Fundamentals of Assessment and Care Planning for Nurses E-Book

Ian Peate

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Fundamentals
• Sprache: Englisch

Seitenzahl: 824

Veröffentlichungsjahr: 2019

Beschreibung

All nursing students are required to meet the seven standards produced by the Nursing & Midwifery Council (NMC) before being entered onto the professional register. Fundamentals of Assessment and Care Planning for Nurses addresses two of these important standards, helping readers become proficient in assessing patient needs, and planning, providing and evaluating care.

This timely publication adopts a practical approach with NMC proficiencies at its core, providing guidance and insight into the application of key skills and demonstrating competency in real-life settings.

• Centres around a fictitious nuclear family to provide a practical basis to the various chapters and assessment
• Offers mnemonics to enable comprehensive history taking and systematic physical assessment
• Helps readers address socio-cultural considerations they may face in practice
• Includes links to literature that provides further support and additional information

Fundamentals of Assessment and Care Planning for Nurses is an important resource for pre-registration nursing students and Nursing Associates who are required to demonstrate proficiency in the new NMC standards, and other registered practitioners seeking to update their knowledge.

Leseprobe

Table of Contents

Cover

Preface

References

Acknowledgements

Meet the family

Reference

Chapter 1: The nature of nursing

Aim

Introduction

The National Health Service

The health care system in Scotland

The health care system in Wales

The health care system in Northern Ireland

The NHS Constitution

Nursing

The 6Cs of nursing

The code

The role of the nurse

Professionalism

Technology and nursing

Conclusion

References

Chapter 2: The provision of care

Aim

Introduction

Duty of care

Professionalism

The Code. Professional standards of practice and behaviour for nurses, midwives, and nursing associates

Accountability

Confidentiality

Autonomy

Advocacy

Delegation

Conclusion

References

Chapter 3: Critical thinking and clinical decision making

Aim

Introduction

Critical thinking

Clinical decision making

Normative, prescriptive, and descriptive models

The decision‐making process

From novice to expert

Conclusion

References

Chapter 4: The nursing process

Aim

Introduction

The nursing process

The stages of the nursing process

Signs and symptoms

Nursing diagnosis

Planning

Implementation

Evaluation

Conclusion

References

Chapter 5: Care plans

Aim

Introduction

Care plans

Indwelling urethral catheter

Care pathways

Care bundles

Discharge planning

Conclusion

References

Chapter 6: Models of nursing

Aim

Introduction

Nursing theories

Nursing models

Orem’s self‐care deficit theory

Roy’s adaptation model

Roper, Logan, and Tierney activities of living model

The five key components

Conclusion

References

Chapter 7: The skills of assessment and planning care

Aim

Introduction

Assessment

Patient history

Planning care

Objectives and goals

Writing goals or objectives

Conclusion

References

Chapter 8: Assessment tools

Aim

Introduction

Tools and instruments

Reliability

Validity

Sensitivity and specificity

Wound assessment tools

Nutritional assessment tools

National Early Warning Score

(

NEWS

) 2

Track and trigger systems

Conclusion

References

Chapter 9: Assessing the musculoskeletal system

Aim

Introduction

Bones

Joints

Skeletal muscles

Storage

Anatomical terms

Assessing needs

The health history

Biographical data

Current health status

Balance and coordination problems

Past health history

Family history

Review of systems

Psychosocial profile

The physical assessment

Method

Undertaking a general survey

Physical examination

Carrying out a musculoskeletal physical assessment

Assessing joints and muscles

Additional tests

Conclusion

References

Chapter 10: Assessing the circulatory system

Aim

Introduction

The circulatory system

Blood

Platelets

Blood groups

The blood vessels

The capillaries

Blood pressure

The lymphatic system

Assessing needs

The health history

Physical examination

Conclusion

References

Chapter 11: Assessing the cardiac system

Aim

Introduction

The cardiac system

The heart

The cardiac cycle

Assessing needs

Chief complaint and history of present condition

Family history

Lifestyle

Past medical history

The physical examination

The blood pressure

Chest examination

Cardiac auscultation

Electrocardiogram

Assessing chest pain

Conclusion

References

Chapter 12: Assessing the gastrointestinal system

Aim

Introduction

The gastrointestinal system

Organs of the gastrointestinal system

The organisation of the gastrointestinal tract

Assessing needs

The history

Past health history

Medication history

Social history and lifestyle risk factors

Family history

Psychosocial health

Nutritional assessment

The physical examination

Auscultation

Percussion

Palpation

Abdominal pain

Using PQRST for pain assessment

Locations of pain

Conclusion

References

Chapter 13: Assessing the renal system

Aim

Introduction

Assessing needs

Obtaining a patient history

The urine

Urinalysis

Focused patient examination

Dysuria and urinary tract infection

Conclusion

References

Chapter 14: Assessing the respiratory system

Aim

Introduction

The respiratory system

The upper respiratory system

The lower respiratory system

The larynx

Trachea

Lungs

Pulmonary ventilation

Inspiration

Exhalation

Factors that affect pulmonary ventilation

The patient history

How to use a stethoscope

Physical examination

Auscultation of the chest

Percussion of the chest

Palpation of the neck and thorax

Conclusion

References

Chapter 15: Assessing the male reproductive system

Aim

Introduction

The male reproductive system

The male genitalia

Assessing needs

The physical examination

Inspection

The foreskin

The scrotal sac

The penis

Erectile physiology

The prostate gland

The patient history

Urodynamic studies

Physical examination

The Penis

The scrotum

Conclusion

References

Chapter 16: Assessing the female reproductive system

Aim

Introduction

The female reproductive system

The fallopian tubes

The breasts

Breast development

Hormones and the breast

The patient history

Physical examination

Assessment of the breasts

Assessment of the organs of the female reproductive system

Equipment

Digital bimanual palpation

Conclusion

References

Chapter 17: Assessing the nervoussystem

Aim

Introduction

The nervous system

Cells of the nervous system

The central nervous system

The patient history

Conclusion

References

Chapter 18: Assessing the endocrine system

Aim

Introduction

The endocrine system

The patient history

Physical examination

Assessing the thyroid Gland

Conclusion

References

Chapter 19: Assessing the immune system

Aim

Introduction

The immune system

Blood cell development

The organs of the immune system

Infectious micro‐organisms

Spread of infection

The patient history

Sore throat

Physical examination

Inspection

Palpation

Conclusion

References

Chapter 20: Assessing the skin

Aim

Introduction

The skin

The epidermis

The accessory skin structures

The functions of the skin

Assessing the skin

The patient history

Physical examination

Inspection

Conclusion

References

Index

End User License Agreement

List of Tables

Chapter 1

Table 1.1 The RCN’s six defining characteristics.

Table 1.2 The 6 Cs.

Chapter 3

Table 3.1 Some of the factors that need to be taken into consideration with rega...

Table 3.2 The decision‐making process in action.

Table 3.3 Some dos and don’ts of decision making.

Table 3.4 From novice to expert.

Chapter 4

Table 4.1 The nine rights of drug administration.

Chapter 5

Table 5.1 An example of a standardised, pre‐written care plan for a patient with...

Chapter 6

Table 6.1 Theories.

Table 6.2 Key concepts of Orem’s Self‐Care Deficit model (Orem 1980).

Table 6.3 Some prompts that may assist with the assessment of each Activity of L...

Table 6.4 The five influencing factors on the Activities of Living (ALs).

Chapter 7

Table 7.1 Types of assessment.

Table 7.2 The specific, measurable, achievable, realistic with a timeframe (SMAR...

Table 7.3 Some measurable verbs.

Table 7.4 Tips for goal setting on the non‐acute care setting.

Table 7.5 An alternative approach to specific, measurable, achievable, realistic...

Chapter 8

Table 8.1 Specificity and sensitivity.

Table 8.2 The components of Malnutrition Universal Screening Tool (MUST) (Britis...

Table 8.3 National Early Warning Score 2 (NEWS2) early warning system scores and...

Table 8.4 Parameters not included in National Early Warning Score 2 (NEWS2).

Table 8.5 Some examples of track and trigger systems.

Chapter 9

Table 9.1 Cells present in the bone.

Table 9.2 Bone shapes.

Table 9.3 Angular movements possible at joints.

Table 9.4 Some risk factors that might predispose the patient to musculoskeletal...

Table 9.5 Some social factors related to musculoskeletal conditions.

Table 9.6 The Oxford Scale.

Table 9.7 Some abnormal musculoskeletal findings.

Chapter 10

Table 10.1 Differences between arteries and veins.

Table 10.2 The carotid artery and internal jugular vein.

Table 10.3 Peripheral pulses.

Table 10.4 CEAP classification system.

Chapter 11

Table 11.1 Summary of the vessels and their functions.

Table 11.2 Common manifestations of cardiovascular problems.

Table 11.3 Possible causes of chest pain.

Table 11.4 The mnemonic OLDCARTS used as a framework when assessing chest pain....

Table 11.5 Inferences that can be made regarding cardiac pain, type, and locatio...

Chapter 12

Table 12.1 The five processes of the gastrointestinal system and their categorie...

Table 12.2 Functions of the small intestine.

Table 12.3 Some manifestations of gastrointestinal disease.

Table 12.4 The abdominopelvic four quadrants.

Table 12.5 Bowel sounds.

Table 12.6 Types of abdominal pain and possible causes.

Table 12.7 Using the PQRST tool to assess, describe, and document pain.

Table 12.8 Abdominal pain, location, and potential causes.

Table 12.9 The Alvarado scoring system using he acronym MANTRELS.

Chapter 13

Table 13.1 Functions of the kidneys.

Table 13.2 Renal system assessment and urinary elimination patterns.

Table 13.3 Some imaging and biopsy investigations.

Table 13.4 Urinalysis.

Table 13.5 Types of urine analysis.

Table 13.6 Signs and symptoms associated with chronic renal failure.

Table 13.7 Questions to ask in relation to dysuria with rationale.

Chapter 14

Table 14.1 Other influences on respiration.

Table 14.2 Some respiratory symptoms.

Table 14.3 A cough OLDCART.

Table 14.4 Characteristics of breathing.

Table 14.5 Breath sounds.

Table 14.6 Lung sounds.

Chapter 15

Table 15.1 The focus of the interview.

Table 15.2 Some questions to ask in relation to the male reproductive system.

Table 15.3 The mnemonic SPACESPIT, features to note regarding lumps or swellings...

Chapter 16

Table 16.1 The three distinct layers of the uterus.

Chapter 17

Table 17.1 The general function of the four main parts of the brain.

Table 17.2 Key specific functions of key cerebral hemispheres.

Table 17.3 The cranial nerves and their major functions.

Table 17.4 Primary and secondary headache.

Table 17.5 Some components of the neurological system history.

Table 17.6 Some common manifestations of neurological problems.

Table 17.7 Assessing the cranial nerves (in the conscious patient).

Table 17.8 Some common terms used to describe the assessment of level of conscio...

Table 17.9 An overview of the Glasgow Coma Scale.

Chapter 18

Table 18.1 Nervous system versus endocrine system.

Table 18.2 Hormones released by the hypothalamus and anterior pituitary gland (C...

Table 18.3 Some effects associated with an abnormal secretion of thyroid hormone...

Table 18.4 Other endocrine glands.

Table 18.5 Some common clinical features in endocrine disease.

Table 18.6 Assessment activity with regard to fatigue.

Table 18.7 Facial changes that can occur in endocrine disorders.

Chapter 19

Table 19.1 A brief glossary of the blood cells (Vickers 2007).

Table 19.2 The five types of antibodies.

Table 19.3 Routes of transmission.

Table 19.4 A guide to history taking, chief complaint – sore throat

Table 19.5 The FeverPAIN score.

Chapter 20

Table 20.1 The layers of the epidermis.

Table 20.2 The past medical history.

Table 20.3 Questions to ask a patient in relation to hair and nails.

Table 20.4 Character, distribution, and shape of lesions; questions to ask.

Table 20.5 A guide to skin examination.

Table 20.6 Psychodermatology.

List of Illustrations

Chapter 1

Figure 1.1 The National Health Service (NHS) Act 1946.

Figure 1.2 The Department of Health (DH) explained.

Figure 1.3 The triad.

Figure 1.4 The six defining characteristics and the how they inform and supp...

Figure 1.5 The four themes underpinning good nursing practice.

Figure 1.6 Partnerships.

Figure 1.7 Digital literacy.

Chapter 2

Figure 2.1 The four guiding principles underpinning the Code (NMC 2018).

Figure 2.2 Spheres of accountability.

Chapter 3

Figure 3.1 The critical reasoning process.

Figure 3.2 Benner’s novice to expert.

Chapter 4

Figure 4.1 The cyclical nursing process.

Chapter 6

Figure 6.1 Four central concepts representing the reality of practice.

Figure 6.2 Roper et al.’s Activities of Living model

Figure 6.3 The 12 ALs.

Figure 6.4 The lifespan continuum.

Figure 6.5 The dependence/independence continuum.

Figure 6.6 The impact of the five influencing factors on the ALs.

Chapter 7

Figure 7.1 Palpation.

Figure 7.2 Percussion.

Chapter 8

Figure 8.1 Malnutrition Universal Screening Tool (MUST): the five steps.

Figure 8.2 National Early Warning Score 2 (NEWS2) physiological parameters u...

Chapter 9

Figure 9.1 The human skeleton.

Figure 9.2 A synovial joint.

Figure 9.3 Skeletal muscle fibre.

Figure 9.4 Maurice’s subjective assessment of pain distribution.

Chapter 10

Figure 10.1 The arterial and venous systems.

Figure 10.2 The appearance of centrifuged blood.

Figure 10.3 The formed elements of blood.

Figure 10.4 Red blood cell.

Figure 10.5 The destruction of a red blood cell.

Figure 10.6 The ABO blood group system.

Figure 10.7 The blood vessels.

Figure 10.8 The structure of arteries, veins, and capillaries.

Figure 10.9 Artery and vein.

Figure 10.10 The lymphatic system.

Figure 10.11 Measuring jugular venous pressure.

Figure 10.12 The peripheral pulses.

Figure 10.13 Varicose veins.

Chapter 11

Figure 11.1 The cardiovascular (cardiac) system.

Figure 11.2 Location of the heart.

Figure 11.3 The heart wall.

Figure 11.4 Cardiac muscle cells.

Figure 11.5 The chambers of the heart.

Figure 11.6 The vessels of the heart.

Figure 11.7 Flow of blood through the heart.

Figure 11.8 Conduction system of the heart.

Figure 11.9 The cardio regulatory centre.

Figure 11.10 Cardiac auscultation points.

Figure 11.11 Lead placement.

Figure 11.12 Placement of the limb leads.

Figure 11.13 A 12‐lead normal electrocardiogram (ECG). Source: Davey (2008)....

Figure 11.14 Areas associated with cardiac pain.

Chapter 12

Figure 12.1 The gastrointestinal system.

Figure 12.2 The digestive processes.

Figure 12.3 The mouth.

Figure 12.4 The salivary glands.

Figure 12.5 Swallowing.

Figure 12.6 Peristalsis in the oesophagus.

Figure 12.7 Structure of the digestive tract.

Figure 12.8 The stomach.

Figure 12.9 Phases of gastric juice secretion.

Figure 12.10 The stomach and small intestine.

Figure 12.11 The pancreas, gall bladder and liver.

Figure 12.12 The large intestine.

Figure 12.13 The four quadrants.

Figure 12.14 Auscultating abdominal sounds.

Chapter 13

Figure 13.1 The renal system.

Figure 13.2 External layers of the kidney.

Figure 13.3 Internal structures showing blood vessels.

Figure 13.4 Nephron.

Figure 13.5 Bowman’s capsule.

Figure 13.6 The nephron with capillaries.

Figure 13.7 Common iliac vessels and ureter.

Figure 13.8 Layers of the urinary bladder.

Figure 13.9 Location of the female urethra.

Chapter 14

Figure 14.1 Respiratory organs.

Figure 14.2 Detailed structures of the upper respiratory tract.

Figure 14.3 The lower respiratory system.

Figure 14.4 The bronchial tree.

Figure 14.5 Boyle’s law.

Figure 14.6 Inspiration and expiration.

Figure 14.7 The respiratory centre.

Figure 14.8 Peripheral chemoreceptors.

Figure 14.9 Gas exchange in the lungs.

Figure 14.10 External respiration.

Figure 14.11 Internal respiration.

Figure 14.12 The stethoscope.

Figure 14.13 The bell and diaphragm.

Figure 14.14 Clubbing.

Figure 14.15 Common sites for auscultation, the anterior chest.

Figure 14.16 Common sites for auscultation, the posterior chest.

Figure 14.17 Technique for percussion.

Figure 14.18 Sites for percussion of the anterior and lateral chest wall.

Figure 14.19 Sites for percussion of the posterior chest wall.

Figure 14.20 Checking for chest expansion.

Figure 14.21 Tactile fremitus.

Chapter 15

Figure 15.1 The male reproductive system.

Figure 15.2 The teste.

Figure 15.3 Components of a sperm.

Figure 15.4 The stages of spermatogenesis.

Figure 15.5 Some male changes related to testosterone.

Figure 15.6 The penis – erectile tissue.

Figure 15.7 The scrotum and testes.

Figure 15.8 The penis.

Figure 15.9 Palpating for an inguinal hernia.

Chapter 16

Figure 16.1 The external female genitalia.

Figure 16.2 The female reproductive system.

Figure 16.3 Developmental sequences related to the maturation of an ovum.

Figure 16.4 Oogenesis.

Figure 16.5 The uterus and associated structures.

Figure 16.6 The breast.

Figure 16.7 The breast and surrounding structures.

Figure 16.8 Breast examination.

Figure 16.9 Cervical cell sampling.

Chapter 17

Figure 17.1 Main components of the nervous system.

Figure 17.2 A typical motor neurone and Schwann cell.

Figure 17.3 Neuroglia.

Figure 17.4 The brain.

Figure 17.5 External anatomy of the spinal cord.

Figure 17.6 The coverings of the brain.

Figure 17.7 Spinal nerves and plexuses.

Figure 17.8 Somatic sensory map in the cerebral cortex.

Figure 17.9 The origins of the cranial nerves.

Chapter 18

Figure 18.1 Location of the endocrine organs.

Figure 18.2 The hypothalamus and pituitary gland.

Figure 18.3 The location of the thyroid and para thyroid gland.

Figure 18.4 Negative feedback control of thyroid hormone production.

Figure 18.5 The position of the adrenal glands.

Figure 18.6 Cross‐section of an adrenal gland.

Figure 18.7 The pancreas.

Figure 18.8 The effects of insulin and glucagon on blood glucose concentrati...

Chapter 19

Figure 19.1 The development of white blood cells.

Figure 19.2 Location of the thymus within the body.

Figure 19.3 The lymphatic system.

Figure 19.4 Structure of a lymph node.

Figure 19.5 The cells of the immune system.

Figure 19.6 Types of acquired immunity.

Figure 19.7 The lymph nodes of the head and neck.

Chapter 20

Figure 20.1 The components of the skin.

Figure 20.2 Types of cells in the epidermis.

Figure 20.3 Microscopic layers of the skin with various strata.

Figure 20.4 A pilosebaceous gland.

Figure 20.5 A sweat gland.

Figure 20.6 The nail.

Figure 20.7 Terminology used with primary lesions.

Figure 20.8 Terminology used with secondary lesions.

Figure 20.9 A body map.

Guide

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Fundamentals of Assessment and Care Planning for Nurses

IAN PEATE, OBE, FRCN

Head of School, School of Health StudiesVisiting Professor of Nursing, St George's University of London, Kingston University LondonEditor in Chief, British Journal of NursingVisiting Senior Clinical Fellow, University of HertfordshireUniversity of Gibraltar

This edition first published 2020© 2020 John Wiley & Sons Ltd

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Names: Peate, Ian, author.Title: Fundamentals of assessment and care planning for nurses / Ian Peate.Description: Hoboken, NJ : John Wiley & Sons, Inc., 2020. | Includes bibliographical references and index. |Identifiers: LCCN 2019019196 (print) | LCCN 2019021655 (ebook) | ISBN 9781119491767 (Adobe PDF) | ISBN 9781119491743 (ePub) | ISBN 9781119491750 (pbk.)Subjects: | MESH: Nursing Assessment | Patient Care PlanningClassification: LCC RT48 (ebook) | LCC RT48 (print) | NLM WY 100.4 | DDC 616.07/5–dc23LC record available at https://lccn.loc.gov/2019019196

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Preface

The Fundamentals of Assessment and Care Planning for Nurses has been written to help develop the assessment and care planning skills of the nurse. In order to assess needs effectively in a patient‐centred way the nurse is required to have a detailed understanding of the nursing process and the skills needed to plan care that is individual and holistic. Assessment and care planning are set against a backdrop of a dynamic and changing nursing profession as well as how contemporary care is being provided (Chapters 1 and 2).

The initial nursing assessment, the first step in the five steps of the nursing process, demands the systematic and continuous collection of data. Chapter 4 provides details concerning the systematic, cyclical nature of the nursing process. The nurse is required to systematically organise and analyse the data that has been gathered. Once primary and secondary data have been gathered there is a need to document and communicate findings in a care plan (Chapter 5) so that care can be delivered in response to an individual’s unique sociocultural and physical needs, incorporating evidence‐based practice.

Using the nursing process effectively demands the application of critical thinking skills that have been applied during the various phases of the nursing process. Critical thinking skills and the decision‐making process feature in Chapter 3. The nursing process is a decision‐making framework that helps the nurse work with the patient where appropriate. The use of a nursing model (Chapter 6) can help develop and steer the plan of care.

During nursing assessment information is gathered regarding the patient’s individual physiological, psychological, sociological, and spiritual needs. This phase is the first phase required for the successful evaluation of care interventions. Working in partnership with the patient, the nurse collects subjective and objective data throughout the nursing process, the skills needed to do this are outlined in Chapter 7.

The Fundamentals of Assessment and Care Planning for Nurses discusses the general and focussed assessment of needs in relation to the body systems. There are a variety of assessment tools that are available to help the nurse in the assessment phase (see Chapter 8).

The first eight chapters of Fundamentals of Assessment and Care Planning for Nurses provide the foundations needed to be able to assess, make a diagnosis, plan care, implement that care, and devise strategies to evaluate outcomes. The nature of nursing offers insight into contemporary health and social care provision. Emphasis is placed on how care provision is dynamic and the voice of the service user is the key driver in how nurses and care providers respond to needs.

Key to understanding the primary and secondary source data that has been collected when assessing needs is the application of critical thinking and clinical decision making in order to formulate a plan of care. The skills and attributes of a critical thinker are outlined as the nurse applies the five phases of the nursing process and the planning of individual care plans using a model of nursing to steer and guide data collection.

The initial nursing assessment is a key component of nursing practice, it begins the nursing process. The use of assessment tools can, when appropriate and when utilised correctly, yield objective data, this is then used to implement care and evaluate impact. There are many assessment tools available and their content varies, they aim to help the nurse provide safe and evidence‐based care. Assessment tools are described in Chapter 8.

The Nursing and Midwifery Council’s (NMC) (2018a) Code is clear when it states that the nurse must ensure that people’s physical, social, and psychological needs are assessed and responded to. In order to demonstrate compliance with this clause the nurse must undertake a comprehensive and systematic nursing assessment, plan nursing care in partnership with the patient and respond in an effective way to changing needs and changing situations.

There are 12 chapters of Fundamentals of Assessment and Care Planning for Nurses dedicated to the assessment of body systems. Each of these chapters begin with a discussion of the anatomy and physiology of the body system. Within these chapters the reader is provided with information and understanding associated with the gathering of subjective and objective data as the nurse conducts a health history interview and performs a physical examination. A practical approach is adopted, urging the nurse to learn the art and science associated with assessment to develop and hone their skills.

This text is timely as the NMC introduces its new Standards of Proficiency for Nurses (NMC 2018b). The proficiencies specify the knowledge and skills that registered nurses must demonstrate when caring for people, these are the proficiencies that the nurse must have met prior to being allowed entry on to the professional register as they gain their licence to practise. Within these new standards, platforms three and four focus on assessing needs and planning care; and providing and evaluating care (respectively).

Those who provide nurse education are required to develop and deliver programmes that give nurses the skills, knowledge and behaviours they need. The NMC’s new Standards for Pre‐registration Nursing set out how they must do this (NMC 2018c). The Fundamentals of Assessment and Care Planning for Nurses echo many of the requirements around assessing needs and planning care, providing and evaluating care.

There have been further developments in the profession as the NMC have also produced standards that outline the proficiencies for Nursing Associates (NMC 2018d) along with the Standards for Pre‐registration Nursing Associate Programmes (NMC 2018e). The nursing associate is required to provide compassionate care and contribute to on‐going assessment, recognising when needed to refer to others for reassessment.

Each chapter begins with an aim and learning outcomes, enabling the reader to contextualise and focus on the chapter content and the NMC proficiencies. The Fundamentals of Assessment and Care Planning for Nurses adopts a practical approach in order to facilitate learning, apply theory to practice, and encourage a person‐centred approach, and to aid recall, a number of features and activities have been incorporated to assist with this. The book is fully illustrated throughout with clear artwork. There are a number of interactive learning features, encouraging the reader to review their learning, take note of key issues, and engage with the various elements associated with the 6Cs. Where appropriate the reader is drawn to cultural considerations where there are specific issues that have to be given due consideration. A fictitious family, the Samudas, is introduced to help link further the assessment of needs, focusing on the individual needs of a family member and the family unit. The chapters have several summary sections interspaced, enabling the reader to digest the bite‐sized theory.

There are a number of mnemonics used throughout the book. Their inclusion is to assist and promote comprehensive history taking and a systematic, focused physical assessment. The mnemonics, however, should not be viewed simply as tick boxes, but rather as a way of triggering the nurse during history taking and examination addressing areas of importance.

I have very much enjoyed writing Fundamentals of Assessment and Care Planning for Nurses, it comes at an interesting time for nurses, the nursing profession, and those who work with us, as we are experiencing much change within and without the profession. My intention has been to help you understand, to apply what it is you are reading as you offer care to people (often the most vulnerable in society), to whet your appetite and inspire you to delve deeper and to stimulate curiosity, but most of all to ensure that the patient is truly at the heart of all you do.

References

Nursing and Midwifery Council (2018a). The Code. Professional standards of practice and behaviour for nurses, midwives and nursing associates.

www.nmc.org.uk/globalassets/sitedocuments/nmc‐publications/nmc‐code.pdf

last accessed October 2018.

Nursing and Midwifery Council (2018b). Standards of proficiency for registered nurses.

www.nmc.org.uk/globalassets/sitedocuments/education‐standards/future‐nurse‐proficiencies.pdf

last accessed October 2018.

Nursing and Midwifery Council (2018c). Standards of pre‐registration nursing programmes.

www.nmc.org.uk/globalassets/sitedocuments/education‐standards/programme‐standards‐nursing.pdf

last accessed October 2018.

Nursing and Midwifery Council (2018d). Standards of proficiency for nursing associates.

www.nmc.org.uk/globalassets/sitedocuments/education‐standards/nursing‐associates‐proficiency‐standards.pdf

Last accessed October 2018.

Nursing and Midwifery Council (2018e). Standards for pre‐registration nursing associate programmes.

www.nmc.org.uk/globalassets/sitedocuments/education‐standards/nursing‐associates‐programme‐standards.pdf

Last accessed October 2018.

Acknowledgements

I would like to thank my partner Jussi Lahtinen, who continues to encourage and support me. I acknowledge my gratitude to my friend Mrs Frances Cohen. I owe thanks to my brother Anthony Peate, who helped with the illustrations. Thank you to the library staff at Gibraltar Health Authority and the Royal College of Nursing. Special thanks to Magenta Styles at Wiley – your enthusiasm is palpable.

Meet the family

One of the features used in Fundamentals of Assessment and Care Planning for Nurses centres around a fictitious family, the Samudas (all names and details are fictional in accordance with the Nursing and Midwifery Council’s (2018) Code). Inclusion of the family helps to provide context to the chapters that focus on assessment of the body systems. In each of these chapters a family member is discussed and the reader is encouraged to consider that individual family member’s needs as well as how their condition may impact on the family unit.

The Samuda family live in a small town on the South West coast, all within walking distance of each other apart from Howard, who lives in Norwich. The Samudas live in a housing complex in Welltown south of the river. They own a four‐bedroomed semi‐detached house.

You will meet various members of the Samuda family in several chapters of the book. There are nine members of the Samuda family, take some time to get to know them (see the genogram in Figure 1).

Figure 1 Genogram.

Ruby Coleman 70 years old (grandmother). Ruby lives in the same street as the Samuda family and offers her daughter support with the family when she can. Ruby is a member of the local bridge club and enjoys watching the soaps. She enjoys baking.

Bob Coleman, 74 years old (grandfather). Bob lives in the same street as the Samuda family. Bob meets up with his mates, with whom he worked on the railway. He finds getting around a little more difficult now as he has been getting ‘caught short’ once too often lately.

Shahine Samuda Mother: 39 years old, part‐time ward clerk. Shahine spends most her time when not working looking after the family. She likes to swim. Shahine and her best friend Marie also like to dance, they are learning to salsa.

Maurice Samuda Father: 44 years old, is a full‐time civil servant. Maurice spends most his free time fixing up old motor bikes in his shed, he gets little physical exercise. He is overweight, smokes 60 cigarettes a week. Maurice drinks alcohol to excess.

Howard Samuda Son: 23 years old, works full time in a law firm. Howard lives in Norwich, left home six years ago after a disagreement with his father. He keeps in touch with the family via Kam. Howard is an avid traveller and is studying part‐time for a Master’s degree in Law.

Kamina (Kam) Samuda Daughter: 17 years old, student at Goodenough School and is about to undergo her A levels. Kam has found being at home recently a little overwhelming at times; she tends to spend her time at her boyfriend’s house, where she says it is much a calmer. Kam wants to go to university and study electrical engineering; she is studying hard at school.

Oswald (Ossie) Samuda Son: 13 years old with special needs, student also attending Goodenough School. Ossie is the youngest child. He uses a wheelchair for mobility and he has a special education needs teacher who supports him at school. Shahine is Ossie’s main carer. Ossie enjoys swimming and playing on his PlayStation.

Judith Higgins (Daughter of Ruby and Bob): 45 years old (Aunty Judy). Judith lives in close proximity to the Samudas and the Colemans. Judy has not worked for the last five years. Judy and her husband Winston are close to the family. They have no children. However, her niece, Shahine, has expressed concerns about Judith’s cognitive state.

Winston Higgins (Son in law of Ruby and Bob): 43 years (Uncle Winston). Winston lives in close proximity to the Samudas and the Colemans. He enjoys cycling and hiking in the highlands whenever he can get a chance, he is a postman. Winston lives with Judith. He is becoming more and more a key carer of Judith, who he says has become very short‐tempered and even more forgetful.

Reference

Nursing and Midwifery Council (2018) The Code. Professional standards of practice for nurses, midwives and nursing associates.

www.nmc.org.uk/globalassets/sitedocuments/nmc‐publications/nmc‐code.pdf

last accessed October 2018.

Chapter 1The nature of nursing

Aim

The aim of this chapter is to introduce the reader to the nature of nursing and offer an overview of how care is offered.

Learning outcomes

By the end of the chapter the reader will be able to:

Provide a timeline outlining key points in the development of contemporary nursing practice

Identify how care provision over the years has impacted on contemporary practice

Discuss how the NHS was formed and its current role in the provision of health and social care

Consider local, national, and international care perspectives

Introduction

The past is where lessons have been learnt and the future is where those lessons learnt are applied. However, living in the past can hinder progress. In an unidentified source, ‘you cannot tell where you are going unless you know where you have been’ is the key theme of this chapter. Much is to be learnt from the past in order to help us in the future, to learn from our mistakes and to help us and the services we provide to develop in an appropriate and patient‐centred manner.

Before the mid‐nineteenth century, nurses, whether employed in hospitals or in private homes, were very often uneducated and usually had no formal training. In Britain in the 1840s nursing sisterhoods were founded to improve standards of nursing, these mimicked the Catholic nursing orders in other European countries. St John’s House, an Anglican Nursing Sisterhood founded in 1848, was one example of these. As a thank‐you to Florence Nightingale for her accomplishments during the 1854–1856 Crimean War, a fund was raised by public donations to allow her to establish a training school for nurses in London, the Nightingale School set up at St Thomas’ Hospital in 1860. Other hospitals, both voluntary hospitals and workhouse infirmaries, formed their own training schools, and many of these were run by superintendents who had trained at the Nightingale School. Nightingale based her curriculum on the following beliefs:

Nutrition is an important part of nursing care.

Fresh, clean air is beneficial to the sick.

Sick people require occupational and recreational therapy.

Nurses should help identify and meet patients’ personal needs and these include the provision of emotional support.

Nursing should be directed towards two conditions: health and illness.

Nursing is separate and distinct from the practice of medicine and as such should be taught by nurses.

Nurses need continuing education.

Review

Think about the list of Nightingale’s beliefs (those that were a part of her nursing curriculum) and reflect on the course or programme of study you are enlisted on and determine if these beliefs are still the foundation of nursing education today.

Provision was also provided to train district nurses to care for the sick and poor in their own homes, and in 1887 the Queen’s Institute of District Nursing was founded.

The 1919 Nurses Registration Act set up the General Nursing Council, which was charged with maintaining a register of nurses to ensure that in future all nurses were appropriately trained. As a result of a shortage of nurses, the Nurses Act established in 1943 provided a roll of assistant nurses.

In 1930 county councils took over the workhouse infirmaries from the Boards of Guardians and the London County Council also acquired all the hospitals that had been previously managed by the Metropolitan Asylums Board. Most hospitals and mental institutions in 1948 passed to the National Health Service (NHS), with the majority of them becoming the responsibility of the regional hospital boards. Four boards assumed responsibility in London and the South East, as well as the North East, North West, South East, and South West Metropolitan Hospital Boards. In each hospital region an Area Nurse Training Committee was established, with the aims of financing, advising and improving all nurse training institutions in the region.

County councils became responsible for district nursing as well as for other personal health services in 1948. All health services were transferred to the newly formed regional and area health authorities in 1974, replacing the regional hospital boards, and in 1982 area health authorities were abolished. There have been numerous other reorganisations that have followed.

The National Health Service

The NHS is over 70 years old, and the NHS and those people it offers a service to today are very different now than in 1948 when it was born. This difference between then and now must be taken into account in any discussion that includes contemporary service provision. Today Britain has become a wealthier society, it is more socially and morally liberal and as a result of this, public expectations have changed considerably. However, the impact that social and economic changes have had on society have been uneven, and there are inequalities.

The NHS was created out of the notion that good healthcare should be available to all, irrespective of wealth. When the NHS was launched on 5 July 1948, it was based on three core principles, that it:

Meets the needs of everyone

Be free at the point of delivery

Be based on clinical need, not ability to pay

(the National Health Service Act – see figure 1.1).

Figure 1.1 The National Health Service (NHS) Act 1946.

These three principles are still very apparent today, they continue to guide the development of the NHS and remain at its centre. The NHS is the largest employer in the UK, there are roughly 1.5 million people employed by the NHS across the UK. By country:

In England 1.2 million

In Scotland 162 000

In Wales 89 000

In

Northern Ireland

(

NI

) 64 000

This data does not include everyone working in the health sector. They leave out some people, for example temporary staff, GPs, dentists, optometrists, and other staff in the independent sector or private hospitals (Full Fact 2017).

In England, around 824 000 clinical staff (those directly involved in patient care) work in the NHS, including 141 000 doctors and 329 000 nurses, midwives and health visitors (National Audit Office 2016).

So far

The NHS was launched in 1948. It was born out of a long‐held ideal that good healthcare should be available to all, regardless of wealth. The NHS provides healthcare for all UK citizens based on their need for healthcare as opposed to their ability to pay for it. It is funded by taxes.

The NHS is the largest employer in the UK – there are around 1.5 million people employed by the NHS across the UK.

Department of Health and Social Care

The purpose of the Department of Health (DH) is to help people live better for longer, the DH shapes and funds health and care in England, ensuring that people have the support, care and treatment they require, with the compassion, respect and dignity that they deserve. The dynamic and changing health and care organisations work together with the DH to achieve this common purpose. In 2018 the Department of Health became the Department of Health and Social Care (DHSC).

The DH facilitates health and social care bodies to deliver services according to national priorities, working with other parts of government to achieve this and setting objectives and budgets and holding the system to account on behalf of the Secretary of State for Health. Ultimate responsibility for ensuring that the whole system works together to meet the needs of patients and the public sits with the Secretary of State for Health. Figure 1.2 provides a visual overview of the DH.

Figure 1.2 The Department of Health (DH) explained.

Source: DH (2013) (permission open government licence: www.nationalarchives.gov.uk/doc/open‐government‐licence/version/3).

NHS England

NHS England assists NHS services nationally ensuring that money spent on NHS services provides the best possible care for patients. It funds local clinical commissioning groups (CCGs) to commission services for their communities and ensures that they do this effectively. NHS England brings together expertise to ensure that national standards are consistently in place across the country. Throughout its work it promotes the NHS Constitution and the Constitution’s values and commitments.

Clinical commissioning groups

These are clinically led statutory NHS bodies responsible for the planning and commissioning of healthcare services for their local area. Membership of CCGs includes nurses and other clinicians, such as GPs and consultants. They are responsible for approximately 60% of the NHS budget and commission the majority of secondary care services as well as playing a part in the commissioning of GP services.

Health and wellbeing boards

Health and wellbeing boards (HWBs) were established by local authorities to act as a forum for local commissioners across the NHS, social care, public health, and other services. The aims of the HWBs are to increase democratic input into strategic decisions about health and wellbeing services and strengthen working relationships between health and social care.

Public Health England

Public Health England (PHE) provides national leadership and expert services to support public health and works with local government and the NHS to respond to emergencies.

Vanguards

These were introduced in 2015. Fifty chosen vanguards are required to develop new care models and potentially redesign the health and care system. It is intended that this could lead to better patient care and service access, and a more simplified system.

Regulation and safeguarding people’s interests

Responsibility for regulating particular aspects of care is shared across a number of different bodies, for example:

The

Care Quality Commission

(

CQC

)

NHS Improvement is an umbrella organisation bringing together a number of other organisations

Individual professional regulatory bodies, that include the Nursing and Midwifery Council (NMC), the General Medical Council, the General Dental Council and the Health Care Professions Council

The health care system in Scotland

Scotland’s NHS operates under separate management, administration and political authority since devolution in 1999. Budgets for each branch of government spending, including the NHS, are determined not by Westminster but by the Scottish government, which decides how to split its block grant between public services.

The responsibility for delivering health services is mainly devolved to the health boards. There are 14 territorial health boards, which arrange services for their local population, and there are seven special health boards which provide a specific service for the whole of Scotland. Since the 1st April 2016, territorial health boards and local authorities have integrated certain health and social care services with the creation of 31 integration authorities.

Health boards are accountable to Scottish Ministers and ultimately to the Scottish Parliament. They are held to account through a number of measures such as Local Delivery Plan standards and annual accountability reviews.

The health care system in Wales

NHS Wales is the publicly funded national healthcare service of Wales, providing healthcare to around three million people who live in the country.

The NHS Wales provides services through seven Health Boards and three NHS Trusts in Wales. Primary care services are provided by GPs, nurses, and other health care professionals in health centres and surgeries across Wales. Secondary care is delivered through hospital and ambulance services and tertiary care is provided by hospitals, treating people with particular types of illness such as cancer. Community care services are usually provided in partnership with local social services and delivered to patients in their own homes.

The health care system in Northern Ireland

The DH sets the policy and legislative context for health and social care in NI. An annual Commissioning Plan Direction sets out ministerial priorities, key outcomes and objectives, and related performance indicators.

The Health and Social Care Board (HSCB), in conjunction with the Public Health Agency (PHA), then produces a Commissioning Plan.

Commissioning is about securing and monitoring health and social care services for the population of NI. The variety and complexity of the services provided is huge, with some local services being designed and secured for a population of a few thousand and for rare disorders, services need to be considered regionally or even nationally. NI’s approach to integrated governance for health and social care sets it apart from other UK jurisdictions.

So far

Since devolution in 1998, the UK has had four increasingly distinct health systems, in England, Northern Ireland, Scotland, and Wales. The key tenets of the NHS, free at the point of need, still feature in all four countries.

Review

Consider health and social care provision in the country where you are working. Analyse the pros and cons of a devolved health and social care provision for the people you offer care and support to and yourself.

The NHS Constitution

The NHS Constitution (DH 2015) establishes the principles and values of the NHS in England, setting out rights to which patients, public, and staff are entitled and pledges which the NHS is committed to achieve, along with responsibilities, which the public, patients, and staff owe to one another, ensuring that the NHS operates fairly and effectively. The Secretary of State for Health, all NHS bodies, private and voluntary sector providers supplying the NHS with services, and local authorities in the exercise of their public health functions have to by law take account of the Constitution in their decisions and actions.

The seven key principles guide the NHS in all it does. They are underpinned by core NHS values, derived from extensive discussions with staff, patients, and the public (see Box 1.1).

Box 1.1 The seven key principles

The NHS provides a comprehensive service, available to all.

Access to NHS services is based on clinical need, not an individual’s ability to pay.

The NHS aspires to the highest standards of excellence and professionalism.

The patient will be at the heart of everything the NHS does.

The NHS works across organisational boundaries.

The NHS is committed to providing best value for taxpayers’ money.

The NHS is accountable to the public, communities and patients that it serves.

Source: DH (2015).

The key principles are underpinned by six values (see Box 1.2). The NHS values provide common ground for cooperation to achieve shared aspirations, at all levels of the NHS.

Box 1.2 The six values

Working together for patients

Respect and dignity

Commitment to quality of care

Compassion

Improving lives

Everyone counts

Source: DH (2015).

For the first time in the history of the NHS, the NHS Constitution brings together details of what staff, patients and the public can expect from our NHS. The Constitution also explains what patients can do to help support the NHS, help it work effectively and help in ensuring that resources are used responsibly.

Review

The Code (NMC 2018) requires you to keep to the laws of the country in which you are practising. What does this mean and how can you ensure that you adhere to this clause?

Nursing

What is nursing? This is a complex question. It is also difficult to answer because nursing is dynamic, it is evolving and is a comparatively new profession. It is not easy to define nursing because the concept is as complex as its numerous activities. According to Nightingale (1859):

Nature alone cures… And what nursing has to do…is to put the patient in the best condition for nature to act upon him.

This is a classic definition of nursing with an emphasis on the promotion of health and healing as opposed to a cure of illness, the definition has a focus on the interconnected triumvirate (see Figure 1.3).

Figure 1.3 The triad.

All three of Nightingale’s features are still central to modern definitions of nursing.

Review

How would you define nursing? Write down your definition. Ask some others about their definition of nursing: do their definitions match yours? What are the similarities, if any?

There are a number of definitions of nursing available. Virginia Henderson (1960), for example, stated that the purpose of nursing is:

To assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge and to do this in such a way as to help him gain independence as rapidly as possible.

The Royal College of Nursing (RCN 2014) defines nursing as:

The use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death.

The RCN’s definition is supported by six defining characteristics (see Table 1.1 and Figure 1.4).

Table 1.1 The RCN’s six defining characteristics.

Source: Adapted RCN (2014).

Defining characteristic

Definition

One

A particular purpose: the purpose of nursing is to promote health, healing, growth and development and to prevent disease, illness, injury, and disability. The purpose of nursing when people become ill or disabled is to minimise distress and suffering and to enable people to understand and cope with their disease or disability, its treatment, and its consequences. In death, the purpose of nursing is to maintain the best possible quality of life until its end.

Two

A particular mode of intervention: nursing interventions are concerned with empowering people, helping them to achieve, maintain, or recover their independence. Nursing is an intellectual, physical, emotional, and moral process which includes the identification of nursing needs; therapeutic interventions and personal care; information, education, advice, and advocacy; and physical, emotional, and spiritual support. In addition to direct patient care, nursing practice includes management, teaching, and the development of knowledge and policy.

Three

A particular domain: the specific domain of nursing is people’s unique responses to and experience of health, illness, frailty, disability, and health‐related life events in whatever environment or circumstances they find themselves. Responses may be physiological, psychological, social, cultural, or spiritual, and often they are a combination of all of these. This includes people of all ages, families, and communities, throughout the life span.

Four

A particular focus: the emphasis of nursing is the whole person and the human response as opposed to a particular aspect of the person or a particular pathological condition.

Five

A particular value base: nursing is based on ethical values; these respect the dignity, autonomy and uniqueness of human beings, the privileged nurse–patient relationship and the acceptance of personal accountability for any actions and omissions.

Six

A commitment to partnership: nurses work in partnership with patients, their relatives, and other carers, and in collaboration with others as members of a multidisciplinary team. Where appropriate they will lead the team, prescribing, delegating, and supervising the work of others; at other times they will participate under the leadership of others. At all times, however, they remain personally and professionally accountable for their own decisions and actions.

Figure 1.4 The six defining characteristics and the how they inform and support the definition of nursing.

Source: RCN (2014).

Wild (2018) notes that the RCNs definition draws on what are seen as the purposes of nursing, they are:

To promote and sustain health

To care for those whose health has been compromised

To aid in the recovery process

To facilitate independence

To meet needs

To improve/maintain wellbeing/quality of life.

Review

Compare your earlier definition of nursing with Henderson’s 1960 definition and the RCN’s 2014 definition. In your own description of nursing, can you identify what Wild (2018) refers to as the purposes of nursing?

So far

The ability to define nursing and what nurses do is elusive, and this may be a good thing as what it is nurses do will (or should) be determined by the unique needs of the person receiving care. There are a number of definitions of nursing available; some may be of use and others may not.

The 6Cs of nursing

The 6Cs of nursing represent the professional commitment to always deliver exceptional care. Each value is equal, no one is more important than the other. Each of them focuses on putting the person who is being cared for at the heart of the care that they are given. See Table 1.2 for an overview of the 6Cs.

Table 1.2 The 6 Cs.

Source: DH (2012).

Care