Patient Pathways of Care in Adult Nursing

Patient Pathways of Care in Adult Nursing 1: Level 5

 

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Type of Assessment:

 

  • Patient centred case study (3000 words). The focus will be on one patient the student has cared for on a medical or surgical nursing ward/unit/ in the community in theatres/recovery or in a prison.
  • Practice Assessment Document (to be handed to the Faculty Office with a Header sheet) date to be advised.

 

The 4 Learning Outcomes that are assessed by the patient centred case study include:

 

  • Demonstrate explicit knowledge of the principles of surgical and medical care in adult nursing both within the hospital and the community
  • Apply the principles of surgical and medical nursing to assess and develop care plans in partnership with multi agency team for various medical and surgical conditions within the hospital and the community setting
  • Demonstrate explicit knowledge and understanding of national policies and local strategies and how these impact on the individual patient.
  • Implement national and local guidance and strategies to support practice within the students’ sphere of practice.

 

Description of task:

 

A 3000 word, patient centred case study focusing on a patient you have cared for in a medical or surgical ward/unit.

 

The student must:

 

  • Select a patient they have cared for on a medical or surgical ward/unit/other area.

 

  • Identify how the patient was admitted to hospital, their presenting complaint and the care pathway they followed.

 

  • Discuss the overarching nursing assessment used to identify the patients’ problems on admission. which nursing assessment tool was used to assess the patient on admission

 

  • Critically analyse one element of care given to the patient during their admission.

 

  • Ensure the discussion refers to relevant local and national policies and strategies and multi professionals involved in the patients care.

 

  • Analyse any potential discharge plans that may be required to ensure the patient remains safe when they return home.

 

 

 

The student should remember:

 

  • These are guidance notes and should be used in conjunction with the assessment specification found in your handbook and assessment lecture slides.

 

  • For this assignment you will need to ensure you clearly cover all 4 learning outcomes.

 

  • Do not breach confidentiality of your Trust or the patient.

 

  • Make sure your arguments are underpinned by relevant and contemporary evidence. You will need to read widely around your patients underlying condition demonstrating best practice and an understanding of the care delivered.

 

  • No drafts will be read by the course leader, so please follow the guidance carefully.

 

  • Do not copy the text in this guidance, all work will be assessed for plagiarism.

 

 

 

 

SUGGESTED LAYOUT FOR YOUR ASSIGNMENT

 

 

Introduction: Be clear and concise, briefly state what you are going to cover in your essay and the tools that were used. Make sure you refer to all of the learning outcomes. Also make sure you state that the patients name and personal details have been changed in line with NMC confidentiality guidelines.

 

FOR EXAMPLE: (This is a brief example yours should be about 150-200 words long and can include references, remember to mention here in the introduction that you have anonymised the patients details in line with policy).

 

In this case study a patient who was admitted to a surgical assessment unit with abdominal pain will be discussed. The patients real name and personal details has been changed in line with the NMC (2015) regulations relating to maintenance of confidentiality. The nursing assessment tool used on admission will be identified and one element of care from this assessment will be critically discussed. Reference will be made to the local and national policies and strategies which informed the care delivered during the patients stay in hospital. Also the other members of the multidisciplinary team that the patient was referred to will be identified. Finally, consideration will be given to any discharge plans made in relation to maintaining the safety of the patient when he returns home.”

 

 

 

 

Case Study: Introduce your chosen patient, explain how and why they presented to the hospital. (Remember your chosen patient has to have a medical or surgical condition and a reason for admission to hospital/unit/prison).

 

Specify the following information (you should be able to derive this information from the patients medical and nursing admission notes):

 

1) What was their admission care pathway? Were they referred by their GP, via A+E, via outpatients or another route? Did they come by ambulance or public transport?

2) What was there presenting complaint and associated symptoms? Why do they need admission, what is the definitive diagnosis and medical plan of care?

3) Who was involved in their admission process? Who were they admitted under? E.g. cardiologist. What type of ward were they admitted to, was this the correct clinical area? Were they transferred from one ward to another before arriving with you? Why was this?

 

FOR EXAMPLE: (This is a very brief example, yours should be about 500 words long with references, be sure to include all the information required in the 3 questions above.

 

“Mr Smith is a 64-year-old man who presented to A+E of his own accord complaining of an 8-hour history of acute central abdominal pain. The associated symptoms included a recently reduced appetite, nausea and severe constipation. Mr Smith was admitted straight from A+E to the surgical assessment unit under the care of the surgeons on the Acute Abdomen Pathway (NICE, 2012) for further investigation and treatment as necessary. Whilst in A+E he had been reviewed by the surgical registrar and a provisional plan of care was implemented including nil by mouth status and effective pain management. The surgical assessment unit was the most appropriate place for Mr Smith to be transferred to as this area is managed by surgically trained nurses (Keep, 2014).”

 

 

Main Body of Essay:

 

State which nursing assessment tool was used to assess the patient on admission, the most likely one you will see is Roper, Logan and Tierney. From the nursing assessment pick one element of care the patient required on admission. Critically analyse this element of care, discussing how it was delivered in accordance to local policy/procedures and guidelines. E.g. As the patient was admitted and kept nil by mouth then you could determine that eating and drinking was the most important element of care that needed to be immediately managed. Make sure that you focus on the nursing rather than medical management as this has to be relevant to your sphere of practice. You should also refer to the other professional bodies involved in the patients care in regards to your chosen element. For example, if you chose eating and drinking you may wish to discuss the importance of referring the patient to the dietician to ensure their nutritional needs were managed appropriately. Make sure you use contemporary references to support your arguments and discussion. A minimum number of references for this type of assignment would be 20.

 

 

FOR EXAMPLE: (this is extremely brief, yours should be approximately 2000 words long including contemporary references and don’t forget to include local policy/strategies that influenced the nursing care that you gave to the patient)

 

“On admission to the surgical assessment unit a full nursing assessment was carried out using the nursing model introduced by Roper et al (1996). This model assesses the 12 activities of daily living which is important to determine the care needs of the patient. Mr Smith had been placed on a nil by mouth order until the cause of the abdominal pain could be determined. This was deemed necessary by the Surgeon in case Mr Smith required emergency surgery in which case he would need to fast for at least 6 hours to reduce the volume of stomach acidity and contents prior to general anaesthesia (Brady et al, 2003). Therefore, it could be argued that Mr Smith had very specific care needs in relation to eating and drinking and this is the chosen activity of daily living that will be critically analysed and discussed in this case study.

 

 It is important for nurses to remember that fasting should be kept to a minimum amount of time where possible and IV fluids should be given to maintain hydration (Long et al, 2011). There is also clear guidance from National Institute of Clinical Excellence (NICE) regarding fasting times and what fluid replacement therapy should be given to patients whilst they remain nil by mouth (NICE, 2008).”

 

 

Conclusion: This needs to be a summary of your findings in relation to the nursing care given to your chosen patient for the one element of care you identified. There should be nothing new here and no new references. Please refer to all 4 learning outcomes, as you did in the introduction.

 

FOR EXAMPLE: (this is too brief, yours should be 300 words long approx.)

 

This case study has explored the nursing care delivered to a patient who was admitted to a surgical assessment unit with central abdominal pain. Mr Smith was assessed used a nursing model designed by Roper et al (1996). This assessment determined an immediate care need in relation to eating and drinking. As Mr Smith was admitted with abdominal pain and he was kept nil by mouth until the cause of his pain could be determined. In accordance to national guidance for the management of acute abdominal pain (NICE, 2012), Mr Smith was prescribed IV fluids to maintain his hydration whilst nil by mouth. This was important to ensure his condition was not exacerbated by dehydration. Whilst on the unit, Mr Smith was referred to the dietician to ensure that his nutritional needs could be met whilst he remained nil by mouth. As the role of the nurse is to ensure the safety of patients in regards to all their care needs it is vital to ensure that all needs are addressed and that local and national policy/strategy and guidelines are adhered to where appropriate.

 

Balkissoon (2020) describes (COPD) as an obstructive respiratory organ disease caused by semi-permanent breathing problems due to airway narrowing. It encompasses three conditions chronic bronchitis, emphysema, and chronic or severe asthma. An estimated 1.2 million people are diagnosed with COPD and the mortality rate is  73% higher than the general population. Besides, COPD  cost the  National Health Service ( NHS) nearly  £930 million a year, however, a research conducted by Chetty et al., (2017) and approved by the British Journal of General Practice explains that the comorbidities of COPD are the cause of hospitalisation, polypharmacy and mortality(Department of Hea

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