a cyclical process of measuring care against agreed criteria (or standards), deciding whether alterations need to be made to care, making changes, and measuring again to see whether the change has been effective. Audits are used to provide information that can help inform best practice and should be carried out regularly.

Figure 1 The clinical audit cycle.

Audit can be done either at a national or at a local level.

Copeland (2005, p. 16) provided the following criteria to help practitioners develop a good local audit:

1. Should be part of a structured programme.
2. Topics chosen should in the main be high risk; high volume or high cost or reflect National Clinical Audits, NSFs (National Service Frameworks) or NICE [National Institute for Health and Care Excellence] guidance.
3. Service users should be part of the clinical audit process.
4. Should be multidisciplinary in nature.
5. Clinical audit should include assessment of process and outcome of care.
6. Standards should be derived from good quality guidelines.
7. The sample size chosen should be adequate to produce credible results.
8. Managers should be actively involved in audit and in particular in the development of action plans from audit enquiry.
9. Action plans should address the local barriers to change and identify those responsible for service improvement.
10. Re‐audit should be applied to ascertain whether improvements in care have been implemented as a result of clinical audit.
11. Systems, structures and specific mechanisms should be made available to monitor service improvements once the audit cycle has been completed.
12. Each audit should have a local lead.

C

Communication

Definition

Communication is the transfer of information between one person and another, and their reaction to it. Communication permeates everything that nurses do, and being able to communicate effectively with patients, their families/carers and colleagues is an essential feature of skilled nursing practice. Skilled communication enhances care.

Communication includes a variety of different verbal and non‐verbal cues and skills. Verbal communication comprises speech and language – this includes the way we use words, tones and inflections; the way we phrase what we say; and the questions that we ask in order to communicate what we are thinking and feeling. Non‐verbal communication involves many things: touch, facial expressions, eye contact and the way we look at each other, gestures, body movements, posture and body p...

Table of contents

• Cover
• Title Page
• Table of Contents
• Introduction
• Acknowledgements
• Part 1: Fundamentals of Nursing Care
• Part 2: Conditions
• References and Websites
• Index
• End User License Agreement