Improving My Skills: Reflection and Patient History

At the same time, reflection would be a great chance to ensure I am in a better position of improving my skills in communication as well as how I relate with others when practicing my professional. I believe, these are useful tactics that can enable me to relate what I learn in class with the practical part of it.

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History of patient

Upon diagnosis, it was noted that Jimmy had Schizophrenia and bipolar disorder something that caused the general practitioner to ask her to start the assessment process. Currently, she has psychotic features.

Objective

The assessment purposed to collect any possible information revealing about Jimmy health needs. All the same, it was a great chance to determine the possible strategies that could be used to address Jimmy health needs.

During the assessment period, Jimmy presented that he was not comfortable taking the oral medications and thus he desired to have drugs that would be administered through other routes. Given that in my practices I am supposed to respect patient's autonomy and at the same time facilitate progressive care therapy I had to ensure the desires of the patient are met. Hence, when conducting my duties I had to ensure Jimmy's desires were met as a way of proving I took his concerns seriously.

Model: Progressive Care Model (PCM)

To ensure the correct clinical judgment and decisions are made, nursing models are very important. As a nurse trainee, models enable me to come up with an appropriate structure that supports assessment.

In the current patient assessment, a progressive care model founded by the Advisory panel and AACN (Association of Critical care Nurses) will be used. The model offers a better understanding of daily patient and health care providers needs as a way of sustaining the process of health care services delivery. PCM is regarded as an effective approach for ensuring patient conditions does not get to chronic levels. Thus, nurses will need to keep assessing and monitoring Jimmy's health condition as a way of ensuring his current health condition state does not deteriorate. Given that Jimmy is subjected to administration of different form of drugs, there are higher chances that his case can get to complicated levels and that is why nurses need to monitor vital signs that are very critical. In relation to this, a nurse should be ready always to implement interventions of saving life if the patient needs them.

When progressive care of patients is used in addressing patient cases, it helps to make sure that cases of patients overflowing in beds are regulated since most of the diseases can be managed at the acute stage. However, implementation of progressive care approach is affected by high cost of care that is likely to be involved, time consumption, heavy work load and unnecessary pressure.

But, it has been indicated that effective leadership is able to support PCM through incorporating the right communication skills, practitioners having the right skills and obtaining necessary support from the management.

Critique

Patient Care Assistants need to have a detailed understanding of Jimmy. This would allow them to overcome a wide range of barriers thereby achieving effective assessment. PCA were able to cultivate a better relationships with Jimmy and as a result succeeded in collecting most significant information (Bosley and Dale, 2008). The benefit of progressive care approach is that it helped in getting positive outcomes, featured my increased gratitude, low health cost as well as intervention adherence easiness (Stewart et al., 2003).

Notably, provision of progressive care is extremely overwhelming and puzzling in the everyday practice despite detriment realizations of the activities. Thus, it is vital to consider the context as it is contained in the culture of care delivery in the environment where changes are taking place unexpectedly. The activity is also characterized by considerable anxiety and can compromise the quality of the standards and the safety of the patient. Delegations played a big role in the assessment by the PCA. The culture of humanistic comprehensiveness have been embrace healthcare settings. It is worth noting that the contributions of the patients either in form of knowledge or voices, are not put into consideration. The response to the patients is through digesting their utterances and know-how in diagnostic terms. The advantage associated with PCA is that they do not only provide assistance by focusing on care but also the patient. The main aim of the culture is to adopt the bureaucratic administrative way of dealing with the client. This makes the obedient of professional requests and directions not to improve the personal hood.

Patient Care Assistants provide their services in a less-powerful position and mainly provide care as the boundary work. They are trained such that they are equipped with skills to execute specific clinical procedures such phlebotomy and health promotion of the patient in general. The mixing of roles PCA does can be confusing to the patients, hence questioning their confidence and the capabilities. It pretty easy for client to communicate with the nurse than a PCA in the perspectives of skills, elaboration and the duration of consultations. The use of PCA in the assessment needs of the patient have an effect of increasing the efficiency as the amount time spent is minimized by mixing of roles. The PCA also are associated with more benefits to the healthcare practices by reducing the waiting times and have the required skills to stay with patients who require to be focused on most of the time as a strategy to get better results for effective treatment. The work of collecting the patient data is also done by the PCA as a way to provide support in meeting the needs that facilitates quality outcome framework. By using the PCAs, the social and cultural resources contexts of Jimmy case could be understood better when compared to the nurses who do not live locally. The resources in the perspectives of social and culture are important in the efforts of indorsing the camaraderie and communication as well as building confidence with patients.

Work responsibilities, expertise boldness and time limitations are among the challenges associated with PCA application efforts. To overcome such hurdles, effective leadership styles and providing support to PCA practitioners are used in cultivating the culture of dealing with the patient being assessed. However, it has been proved that when the practitioners have adequate skills especially in communication, and the management of the facility provides the necessary support, then it will be possible for the PCA culture to be easily supported.

Legal and ethical consideration

During delivery of progressive health care services various legal and ethical considerations must be put in place. In this case, a nurse is required to observe principles of beneficence, respect of autonomy, fairness and non-maleficence.

When carrying out nursing practices, it is possible to have benefit and harm in attempt to implement different forms of interventions. Although implementation of most nursing interventions is intended to be helpful; in some cases the benefits may not be realized. Thus, as a nursing core ethic harms should be regulated in every way possible. In some instances, it could be very beneficial to have harm that lasts for a short term if it enhances safety risks to the patient and others instead of using a service that will continuously increase pain or harm to a patient. An example of such an instance is when seclusion practice is done and involuntary restrictive and detention practices are employed. All the professionals especially in the mental health field should pay more focus on ensuring they do what is good and not what causes harm.

It is important to enhance justice in nursing practices. Discrimination practices should not be allowed since it make it hard for nurses to offer progressive care. Regardless of the economic status of a client or whether useful resources are scarce; it is important for all those with needs to be treated equally. At the same time, the essence of respecting client's dignity should be highly embraced. As a PCA core value dignity and respectfulness should be put into consideration. When justice is promoted, then it becomes easier for nurses to offer equitable services to all patients especially in situations where resources are limited. Most importantly, there is need for all patients to be treated with dignity. In this case, all patients deserve to be respected and be offered the necessary support. As demonstrated by both RNC (2008) and DH (2009), when a patient is treated with dignity that is similar to treating them with the respect they are worth receiving.

As recorded by MCA (2005), the nursing practice entails working under the PCA framework and thus as a nurse I am entitled to assume Jimmy's capacity despite the nature of his mental health. When patients like Jimmy are present, the law requires that I offer him full support and at the same time I assume full capacity. If it happens that unwise decision has to be made, then the patient should not be treated like the person who does not have capacity. Thus, the option that offers the best treatment should be chosen for such cases. Above all, integrity, wisdom in professional practice and courage should be highly observed when working in a PCA.

More, the issue of respect of autonomy deserve to be observed. Thus, patients should be able to control the process of making their decisions by choosing the services which they desire and the ones which they do not need. But in some cases, according to mental health act (1983), a person can be detained for assessment if they are in the category of being detained compulsory. Only in such instances can services not approved by patient be administered.

Critical Reflection

Ensuring effective assessment of Jimmy's case

As indicated by Jimmy, he wanted me to take note of everything he presented so that I would make decisions concerning the best form of treatment that I could have provided. His concern was valid and of great importance because effective treatment required the right diagnosis. As recorded by Crumble (2006), during assessment, the introductory phase is very important. Therefore, as a nurse I am supposed to note every detail that the patient give as a way of ensuring that the right diagnosis and treatment will be offered to enhance the wellbeing of the patient. Further, it is necessary to have a good rapport with the patient during the introductory phase to ensure their level of anxiety is reduced and that they are in a better position to give any crucial information. All the same, having a good introduction enabled the patient to have a good relationship with the nurse and this makes the treatment process quite easy.Demonstrating efficiency of the communication styles during assessment.

Conclusi...