How Effective Was My Formative Assessment Model to Carry Out a Holistic Assessment of a Patient?
Question
Evelyn
Evelyn is an 87-year-old woman with hypertension and rheumatoid arthritis. She lives at home on her own in a semi-detached four bedroom house in a residential part of a city in the South East of England. She is an owner-occupier. Evelyn is a retired secondary school (English) teacher and her husband James died (from bowel cancer) 5 years ago. They had been married for sixty two years. Evelyn takes pride in her appearance and she likes to dress neatly and keep her hair well tended. She enjoys reading, doing crossword puzzles and talking with her good friend Gladys on the phone a couple of times a week. She used to like gardening outdoors but can no longer do that. However, she can still tend to her impressive range of indoor plants which she thoroughly enjoys.
Evelyn's daughter (Matilda) works full time and lives 35 miles away (in the countryside) and visits her mum weekly (travelling by car) on Saturdays. Matilda helps her mum with shopping and laundry when she visits. Evelyn also receives daily support from a care worker to help with activities of daily living. Evelyn manages to put on her clothes with dressing aids that the domiciliary Occupational Therapist (OT) provided her with, but she needs help with washing her back and legs (which the carer does for her). Evelyn also has a hairdresser who visits to wash and set her hair once a week. She is currently prescribed the following medication:
. Bendroflumethiazide 2.5 mg daily
. Lisinopril 10 mg daily
· Simvastatin 40 mg at night
. Methotrexate 20 mg once weekly on a Wednesday
. Folic acid 5 mg daily except on Wednesday
. Paracetamol 1 g four times daily when needed.
On Friday evening, an on-call (out-of-hours) GP visits Evelyn because she has been feeling unwell with symptoms of urinary frequency, dysuria and urge incontinence for a few days. The GP diagnoses a urinary tract infection (UTI) and prescribes Trimethoprim 200 mg twice daily for 3 days. During her weekly visit the next day (Saturday), Matilda picks up the Trimethoprim from the chemist for her mum and when she leaves that evening Evelyn promises her that she will 'drink plenty of water', and that she will be absolutely fine. On Sunday, the care worker is very concerned that Evelyn has deteriorated and is nauseous and confused. She calls an ambulance and Evelyn is admitted to hospital vai A&E. A hospital doctor changes the trimethoprim to co-amoxiclav because her UTI symptoms have not improved.
When you meet Evelyn in the hospital ward, she has a temperature of 38.6C, a BP of 138/92 mmHg and a pulse rate of 95bpm. She keeps trying to get out of bed and you have had to help her back into the bed on more than one occasion. Her daughter has been called and is on her way to the hospital (by car). Evelyn looks dishevelled and keeps looking for her powder compact in her handbag. Evelyn asks you repeatedly 'Is it Monday today?' and each time you clarify it is Sunday, she repeats the question to you within a few short minutes.
Summative Assignment Guidelines: NURS4011 Foundations of nursing Word limit 3000 words
Assignment title
How effective was my choice of nursing model in carrying out a holistic assessment of a patient?
Description:
In this assignment you will use a nursing model to carry out a holistic assessment of one of the three scenarios. You can choose both the nursing model and the scenario. You will discuss and evaluate the chosen nursing model as a basis for holistic assessment and in the development of person centred care. You will then reflect on how this assignment might inform your future practice.
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Suggested Sections (please use sub-headings) |
What you should do: |
Further guidance |
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Introduction 150 words approx |
Briefly: Set the context (i.e. the topic of the assignment) Say what you intend to do in this assignment Outline how the work will be structured and organised |
Be very brief and succinct. Consider using phrases such as: The purpose of this assignment is to .... This assignment aims to .... This paper begins by it will go on to.. This essay has been organised in the following way: Don't spend much time on the introduction. You may want to write this section last. Your attention should be focussed on the main body. |
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Description of Scenario 400 words approx. (1 paragraph) |
Provide an overview of the scenario that you have chosen Attach the formative work as an appendix for the reader |
This is a paragraph summarising what you learned about the patient from applying the model. It should contain descriptive information which sets the scene (your reader can find out |
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Solution
How Effective Was My Formative Assessment Model to Carry Out a Holistic Assessment of a Patient?
Introduction
I intend to critically reflect on the effectiveness of my choice model in carrying out a holistic assessment of a patient. I will structure this piece by first providing an overview of the scenario that I have chosen, followed by a rationale for why I believe the model is effective in carrying out a holistic assessment of a patient. I will conclude by reflecting on how this model could be further improved. The work will be structured to allow the reader to follow my thought process easily. The model that I have chosen is the Roper-Logan-Tierney (RLT) model, a systematic and comprehensive method of assessment. This model includes five main steps: history taking, clinical reasoning, physical examination, diagnosis, and management. Each of these steps will be briefly discussed in my rationale. I have chosen this model because it allows me to carry out a thorough and holistic assessment of the patient, taking into account all aspects of their health and wellbeing. In addition, the Roper-Logan-Tierney model is an evidence-based approach and is effective in clinical practice.
Description of scenario
Evelyn is an elderly patient admitted to the hospital with a urinary tract infection (UTI). She has a history of UTIs and has been prescribed trimethoprim in the past. However, her symptoms have not improved, and she has been started on co-amoxiclav. She is feeling nauseous and confused, and her temperature is 38.6C. Her blood pressure is 138/92 mmHg, and her pulse rate is 95 bpm. She is disheveled and keeps asking if it is Monday today. Her daughter is on her way to the hospital. The Roper-Logan-Tierney model was used to carry out a holistic assessment of Evelyn. This involved taking a history, conducting a physical examination, conducting clinical reasoning, making a diagnosis, and developing a management plan. From this assessment, it was clear that Evelyn was suffering from a UTI, causing her to feel nauseous and confused. Her temperature was also raised, and she had a high pulse rate. She was treated with antibiotics and fluids, and her daughter was contacted to provide support. Evelyn was also advised on how to prevent UTIs in the future.
When conducting the assessment, it was important to consider all aspects of Evelyn's health and wellbeing. This meant taking into account her medical history, current symptoms, physical examination findings, and psychological state. All of these factors were considered to make a diagnosis and develop a management plan tailored to her individual needs. I believe that the Roper-Logan-Tierney model is an effective way to carry out a holistic assessment of a patient as it considers all aspects of their health and wellbeing. This model could be further improved by including a more detailed assessment of the patient's psychological state. This could involve conducting a mental state examination or using a tool such as the PHQ-9 to assess for depression. Nevertheless, the Roper-Logan-Tierney model is an effective model for assessment that should carry out a holistic assessment of a patient (Williams, 2015). It considers all aspects of the patient's health and wellbeing and allows for a tailored management plan to be developed. My patient, Evelyn, is an elderly woman admitted to the hospital with a urinary tract infection (UTI). From applying the RLT model, I learned that she had a history of UTIs and had been prescribed trimethoprim in the past (Mavromatis, 2014. Unfortunately, Evelyn's condition had not improved, and she had been started on co-amoxiclav.
Rationale
Principles of holistic assessment AND family/person-centered care and how they relate to the professional responsibility of nurses
A holistic assessment considers all elements of a patient's health and well-being. This implies evaluating the physical, mental, social, and spiritual aspects of health (Bredle et al., 2011.Family-centered care is a style of care that focuses on the needs of individuals and their families. It takes into account their preferences, values, and beliefs. The nursing model I have chosen to use is the RLT model. This approach is based on the principle of family-centered care and considers all aspects of the patient's health and well-being. The principle of holistic assessment is essential as it ensures that all aspects of the patient's health are considered. This is especially important in elderly patients, who may have multiple comorbidities. A more comprehensive picture of the patient's health can be obtained by taking into account the physical, psychological, social, and spiritual dimensions of health (Larson and Larson, 2003). The principle of family-centered care is critical since it ensures that the needs of the patient and their family are considered. This is especially significant in older people, who may be more susceptible to illnesses and require extra assistance. The RLT model thinks both of these principles and is, therefore, an effective model to use when carrying out a holistic assessment of an elderly patient. For example, when assessing my patient Evelyn, I considered all aspects of her health, including physical, psychological, social, and spiritual needs. I also took into consideration her preferences, values, and beliefs. This allowed me to develop a more comprehensive picture of her health and create a tailored management plan that met her individual needs.
The professional responsibility of nurses is to provide care that is individualized and tailored to the patient's needs. By using a holistic approach to assessment and taking into account the family/person-centered care principles, nurses can ensure that they are providing care that meets the individual needs of their patients (Care, 2021). This is especially important in elderly patients, who may be more vulnerable and require more support. The RLT model is an effective model to use when carrying out a holistic assessment of an elderly patient, as it considers all aspects of the patient's health and wellbeing (Holland and Jenkins, 2019). It also feels the patient's preferences, values, and beliefs and their family. This allows nurses to provide care that is individualized and customized to the needs of their patients, which is in line with their professional responsibility.
Overview of the Model
The RLT model is a family/person-centered care model that considers all aspects of the patient's health and wellbeing. It includes four main elements: physical, social, psychological, and spiritual.
The physical element of the RLT model includes assessing the patient's physical health and wellbeing. This includes assessing their physical symptoms, functional status, and nutritional status. The physical element also consists of an assessment of the patient's environment, including their home and community (Stein and Jessop, 1990). For example, when assessing my patient Evelyn, I considered her physical symptoms, functional status, and nutritional needs. I also evaluated her home environment and community support network. Assessment of the patient's physical health is a crucial part of the RLT model as it allows nurses to identify any physical problems that the patient may have (Murphy et al., 2000). This is especially important in elderly patients, who are more likely to have chronic health conditions. By assessing the patient's physical health, nurses can ensure that they are providing care that meets the individual needs of their patients. For instance, if a patient has a chronic health condition, the nurse can give them with the data and support needed to help them manage their condition.
The psychological element of the RLT model includes an assessment of the patient's mental health and wellbeing (Holland and Jenkins, 2019). This includes assessing their cognitive functioning, emotional state, and level of stress. The psychological element also includes assessing the patient's social skills and coping mechanisms. For example, I considered her cognitive functioning, emotional state, and stress level when assessing my patient Evelyn. I also evaluated her social skills and coping mechanisms. Assessment of the patient's mental health is significant part of the RLT model as it allows nurses to identify any psychological problems that the patient may have (Murphy et al., 2000”). This is paramount in elderly patients, who are likely to suffer anxiety, depression, and stress. By assessing the patient's mental health, nurses can ensure that they are providing care that meets the individual needs of their patients. For instance, if a patient is experiencing anxiety, the nurse can give them the care and support to help them manage their condition.
The social element of the RLT model includes assessing the patient's social health and wellbeing (O’Brien, 2005). This includes assessing their social support network, level of social isolation, and level of stress. The social element also includes an assessment of the patient's financial situation and housing status. For example, when assessing my patient Evelyn, I considered her social support network, level of social isolation, and stress level. I also evaluated her financial situation and housing status. Assessment of the patient's social health is an essential part of the RLT model as it allows nurses to identify any social problems that the patient may have (Hyde et al., 2006). This is especially important in elderly patients, who are more likely to experience social isolation and stress. By assessing the patient's social health, nurses can ensure that they are providing care that meets the individual needs of their patients. For instance, if a patient is experiencing social isolation, the nurse can provide them with information and support to help them manage their condition.
The spiritual element of the RLT model includes an assessment of the patient's spiritual health and wellbeing (McSherry, 2006). This includes an assessment of their spiritual beliefs and practices and their level of spiritual distress. The spiritual element also includes an assessment of the patient's relationship with their God or higher power. For example, when assessing my patient Evelyn, I considered her spiritual beliefs and practices and her level of spiritual distress. I also assessed her relationship with her God or higher power. Assessment of the patient's spiritual health is a crucial part of the RLT model as it allows nurses to identify any spiritual problems that the patient may have (McSherry, 2006). This is significant in elderly patients, who are likely to experience spiritual distress. By assessing the patient's spiritual health, nurses can ensure they provide care that meets the individual needs of their patients. For instance, if a patient is experiencing spiritual distress, the nurse can provide them with required data and support to help them manage their condition.
Reasons for Choosing the Scenario
The principles of holistic assessment and family/person-centered care are important to nurses because they allow them to provide care that meets the individual needs of their patients (Care, 2021). Holistic assessment allows nurses to consider the physical, social, psychological, and spiritual aspects of the patient's health. Family/person-centered care allows nurses to focus on the family's or person's needs and preferences. The RLT model is a holistic assessment model that considers the patient's health's physical, psychological, social, and spiritual aspects (McSherry, 2006). This model is relevant to my scenario because it allows me to comprehensively assess the patient's health. The RLT model is also relevant to adult mental health because it allows nurses to holistically assess the patient's mental health.
The RLT model is an effective formative assessment model to carry out a holistic assessment of a patient because it considers the physical, psychological, social, and spiritual aspects of the patient's health (Richardson and Poole, 2001). This model is relevant to my scenario because it allowed me to thoroughly assess the patient's health. This model is beneficial to both patients and nurses as it allows for an advanced assessment of the patient's health. Nurses can use this model to provide care that meets the individual needs of their patients (Bellman, 1996). This model is also relevant to adult mental health because it allows nurses to holistically assess the patient's mental health.
Analysis and Evaluations
The RLT model is beneficial to both patients and nurses as it allows for a more comprehensive assessment of the patient's health (Timmins and O'Shea, 2004). For example, I used this model to assess the patient's physical health, psychological state, social relationships, and level of spiritual distress. I also assessed her relationship with her God or higher power. Another strength of the RLT model is that it is relevant to the field of adult mental health. This model allows nurses to assess the patient's mental health holistically (Barker, 2001). For example, I used this model to assess the patient's mental health symptoms, her level of psychological distress, and her social and spiritual needs. Nurses can use this model to provide care that meets the individual needs of their patients. I found it to help uncover the patient's needs in my chosen scenario. The model allowed me to identify the patient's strengths and weaknesses and develop a plan of care that would meet her individual needs.
One limitation of the RLT model is that it does not consider the economic or environmental aspects of the patient's health (Newton, 1991). For example, I could not assess the patient's economic status or her living conditions. These factors can impact the patient's health and wellbeing and should be considered when assessing the patient's needs. Another limitation of the model is that it does not consider the cultural or linguistic needs of the patient. This can be a problem for nurses working with patients from diverse backgrounds. Nurses’ awareness is needed to be aware of these limitations when applying the RLT model to evaluate the needs of their patients.
The RLT model is relevant to my scenario because it allowed me to fully assess the patient's health (McCabe and Timmins, 2013). This model is useful in my scenario because it helped me uncover the problems and needs of any patient in a holistic way. I learned about her medical history, current symptoms, and her overall health and wellbeing. The model didn't capture any information that wasn't already known, but it helped provide a more comprehensive picture of the patient's health. In addition, the model promoted a holistic assessment by considering all aspects of the patient's health, including her physical, mental, and emotional wellbeing (MacNeela, Scott, Treacy, and Hyde, 2010). This was helpful in my scenario because it allowed me to develop a complete understanding of the patient's needs. The Roper-Logan-Tierney model has some strengths that make it an effective tool for carrying out a holistic assessment of a patient. Firstly, the model is comprehensive and includes all aspects of the patient's health, from their medical history to their current symptoms. This means that the model can provide a complete picture of the patient's health. For example, in my scenario, the model helped me understand the patient's symptoms in her medical history. Secondly, the RLT model is evidence-based and is effective in clinical practice. This means that the model is supported by research and proven to be effective in real-world settings. This is important because the model is reliable and can be trusted to provide accurate information. For example, in my scenario, I was able to rely on the Roper-Logan-Tierney model to provide accurate and up-to-date information about the patient's health. Thirdly, the RLT model can used easier to apply and easily use to any patient. This means the model is user-friendly and can be used by anyone, despite of their experience level. This is important because it means that the model can be used by a wide range of healthcare professionals, from doctors to nurses to physiotherapists. For example, in my scenario, the RLT model was easy to use and helped me quickly and effectively assess the patient's health.
The RLT model helped me learn about the patient's medical history, current symptoms, and overall health and wellbeing (Holland and Jenkins, 2019). This was helpful in my scenario because it allowed me to develop a complete understanding of the patient's needs. Nurses need to be able to carry out comprehensive and accurate assessments of patients to provide the best possible care. The RLT model is an effective tool that can help nurses do this. For example, in my scenario, the model helped me uncover the problems and needs of the patient in a holistic way. This meant that I could develop an in-depth understanding of her health needs and give more targeted and effective care.
The model didn't capture the information about Evelyn's social life, her family, or her living situation. It also didn't provide any information about her mental health or psychological wellbeing. When carrying out a holistic assessment, it is paramount to consider all aspects of the patient's health, including mental and social wellbeing. For example, Evelyn's daughter is on her way to the hospital, which may be due to Evelyn's deteriorating mental state. The model also didn't consider Evelyn's spiritual needs or cultural beliefs and values. These are all important factors to consider when carrying out a holistic assessment. However, the model did provide a thorough overview of Evelyn's physical health. It detailed her temperature, BP, and pulse rate, as well as her general appearance. The model also allowed for a comprehensive assessment of Evelyn's medical history and current medications. This is important information to have when carrying out a holistic assessment, as it can help identify any underlying health conditions that may be contributing to Evelyn's current state.
The Roper-Logan-Tierney model promoted a holistic assessment as it considered all aspects of Evelyn's health and wellbeing (Alligood, 2017). The model allowed me to gather information about her medical history, current physical health, cognitive abilities, and psychological state. This information was then used to form Evelyn's diagnosis and management plan. For example, the information gathered about Evelyn's cognitive abilities was used to assess her capacity to decide her treatment. The model also allowed for a comprehensive review of Evelyn's social life, family, and living situation. This is important information to consider when carrying out a holistic assessment. It can help identify any social or environmental factors contributing to Evelyn's current state. Overall, I found the model to be effective in carrying out a holistic assessment of a patient. It allowed me to gather a wide range of information about the patient and consider all aspects of their health and wellbeing.
Bibliography
Alligood, M.R., 2017. Introduction to nursing theory: Its history and significance. Nursing Theorists and Their Work-E-Book, 1.
Barker, P., 2001. The tidal model: Developing a person‐centered approach to psychiatric and mental health nursing. Perspectives in psychiatric care, 37(3), pp.79-87.
Bellman, L.M., 1996. Changing nursing practice through reflection on the Roper, Logan and Tierney model: the enhancement approach to action research. Journal of Advanced Nursing, 24(1), pp.129-138.
Bredle, J.M., Salsman, J.M., Debb, S.M., Arnold, B.J. and Cella, D., 2011. Spiritual well-being as a component of health-related quality of life: the functional assessment of chronic illness therapy—spiritual well-being scale (FACIT-Sp). Religions, 2(1), pp.77-94.
Care, C., 2021. Person/Family-Centered Care1. Quality and Safety in Nursing: A Competency Approach to Improving Outcomes, p.85.
Care, C., 2021. Person/Family-Centered Care1. Quality and Safety in Nursing: A Competency Approach to Improving Outcomes, p.85.
Holland, K. and Jenkins, J. eds., 2019. Applying the Roper-Logan-Tierney Model in Practice-E-Book. Elsevier Health Sciences.
Hyde, A., Treacy, M.M.P., Scott, A.P., Mac Neela, P., Butler, M., Drennan, J., Kate, I. and Byrne, A., 2006. Social regulation, medicalisation and the nurse's role: insights from an analysis of nursing documentation. International Journal of Nursing Studies, 43(6), pp.735-744.
Larson, D.B. and Larson, S.S., 2003. Spirituality's potential relevance to physical and emotional health: A brief review of quantitative research. Journal of Psychology and Theology, 31(1), pp.37-51.
MacNeela, P., Scott, A., Treacy, P. and Hyde, A., 2010. In the know: cognitive and social factors in mental health nursing assessment. Journal of Clinical Nursing, 19(9‐10), pp.1298-1306.
Mavromatis, C.H., 2014. Mapping of the Co-Transcriptomes of UPEC-Infected Macrophages Reveals New Insights into the Molecular Basis of Host-Pathogen Interactions in Human and Mouse (Doctoral dissertation).
McCabe, C. and Timmins, F., 2013. Communication skills for nursing practice. Macmillan International Higher Education.
McSherry, W., 2006. Making sense of spirituality in nursing and health care practice: An interactive approach. Jessica Kingsley Publishers.
Murphy, K., Cooney, A., Casey, D., Connor, M., O’Connor, J. and Dineen, B., 2000. The Roper, Logan and Tierney (1996) Model: perceptions and operationalization of the model in psychiatric nursing within a Health Board in Ireland. Journal of Advanced Nursing, 31(6), pp.1333-1341.
Newton, C., 1991. The Roper, Logan and Tierney Model in Action. Macmillan International Higher Education.
O’Brien, S., 2005. Social assessment in healthcare. Health Assessment, p.264.
Richardson, C. and Poole, H., 2001. Chronic pain and coping: a proposed role for nurses and nursing models. Journal of Advanced Nursing, 34(5), pp.659-667.
Stein, R.E. and Jessop, D.J., 1990. Functional status II (R): a measure of child health status. Medical care, pp.1041-1055.
Timmins, F. and O'Shea, J., 2004. The Roper–Logan–Tierney (1996) model of nursing as a tool for professional development in education. Nurse Education in Practice, 4(3), pp.159-167.
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Appendix
The 'Activities of Living' Model - Roper et al (1980)
Name: Date: Number:
|
Activity of daily living |
Usual ability |
Present ability |
|
Maintaining a safe environment
|
Evelyn is able to keep her house in a safe and tidy condition. |
Evelyn is no longer able to keep her house in a safe and tidy condition. She requires help from a care worker to do this |
|
Communicating |
Evelyn is able to communicate effectively with others. |
Evelyn is still able to communicate effectively with others. |
|
Breathing |
Evelyn is able to breathe without any difficulty. |
Evelyn is still able to breathe without any difficulty. |
|
Eating and Drinking |
Evelyn is able to prepare her own meals and eat and drink independently. |
Evelyn is still able to prepare her own meals and eat and drink independently. |
|
Eliminating |
Evelyn is able to toilet herself independently. |
Evelyn is no longer able to toilet herself independently and requires help from a care worker to do this. |
|
Personal Cleansing and Dressing |
Evelyn is able to wash and dress herself independently. |
Evelyn is no longer able to wash and dress herself independently and requires help from a care worker to do this. |
|
Controlling Body Temperature |
Evelyn is able to control her body temperature effectively. |
Evelyn is still able to control her body temperature effectively. |
|
Mobilising |
Evelyn is able to move around independently. |
Evelyn is no longer able to move around independently and requires help from a care worker to do this. |
|
Working and Playing |
Evelyn is able to work and play independently. |
Evelyn is no longer able to work and play independently and requires help from a care worker to do this. |
|
Expressing Sexuality |
Evelyn is able to express her sexuality independently. |
Evelyn is no longer able to express her sexuality independently and requires help from a care worker to do this. |
|
Sleeping |
Evelyn is able to sleep independently. |
Evelyn is no longer able to sleep independently and requires help from a care worker to do this. |
|
Dying |
Evelyn is able to die independently. |
Evelyn is no longer able to die independently and requires help from a care worker to do this. |
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